“Evaluating the Impact of Family-Based Programs” covers best practices in evaluating family-based programs, geared toward agencies that provide family-based services. The need for evidence of these programs’ effectiveness is pressing and urgent. The authors describe a comprehensive evaluation process that takes place within the larger context of culture, climate, policy, current evaluation standards, and funding requirements. The chapter covers needs assessment, evaluation planning, training of evaluation staff, data collection, analysis, reporting, and dissemination. Special attention is paid to the requirements of the Family First Prevention Services Act of 2018, which permits the federal government to reimburse prevention services and also requires that eligible reimbursable prevention programs must meet specific evidence-based effectiveness standards.

Evidence-based parenting programs promote children's safety, permanency, and well-being. Despite strong evidence of effectiveness, widespread adoption and sustained implementation remain limited. This study examined barriers to implementing Attachment and Biobehavioral Catch-up (ABC), a home-visiting intervention, within a Regional Partnership Grant serving child welfare-involved families in a Midwestern state. A retrospective post-implementation survey of 20 professionals (23.8% response rate) identified barriers including limited professional engagement, duplication of services, weak referral pathways, poor cross-system collaboration, and stakeholder buy-in. Despite funding, planning, and training, barriers hindered implementation, highlighting the complexity of sustaining evidence-based interventions in child welfare systems.

Limited research is available examining distal child welfare outcomes after participation in evidence-based parenting interventions. To address this gap, this study employed a multi-tiered analytic approach to examine child welfare outcomes after participation in Attachment and Biobehavioral Catch-up (ABC). Using propensity score analytic techniques to establish a matched comparison group, logistic regressions examined subsequent maltreatment reports and substantiation, and survival analyses observed time to and likelihood of reunification for children who received one of three ABC curriculums compared to comparison group children (child welfare services as usual). In total, 205 children were included in the impact analysis ( n = 66 treatment; n = 139 comparison); the majority of the children were White (53.7%), non-Hispanic (84.4%), males (59.5%) with an average age of 6 months (M [SD] = .50 [1.0]). Over half (56.1%) of the study sample was in out-of-home placement; 23.5% of the removed children experienced reunification. No statistically significant group differences were observed on the likelihood of subsequent or substantiated maltreatment reports. All three ABC curriculums were associated with a statistically significant increased likelihood of reunification, when compared to their matched counterpart. Additional research is warranted, though results indicate ABC may be a promising intervention to help enhance the likelihood of reunification.

The rate of children entering foster care due to parental substance use continues to climb, particularly in rural areas. States and localities grappling with how to best serve these cases may be interested in implementing family treatment courts (FTC) but unsure of the return on investment for this enhanced approach. The few existing cost analyses of FTC focus primarily on large programs in urban settings. We present findings from a 4-year quasi-experimental study of a Midwestern rural FTC and conduct a cost analysis of observed effects on time in foster care. Using survival analyses to capture daily differences in permanency rates between groups and calculating the integral of the difference between survival curves, we observed that treatment group children spent, on average, 361 fewer days in care compared to children in the traditional system. The difference between FTC implementation costs and daily foster care costs avoided for the 91 treatment group children was estimated at over $26,000 per child served.

While the helping relationship is often viewed as a core element of child welfare practice, there is limited research on how birth parents and caseworkers describe the helping relationship in the foster care context. We interviewed six parent-worker dyads individually (N = 12) to explore how parents and caseworkers describe their helping relationship and perspectives on the role of the helping relationship on parents’ participation in foster care case activities. We used thematic analysis to analyze data within and between dyads. We developed two main themes: (a) foundations of the helping relationship and (b) case participation influences. Parents and caseworkers endorsed similar skills, characteristics, and behaviors from caseworkers that supported a good helping relationship: honesty and openness, nonjudgmental attitude, respect, and communication. Parents and caseworkers had different views on the role of the helping relationship in parents’ case participation. Parents emphasized their children as motivation for engaging in case activities; yet they indicated the helping relationship can support or hinder their participation in services. Caseworkers elevated the role of the helping relationship in participation more than did parents. Parents and caseworkers also identified parents’ context and agency/system factors as influencing parent participation.

