Identifying U.S. Child Welfare System Processes Associated with Parental and Child Health Outcomes

Background and Purpose: Black children and parents are overrepresented in the U.S. child welfare system (CWS) and have some of the worst health outcomes compared to other racial/ethnic groups (Briggs et al., 2012). In addition to social determinants of health, factors and processes unique to CWS likely contribute to such health disparities (Boyd, 2014). However, little is known about the CWS processes by which these disparities are produced. As such, the current study aimed to (1) identify child welfare processes linked to parental and child health and (2) examine whether such processes differ for Black and white families.

Methods: Data came from the National Survey of Child and Adolescent Well-Being Second Cohort (NSCAW-II), a nationally representative longitudinal study of families within the U.S. CWS. The analytic sample included 2,732 families with data across three time points: baseline when the index child maltreatment investigation closed (T1), 18-month follow-up (T2), and 36-month (T3) follow-up. Random Intercept-Cross Lagged Panel Modeling (RI-CLPM) was conducted to examine bidirectional relations between CWS factors (i.e., NSCAW-created items on families’ needs identified, services families received, caseworker-parent satisfaction) and parental and child health measured using the Short-Form Health Survey (SF-12) and Child Health Questionnaire (CHQ), respectively. Multigroup modeling (MGM) was employed for race/ethnicity moderation.

Results: Families were from socioeconomically disadvantaged backgrounds. Most parents were mothers who were below 45 years old; 67% had an education level of high school diploma or below; and 75% lived with low income. Chilren’s mean age was 1 year old. Approximately 30% of the families were Black. RI-CLPM results primarily showed a bidirectional relationship between families’ service needs and parental mental health, with better mental health at T1 linked to fewer service needs at T2 (β = -.11, SE = .05, p = .02) and more service needs at T1 linked to worse parental mental health at T2 (β = -.06, SE = .03, p = .04). Better parental mental health at T2 was subsequently associated with enhanced overall child health at T3 (β = .07, SE = .03, p = .03). MGM results showed distinct processes for Black and White families. For example, for Black families only, more service receipt at T1 was associated with better parental mental health at T2 (β = .09, SE = .04, p = .02). For white families only, more satisfaction at T1 was associated with more service receipt at T2 (β = .14, SE = .07, p = .04).

Conclusions and Implications: The results have significant child welfare practice and policy implications. Results suggest that CWS-identified service needs for families are likely contributing to poor parental mental health over time. Thus, the CWS should prioritize addressing families’ service needs, particularly focusing on parental mental health, as this has downstream effects on improving child health outcomes. Additionally, different processes for Black and White families suggest the need for the CWS to approach families with their unique needs in mind, ensuring services provided and caseworker-parent interactions are tailored to meet the distinct needs of each family.