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Barbara Fallon - One of the best experts on this subject based on the ideXlab platform.
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differences and disparities over time black and white families investigated by ontario s Child Welfare System
Child Abuse & Neglect, 2020Co-Authors: Kofi Antwiboasiako, Nico Trocme, Barbara Fallon, Bryn King, John D Fluke, Martin Chabot, Tonino EspositoAbstract:Abstract Background Black-White disparities in Child Welfare involvement have been well-documented in the United States, but there is a significant knowledge gap in Ontario about how and when these disparities emerge. Objective This paper compares incidence data on Black and White families investigated by Ontario’s Child Welfare System over a 20-year period. Methods Data from the first five cycles of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) (1993–2013) were used to examine trends in Child maltreatment investigations involving Black and White families. Incidence rates were calculated. T-tests were conducted to assess statistically significant differences between and within cycles. Population and decision-based enumeration approaches were also used to examine Child Welfare disparities. Results The incidence of investigations involving White families almost doubled between 1998 and 2003, but for Black families the incidence increased almost fourfold during the same period. These increases and the difference between Black and White families in 2003 were statistically significant. The results further indicate that Black families experience disparate representation in Ontario’s Child Welfare System over time for most service dispositions. Conclusions Several possible explanations are offered for the study’s outcome, including changes in risk related to social safety net, the threshold for risk of harm, and bias and racist institutional policies and practices. This study invites policy-makers and Child Welfare authorities to rethink service delivery in addressing the disparate representation of Black families in the Child Welfare System.
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asian canadian Children and families involved in the Child Welfare System in canada a mixed methods study
Child Abuse & Neglect, 2017Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:Abstract Objective The purpose of the study is to understand the similarities and differences in Child Welfare involvement for Asian- Canadian (East and Southeast Asian) versus White-Canadian Children and families involved in the Child Welfare System in Canada, and to consider the implications and recommendations for service. This mixed methods study began by replicating this author’s previous study that found significant differences in the case characteristics and services used by Asian compared to non-Asian families in the Child Welfare System. The present study used a mixed method approach to further build a comprehensive descriptive understanding of Asian-Canadian Children and families involved in the Child Welfare System at national and local levels. Methods Secondary data analysis of the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) was conducted to identify the case characteristics (such as referral source, investigation type, and primary maltreatment type) and short-term service outcome (such as substantiation decision and decision to transfer to ongoing Child protection services) of Child maltreatment investigations involving Asian-Canadian Children and families in the Child Welfare System. The results were presented to focus group participants in a workshop, and a semi-structured interview guide was used to document Child Welfare workers’ experience with and perception of Asian-Canadian service users. Results The results indicated substantial differences between Asian- Canadian and White-Canadian Children and families investigated by Child Welfare agencies in respect to the household composition, maltreatment type, substantiation decision and decision to transfer to ongoing Child protection services. Child Welfare workers validated the results from secondary data analysis of the CIS-2008 and offer a broader cultural and structural context for understanding Child Welfare involvement with Asian-Canadians. Conclusion Asian-Canadian Children and families bring a diversity of cultural values and family norms. This study prompts further consideration for social work practice and policies in working with Asian-Canadian Children and families involved in the Child Welfare System.
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delineating disproportionality and disparity of asian canadian versus white canadian families in the Child Welfare System
Children and Youth Services Review, 2016Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:This paper builds upon the analyses presented in three companion papers using data from the 2003 and 2008cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003 and CIS-2008) and the Ontario Child Abuse and Neglect Data System (OCANDS) to examine disproportionality and disparity of Child Welfare involvement for Asian-Canadian Children involved in the Child Welfare System.