Objective This study examines whether parents involved in the child welfare system, due to substance abuse, who receive solution-focused brief therapy (SFBT) counseling experience more hope and positive emotions than those receiving treatment-as-usual counseling services. Methods Randomized controlled trial design was used to evaluate the effectiveness of SFBT in primary substance use treatment services for parents (n = 123). Difference-in-Difference (DiD) estimation was used to assess the effect of SFBT intervention on hope, positive emotions, and negative emotions. Results DiD analyses showed SFBT parents had slightly worse scores on hope and emotion subscales at baseline and demonstrated slightly greater positive changes on all scales at posttest, though these findings were not statistically different from control group. Positive associations between SFBT and hope sub-scales were found; however, effects were not statistically significant. Conclusion SFBT may help increase positive emotions and hope in parents through a solution-building approach, but more research is needed.

ABSTRACT Through intensive, treatment-focused interdisciplinary practice, family treatment courts (FTC) offer a speedier pathway to reunification for families with substance use disorder in the foster care system compared to traditional settings. Less is known regarding differences in outcomes among FTC participants on the basis of clinical risk and need characteristics. We analyzed parent–child dyads in a rural Midwestern FTC program to understand the effect of these key variables on successful treatment completion and family reunification. Results revealed that treatment completion was more likely for parents who reported greater frequency of methamphetamine use in the 30 days prior to treatment entry and less likely for parents who reported more trauma symptoms. Longer time to treatment start from child removal date was associated with a very small increased likelihood of treatment completion as well. Reunification was significantly more likely for parents employed at treatment entry and those who spent more days in treatment. Reunification was less likely for parents who reported more social support and more trauma symptoms at treatment entry. Taken together, these findings suggest that FTC are effective for parents with methamphetamine use disorder, but may see improved outcomes when providing increased supports for parents with severe trauma symptoms.

Children involved in the foster care system are at risk of experiencing traumatic events, which can lead to negative outcomes for youth. Child welfare service providers are tasked with providing trauma-responsive services to youth in foster care; yet, the trauma-related needs of youth are often under-identified and undertreated. This study's purpose was to examine the initial implementation of a trauma-responsive approach from the perspective of frontline child welfare workers and trainers. We sought to further knowledge on how the competency drivers of staff selection/hiring, training, coaching, and fidelity facilitate or inhibit initial implementation. We conducted focus groups with workers (n = 28) and semi-structured interviews with trainers (n = 6) implementing a new trauma-responsive assessment and case planning approach. Transcripts were coded and analyzed using thematic analysis. Using competency drivers as a guide, several facilitators and barriers were identified. Overall, workers and trainers identified each of the four competency drivers as key to the uptake of the new practice approach. Our findings highlight the need for agencies implementing new practices to provide critical supports to frontline workers during implementation, such as specialized support positions and mechanisms for structure and accountability, and emphasize the importance of post-training support (e.g., coaching).

Objective: Solution-focused brief therapy (SFBT) has shown promise as an effective intervention with substance-abusing adults. This study expands on a preliminary study by Kim et al. (2018) by examining the results from the complete sample on substance abuse and trauma-related problems. Method: Child-welfare-involved parents were randomly assigned to either the SFBT (N = 90) or treatment-as-usual (N = 89) control group. Mixed linear models tested changes using intent-to-treat analysis, and effect sizes examined the magnitude of treatment effects. Results: Both the SFBT and control groups decreased on most of the Addiction Severity Index-SR (ASI-SR) measures and on all Trauma Symptom Checklist-40 (TSC-40) measures, indicating improvements. Between-group effect sizes favored the control group for two ASI-SR subscales—medical status and drug use—and favored SFBT for the TSC-40 subscale measures, although none was statistically significant except for the TSC-40 depression subscale. Conclusions: Further exploration of SFBT as an intervention to treat substance abuse and trauma among parents involved in the child welfare system is warranted.

Substance-affected families are frequently cited as the most challenging families to serve within the child welfare context, particularly in rural settings where treatment services may be few and far between. Growing evidence suggests that family treatment courts (FTCs) may be more effective than their traditional counterpart at achieving key child welfare goals; however, prior studies have been limited in their methodological rigour. This study used treatment and matched comparison data to test foster care exit patterns of families with children in foster care due to parental substance use. Treatment group data were collected on a sample of 91 children with open dependency cases in an integrated FTC in a rural Midwestern town. Propensity score nearest neighbour one-to-two matching was used to identify a comparison group of 146 children. Findings suggest that FTC participation significantly influenced foster care exits. Survival analyses revealed that FTC children were 170% more likely to reunify, and 58% more likely to achieve permanency, than comparison cases. The effect of FTC participation on likelihood of reunification and likelihood of permanency was stronger when models estimated outcomes from FTC start date, rather than child removal date. Implications for social work practice, research, and education are discussed.

