Substantiated allegations of failure to protect in the child welfare system: Against whom, in what context, and with what justification?

University of California, Berkeley

Failure to protect (FTP), a sub-type of neglect, is used by child welfare systems to categorize and substantiate allegations of child maltreatment. Scholars and advocates have raised concerns that FTP is disproportionately used to substantiate mothers and people of color for harm perpetrated by others, particularly in the contexts of sexual abuse and domestic violence. Limited data exist about how FTP is used in practice or if substantiation of FTP varies by context across gendered or racialized groups. This study extends our understanding of use of FTP by examining who workers substantiate for FTP, in what context, and the justifications they use. Data for this study were drawn from child welfare records in a large, Midwestern county. Mixed methods were used to analyze data from 150 maltreatment referrals which included at least one substantiated allegation of FTP. Findings indicate that the contexts and rate at which caregivers were substantiated for FTP differed significantly across gendered groups. Mothers were most frequently substantiated for FTP in the contexts of sexual abuse, physical abuse, and domestic violence. Fathers were most frequently substantiated in the context of substance use. In addition, rates of FTP substantiation varied across racialized groups. Black caregivers were substantiated disproportionately across all contexts. White caregivers were overrepresented among those substantiated for FTP in the context of substance use. Notably, justification for substantiation decisions was often not documented in data. Implications for policy and practice are discussed.

Publication
Children and Youth Services Review
Publication Year
2020

The Role of Social Support in the Link Between Economic Abuse and Economic Hardship

Washington University in St. Louis

More data is needed about the pathways through which intimate partner violence (IPV) impacts the economic well-being of survivors. The current study assesses the moderating influence of social support on the association between economic abuse (EA) and economic hardship. Female participants (n = 435) were recruited to participate in a web-based survey which included standardized measures of EA, other forms of IPV, domains of social support, and economic hardship. Analysis included bivariate and multivariate regression with an investigation into interaction effects.Experiencing EA was significantly correlated with economic hardship, even with extent of physical and emotional IPV controlled. Both tangible and appraisal support had significant negative association with extent of material hardship. Significant interactions between forms of social support and economic abuse were observed. For those at high levels of economic abuse, support had less influence on economic hardship. A mix of direct economic aid, advocacy, education and support could provide a blueprint for addressing the economic hardship experiences of community-dwelling survivors of economic abuse. A comprehensive response to EA requires interventions aimed directly at economically controlling and exploitative tactics, including credit building, individual economic advocacy, and education. Interventions that seek to enhance survivors’ access to social support may be necessary but not sufficient to buffer the impacts of violence on survivors’ economic outcomes.

Publication
Journal of Family Violence
Publication Year
2020

Organizing as “Collective-Self” Care Among African American Youth in Precarious Times

Fordham University

African American youth have responded with hope and action to protect their well-being in violent political, economic, and social conditions, through organizing. While contemporary organizing frameworks prioritize self-care to promote sustainability, there is little research on the meaning and definition of self-care for African American youth organizers, in their own words. In this paper, findings from interviews with 20 Black youths in navigating organizing spaces in New York City will be presented, highlighting how they destabilize the narrowness of commonly defined self-care to embody “collective-self” care strategies. Implications for community practice, recovery from systemic violence, and historical trauma among African Americans will be explored.

Publication
Journal of African American Studies
Publication Year
2020

#PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign

University of Chicago

Pre-exposure prophylaxis (PrEP) is an effective yet under-utilised method for preventing HIV transmission in high-risk groups. Despite ongoing social marketing to increase PrEP awareness, few studies have evaluated public responses. This paper contextualises negative responses to Chicago’s PrEP4Love campaign. In February 2016, a sex-positive ad campaign called PrEP4Love was launched online and throughout public spaces in Chicago. A gender and sexuality inclusive campaign, PrEP4Love is intended to be culturally responsive and sex positive, while retaining a focus on risk reduction. Advertisements prominently feature Black sexual minority men, and Black transgender women, and were strategically placed in diverse Chicago neighbourhoods. In response, there were 212 new callers to the PrEPLine during the two-month study period. Negative responses were concerned with: negatively depicting Black homosexuality (4), general anti-LGBTQ comments (7), adverse effects on children (6), sexually explicit nature (5), and general stigmatisation of racial minorities (4). Discussion focuses on sex-positive frameworks, normalising intimacy, stigma and historical mistrust of medical and pharmaceutical institutions, and the social meanings of biomedical prevention technologies (e.g. PrEP) in relation to dominant norms of sexuality and gender. This study is the first to investigate public responses to a sex-positive PrEP campaign. More studies of PrEP social marketing are needed to evaluate targeted public health campaigns to guide future PrEP promotion strategies.