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delineating disproportionality and disparity of asian canadian versus white canadian families in the Child Welfare System
Children and Youth Services Review, 2016Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:Abstract Objective This paper builds upon the analyses presented in three companion papers using data from the 2003 and 2008 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003 and CIS-2008) and the Ontario Child Abuse and Neglect Data System (OCANDS) to examine disproportionality and disparity of Child Welfare involvement for Asian-Canadian Children involved in the Child Welfare System. Methods This study used CIS-2008 data adjusted by Census Child population data to examine rates per 1000 and three disparity indexes (population-based disparity index [PDI], decision-based disparity index [DDI], and maltreatment-based disparity index [MDI]) to determine the representation of Child maltreatment investigations for Asian-Canadian versus White-Canadian Children involved in the Child Welfare System. Logistic regression analyses were conducted to determine the odds of case closure for substantiated Child maltreatment investigations, and whether Asian ethnicity remained significant while controlling for Child demographics and household composition, case characteristics, and clinical concerns. Results This study found that Asian-Canadian Children were underrepresented in the Child Welfare System compared to White-Canadian Children (13.9 per 1000 Asian Children in the Canadian population vs. 36.1 per 1000 White Children in the Canadian population). Child Welfare involvement for Asian-Canadian Children are almost 2 times more likely to close after an investigation than White-Canadian Children. The three disparity indexes (PDI, DDI, MDI) showed substantially different results with respect to the representation of Child maltreatment investigations involving Asian-Canadian versus White-Canadian Children for physical abuse, sexual abuse, neglect, emotional maltreatment, and exposure to domestic violence. Conclusions Disproportionality and disparity are complex phenomena. The variation in results derived from different methods of calculating representation suggests the need for greater clarity and consistency in the definitions and methodology in examining racial disparity in Child Welfare research. Some methodological considerations for future Child Welfare research with Asian-Canadian populations were discussed.
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physical abuse among asian families in the canadian Child Welfare System
Journal of Aggression Maltreatment & Trauma, 2014Co-Authors: Barbara Lee, Wendy Rha, Barbara FallonAbstract:This study examines Child maltreatment investigations, Child Welfare placement, and transfer to ongoing services for a Canadian sample of East and Southeast Asian families. Findings revealed a higher percentage of substantiated physical abuse investigations involving the most harmful subtype “hit with object,” greater likelihood for Child Welfare placement despite lower rates of emotional harm, no significant differences in physical harm, and fewer identified caregiver risk factors for Child maltreatment investigations involving Asian versus non-Asian families. The findings suggest differences in services experienced by Asian compared to non-Asian families in the Canadian Child Welfare System. This is a crucial first step for Child Welfare professionals and community partners to better understand and provide services to Canadian Children and families.
Tara Black - One of the best experts on this subject based on the ideXlab platform.
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asian canadian Children and families involved in the Child Welfare System in canada a mixed methods study
Child Abuse & Neglect, 2017Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:Abstract Objective The purpose of the study is to understand the similarities and differences in Child Welfare involvement for Asian- Canadian (East and Southeast Asian) versus White-Canadian Children and families involved in the Child Welfare System in Canada, and to consider the implications and recommendations for service. This mixed methods study began by replicating this author’s previous study that found significant differences in the case characteristics and services used by Asian compared to non-Asian families in the Child Welfare System. The present study used a mixed method approach to further build a comprehensive descriptive understanding of Asian-Canadian Children and families involved in the Child Welfare System at national and local levels. Methods Secondary data analysis of the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) was conducted to identify the case characteristics (such as referral source, investigation type, and primary maltreatment type) and short-term service outcome (such as substantiation decision and decision to transfer to ongoing Child protection services) of Child maltreatment investigations involving Asian-Canadian Children and families in the Child Welfare System. The results were presented to focus group participants in a workshop, and a semi-structured interview guide was used to document Child Welfare workers’ experience with and perception of Asian-Canadian service users. Results The results indicated substantial differences between Asian- Canadian and White-Canadian Children and families investigated by Child Welfare agencies in respect to the household composition, maltreatment type, substantiation decision and decision to transfer to ongoing Child protection services. Child Welfare workers validated the results from secondary data analysis of the CIS-2008 and offer a broader cultural and structural context for understanding Child Welfare involvement with Asian-Canadians. Conclusion Asian-Canadian Children and families bring a diversity of cultural values and family norms. This study prompts further consideration for social work practice and policies in working with Asian-Canadian Children and families involved in the Child Welfare System.
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delineating disproportionality and disparity of asian canadian versus white canadian families in the Child Welfare System
Children and Youth Services Review, 2016Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:This paper builds upon the analyses presented in three companion papers using data from the 2003 and 2008cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003 and CIS-2008) and the Ontario Child Abuse and Neglect Data System (OCANDS) to examine disproportionality and disparity of Child Welfare involvement for Asian-Canadian Children involved in the Child Welfare System.
