Te Whare Māwhaiwhai is a culturally embedded, strengths-based framework for guiding the development of support planning for people with neurodivergence in Aotearoa New Zealand, particularly fetal alcohol spectrum disorder (FASD), autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The present study sought to identify common evidence-informed approaches to neurodevelopmental needs that were publicly available, drawing heavily upon lived experience, practice wisdom, and cultural knowledge, and to align these with the existing Te Whare Māwhaiwhai framework. This paper describes 20 approaches to supporting neurodivergence, each aligned with one of the four areas of Te Whare Māwhaiwhai. These were developed through literature review and a multidisciplinary review by Māori practitioners. The results of this paper will be applied within a Māori FASD assessment pilot in 2026. The approaches outlined will be used during assessment feedback phase to collaboratively identify and time strategies that meet the identified needs and build on strengths present within the person, whānau, and community. This responds to a call for Indigenous approaches to FASD by Māori families caring for people with FASD, and recent strategic research priorities for FASD. This paper outlines the methodology for selecting and aligning these approaches to the framework and provides an introductory description of approaches and next steps in the development of a culturally-centred strengths-based approach to FASD.
Prenatal alcohol exposure (PAE) has the potential to adversely impact development of the embryo and fetus and may result in fetal alcohol spectrum disorder (FASD). Traditionally, research into the effects of PAE has predominately taken a single-exposure approach to examining adverse outcomes, rarely capturing cumulative or interacting exposures. However, adopting the exposome concept could transform this approach by considering lifetime environmental exposures as an interconnected and dynamic system. This is particularly relevant in global settings with heterogeneous environmental and social risk profiles. The exposome framework provides a holistic view of quantifiable environmental exposures on health and development across an individuals’ lifespan, including both beneficial and adverse exposures and external and internal factors. By examining the complex interplay between PAE and other environmental factors through the exposome lens, we can uncover new insights into both risk and resilience. Moreover, given the increased risk of child protection involvement and out-of-home care placement amongst children with FASD, this has the potential to inform prevention, assessment and support within child welfare systems, and shift statutory responses from individualised blame to structural and environmental understanding. Thus, this discussion paper provides a comprehensive overview of the exposome approach, how it has historically been used in PAE research, and how it can evolve, including in the field of child welfare.
Background Professionals working in out-of-home child welfare care routinely encounter emotionally demanding caregiving situations. The adaptiveness of emotional responses may depend on caregiving context. The present study examined expert-rated patterns of emotional adaptiveness across caregiving situations. Objective To identify patterns relevant to future caregiver assessment in out-of-home child welfare care. Participants and Setting: Expert raters included child welfare psychologists and advanced psychology trainees with supervised field experience in child welfare suitability assessment within the Hungarian child welfare system. Methods Raters evaluated the perceived adaptiveness of hypothetical adult responses organized by 25 caregiver response tendencies across five caregiving situations using an 11-point scale. Data were analyzed using canonical correlation analysis, cluster analysis, non-metric multidimensional scaling, and linear mixed-effects models. Findings Expert evaluations showed high structural agreement (mean first canonical correlation = .949, SD = .031) and identified four interpretable response clusters. The four clusters represented consistently unfavorable responses, context-sensitive negative responses, consistently favorable supportive-regulatory responses, and positive-reinforcing responses. A linear mixed-effects model showed that including the Response × Situation interaction significantly improved model fit (χ2(96) = 1818.8, p < .001), with high explanatory power (R2m = .688; R2c = .701). Conclusions These findings provide preliminary expert-consensus evidence for a context-sensitive conceptualization of caregiver emotional functioning and may contribute to future caregiver assessment and training development in out-of-home child welfare care.
