Pathways to Service Use Among Families at Risk of Child Maltreatment

Background and Purpose: Families at risk of child maltreatment or those already involved with child welfare have multiple problems. Yet many do not receive enough services to meet their needs (Drake, Johnson-Reid, Way & Chung, 2003; UHHS, 2009). Previous studies found that involvement in child welfare, types and numbers of caregiver's problems, (Staudt & Cherry, 2009) and ethnicity (Libby et al., 2006) were associated with service receipt. However, what other factors hinders or facilitates service use for at-risk families is not fully understood. This is troublesome because caregivers' service use can be closely related to children's well-being and safety. To know whether pathways to service use vary among at-risk caregivers, this study examines what predicts service use of caregivers with perceived service needs and caregivers without perceived service needs. I hypothesize that there is a difference in predictors of service use between these two groups of caregivers.

Methods: The sample is a subgroup of caregivers associated with the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) (N=250). Two groups of caregivers are created; caregivers who perceived service needs (n=77) and those who did not perceive service needs (n=173). Caregivers of CPS reported families and matched non-reported families were interviewed biannually and the current study utilizes information provided when children were 4 and 6 years old. The outcome of caregiver service use (measured at child age 6) is defined as caregivers' receipt of help from professionals in various areas including mental health, health, social services, work counseling, and substance abuse treatment. Perceived service needs (measured at child age 4) is defined as caregiver having considered service use because of their problems. A variety of factors were entered in two multivariate logistic regression models with two groups of caregivers including caregivers' previous service use, perceived service needs for children and previous service use of children, caregiver's psychosomatic symptoms, life experience, family function, everyday stressors, social support, and previous child maltreatment report.

Results: As hypothesized, different factors predicted caregivers' service use depending on caregiver's perceived service needs. For those with perceived service needs, more social support (OR: 1.46, p<.05) predicted service use along with fewer health problems (OR: 0.19, p<.05). For caregivers without perceived service needs, problem-related factors predicted service use such as previous caregivers' service use (OR: 5.72, p<.05), ever being residential program (OR: 9.14, p<.05), more everyday stressors (OR: 1.73, p<.001), along with ethnicity (not being African American), single parent, education after high school, and unemployment.

Conclusions and implications: The findings suggest the importance of multiple approaches to facilitate at-risk caregivers' service use. Developing caregivers' social support and helping them to realize their needs is important to caregivers' service use, in addition to connecting them to services directly. When caregivers perceive their needs, social support can help caregivers get information on services, have access to services and complete service receipt. Future studies need to examine specific types of social support and service use.