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delineating disproportionality and disparity of asian canadian versus white canadian families in the Child Welfare System
Children and Youth Services Review, 2016Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:Abstract Objective This paper builds upon the analyses presented in three companion papers using data from the 2003 and 2008 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003 and CIS-2008) and the Ontario Child Abuse and Neglect Data System (OCANDS) to examine disproportionality and disparity of Child Welfare involvement for Asian-Canadian Children involved in the Child Welfare System. Methods This study used CIS-2008 data adjusted by Census Child population data to examine rates per 1000 and three disparity indexes (population-based disparity index [PDI], decision-based disparity index [DDI], and maltreatment-based disparity index [MDI]) to determine the representation of Child maltreatment investigations for Asian-Canadian versus White-Canadian Children involved in the Child Welfare System. Logistic regression analyses were conducted to determine the odds of case closure for substantiated Child maltreatment investigations, and whether Asian ethnicity remained significant while controlling for Child demographics and household composition, case characteristics, and clinical concerns. Results This study found that Asian-Canadian Children were underrepresented in the Child Welfare System compared to White-Canadian Children (13.9 per 1000 Asian Children in the Canadian population vs. 36.1 per 1000 White Children in the Canadian population). Child Welfare involvement for Asian-Canadian Children are almost 2 times more likely to close after an investigation than White-Canadian Children. The three disparity indexes (PDI, DDI, MDI) showed substantially different results with respect to the representation of Child maltreatment investigations involving Asian-Canadian versus White-Canadian Children for physical abuse, sexual abuse, neglect, emotional maltreatment, and exposure to domestic violence. Conclusions Disproportionality and disparity are complex phenomena. The variation in results derived from different methods of calculating representation suggests the need for greater clarity and consistency in the definitions and methodology in examining racial disparity in Child Welfare research. Some methodological considerations for future Child Welfare research with Asian-Canadian populations were discussed.
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the canadian Child Welfare System response to exposure to domestic violence investigations
Child Abuse & Neglect, 2008Co-Authors: Tara Black, Nico Trocme, Barbara Fallon, Bruce MaclaurinAbstract:OBJECTIVE: While Child Welfare policy and legislation reflects that Children who are exposed to domestic violence are in need of protection because they are at risk of emotional and physical harm, little is known about the profile of families and Children identified to the Child Welfare System and the System's response. The objective of this study was to examine the Child Welfare System's response to Child maltreatment investigations substantiated for exposure to domestic violence (EDV). METHODS: This study is based on a secondary analysis of data collected in the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003). Bivariate analyses were conducted on substantiated investigations. A binary logistic regression was also conducted to attempt to predict Child Welfare placements for investigations involving EDV. RESULTS: What emerges from this study is that the Child Welfare System's response to EDV largely depends on whether it occurs in isolation or with another substantiated form of Child maltreatment. For example, Children involved in substantiated investigations that involve EDV with another form of substantiated maltreatment are almost four times more likely than investigations involving only EDV to be placed in a Child Welfare setting (Adjusted Odds Ratio= 3.87, p Language: en
Nico Trocme - One of the best experts on this subject based on the ideXlab platform.
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differences and disparities over time black and white families investigated by ontario s Child Welfare System
Child Abuse & Neglect, 2020Co-Authors: Kofi Antwiboasiako, Nico Trocme, Barbara Fallon, Bryn King, John D Fluke, Martin Chabot, Tonino EspositoAbstract:Abstract Background Black-White disparities in Child Welfare involvement have been well-documented in the United States, but there is a significant knowledge gap in Ontario about how and when these disparities emerge. Objective This paper compares incidence data on Black and White families investigated by Ontario’s Child Welfare System over a 20-year period. Methods Data from the first five cycles of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) (1993–2013) were used to examine trends in Child maltreatment investigations involving Black and White families. Incidence rates were calculated. T-tests were conducted to assess statistically significant differences between and within cycles. Population and decision-based enumeration approaches were also used to examine Child Welfare disparities. Results The incidence of investigations involving White families almost doubled between 1998 and 2003, but for Black families the incidence increased almost fourfold during the same period. These increases and the difference between Black and White families in 2003 were statistically significant. The results further indicate that Black families experience disparate representation in Ontario’s Child Welfare System over time for most service dispositions. Conclusions Several possible explanations are offered for the study’s outcome, including changes in risk related to social safety net, the threshold for risk of harm, and bias and racist institutional policies and practices. This study invites policy-makers and Child Welfare authorities to rethink service delivery in addressing the disparate representation of Black families in the Child Welfare System.