Background Best practice in the assessment of child trauma symptoms involves collecting reports from multiple informants, including both children and caregivers. However, previous research has shown that caregiver and child reports of child trauma symptoms often differ. Objective This study examined whether child- and caregiver-level protective factors were associated with the degree of concordance between caregiver and child reports of trauma symptoms among children receiving mental health services following exposure to child maltreatment. Participants and Setting Seventy-one children aged 8 to 17 and their caregivers were recruited from the [anonymized] Child and Youth Advocacy Centre in [anonymized] to participate in this study. Methods A retrospective file review was conducted to obtain demographic information and the child’s exposure to adverse childhood experiences (ACEs). Children and their caregiver also completed questionnaires to assess trauma symptoms, as well as personal and caregiver protective factors. Findings Results indicated moderate concordance between caregiver and child reports of trauma symptoms (ICC = .59, p < .001). Child age, child gender, and ACEs were not significantly associated with concordance. Children’s perceptions of caregiver warmth and support was associated with lower discordance (β = –.38, p = .005). Conclusion These findings suggest that caregiver protective factors, such as the quality of the caregiver-child relationship, may influence the extent to which caregivers and children agree in their reports of trauma symptoms. They underscore the importance of considering relationship factors when interpreting discrepancies between informants and support the inclusion of caregivers in trauma-focused interventions aimed at strengthening caregiver-child relationships.
Background Children placed in out-of-home care (OHC) are often exposed to severe childhood adversity and face elevated risks of adverse outcomes. Yet, less is known about how such outcomes cluster across adulthood, particularly when premature mortality is considered. Objective This study examines the prevalence of offending, psychiatric disorders, and early death from early adulthood to retirement age, as well as the co-occurrence of offending and psychiatric disorders, and assesses variation by timing and reasons for placement. Participants and Setting The study uses longitudinal Swedish data from the Stockholm Birth Cohort Multigenerational Study (SBC Multigen), including over 14,000 individuals born in 1953. Methods Sex-stratified multinomial regression analyses compared outcomes among individuals with OHC experience, those investigated by child welfare services but not placed, and majority population peers, adjusting for early-life confounders. Results Individuals with OHC experience had elevated risks compared with majority population peers, with the strongest associations for co-occurring offending and psychiatric disorders. Risks were highest among those first placed during adolescence and those placed for reasons related to individual behavior. Individuals investigated but not placed generally showed intermediate risks. Including mortality highlighted that premature death as an important component of long-term outcome patterns. Conclusions Childhood OHC experience is associated with risks of criminal and mental health problems into later adulthood. Findings highlight the importance of considering co-occurring outcomes, mortality, and heterogeneity in placement experiences in child welfare systems, particularly for risk assessment, service planning, and long-term support.
Background Globally, about one billion children experience violence, affecting individuals, families, communities, and society. In Colombia, ongoing conflict and drug-related armed violence drive high violence rates. Objectives The objective of the study was to assess the feasibility of: (i) a community-led approach to protect children (Seeds) and, (ii) its evaluation procedures, in order to inform refinements to the intervention manual and evaluation design and methods prior to a large-scale effectiveness evaluation. Participants Quantitative data were gathered from random samples of adolescents (n=25) and adults (n=32), and a purposive sample of adults (n=14). Qualitative data were gathered from purposive samples of adolescents (n=18) and adults (n=17). Methods The study, employing a multiple-baseline longitudinal mixed-methods design, was conducted in two neighborhoods in Bogotá, Colombia. Linear regression assessed sensitivity to change of pre-defined outcomes, completed by thematic analysis of qualitative data. Findings Overall, the Seeds approach was received positively by participants. However, challenges related to time constraints and adult participation were identified, indicating the need for adjustments to the intervention manual before the next evaluation. Additional practical revisions, including simplifying the tools and improving the flow between intervention phases, were also noted and will be incorporated. Using the current study design and instruments, changes were detected in several, but not all, outcomes. The findings further suggested several modifications to strengthen future evaluations of pre-defined Seeds outcomes, including adding a control group, measuring community ownership, and developing instruments to capture context-specific risks and observable changes resulting from community action plans. Conclusion Participants responded positively to Seeds, despite challenges from time constraints and limited adult participation. The study informed intervention manual updates and identified recommendations to refine design and methods for a future adequately powered Seeds evaluation.