OBJECTIVES To examine the impact of cumulative adverse childhood experiences (ACEs) on a child's foster care placement stability in Kansas. METHODS Secondary data analysis was conducted by using a purposive cohort sample of 2998 children, from 6 to 18 years old, in Kansas's foster care system between October 2015 and July 2019. Multivariate hierarchical logistic regression models were used to examine the influence of cumulative ACEs on a child's placement stability. ACEs were measured at foster care intake and self-reported by the child. Placement stability variables were obtained through the state administrative database. RESULTS Children in foster care with greater cumulative ACE exposure were significantly more likely to experience placement instability. Compared to children with 1 to 5 ACEs, when controlling for all other variables, children with ≥10 ACEs had an increased odds of experiencing placement instability by 31% (odds ratio: 1.31; P < .05); and children with 6 to 9 ACEs had a 52% (odds ratio: 1.52, P < .001) increased odds of experiencing placement instability. A child's race, biological sex, age at episode start, and whether they had siblings in foster care all significantly influenced placement instability. CONCLUSIONS Findings from this study, in conjunction with previous research on ACEs and foster care, highlight the need to proactively address ACEs and trauma exposure at foster care entry.

BACKGROUND:Research shows children in foster care are at amplified risk of experiencing cumulative adverse childhood experiences (ACEs). Though separate bodies of literature exist for ACEs and foster care, ample research demonstrates overlap in negative outcomes between ACEs and foster care involvement, such as substance use, early pregnancy, and poorer educational outcomes, among others. Rare are studies that have explored ACEs influence on targeted foster care outcomes.OBJECTIVE:To address this gap in the literature, this study's objective was to investigate the association between cumulative ACEs and reunification.PARTICIPANTS AND SETTING:2,998 American children between 6-18 years old in foster care between October 2015 and July 2019 in a Midwestern state.METHODS:Cox proportional hazard regression was utilized to examine likelihood of and time to reunification, comparing children with 1-5 ACEs, 6-9 ACEs, and 10+ ACEs.RESULTS:Increased cumulative ACE exposure among children in foster care significantly impeded likelihood of reunification, and slowed time to reunification. Children with 6-9 ACEs and 10+ ACEs were 28 % (HR = .72, p = .024) and 42 % (HR = .58, p = .000) less likely to reunify, respectively, when compared to their counterparts with 1-5 ACEs. Other significant predictors of reunification included: race, age at foster care entry, siblings in foster care, and placement setting type.CONCLUSION:Results support the notion that among an already vulnerable population, subgroups of children may disproportionally experience negative foster care outcomes. Continued research is necessary to further examine intersections and implications of cumulative ACEs among children in foster care.

BackgroundPlacement stability while in foster care has important implications for children’s permanency and well-being. Though a majority of youth have adequate placement stability while in foster care, a substantial minority experience multiple moves during their time in care. Research on correlates of placement instability has demonstrated a relationship between externalizing behaviors and placement instability. Likewise, evidence suggests higher levels of trauma are associated with increased externalizing behaviors. However, few studies have examined the relationship between trauma symptoms and placement instability.ObjectiveThe purpose of this study was to investigate whether children with clinically significant trauma symptoms had higher odds of placement instability.Participants and settingAdministrative data collected as a part of a summative evaluation for a federally-funded trauma III grant project were used. The sample included 1,668 children ages 5 and older who entered foster care during a 30-month period in a Midwestern state and completed a self-reported trauma screen within 120 days of entering care.MethodsHierarchical logistic regression was conducted to examine the contributions of trauma symptoms scores to placement instability, above and beyond demographic characteristics and case characteristics.ResultsResults from the final analytic model, which controlled for demographic and case characteristics, showed that children with clinically significant trauma symptoms (i.e., scores ≥19) had 46% higher odds of experiencing placement instability (OR = 1.46, 95% CIs [1.16, 1.82], p =  .001). Findings support the need to screen for and treat trauma symptomology among youth in foster care.

