Intensive Family Preservation Services to prevent out-of-home placement of children: A systematic review and meta-analysis

The effectiveness of interventions to prevent and reduce child maltreatment in high-income countries: An umbrella review

BACKGROUND

In recent decades, many interventions targeting the occurrence (primary prevention) or the recurrence (secondary prevention) of child abuse and neglect have been tested. Findings have been synthesized in several meta-analyses and systematic reviews. However, the range of interventions addressed in these studies is very broad, and an integrative assessment of this large spectrum is lacking.

OBJECTIVE

Focusing on high-income countries, we ask (i) what is known about the effectiveness of interventions to prevent or reduce child abuse and neglect and (ii) how robust this evidence is.

METHODS

A systematic review of systematic reviews, called an umbrella review, was conducted. Ten databases on OvidSP and Web of Science were searched up until April 2023. Narrative synthesis was used to document the publications' findings.

RESULTS

44 publications were included in the umbrella review. We did not find that any type of intervention had a clear, consistent, and robust track record of preventing or reducing the occurrence of child abuse and neglect. Rather, publications examining the effectiveness of interventions in all areas frequently reported non-existent, small or inconsistent effects. However, positive effects for particular interventions in specific settings did emerge. Research methodologies showed several and often severe problems.

CONCLUSIONS

We suggest several measures to improve the quality of research and call on practitioners to be persistent in developing more effective interventions.

Protocol: Interventions aimed at preventing out-of-home placement of children: A systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows. The aim of the present review is to synthesize evidence on the effectiveness of interventions for at-risk families aimed at preventing the out-of-home placement of children or increasing the likelihood that children are reunited with their birth families following temporary care arrangements. The review has two objectives: (1) To assess the effectiveness of interventions for at-risk families with children aged between 0 and 17 years old on measures of out-of-home placement and on secondary outcomes. (2) To identify factors that modify intervention effectiveness (e.g., prior placements, parental risk factors such as substance abuse, mental health issues, age, minority status, child risk factors such as disabilities, age, and gender).

State Policies on Child Maltreatment and Racial Disproportionality

Over the past several decades researchers have documented disproportionality for Black families across multiple decision-making points within the child welfare system. Yet, few studies have examined how specific state policies may impact disproportionality across decision points. The racial disproportionality index (RDI) was calculated for Black children in each state and Washington DC (N = 51) based on the proportion of children who were received a referral to CPS, a substantiated investigation, or entered foster care. A series of bivariate analyses (one-way ANOVAs; independent sample t-tests) were used to explore the relationship between the RDI and these decision points. Further analyses were conducted between the RDI and state policies (e.g., child maltreatment definitions, mandated reporting, and alternative response). Our results suggest there is an overrepresentation of Black children in CPS across the three decision points. This overrepresentation continues with specific state policies such as a state using harsh punishment in their definition of child maltreatment. Recommendations are provided for policy and research, including a suggestion for further exploration of state policies and county-level disproportionality indexes.

A scoping review of system-level mechanisms to prevent children being in out-of-home care

Identifying which approaches can effectively reduce the need for out-of-home care for children is critically important. Despite the proliferation of different interventions and approaches globally, evidence summaries on this topic are limited. This study is a scoping review using a realist framework to explore what research evidence exists about reducing the number of children and young people in care. Searches of databases and websites were used to identify studies evaluating intervention effect on at least one of the following outcomes: reduction in initial entry to care; increase in family reunification post care. Data extracted from papers included type of study, outcome, type and level of intervention, effect, mechanism and moderator, implementation issues and economic (EMMIE) considerations. Data were coded by: primary outcome; level of intervention (community, policy, organisation, family or child); and type of evidence, using the realist EMMIE framework. This is the first example of a scoping review on any topic using this framework. Evaluated interventions were grouped and analysed according to system-level mechanism. We present the spread of evidence across system-level mechanisms and an overview of how each system-level mechanism might reduce the number of children in care. Implications and gaps are identified.

Reasonable efforts to preserve families? An examination of service utilization and child removal

BACKGROUND

Recent federal policy has solidified the importance of preserving families, yet over 400,000 children enter foster care each year. Although a few studies have found that certain types of services, like intensive family preservation services, may reduce child removals, more research is needed.

OBJECTIVE

This study examined the relationship between family preservation, family support, and basic need service utilization and child removal among families with substantiated cases of maltreatment.

METHODS

We conducted a survival analysis using data from the National Child Abuse and Neglect Data System (NCANDS). We took a cohort of families with an investigation and substantiation of maltreatment in FY 2018 and followed them through FY 2019 to identify any that experienced a child removal during the study period. This included a total of n = 558,915 children.

RESULTS

Approximately 15.33% of children experienced a removal during the study period. Case management was the most frequently reported service, followed by transportation services and family preservation services. In the multivariable analysis, family preservation services (HR = 0.95, p < .01), home-based services (HR = 0.98, p < .001), and housing services (HR = 0.87, p < .001) decreased the hazards of child removal. Family support services (HR = 1.36, p < .001), transportation services (HR = 2.30, p < .001), education (HR = 1.13, p < .01), case management (HR = 1.83, p < .001), or daycare (HR = 1.26, p < .001) increased the hazards of child removal.

DISCUSSION

Findings from this study suggest that utilization of various services is associated with future child removals. While preservation and home-based services decreased the likelihood of removal, several basic needs services increased the hazards of child removal. This may reflect too little too late with services that may be better applied as primary or secondary preventive efforts. Implications for policy and future rollout of the Families First Prevention Services Act are explored.