The key impacts of restrictive measures in residential care relate to safeguarding, care, context, and rehabilitation. These domains are interconnected: physical safeguarding is essential for enabling care and rehabilitation, while positive effects on care and community form the foundation for rehabilitative work. This article addresses a knowledge gap in understanding the complexity and sensitivity of decision-making on restrictive measures from the perspective of care workers by exploring their use in Finnish residential care. The study focuses on intended and unintended effects on the life trajectories of placed adolescents. The article seeks to answer the following question: How do professional decisions concerning restrictive measures impact the care and trajectories of adolescents in residential care? Considering both immediate consequences and long-term implications, the study draws on data collected from 39 professionals working in residential care who participated in six group interviews that took place in 2023 and 2024; these interviews focused on the use of restrictive measures in everyday practice. The qualitative data were analyzеd using abductive content analysis. Restrictive measures can support a adolescent’s survival, safety, and sense of security; however, they must be applied only as a last resort, as such measures risk retraumatizing adolescent s. Breaking harmful cycles requires care, trust, and hope—not just control. Strategic reform calls for increased resources, comprehensive staff training, and clear national guidelines. Coordinated planning could help reduce care disruptions and promote continuity, stability, and belonging for adolescents.
Child protection workers (CPWs) must make complex decisions that deeply affect children and families. They operate within a demanding accountability framework, which requires them to justify their actions to supervisors, organizations, courts, and the public. While accountability is essential to ensure ethical and transparent practice, its definition and day-to-day impact on CPWs remain unclear. This qualitative study explored how Canadian CPWs define accountability, how it affects their personal and professional lives, and what strategies are used to manage it. Through thematic analysis of interviews with 30 CPWs in the Greater Montreal area, participants described accountability as a mix of professional, organizational, legal, and medical responsibilities. Many related it with heavy emotional and cognitive demands such as stress, self-doubt, and overload, particularly when facing scrutiny or unclear expectations. CPWs also identified positive dimensions of accountability, including greater rigor, reflection, and shared responsibility. Peer support and supervision emerged as vital tools for navigating accountability pressures in daily practice. By shedding light on how CPWs understand and manage accountability, this study invites reflection on how organizations and supervisors can better support their staff. When accountability is shared and grounded in collaboration rather than control, it can foster trust, ethical reflection, and healthier work environments for those involved in supporting children and families.
Background Alcohol consumption during pregnancy is a major public health concern and the leading cause of foetal alcohol spectrum disorders (FASD), one of the most common preventable congenital conditions in Europe. Despite clear recommendations for abstinence, uncertainty persists among both pregnant women and healthcare professionals about how to address the issue. Objective This study explores expert perspectives on alcohol use during pregnancy and examines counselling practices and challenges in antenatal care. Participants and settings A qualitative study was conducted using structured interviews with 14 midwives in Austria and four addiction medicine experts between May and July 2025. Methods Interviews were transcribed, pseudonymised and analysed inductively following Mayring's qualitative content analysis to develop higher-level categories. Findings Alcohol consumption affects women across all social groups and is highly stigmatised during pregnancy. Shame, fear of judgement and the social normalisation of alcohol hinder open communication. Midwives generally adopt a zero-tolerance approach but report uncertainty in managing psychosocial aspects and suspect underreporting. Counselling mainly relies on verbal history-taking and documentation in the parent-child-pass, while standardised screening tools are rarely used. A strong need for interprofessional collaboration, clear referral pathways and practical support services was identified. Conclusion Alcohol use during pregnancy is complex and highly stigmatised, posing challenges for counselling and prevention. Midwives play a central role but require stronger structural support, training and networks. Effective prevention depends on early, low-threshold, non-judgemental education, consistent screening and improved public awareness of prenatal alcohol risks.
