Concordance of Caseworker and Caregiver Identification of Psycho-Social Problems in Child Welfare

Purpose: The goals of in-home child welfare interventions are to preserve and strengthen families and to protect children in the home. A child welfare worker's ability to accurately identify problem areas and to work constructively with caregivers, generally biological parents, should contribute to achieving these goals. Multiple explanations exist for why child welfare workers may or may not attend to particular problems. Assumptions and biases may color a worker's vision or the worker's priorities may not reflect the caregiver's priorities. Limited community services may contribute to workers overlooking particular issues. If caregivers and workers have different views about what problems caregivers have in caring for their children, creating successful intervention plans is challenging. This paper builds on the work of prior research from the National Survey of Child and Adolescent Well-Being (NSCAW) (Chapman, et al, 2003 & Kohl et al, 2005) to investigate the concordance between caregivers and workers in three prevalent problem areas in child welfare: substance abuse, mental health problems, and domestic violence. The analysis examines case-worker/caregiver relationship quality as perceived by the caregiver on concordance and service referral and receipt.

Methods: Using data from the NSCAW baseline survey, this analysis includes caregivers, predominantly birth parents, of children remaining in the home following investigation who had talked with a child welfare worker since the investigation (n= 1872). Within this group we compare caseworkers and caregivers' assessment of family problem areas and use logistic regression models to assess the impact of demographic factors, concordance between parent and caseworker, and case-worker/caregiver relationship quality on the odds of service referral and receipt for each problem areas.

Results: Caseworker and caregiver reports agree 68.5% of the time on whether the caregiver has a mental health problem, less than the agreement on domestic violence (70%) and substance abuse (> 90%). A caregiver who is older and non-Hispanic white increases the likelihood that their caseworker reports a mental health need. The type of alleged abuse affects a caseworker's indication of domestic violence and substance abuse. For caregivers who indicate a mental health issue, CW indication of a drug or alcohol problem increases the odds that they will indicate a mental health problem (Odds Ratio 5.7 and 7.4, respectively). Male children and caregiver age also influence mental health need as indicated by the caseworker. Among caregivers whose caseworkers indicated a mental health problem, referral for mental health services is increased if there is an indication of a drug abuse problem by the caregiver, the caregiver lives in an urban area, and the caseworker and caregiver agree on the mental health need. Relationship quality also appears to play a role.

Conclusions and Implications: These findings highlight the complex interplay between caregiver and worker in identifying problem areas in child welfare. The findings suggest a need for increased training for child welfare workers particularly in identifying parental mental health problems. The findings also point out important demographic and relational factors that predict service receipt.