The United States is experiencing unprecedented rates of drug overdose deaths and drug-related problems. This epidemic is driven primarily by opioids. Although most responses to this opioid epidemic are focused on preventing harm to adults, there are at least 5 pathways by which opioid-related problems can spill over and affect child health and safety:Indeed, quantitative and qualitative studies suggest that increases in parental opioid misuse and overdose death have resulted in concomitant increases in these adverse childhood experiences and that many children are ending up in foster care.1–3 Three decades of evidence now make clear that this type of childhood adversity increases the risk of physical and mental health problems and many of the leading causes of adult death.4 There is, therefore, an urgent need to meet the needs of these children and their families to prevent and remediate the long-term developmental consequences of parental opioid misuse.Effective opioid use disorder treatment of parents is the first step to keeping children safe and healthy. Medication-assisted treatments (MATs) with buprenorphine or methadone have significantly improved outcomes for patients with opioid use disorder compared with treatments that do not include medication. This is true for both women who are pregnant and parents who are involved with child welfare, among whom research reveals that MAT is associated with improved birth outcomes and child safety, respectively.1,5 MAT also increases engagement in obstetric care, which may facilitate access to family planning and prevent further unwanted pregnancies. Providers should review safe storage practices with patients and may consider the presence of children in the household when determining dosage and the frequency of follow-up visits to avoid accidental ingestion by children.However, accessing treatment may be challenging because of financial barriers and a shortage of specialty programs for women who are pregnant.1 In addition, substance use treatment alone is necessary but not sufficient because the needs of families affected by opioid use disorder are complex and are often intertwined with a host of other problems. These include poverty, co-occurring mental health conditions, use of other substances, domestic violence, and homelessness. Cross systems collaboration (collaboration that moves beyond the implementation of isolated evidence-based practices to a “best systems practice” approach) is needed to ensure comprehensive, collaborative care for these parents and their children. Unfortunately, substance use treatment programs are often not well equipped to meet the needs of families,1 and child welfare systems often lack knowledge, guidance, and/or resources to adopt best practices for substance use treatment.2Since 2007, the Children’s Bureau’s Regional Partnership Grants (91 grants in total) have been used to explore ways in which the child welfare, behavioral health, and justice systems can collaborate more effectively to serve families. Promising approaches have emerged. Shared outcome measures, joint trainings for professionals, and formal data sharing agreements can increase coordination across these 3 systems. Expanding both parenting programs for parents in substance use treatment and peer recovery programs for parents involved with child welfare has improved substance use and child welfare outcomes. Family drug courts (specialized dockets used to divert parents who are using drugs into treatment) increase treatment retention and reduce foster care time. Adopting trauma-informed practices and addressing housing needs also improve outcomes.6Two recent changes in federal policy have major implications for the ability of states to address the pediatric impact of the opioid epidemic.First are changes in Medicaid policy. The 2014 expansion of Medicaid to more adults with low income sharply reduced the uninsured rate for adults with opioid use disorder7 and is likely helping to facilitate parents’ access to MAT of opioid use disorder.2 In contrast, in 2018, states were permitted for the first time to deny Medicaid coverage to parents who neither worked nor had a disability that prevented working. Intended to incentivize workforce participation, this policy may be counterproductive for parents with opioid use disorder, who cannot legally confer eligibility for disability. Without insurance, these parents may be unable to afford the treatment they need to remain in the workforce.Second, in 2019, state child welfare agencies will, for the first time, be able to receive partial federal reimbursement for time-limited substance use, mental health, and parental training services provided to families with a child at risk for entering foster care. This could offer child welfare agencies the freedom to fund new services for families with substance use problems. In addition, these services will have to meet certain standards of evidence to qualify for reimbursement. Interventions for family substance use disorders are of mixed quality, and new reimbursement incentives and best practice guidelines should motivate child welfare agencies to increase the proportion of evidence-based practices in their existing portfolio of services for families with substance use disorders.It is urgent that states begin planning immediately to leverage new federal reimbursement for preventive services to better support families involved with the child welfare system because of opioids. A new investment in evidence-based programs that simultaneously offer MAT and evidence-based parenting interventions can help address long-term consequences of this epidemic for children. The extensive evidence provided by regional partnership grants can help inform the adoption and implementation of these and other best practices across public and private agencies.6 States should also reconsider establishing work requirements for Medicaid; these requirements will likely impede access to precisely the services that are needed to protect children and preserve families negatively affected by opioids.For researchers, there is an urgent need to consolidate evidence about both the consequences of the opioid epidemic for children and how these consequences can be prevented or ameliorated. Currently, there are not even accurate estimates of the number of children growing up in a household with a parent who has an opioid use disorder. There are no estimates of the substance use treatment or parenting services that these families are already receiving nor of the gap between the need for these services and states’ capacities to provide them. There is also substantial opportunity for the refinement of existing interventions and the development of improved interventions for families affected by opioid-related problems. As states seek to meet the needs of children affected by the opioid epidemic, a better evidence base can help guide decision-making.Finally, pediatricians and other child-serving medical, social service, and research professionals must be vocal advocates for the needs of children whose families are affected by opioid-related problems. Public officials must be made aware of the imperative to act on behalf of the next generation, whose long-term health depends on our ability to meet the unique needs of children in this opioid epidemic.