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asian canadian Children and families involved in the Child Welfare System in canada a mixed methods study
Child Abuse & Neglect, 2017Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:Abstract Objective The purpose of the study is to understand the similarities and differences in Child Welfare involvement for Asian- Canadian (East and Southeast Asian) versus White-Canadian Children and families involved in the Child Welfare System in Canada, and to consider the implications and recommendations for service. This mixed methods study began by replicating this author’s previous study that found significant differences in the case characteristics and services used by Asian compared to non-Asian families in the Child Welfare System. The present study used a mixed method approach to further build a comprehensive descriptive understanding of Asian-Canadian Children and families involved in the Child Welfare System at national and local levels. Methods Secondary data analysis of the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) was conducted to identify the case characteristics (such as referral source, investigation type, and primary maltreatment type) and short-term service outcome (such as substantiation decision and decision to transfer to ongoing Child protection services) of Child maltreatment investigations involving Asian-Canadian Children and families in the Child Welfare System. The results were presented to focus group participants in a workshop, and a semi-structured interview guide was used to document Child Welfare workers’ experience with and perception of Asian-Canadian service users. Results The results indicated substantial differences between Asian- Canadian and White-Canadian Children and families investigated by Child Welfare agencies in respect to the household composition, maltreatment type, substantiation decision and decision to transfer to ongoing Child protection services. Child Welfare workers validated the results from secondary data analysis of the CIS-2008 and offer a broader cultural and structural context for understanding Child Welfare involvement with Asian-Canadians. Conclusion Asian-Canadian Children and families bring a diversity of cultural values and family norms. This study prompts further consideration for social work practice and policies in working with Asian-Canadian Children and families involved in the Child Welfare System.
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delineating disproportionality and disparity of asian canadian versus white canadian families in the Child Welfare System
Children and Youth Services Review, 2016Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:This paper builds upon the analyses presented in three companion papers using data from the 2003 and 2008cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003 and CIS-2008) and the Ontario Child Abuse and Neglect Data System (OCANDS) to examine disproportionality and disparity of Child Welfare involvement for Asian-Canadian Children involved in the Child Welfare System.
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delineating disproportionality and disparity of asian canadian versus white canadian families in the Child Welfare System
Children and Youth Services Review, 2016Co-Authors: Barbara Lee, Nico Trocme, Barbara Fallon, Esme Fullerthomson, Tara BlackAbstract:Abstract Objective This paper builds upon the analyses presented in three companion papers using data from the 2003 and 2008 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003 and CIS-2008) and the Ontario Child Abuse and Neglect Data System (OCANDS) to examine disproportionality and disparity of Child Welfare involvement for Asian-Canadian Children involved in the Child Welfare System. Methods This study used CIS-2008 data adjusted by Census Child population data to examine rates per 1000 and three disparity indexes (population-based disparity index [PDI], decision-based disparity index [DDI], and maltreatment-based disparity index [MDI]) to determine the representation of Child maltreatment investigations for Asian-Canadian versus White-Canadian Children involved in the Child Welfare System. Logistic regression analyses were conducted to determine the odds of case closure for substantiated Child maltreatment investigations, and whether Asian ethnicity remained significant while controlling for Child demographics and household composition, case characteristics, and clinical concerns. Results This study found that Asian-Canadian Children were underrepresented in the Child Welfare System compared to White-Canadian Children (13.9 per 1000 Asian Children in the Canadian population vs. 36.1 per 1000 White Children in the Canadian population). Child Welfare involvement for Asian-Canadian Children are almost 2 times more likely to close after an investigation than White-Canadian Children. The three disparity indexes (PDI, DDI, MDI) showed substantially different results with respect to the representation of Child maltreatment investigations involving Asian-Canadian versus White-Canadian Children for physical abuse, sexual abuse, neglect, emotional maltreatment, and exposure to domestic violence. Conclusions Disproportionality and disparity are complex phenomena. The variation in results derived from different methods of calculating representation suggests the need for greater clarity and consistency in the definitions and methodology in examining racial disparity in Child Welfare research. Some methodological considerations for future Child Welfare research with Asian-Canadian populations were discussed.