Introduction The juvenile court may issue an immediate supervision order if there is an immediate risk to a child’s health or development. Little is known about the decision-making process behind such orders. Aim This study aims to establish whether the advice that social workers give to child protection boards regarding the follow-up after an immediate measure is well-founded and traceable. Method We conducted a retrospective qualitative case file study, analyzing 50 files of children who received an immediate supervision order from a Dutch youth care organization. We assessed the advice using a tool based on Toulmin’s argumentation model and the three perspectives of evidence based (scientific, professional and client perspective). Results Advice to the child protection board was explicitly found in seven files (14%). Most of the advice was found in the child protection board’s report (52%). None of the advice included all Toulmin’s elements and all three perspectives of evidence-based practice. Although information was available elsewhere in the case files, this was not reflected in the advice. Conclusion The risk of not including this information in the advice is that vital information is not considered by the child protection board and, later, the court. We recommend that youth care organizations treat the advice as a distinct and critical decision, giving it separate status in protocols. Furthermore, we recommend using a model of argumentation and incorporating the three perspectives to ensure that critical information is well-founded in the advice.
Children involved in child welfare systems frequently experience complex and overlapping biopsychosocial adversities, including neurodevelopmental impairments associated with prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD). Despite evidence indicating disproportionately high rates of FASD among child welfare populations, identification and response pathways remain inconsistent, with many systems lacking structured approaches to screening, assessment, and intervention. Consequently, neurodevelopmental impairments are often misunderstood, resulting in inappropriate behavioral interpretations, ineffective interventions, placement instability, and poor long-term outcomes. This discussion paper examines the role of neurodevelopmentally informed practice within child welfare and situates the 5-Step Neurodevelopmental Screening Pathway within a biopsychosocial framework. Developed from practitioner-generated data and frontline social work experience, the pathway offers a structured, non-diagnostic approach to information gathering, functional observation, pattern recognition, and decision-making in environments where specialist assessment is often unavailable or inaccessible. The model supports earlier recognition of neurodevelopmental vulnerability while promoting disability-informed responses that extend beyond diagnostic status alone. This paper argues that strengthening neurodevelopmental literacy within child welfare practice is both a clinical and organizational imperative. Embedding structured screening pathways into routine assessment processes may improve intervention planning, enhance interprofessional collaboration, and strengthen the capacity of child welfare agencies to fulfil their responsibilities as corporate parents. Ultimately, a proactive neurodevelopmental approach has the potential to reduce escalation into crisis services, youth justice involvement, homelessness, substance misuse, and adverse lifelong outcomes for children and young people affected by PAE and FASD.
Background Parental substance use disorder (SUD) significantly increases complexity and severity of child maltreatment. Sobriety Treatment and Recovery Teams (START), an evidence-based intervention, has improved unification and reduced recurrence of maltreatment risk through cross-system collaboration between child welfare and behavioral health organizations. Currently little is known about perceived factors influencing successful collaboration. Objective This qualitative study identified factors that influenced cross-system collaboration in a state-wide implementation of an integrated social service and behavioral health intervention. Participants and setting Embedded in an implementation study of Ohio START, this study used semi-structured small group interviews with 104 administrators and frontline providers, and structured focus groups with 26 child welfare caseworkers and family peer mentors. Method Virtual small-group interviews were conducted between January 2020 and April 2021, and structured focus groups were conducted in February 2021. To identify barriers and facilitators of cross-system collaboration, thematic analysis was applied to transcripts, using inductive and deductive coding methods. Results Overall, participants from both child welfare and behavioral health fields reported positive collaboration experiences and noted improvement in mutual understanding and service provision. Two main barriers emerged: misalignment of treatment requirements and expectations, and varied attitudes toward substance use and treatment. Facilitators included prior established collaboration, dedicated collaboration personnel, and supportive leadership. Conclusions Cross-systems alignment of services and expectations, efforts to address stigma and negative perceptions, and leveraging leadership support and dedicated personnel are crucial for successful cross-system collaboration.