Toward tailored care for families with multiple problems: A quasi-experimental study on effective elements of care

Several effective interventions have been developed for families with multiple problems (FMP), but knowledge is lacking as to which specific practice and program elements of these interventions deliver positive outcomes. The aim of this study is to assess the degree to which practice and program elements (contents of and structure in which care is provided) contribute to the effectiveness of interventions for FMP in general and for subgroups with child and/or parental psychiatric problems, intellectual disabilities, or substance use. We performed a quasi-experimental study on the effectiveness of practice and program elements provided in attested FMP interventions. Using self-report questionnaires, we measured primary (child's internalizing and externalizing problems) and secondary (parental stress and social contacts) outcomes at the beginning, end, and three months thereafter. By means of Latent Profile Analysis, we identified groups of families receiving similar combinations of practice elements ("profiles"), and we calculated propensity scores. Next, we assessed how practice element profiles and program elements affected improvement in outcomes, and whether these effects were moderated by subgroup characteristics. We found three practice element profiles (explorative/supportive, action-oriented, and their combination), which were equally effective. Regarding program elements, effects were enhanced by more frequent telephone contact between visits and more frequent intervision. Effectiveness of practice and program elements varied for specific FMP subgroups. Variations in the content of care for FMP do not affect its effectiveness, but variations in the structure of the care do. This finding can help to further improve effective interventions.

Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness- "It Takes a Village" Approach

Providing support to parents and their children to help address the cycle of intergenerational impacts of mental illness and reduce the negative consequences for children is a key focus of selective prevention approaches in public mental health. However, a key issue for children of parents with a mental illness is the lack of access to early intervention and prevention support when needed. They are not easily identifiable (until presenting with significant mental health issues of their own) and not easily accessing the necessary support that address the complex interplay of parental mental illness within families. There are significant barriers to the early identification of these children, particularly for mental health care. Furthermore, there is a lack of collaborative care that might enhance identification as well as offer services and support for these families. The "It takes a Village" project seeks to improve mental health outcomes for children through the co-development, implementation and evaluation of an approach to collaborative practice concerned with the identification of families where a parent has a mental illness, and establishing a service model to promote child-focused support networks in Austria. Here we describe the development of service delivery approach for the "It takes a Village" project that aims to improve identification and support of these children within enhancements of the existing service systems and informal supports. The paper describes the use of codesign and other implementation strategies, applied to a research setting, with the aim of impacting the sustainability of workforce reform to achieve lasting social impact. Results highlight the steps involved in translating evidence-based components, local practice wisdom and lived experience into the "It takes a Village" practice model for Tyrol, Austria. We highlight through this paper how regional context-specific solutions are essential in the redesign of care models that meet the complex needs of children of parents with a mental illness. Service system and policy formation with local and experienced stakeholders are also vital to ensure the solutions are implementation-ready, particularly when introducing new practice models that rely on organizational change and new ways of practice with vulnerable families. This also creates a solid foundation for the evaluation of the "It take a Village" approach for children of parents with a mental illness in Austria.

MacKillop Family Services' Family Preservation and Reunification Response for Vulnerable Families-Protocol for an Effectiveness-Implementation Study

International evidence supports the effect of intensive family preservation and reunification services in preventing children's placement in out-of-home care (OOHC). Evidence within Australia is scarce. This protocol paper describes a hybrid effectiveness-implementation evaluation of the Victorian Family Preservation and Reunification (FPR) Response implemented by MacKillop Family Services. Participants include families engaged in the program and staff involved in program delivery. A pre-post study design will be used to assess the effectiveness of the FPR in improving family outcomes from intake to closure, including: (i) parenting knowledge, skills, and capability; (ii) family safety and home environment; (iii) child development, adolescent behaviour, education attendance and attachment; (iv) connection to services; and (v) prevention of children from entering or re-entering OOHC. Interviews and focus groups will be conducted with staff to evaluate the program's fidelity, reach, feasibility, acceptability, and enablers and barriers to implementation. Quantitative data will be analysed using descriptive statistics and a series of paired-samples t-tests and F tests to examine changes in outcomes over time; thematic analysis will be used for qualitative data. If the FPR can yield significant improvements in families' outcomes, this would provide strong support for its scale-up across Australia, to better support vulnerable families.

Infant Safe Sleep Promotion: Increasing Capacity of Child Protective Services Employees

Sleep-related infant deaths, including Sudden Infant Death Syndrome (SIDS), are the number one cause of death in infants between 28 days and one year of life. Nearly half of families experiencing a sleep-related infant death in Kansas were involved with the Department of Children and Families Child Protective Services (CPS), making CPS staff a priority for safe sleep training. This study assessed the impact of the two-day Kansas Infant Death and SIDS (KIDS) Network Safe Sleep Instructor (SSI) train-the-trainer program on CPS staffs’ knowledge of the American Academy of Pediatrics safe sleep recommendations. Training was attended by 43 participants, 27 (63%) of whom were employed by CPS. CPS staff had significantly lower baseline knowledge on the 10-item pretest (t = 3.33, p = 0.002), but both CPS and other attendees showed significant improvement by posttest (t = 8.53, p < 0.001 and t = 4.44, p < 0.001, respectively). Following SSI certification, CPS SSIs provided more safe sleep training to professionals than other SSIs (1051 vs. 165, respectively), and both groups of SSIs were able to significantly increase the knowledge of their trainees. Overall, the KIDS Network SSI training was successful. The innovative partnership with CPS allowed for provision of training to a group not historically targeted for safe sleep education.