Publication
Culture, Health & Sexuality
Publication Year
2020

Examining Caretaker Attitudes Towards Primary Prevention of Pediatric Behavioral Health Problems in Integrated Care

University of Nevada, Reno

Understanding caretaker attitudes towards the prevention of pediatric behavioral disorders is important for the effective delivery of prevention services. Caretakers of children ages 0–18 (N = 385) read a description of pediatric prevention services in an integrated primary care setting. Attitudes towards these services were assessed. The majority of participants (80%) agreed that prevention is important, 87% reported interest in learning their child’s risk for a behavioral disorder, 84% were interested in learning the results of a screen for behavioral disorders, and 88% were interested in learning parenting strategies. Participants endorsed similarly positive attitudes towards prevention in integrated care. Perceived risks outweighing perceived benefits, younger caregiver age, and identifying as non-Hispanic White predicted less favorable attitudes towards prevention. Other socio-demographic characteristics (e.g., caretaker education) were associated with disorder-specific beliefs about the importance of prevention, but not general attitudes. Findings suggest generally positive attitudes towards preventing behavioral disorders in an integrated care setting.

Publication
The Journal of Behavioral Health Services & Research
Publication Year
2020

Neural Correlates of Smartphone Dependence in Adolescents

University of California, San Francisco

Increases in depressive and suicide-related symptoms among United States adolescents have been recently linked to increased use of smartphones. Understanding of the brain mechanisms that underlie the potential smartphone dependence may help develop interventions to address this important problem. In this exploratory study, we investigated the neural mechanisms underlying potential smartphone dependence in a sample of 19 adolescent volunteers who completed self-assessments of their smartphone dependence, depressive symptoms, and sleep problems. All 19 adolescents underwent diffusion MRI that allowed for assessment of white matter structural connectivity within the framework of connectomics. Based on previous literature on the neurobiology of addiction, we hypothesized a disruption of network centrality of three nodes in the mesolimbic network: Nucleus Accumbens, anterior cingulate cortex, and amygdala. Our results showed positive correlations between the node centrality of the right amygdala and self-reported smartphone dependence, between smartphone dependence and sleep problems, and between sleep problems and depressive symptoms. A higher phone dependence was observed in females compared to males. Supported by these results, we propose a model of how smartphone dependence can be linked to aberrations in brain networks, sex, sleep disturbances, and depression in adolescents.

Publication
Frontiers in Human Neuroscience
Publication Year
2020

The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

Washington University

To determine the effect of Medicaid expansion on the use of opioid agonist treatment for opioid use disorder (OUD) and to examine heterogeneous effects by provider supply and Medicaid acceptance rates. Yearly state-level data on methadone dispensed from opioid treatment programs (OTPs), buprenorphine dispensed from OTPs and pharmacies, number of OTPs and buprenorphine-waivered providers, and percent of OTPs and physicians accepting Medicaid. This study used difference-in-differences models to examine the effect of Medicaid expansion on the amount of methadone and buprenorphine dispensed in states between 2006 and 2017. Interaction terms were used to estimate heterogeneous effects. Sensitivity analyses included testing the association of outcomes with Medicaid enrollment and state insurance rates. The estimated effects of Medicaid expansion on buprenorphine and methadone dispensed were positive but imprecise, meaning we could not rule out negative or null effects of expansion. The estimated associations between state insurance rates and dispensed methadone and buprenorphine were centered near zero, suggesting that improvements in health coverage may not have increased OUD treatment use. The effect of Medicaid expansion was larger in the states with the most waivered providers compared to states with the fewest waivered providers. In the states with the most waivered providers, the average estimated effect of expansion on buprenorphine dispensed was 12 kg/y, enough to treat about 7500 individuals. We did not find evidence that the effect of expansion was consistently modified by OTP concentration, OTP Medicaid acceptance, or physician Medicaid acceptance. Gains in health coverage may not be sufficient to increase OUD treatment, even in the context of high treatment need. Provider capacity likely limited Medicaid expansion’s effect on buprenorphine dispensed. Policies to increase buprenorphine providers, such as ending the waiver requirement, may be needed to ensure coverage gains translate to treatment access.