Background Self-report tools to identify adolescents exposed to commercial sexual exploitation are scarce, particularly for sexual and gender minority youth at elevated risk. Many existing screeners hinge on a single direct item and focus on behavior over coercion, which can inadvertently imply victim responsibility. Objective To develop and validate the Adolescent and Young Adult Commercial Sexual Exploitation screener and evaluate scoring rules for identifying youth at risk for commercial sexual exploitation. Participants and setting The sample consist of 612 sexual and gender minority adolescents and young adults (ages 13–22) recruited through social media in the United States. Methods Seven trauma-informed, behaviorally anchored items were evaluated using Exploratory Graph Analysis, Item Response Theory, and Classical Test Theory. Convergent (risk behaviors) and discriminant (social connectedness) validity were examined. Cutoffs were optimized across simple-sum, network-weighted, and Item Response Theory-weighted scores against a criterion of 51 youths endorsing direct commercial sexual exploitation items (8.3%). Findings Analyses supported a unidimensional, nonredundant scale. Sexual assault and being offered something for sex were most central. The screener showed acceptable internal consistency (α = .74), precise measurement at moderate–high risk, moderate correlations with risk behaviors, and near-zero associations with social connectedness. A network-weighted score (0–13) with a ≥5.5 cutoff balanced sensitivity (76.5%) and specificity (83.1%) and reduced false positives compared with simple-sum scoring. Conclusion The Adolescent and Young Adult Commercial Sexual Exploitation screener is a brief, trauma-informed screener that can support early identification of youth at risk for commercial sexual exploitation by focusing on experiences of coercion and vulnerability rather than self-identified “trading sex.” It offers a practice tool for use in youth-serving settings, with particular relevance for sexual and gender minority youth.
This study sought to identify the factors associated with sustained implementation of a home visiting project model in nine sites in Mongolia, following withdrawal of their original funding. The home visiting model uses trained community volunteers as home visitors to develop supportive relationships with vulnerable children and families, assess needs, and connect them to support networks and community services. Using an evidence-based post-program sustainability framework, we examined the role of advanced sustainability planning; sustained motivations, resources, capacity, and linkages; local partner transitions; and contextual factors. We conducted 73 qualitative interviews with implementation stakeholders and 235 quantitative surveys with current and former home visitors.Only two of the home visiting sites were found to have continued operations following the discontinuation of their original funding. In both cases, the program implementation transitioned to local schools using salaried teachers as home visitors. In the discontinued sites, the principal barriers to sustainability were inadequate and untimely sustainability planning and lack of financial resources to support program coordination. Current and former home visitors had high levels of motivation, perceived capacity, and linkages. However, emotional strain was a challenge, as were resource constraints. However, program closure was the single biggest factor associated with home visitor discontinuation.Home visiting can be sustained long-term in low- and middle-income countries. Adequate and timely planning for sustainability is necessary to ensure implementation after initial funding ends. Community-based home visiting programs must consider sustained sources of capacity, motivation, and resources at administrative and provider levels.
Educators are legally mandated to identify and report suspected Child Abuse and Neglect (CAN). Despite this responsibility, reporting practices continue to vary, and educators often under-report or over-report racialized children and families in child welfare systems. This study explored educators' perspectives and experiences in identifying and reporting suspected CAN in the provinces of Ontario and British Columbia, Canada. Ten educators from Ontario (n = 4) and British Columbia (n = 6) participated. All were educators working in elementary, middle, or high school settings. A qualitative design was used. Semi-structured interviews were conducted via Zoom. Interviews were audio-recorded, transcribed verbatim, and managed using NVivo software. Data were thematically analyzed, guided by the Social Ecological Model. Educators' decisions to report suspected child abuse and neglect were influenced by five interconnected themes. These included; educators' misconceptions of cultural and religious practices, scrutiny around racialized families and geography, educators’ perceptions of parental behavior and differential application of empathy, fear of reporting and burden of responsibility, and the lack of follow-up by child welfare services. These factors interacted across individual, interpersonal, community, and institutional levels, contributing to uncertainty and variability in reporting suspected CAN. Mandatory reporting is a multi-level process extending beyond legal compliance. Findings highlight the need for cultural responsiveness, anti-bias and equity-based awareness for educators alongside stronger interagency collaboration. Promoting fairness and cultural responsiveness in child welfare requires policy frameworks that move away from punitive, surveillance-based approaches and toward supportive, community-based models.