Despite trauma as a prevalent and substantial need among children in foster care, child welfare systems are challenged with fully implementing trauma-responsive programs and policies. Furthermore, evidence on effective implementation strategies for trauma-responsive programs in child welfare is scarce. This study's overarching purpose was to examine child welfare supervisor and administrator views on the initial implementation of a trauma-responsive approach through an organization driver lens. We sought to build knowledge on the ways in which organization drivers of systems intervention, facilitative administration, and decision-support data systems facilitate or inhibit initial implementation. Semi-structured interviews were conducted with 26 child welfare supervisors and administrators implementing a trauma-responsive assessment and case planning approach. Transcripts were coded and analyzed using theoretical thematic analysis. Applying organization drivers to the results, multiple facilitators and barriers were identified. Collectively, findings suggest that implementation of trauma-responsive programs in child welfare should consider all organization drivers as relevant to initial implementation, emphasizing systems intervention and facilitative administration drivers as the most vital to successful implementations. Translational researchers and implementation scientists should strive to identify robust implementation strategies for addressing organization and systems level factors as key supports for initial implementation of trauma-responsive programs and policies.

As part of the process of examining their theory of change (TOC) and reflecting on grant making activity, one Midwestern foundation employed a multipronged strategy to assess 209 community-based mental health grants across seven years of funding. This article details the evaluation approach, which comprised these areas of the TOC: grantees' use of evidence-based interventions, cultural competency, quality improvement, community collaboration, and use of integrated care. Inductive analyses identified grantees' use of innovative practices, trauma-informed care, and use of validated instruments. In an iterative exercise spanning multiple years, the foundation and researchers found ways to gather information about community capacity and impact while simultaneously minimizing grantee data collection/reporting burden. Findings revealed that community agencies were improving in their uptake of evidence-based interventions and use of validated instruments. Community grantee use of trauma informed care also improved over the study period. Grantee desire to collaborate and coordinate services within the community was also strong. The research also revealed that in multiple domains (such as technology and non-profit operating costs) grantees needed support in building agency capacity. These findings shed light on which aspects of the foundation's TOC were being addressed through funding, and which areas of the community needed additional support.

Although its true prevalence is unknown, drug testing is a common practice with child welfare-involved parents. In fact, the Center for Substance Abuse Treatment (2010) suggests that “some child welfare agencies have decided to conduct drug tests on all parents under court jurisdiction” (p. 6). Unfortunately, researchers have largely overlooked this practice. This paper presents findings from a systematic review of the studies that measured drug testing and utilized a child welfare-involved sample. Eighteen studies met inclusion criteria and were analyzed according to seven research questions, including drug test operationalization, testing frequency, and implications of testing.

This article describes results from a state-wide survey of social services professionals ( n = 259) regarding knowledge of the Child Abuse Prevention and Treatment Act Reauthorization of 2010 (CAPTA), clinically based markers of prenatal substance exposure (PSE), and appropriate child protection responses following a PSE referral. Few respondents were aware of CAPTA, and knowledge of clinical markers of PSE and appropriate child protective services responses to prenatal exposure varied according to substance type (alcohol or drugs). Regression models revealed that fewer years in practice and fewer annual drug referrals predicted more drug-exposure knowledge. Fewer years in practice and awareness of CAPTA predicted more alcohol-exposure knowledge. Policy implementation strategies are needed to increase the likelihood that CAPTA achieves its desired intent, particularly with professionals who have been in the field longer and may be less open to changing practice behaviors.