Young Children In Child Welfare: Developmental Screening Results and Caregiver Experiences

Developmental delays and social-emotional difficulties are high among young children referred to child welfare services (CWS), yet few receive early intervention. Children with unsubstantiated abuse may be even less likely to have delays detected, and may receive fewer services. This study reports data from children receiving CWS across Pennsylvania. Children aged 0 to 3 (N=1957) were screened using the Ages & Stages Questionnaires® (ASQ) and its social-emotional version (ASQ:SE). Objectives are to inform CWS planning and policy around screening strategies for young children. Three questions were examined: (1) What are the ASQ and the ASQ:SE concern rates among children receiving CWS?(2) Is there evidence to support policies that screen only children with substantiated maltreatment? and,(3) Which child and maltreatment-related characteristics predict positive screening results? The study also reports preliminary data from caregiver interviews (N=104) to examine the extent to which the screening process engages caregivers. Data are from a statewide database of children screened following CWS referral between 2008 and 2011. Data include screening results, child demographics, and maltreatment characteristics. Descriptive, bivariate, and multivariate logistic regression analyses were used. Two models predicted children with any developmental and any social-emotional concerns. Independent variables were child demographics, living situation, maltreatment type, neo-natal intensive care unit, subject of the referral, and substantiation status. Children's average age was 24 months, and their race is 81% White, 11% African American, and 5% biracial. Thirty-four percent had substantiated maltreatment and most lived with biological parents (76%). A random sample of caregivers completed in-depth interviews regarding multiple areas of risk, experiences with CWS, and impressions of the screening process. Caregivers were predominantly mothers, although 18% were fathers. Over one-half were involved in the child welfare system as children. Forty-six percent receiving CWS showed either developmental (23%) or social-emotional (34%) concerns warranting early intervention referral. Multivariate analyses showed that children living in foster care were more likely to show both developmental (p<.0001) and social-emotional concerns (p<.05). Biracial children were more likely to have social-emotional concerns (p<.05). Developmental concerns were more likely among children referred for physical neglect (p<.05). Physical abuse was significant for both developmental and social-emotional concerns (p<.05). Caregiver mental health was significant for developmental problems (p<.05). No other variables predicted concerns, including substantiation status. Results showing more positive screenings among children in foster care suggest that these children experienced greater instability contributing to non-familial placement. Higher social-emotional concerns among biracial children may reflect a cultural disconnect and the need for more culturally sound services. Greater positive social-emotional and developmental screens among children referred for physical abuse may indicate that the screening tool is particularly sensitive for this population. Higher developmental concerns among children referred for physical neglect may suggest a reciprocal effect with caregiver mental health status. The lack of significant differences by substantiation status demonstrates the need for universal screening among all children at risk, not just when abuse is suspected. Targeting caregiver needs to enhance protective capacities requires addressing socioeconomic needs, social support, providing focused parent-child interventions, and promoting behavioral health care access.