Publication
Health Services Research
Publication Year
2020

Gender Differences in Intimate Partner Violence Victimization, Help-Seeking, And Outcomes Among College Students

University of Georgia

Many college students experience intimate partner violence (IPV). Although receiving help from formal and informal sources may ameliorate possible negative impacts of IPV victimization, the outcomes of help-seeking are not always positive. This study used survey data collected at six universities across the United States (U.S.) to examine gender differences in IPV, help-seeking, and its outcomes (n=3,070). Major variables included IPV victimization, IPV consequences, help-seeking, and outcomes. Descriptive and bivariate analyses revealed higher rates of victimization among females as well as poorer health status, higher levels of depression, and more daily routine problems. Females also used more formal help, and reported it as being useful more often than males. Inversely, more males than females reported that informal supports were helpful. Recommendations include social workers providing tailored services both for male and female survivors, service providers developing educational programs that target informal help sources, and social work education providing relevant trainings.

Publication
Advances in Social Work
Publication Year
2020

Marginalized Youth, Mental Health, and Connection with Others: A Review of the Literature

Rutgers University

For marginalized youth, the transition to adulthood is a stage of life in which inequalities can be either magnified or reduced. While most descriptions of these young people highlight their difficulties achieving self-sufficiency, the ability to form connections with others is an equally significant marker of adult maturity. Given that social isolation poses serious risks to health and well-being, the relational experiences of marginalized youth are a critical component of the transition to adulthood. Experiences of trauma, marginalization, and involvement in public systems of care can place these youth at heightened risk for mental health difficulties, all of which can pose particular challenges for interpersonal relationships. This critical review of the literature explores the research on the relational experiences of marginalized young people living with emotional and behavioral challenges. It discusses the unique developmental context of marginalized youth, including experiences with trauma, mental illness, marginalization, and involvement in public systems of care. It then reviews the benefits young people derive from mutually empathic connections with others. The review explores facilitators of connection for marginalized youth, as well as barriers to connection for these young people. Following this review, the article identifies several gaps in the literature, and ends with a call for both practitioners and researchers to focus on the importance of connection as an underappreciated and crucial resource for marginalized youth.

Publication
Child and Adolescent Social Work Journal 
Publication Year
2020

The Process of Change in Systemic Family Therapy

Oklahoma State University

This chapter provides a comprehensive review of the research on the processes of change in systemic family therapy (SFT). We begin by clearly defining SFT process research including what it fully entails: systemically oriented mechanisms and contexts of change. Our review of the research is uniquely organized according to our view of the evolution of SFT practice (a) beginning with an overview of process findings from the traditional schools of SFT, (b) followed by findings from empirically supported treatments in SFT, and then (c) finalized by an assessment of the research from an integrative perspective of SFT including common and unique change processes (systemic alliances, systemic engagement and retention, systemic reframing, and systemic enactments). Following this overview, we provide directions for future areas of research that will need to be explored in order to more fully articulate the pathways of change in SFT including the need to better clarify the contexts in which certain process are most important. Finally, several implications for SFT training and practice are articulated including how this review points to the need for a potential paradigm shift that squarely places systemically oriented principles of change and client system‐centered integration and at the heart of our work.

Publication
The Handbook of Systemic Family Therapy
Publication Year
2020

Rethinking classroom quality: What we know and what we are learning

New York University

As the federal and state governments increasingly invest in ECE programs to improve their quality, MDRC is leading several studies that conceive and measure the quality of ECE classrooms in new and innovative ways. In particular, MDRC is focusing on instructional quality by examining promising instructional practices, such as the use of rich content and individualized activity settings and the promotion of higher-order skills within a broad range of learning domains. In doing so, MDRC aims to improve the understanding of the critical aspects of instructional quality that promote school readiness among low-income children and their sustained academic success as they move through elementary school and beyond.

Publication
MDRC
Publication Year
2020

Intimate Partner Violence in India: Abuse in India’s Empowered Action Group States

The Ohio State University

Married women in India experience intimate partner violence (IPV) at alarming rates. This study explores regional differences in Indian women’s physical IPV experiences by looking at the effect of living in eight Empowered Action Group (EAG) states. It is hypothesized that women in EAG states will be more likely to have experienced physical IPV than women living outside EAG states. A sample of 65,587 women was selected from the 2005-2006 India National Family Health Survey (NFHS-3). Counter to our hypothesis, logistic regression results show that living in an EAG state decreases likelihood of physical IPV in the past 12 months.

