Dr. Joyce Lee, College of Social Work
Dr. Cecilia Mengo, College of Social Work
Dr. Susan Yoon, College of Social Work
SUMMARY/ABSTRACT
Over 3 million children and their families are reported for alleged child maltreatment to the U.S. child welfare system each year. Children and families who get involved with the child welfare system represent some of the most vulnerable populations in the country. For example, compared to children in the general population, those in the child welfare system are disproportionately more likely to be persons of color, from socioeconomically disadvantaged backgrounds, have experienced some of the most serious forms of violence and trauma, and have poorer health outcomes. That is, children and families in the child welfare system are highly economically and medically vulnerable and thus are prone to experience health disparities. Health disparities by race and ethnicity are also present within the child welfare population, with Black children and mothers experiencing some of the poorest maternal and child health (MCH) outcomes. Prior work documents that social determinants of health (SDOH) (e.g., socioeconomic status, families’ material hardship, parental substance use) are associated with such MCH disparities. However, the persistently worse health outcomes of children and families in the child welfare system compared to those of matched counterparts in the general population suggest additional drivers of MCH disparities, potentially unique to the child welfare system. Key child welfare system-level factors identified to be linked with MCH disparities include service access (e.g., service referral and receipt by families) and caseworkers’ interactions with families (e.g., caseworker-parent relationship quality where racially biased practices associated with case outcomes can occur). These child welfare system-level factors have been documented to adversely impact Black children and mothers in particular. Studies have found that Black children and mothers receive fewer and lower quality health and social services, have less access to mental health and drug treatment programs, and experience fewer contacts from their caseworkers compared to their counterparts from other race/ethnic groups.
Despite research pointing to distinct child welfare system-level factors (i.e., child welfare services access and caseworkers’ interactions with families) contributing to MCH disparities, we currently know little about the exact processes by which these system-level factors work to affect MCH outcomes in the child welfare population. As such, the proposed study involves secondary analysis of data from the National Survey of Child and Adolescent Well-Being Second Cohort (NSCAW-II), a nationally representative longitudinal dataset ideal for answering questions about the service use and health needs of children and families who come in contact with the U.S. child welfare system. We apply the World Health Organization’s SDOH framework, combined with an African American disproportionality and disparity in the child welfare system conceptual framework to a sample of NSCAW-II data (n= 5,307 mothers; n=1,054 adolescents) to address three aims: (1) test reciprocal and longitudinal associations between caseworker-family relationship quality and child welfare services access; (2) determine whether caseworker-family relationship quality and child welfare services access are associated with MCH outcomes; and (3) identify whether child welfare system processes linked with MCH outcomes look similar or different across race/ethnic groups, with a focus on Black mothers and adolescents. The proposed study aligns well with the National Institute of Child Health and Human Development (NICHD) Population Dynamics Branch’s and Child Development and Behavior Branch’s research priorities (i.e., Disparities in Maternal and Infant Morbidity and Mortality; Understanding Social Determinants of Health and Developmentally Informed Strategies to Mitigate Health Disparities). Findings from our study would move forward these NICHD research priorities and the child welfare field by applying and testing an SDOH informed theoretical framework; identifying child welfare system targets of interventions to reduce MCH disparities; challenging traditional research norms around race/ethnic group comparison; and promoting antioppressive approaches to health equity research in child welfare.