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supervisory neglect and risk of harm evidence from the canadian Child Welfare System
Child Abuse & Neglect, 2012Co-Authors: Monica Ruizcasares, Nico Trocme, Barbara FallonAbstract:OBJECTIVE: This study explores prevalence and characteristics associated with supervisory neglect and physical harm in Children in the Child Welfare System in Canada. METHODS: The sample included all substantiated primary maltreatment investigations in the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect excluding cases where exposure to intimate partner violence was the sole reason for investigation (n=3,380). Bivariate tests were used to assess differences across types of maltreatments and to compare supervisory neglect cases with and without physical harm on factors related to Child injury and supervision. RESULTS: Supervisory neglect was the primary concern in an estimated 12,793 cases of substantiated maltreatment across Canada in 2008. Compared to other types of maltreatment, cases of supervisory neglect involved more overcrowded housing conditions and Children who were younger and less likely to have any functioning issue. Injuries were noted in only 2% of cases supervisory neglect and half of these injuries were not severe enough to require medical treatment. Other physical health conditions were noted in 2% of supervisory neglect cases. Physical harm was noted most often for toddlers (1-2 years old) and adolescents (12-15 years old). Household and caregiver characteristics were not associated with greater rates of physical harm. In contrast, 7% of Children with any risk factor suffered physical harm as a result of supervisory neglect mainly related to substance abuse, self-harming behavior, and multiple incidents of running from care. CONCLUSIONS: Child risk factors are often present in cases of supervisory neglect with physical harm. Nonetheless, 96% of all cases of supervisory neglect substantiated by Canadian Child Welfare authorities do not involve physical harm. Clearer guidelines are needed for the assessment of supervisory neglect. Alternative response Systems may be more suitable for low-risk cases. Language: en
John Landsverk - One of the best experts on this subject based on the ideXlab platform.
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a preliminary analysis of the receipt of mental health services consistent with national standards among Children in the Child Welfare System
American Journal of Public Health, 2010Co-Authors: Ramesh Raghavan, Megumi Inoue, Susan L Ettner, Barton H Hamilton, John LandsverkAbstract:Objectives. We sought to examine the extent to which Children in the Child Welfare System receive mental health care consistent with national standards.Methods. We used data from 4 waves (3 years of follow-up) of the National Survey of Child and Adolescent Well-Being, the nation's first longitudinal study of Children in the Child Welfare System, and the Area Resource File to examine rates of screening, assessment, and referral to mental health services among 3802 youths presenting to Child Welfare agencies. Weighted population-averaged logistic regression models were used to identify variables associated with standards-consistent care.Results. Only half of all Children in the sample received care consistent with any 1 national standard, and less than one tenth received care consistent with all of them. Older Children, those exhibiting externalizing behaviors, and those placed in foster care had, on average, higher odds of receiving care consistent with national standards.Conclusions. Adverse consequences ...
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effects of medicaid managed care policies on mental health service use among a national probability sample of Children in the Child Welfare System
Children and Youth Services Review, 2006Co-Authors: Ramesh Raghavan, Arleen Leibowitz, Ronald Andersen, Bonnie T Zima, Mark A Schuster, John LandsverkAbstract:Abstract Children in the Child Welfare System are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of Children in the Child Welfare System. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on Children's use of mental health services, controlling for Child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect Children in the Child Welfare System who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these Children.
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psychotropic medication use in a national probability sample of Children in the Child Welfare System
Journal of Child and Adolescent Psychopharmacology, 2005Co-Authors: Ramesh Raghavan, Arleen Leibowitz, Bonnie T Zima, Mark A Schuster, Ronald M Andersen, John LandsverkAbstract:Objectives: The aim of this study was to estimate the point prevalence of psychotropic medication use, and to describe relationships between Child-level characteristics, provider type, and medication use among Children in the Child Welfare System. Methods: The National Survey of Child and Adolescent Well-Being is the first nationally representative study of Children coming into contact with the Child Welfare System. We used data from its baseline and 12-month follow-up waves, and conducted weighted bivariate analyses on a sample of 3114 Children and adolescents, 87% of whom were residing in-home. Results: Overall, 13.5% of Children in Child Welfare were taking psychotropic medications in 2001–2002. Older age, male gender, Caucasian race/ethnicity, history of physical abuse, public insurance, and borderline scores on the internalizing and externalizing subscales of the Child Behavior Checklist were associated with higher proportions of medication use. African-American and Latino ethnicities, and a history ...
