Caregiver Engagement in the Behavioral Health Screening for Child Welfare Involved-Children: A Qualitative Study

Background

About 50% of youth involved in child welfare systems have reported behavioral health problems, yet many children failed to receive needed treatment. Use of validated behavioral health screening tools in routine child welfare practice could help quickly identify children’s behavioral health needs and facilitate linkages to further assessment and services. However, most screening tools rely on caregiver reports, and engaging caregivers to provide accurate information on the child’s behaviors can be challenging in the child welfare context. No single study has examined challenges of engaging child welfare-involved caregivers in the behavioral health screening. Informed by Staudt’s (2007) framework that explicates the pathway through which practitioner behaviors could influence engagement process in child welfare systems, this study explores how workers characterize their experience with caregivers while screening behavioral health needs of system-involved children. Specifically, we sought to answer, 1) what are the barriers to engaging caregivers during the screening process; 2) what factors contributed to engagement challenges; 3) what strategies might improve caregiver engagement?

Method

This study was conducted during the implementation of a demonstration project designed to improve behavioral health services access for child welfare involved youth at an urban county child welfare agency in the Mid-western U.S. Forty-four child welfare workers who implemented validated behavioral health screening tools into their practice, and seven behavioral health workers who provided assessment services in the same agency participated in six focus groups. All focus groups were audio recorded and professionally transcribed. We used principles of grounded theory to analyze the data. An inter-coder agreement above 90% was reached among coders.

Findings

First, intake workers reported several barriers they faced when engaging caregivers in the screening process. Reported barriers included caregivers’ non-cooperative attitudes,  and not providing accurate information about the child, especially among those with young children.   Behavioral health workers noted that these barriers at the screening stage impacted subsequent assessment practices and service referrals. Second, participants discussed potential explanations for identified barriers to engagement. They emphasized characteristics of the screening tool (e.g. too long, ease of language, use of iPad), caregiver stress associated with custody loss, and caregivers’ mental health concerns. Third, participants recommended strategies to reduce engagement barriers such as framing the screening tool as a mechanism for linking families to needed services, building trust between caregivers and workers (e.g. use ongoing workers rather than those involved with custody decisions to conduct the screening), or providing space on the screening tool to indicate caregivers’ capacity to provide valid responses.

Implications

Findings stress the challenges of engaging caregivers in behavioral health screening in the child welfare context, which could result in misidentification of children’s needs. Results also corroborate the important role practitioners could play in engagement process emphasized in Staudt’s framework. It is important that child welfare practitioners link the screening with desired outcomes caregivers want, building trust, and be cognizant of caregivers’ capacity to provide accurate information in the screening process. Future research should explore caregivers’ perception of the behavioral health screening in the child welfare system.