Publication
Violence Against Women
Publication Year
2020

Children and the Welfare State: The Need for a Child-Centered Analysis

University of California, Berkeley

Variation in child well-being across rich Western nations suggests that the welfare state may play a role in shaping child well-being. However, welfare scholars have largely overlooked children in their analyses. This paper seeks to bring children to the center of welfare state analysis by examining how comparative welfare state theory can consider child well-being. The paper begins with an examination of Esping-Andersen’s seminal work, The Three Worlds of Welfare Capitalism, which has come to frame welfare state analysis for nearly three decades. Next, the paper explores the main critiques of Esping-Andersen’s work, with special attention paid to the feminist critique and the construction of alternative feminist and family policy regimes. Finally, this paper extends and reworks Esping-Andersen’s Three Worlds to offer a new framework for conducting child-centered welfare state analyses.

Publication
Journal of Sociology and Social Welfare
Publication Year
2020

“Listen and Let It Flow”: A Researcher and Participant Reflect on the Qualitative Research Experience

The University of Chicago

Ethnographic research involves prolonged and often personal interaction between the researcher and research participants. This paper is a collaboration between a social work researcher and a research participant who became acquainted through the researcher’s ethnographic fieldwork for her dissertation. Despite differing in numerous and significant ways, not the least of which are age, class, education, and race, the two women developed a quasi-friendship after the researcher exited the field–a time when many researcher-participant relationships wane or terminate entirely. The two recorded and transcribed a series of informal conversations wherein they reflected on their experiences in the research process. Of particular salience is the research participant’s perspective of the immaterial benefits she experienced through her participation in the research and her perception of the qualities of a “good” qualitative researcher: one who approaches listening as a practice and cultivates relationships with participants slowly and naturally. The authors’ reflections indicate that participants may be able to offer valuable feedback on the research experience, and researchers might use participants’ unique perspectives to alter their research approach and/or techniques.

Publication
The Qualitative Report
Publication Year
2020

The Impact of the COVID-19 Pandemic on College Student Mental Health: A Longitudinal Examination of Risk and Protective Factors

University of Nevada, Reno

The spread of the novel coronavirus has led to unprecedented changes in daily living. College students may face unique challenges associated with these changes. In the present study, college students (N = 205) completed a battery of questionnaires in April of 2020, after having completed similar measures 8, 5, and 2 months prior as part of a larger study. A repeated measures ANOVA suggested significantly greater depression and anxiety symptom severity during the pandemic than at any other time during the 2019-2020 academic year. Static and modifiable factors associated with psychological distress and controlling for pre-existing psychological distress were examined. Cognitive and behavioral avoidance was the most consistent predictor of psychological distress during the pandemic. Online social engagement and problematic Internet use also conferred greater risk. Women and Latinx participants were more likely to experience elevated distress during the pandemic, even when controlling for distress prior to the pandemic.

Publication
PsyArXiv Preprints
Publication Year
2020

“Mental Health Is for Crazy People”: Perceptions and Barriers to Mental Health Service Use among Refugees from Burma

University at Buffalo

Good mental health is essential to successful integration for refugee populations that resettle in the U.S. We explored perceptions of mental illnesses and barriers to mental health service use as well as solutions to current mental health problems from the perspective of refugees. The interviews with a convenience sampling of 11 community leaders (6 men and 5 women) from various Burmese ethnic communities revealed three major categories, including sources of mental illnesses (e.g. traumatic experiences and post-resettlement challenges), barriers to service use (e.g. lack of understanding about mental health, linguistic challenges, cultural stigma, alternative treatments, and unresponsive system), and proposed community solutions (e.g. community education, culturally-competent providers, and beyond mental health treatment). The findings suggest that the ethnic community can be a source of potential solutions to mitigate barriers to mental health service use.