Ramesh Raghavan - One of the best experts on this subject based on the ideXlab platform.
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medicaid expenditures on psychotropic medications for Children in the Child Welfare System
Journal of Child and Adolescent Psychopharmacology, 2012Co-Authors: Ramesh Raghavan, Susan L Ettner, Derek S Brown, Hope Thompson, Lisa M Clements, Whitney KeyAbstract:Abstract Objective: Children in the Child Welfare System are the most expensive Child population to insure for their mental health needs. The objective of this article is to estimate the amount of Medicaid expenditures incurred from the purchase of psychotropic drugs – the primary drivers of mental health expenditures – for these Children. Methods: We linked a subsample of Children interviewed in the first nationally representative survey of Children coming into contact with U.S. Child Welfare agencies, the National Survey of Child and Adolescent Well-Being (NSCAW), to their Medicaid claims files obtained from the Medicaid Analytic Extract. Our data consist of Children living in 14 states, and Medicaid claims for 4 years, adjusted to 2010 dollars. We compared expenditures on psychotropic medications in the NSCAW sample to a propensity score-matched comparison sample obtained from Medicaid files. Results: Children surveyed in NSCAW had over thrice the odds of any psychotropic drug use than the comparison s...
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a preliminary analysis of the receipt of mental health services consistent with national standards among Children in the Child Welfare System
American Journal of Public Health, 2010Co-Authors: Ramesh Raghavan, Megumi Inoue, Susan L Ettner, Barton H Hamilton, John LandsverkAbstract:Objectives. We sought to examine the extent to which Children in the Child Welfare System receive mental health care consistent with national standards.Methods. We used data from 4 waves (3 years of follow-up) of the National Survey of Child and Adolescent Well-Being, the nation's first longitudinal study of Children in the Child Welfare System, and the Area Resource File to examine rates of screening, assessment, and referral to mental health services among 3802 youths presenting to Child Welfare agencies. Weighted population-averaged logistic regression models were used to identify variables associated with standards-consistent care.Results. Only half of all Children in the sample received care consistent with any 1 national standard, and less than one tenth received care consistent with all of them. Older Children, those exhibiting externalizing behaviors, and those placed in foster care had, on average, higher odds of receiving care consistent with national standards.Conclusions. Adverse consequences ...
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effects of medicaid managed care policies on mental health service use among a national probability sample of Children in the Child Welfare System
Children and Youth Services Review, 2006Co-Authors: Ramesh Raghavan, Arleen Leibowitz, Ronald Andersen, Bonnie T Zima, Mark A Schuster, John LandsverkAbstract:Abstract Children in the Child Welfare System are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of Children in the Child Welfare System. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on Children's use of mental health services, controlling for Child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect Children in the Child Welfare System who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these Children.
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psychotropic medication use in a national probability sample of Children in the Child Welfare System
Journal of Child and Adolescent Psychopharmacology, 2005Co-Authors: Ramesh Raghavan, Arleen Leibowitz, Bonnie T Zima, Mark A Schuster, Ronald M Andersen, John LandsverkAbstract:Objectives: The aim of this study was to estimate the point prevalence of psychotropic medication use, and to describe relationships between Child-level characteristics, provider type, and medication use among Children in the Child Welfare System. Methods: The National Survey of Child and Adolescent Well-Being is the first nationally representative study of Children coming into contact with the Child Welfare System. We used data from its baseline and 12-month follow-up waves, and conducted weighted bivariate analyses on a sample of 3114 Children and adolescents, 87% of whom were residing in-home. Results: Overall, 13.5% of Children in Child Welfare were taking psychotropic medications in 2001–2002. Older age, male gender, Caucasian race/ethnicity, history of physical abuse, public insurance, and borderline scores on the internalizing and externalizing subscales of the Child Behavior Checklist were associated with higher proportions of medication use. African-American and Latino ethnicities, and a history ...