Background A large proportion of non-offending mothers of children exposed to maltreatment may themselves have lifetime exposure to violence and abuse. However, there is limited knowledge about the prevalence of such experiences and their relationship to socioeconomic factors. Objective To examine the prevalence and sociodemographic correlates of interpersonal victimization across childhood and adulthood among mothers of children exposed to maltreatment, and to investigate whether cumulative exposure across developmental periods was associated with perceived financial well-being, employment status, and educational attainment. Method The sample comprised 488 mothers of children with substantiated maltreatment. Participants were categorized into four mutually exclusive victimization profiles: (1) non-victimized, (2) victimized in adulthood only, (3) victimized in childhood only, and (4) victimized in both childhood and adulthood. Sociodemographic indicators were compared across groups using chi-square tests and age-adjusted logistic regression. Findings Childhood and adult victimization were both common in this sample, and a substantial proportion reported cumulative exposure across these developmental periods. Mothers with cumulative exposure showed the highest levels of socioeconomic vulnerability and were more likely to report financial hardship and the lowest rates of paid employment. Relative to non-victimized mothers, those exposed in both childhood and adulthood had substantially higher odds of financial hardship (adjusted OR = 3.75, 95% CI [2.04, 6.88]) and no paid employment (adjusted OR = 3.39, 95% CI [1.89, 5.99]). Educational attainment did not differ significantly across victimization groups. Conclusion Lifetime experiences of interpersonal violence were associated with financial hardship and reduced work participation among mothers of maltreated children. Support services may need to address both trauma histories and economic strain to help strengthen the caregiving environment and reduce the risk of continued adversity across generations.
Background: Circle of Security-Parenting (COS-P) is an attachment-based parenting intervention. It is accessible to vulnerable families, including those at risk of child abuse and neglect, targeting primary outcomes of parenting skills, functioning, and experiences, along with secondary outcomes related to parent-child attachment. Despite its potential for preventing child maltreatment, research on COS-P's effectiveness and participant experiences are mixed. Objective: This study conducted a mixed methods systematic review and convergent approach to data integration to examine the impacts of the COS-P for families at risk of child abuse and neglect. Methods: Following a PICOS-driven question defining 6 family risk factors, searches were completed across 6 key bibliographical and 5 grey literature databases. Following screening and extraction, both content and narrative synthetic approaches were utilized to analyze the included qualitative, quantitative, and mixed-method studies. Results: A total of 23 studies met the inclusion criteria (7 qualitative, 15 quantitative, and 1 mixed). Both qualitative and quantitative studies suggested improvements in parental cognitions, emotion regulation, sensitivity, efficacy, and reflective functioning. While changes in parenting responses and behaviours were modest, some studies noted a reduction in corporal punishment. Secondary outcomes, such as secure attachment and child behavioural problems, showed mixed findings. Conclusions: From the perspectives of child maltreatment prevention, COS-P appears promising in promoting safer caregiving environments, although evidence is constrained by methodological limitations. Future research could investigate potential mechanisms of change (e.g., reflective functioning) to strengthen the evidence base for COS-P.
Background Children and young people (CYP) who use child welfare services are disproportionately affected by poor mental health in comparison to those who do not, due to adverse child experiences, such as maltreatment and family difficulties. Strengthening early interventions requires a better understanding of the risk and protective factors influencing mental health outcomes. Objective To understand the risk and protective factors that may impact the mental health difficulties among children in contact with child welfare services. Participants and settings CYP and their parents/caregivers and three Local Authorities across the North East of England. Methods Semi structured interviews were conducted with 23 CYP and 18 parents/caregivers between November 2022 and February 2023. Interviews explored risk and protective factors for mental health difficulties of CYP, using four practitioner-informed case vignettes and optional semi-structured optional exercises and. Data were thematically analysed. Results CYP using child welfare services primarily experienced mental health risk factors within the home and school environments, with parent/caregiver factors having a particularly negative impact on all aspects of CYP's lives including emotional regulation. However, not all CYP exposed to adversity develop mental health difficulties, certain protective factors like a strong supportive network, particularly from their parent/caregiver are more likely to thrive. Conclusions This study demonstrates the importance of parent/caregiver factors in shaping CYP mental health. Preventative interventions should focus on strengthening the parent/caregiver-child relationship and supporting the parent/caregiver to respond appropriately to their child's need in the context of adversity.
