Interagency and Cross-System Collaboration in the United States to Improve Child Welfare Outcomes: A Systematic Review of Experimental and Quasi-Experimental Studies

Background and Purpose: Recognizing that families involved with the child welfare system often experience co-occurring issues (e.g. domestic violence, mental health, poverty), there is a need for collaboration with other agencies and systems. Consequently, federal policy has mandated interagency and cross-system collaboration to improve child welfare services and outcomes (“Fostering Connections” P.L. 110-351); however, the effects of collaborations on child welfare outcomes have not been systematically assessed. This review aims to systematically summarize research results related to the effectiveness of interagency and cross-system collaborations with child welfare. Findings are discussed in terms of client outcomes, level of collaboration, collaboration type, and intervention exposure.

Methods: Six electronic databases (PsychoINFO, Social Service Abstracts, CINAHL, ERIC EBSCO, Medline and Sociological Abstracts) were searched for articles published up until March 2018, resulting in 1,239 studies after eliminating duplicates. Two authors independently assessed each citation for inclusion to, or exclusion from, the systematic review. Articles with discrepancies in inclusion or exclusion decisions were resolved by consensus. Inclusion criteria were: (1) had child welfare collaboration as the independent variable; (2) used an experimental or quasi-experimental design with a non-collaborative service comparison condition; (3) focused on an interdisciplinary collaboration; (4) included study participants of any age involved with the United States child welfare system; (5) assessed any outcomes(s) related to child welfare client/family; and (6) had a specified collaboration type. Seven studies met the inclusion criteria and ten studies were identified by examining these study’s references. A total of 17 studies were included in the systematic review.

Results: Included studies clustered around child welfare collaborations with substance abuse (n=12), juvenile justice (n=2), substance abuse and mental health (n=1), mental health (n=1), and school and mental health (n=1). Only two levels of collaboration were identified: co-ordination and integration. Studies compared the effectiveness of the following intervention exposures: cross-training, co-location of staff, shared information systems, and/or team approaches. The team approach was the most commonly studied intervention and only used in substance abuse studies. Collaboration was positively associated with service receipt, health-related outcomes, reunification, and time in out-of-home placement. However, results related to time to: (a) subsequent substantiated report, (b) permanency, and (c) reunification were less positive.

Conclusions and Implications: Results illustrate cross-system collaborations may significantly influence clients’ odds of having positive child welfare outcomes, but not necessarily the rate at which these outcomes occur. This was true regardless if there existed a lower (co-ordination) or higher (integration) level of collaboration, demonstrating positive collaboration outcomes may occur using limited child welfare resources. Most studies related to substance abuse collaborations. We found nothing in our search related to other commonly identified co-occurring conditions, such as domestic violence, poverty, or physical health. Additional research exploring the effects of different collaboration types with different exposure levels is recommended. This type of research can benefit practitioners, policymakers, and child welfare-involved caregivers in selecting the most appropriate and effective cross-system services for the treatment of symptoms in their clients, self, and/or children.