Publication
Community Mental Health Journal
Publication Year
2020

MRI Insights Into Adolescent Neurocircuitry—A Vision for the Future

University of California, San Francisco

Adolescence is the time of onset of many psychiatric disorders. Half of pediatric patients present with comorbid psychiatric disorders that complicate both their medical and psychiatric care. Currently, diagnosis and treatment decisions are based on symptoms. The field urgently needs brain-based diagnosis and personalized care. Neuroimaging can shed light on how aberrations in brain circuits might underlie psychiatric disorders and their development in adolescents. In this perspective article, we summarize recent MRI literature that provides insights into development of psychiatric disorders in adolescents. We specifically focus on studies of brain structural and functional connectivity. Ninety-six included studies demonstrate the potential of MRI to assess psychiatrically relevant constructs, diagnose psychiatric disorders, predict their development or predict response to treatment. Limitations of the included studies are discussed, and recommendations for future research are offered. We also present a vision for the role that neuroimaging may play in pediatrics and primary care in the future: a routine neuropsychological and neuropsychiatric imaging (NPPI) protocol for adolescent patients, which would include a 30-min brain scan, a quality control and safety read of the scan, followed by computer-based calculation of the structural and functional brain network metrics that can be compared to the normative data by the pediatrician. We also perform a cost-benefit analysis to support this vision and provide a roadmap of the steps required for this vision to be implemented.

Publication
Frontiers in Human Neuroscience
Publication Year
2020

Associations Between Service Members’ Posttraumatic Stress Disorder Symptoms and Partner Accommodation Over Time

University of Denver

When service members manifest symptoms of posttraumatic stress disorder (PTSD), intimate partners may engage in behaviors to accommodate their partners’ experiences (e.g., helping service members avoid situations that could make them uncomfortable, not expressing own thoughts and feelings to minimize PTSD‐related conflict), which may inadvertently serve to maintain or increase PTSD symptoms over time. In a sample of 274 male service member/female civilian couples, we evaluated hypothesized bidirectional pathways between self‐reported service member PTSD symptoms and partner accommodation, assessed four times over an approximately 18‐month period. A random‐intercept cross‐lagged panel model disaggregating between and within effects revealed that, on average, couples in which the service member had higher levels of total PTSD symptoms also scored higher in partner accommodation, between‐couple correlation, r = .40. In addition, at time points when service members’ PTSD symptoms were higher relative to their own average symptom level, their partners’ level of accommodation was also higher than their personal average, within‐couple correlation r = .22. Longitudinally, service member PTSD symptom scores higher than their personal average predicted subsequent increases in partner accommodation, β = .19, but not vice versa, β = .03. Overall, the findings indicate both stable and time‐specific significant associations between service member PTSD symptoms and partner accommodation and suggest that higher levels of PTSD symptoms are a significant driver of later increases in partner accommodation. These findings add further support for treating PTSD in an interpersonal context to address the disorder and concomitant relational processes that can adversely impact individual and relational well‐being.

Publication
Journal of Traumatic Stress
Publication Year
2020

The organizational challenges of mixed-income development: privatizing public housing through cross-sector collaboration

University of Chicago

One of the largely undocumented dimensions of public housing transformation in the United States is the multi-sector, multi-organizational collaborations whose charge is to manage the local implementation of mixed-income developments. In Chicago, private real estate developers entered into partnerships with the Chicago Housing Authority to finance, design, build, and manage the new developments. Key topics considered in this paper include the structures and processes of new organizational working relationships that have been established, how they are evolving over time, and the key operational challenges confronted in creating and sustaining them. We argue that these cross-sector collaborations within the context of the privatization of public housing generate complex organizational roles and dynamics that would benefit from far greater intentionality, clarity, and support to promote effectiveness and accountability.

Publication
Urban Research & Practice
Publication Year
2019

Casualties of context? Risk of cognitive, behavioral and physical health difficulties among children living in high-incarceration neighborhoods

Cornell University

Aim We examined if residence in high-incarceration neighborhoods is associated with risk of cognitive, behavioral and physical health problems for young children net of individual-level parental incarceration status. Subjects and methods We used regression analysis and linked data from Year 9 of the Fragile Families and Child Wellbeing Study and zip code level information on neighborhood prison admission rates from Justice Atlas of Sentencing and Corrections in 2008. Results Neighborhood incarceration rates appear to have some independent and negative associations with child cognitive outcomes. For behavioral outcomes, individual-level parental incarceration appears to be the most meaningful. For child physical health outcomes as indicated by BMI percentages and overall good health, neither neighborhood incarceration rates nor individual-level parental incarceration experiences show persistent significant associations. Living in a neighborhood with high incarceration may threaten children’s health and wellbeing, suggesting that mass incarceration feeds into a system of inequality that extends beyond those who experience individual-level parental incarceration by exerting a broader public health impact.

Publication
Journal of Public Health
Publication Year
2019