Center for Advanced Studies in Child Welfare School of Social Work, College of Education and Human Development, University of Minnesota

Center for Advanced Studies in Child Welfare

Research & Evaluation

Child Welfare News #25- April, 2005

Table of Contents

CASCW Online

Welcome to the first online edition of Child Welfare News! In an effort to reach a wider audience, Child Welfare News (and Practice Notes) will be distributed electronically in a printer friendly format. Each issue will continue to be archived on the Center's Publications site. Comments on or suggestions for Child Welfare News content should be emailed to Tracy Crudo (tcrudo@umn.edu). To add your name to the Child Welfare News online subscriber list, email cascw@umn.edu.

And, in response to a college-wide initiative, the Center's website has also been restructured. Be sure to visit our new site at http://cehd.umn.edu/SSW/cascw where, in addition to publications, you'll find information on both graduate and undergraduate training and funding, in-service professional training, and curriculum modules.

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CASCW Structural Changes

 In an effort to better facilitate comprehensive public child welfare training, CASCW and the Minnesota Child Welfare Training System (MCWTS) merged efforts in fall, 2004. (More information on MCWTS can be found through the CASCW website.)

Gerilyn Rodriguez Courneya, MCWTS's new director, joined us at that time. Former MCWTS director, Nan Kalke has maintained her role as director of the state’s Title IV-E Eligibility Determination Project, while she pursues a doctoral degree in higher education.

Prior to joining us, Geri worked in child welfare at Dakota County. Her efforts there included collaboration with the county’s employee relations unit to expand the racial and ethnic diversity of its work force.

Anita Larson joined CASCW in January as the new Data Project Coordinator. Anita worked at Hennepin County, most recently as a principal planner. She has done a good deal of work in early childhood and data analysis. She will continue to do some part-time work outside of CASCW as a data consultant for public and private sector organizations.

Heidi Wagner is the newest staff member in CASCW. Heidi joins us as the Center's Executive Administrative Specialist, after working in the School of Music at Wichita State University.

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School of Social Work/CASCW Announce BSW IV-E Consortium

In January, 2005, CASCW and the School of Social Work began a state-wide BSW-level Title IV-E training collaboration. Although the University of Minnesota's School of Social Work does not offer a bachelor's program, it will share its model of graduate IV-E training with accredited public BSW programs.

The University of Minnesota's BSW IV-E Consortium consists of the following social work programs: Bemidji State University, Minnesota State University Mankato, Minnesota State University Moorhead, St. Cloud State University, and Winona State University. Further information on each school's BSW IV-E program can be obtained through CASCW's website.

The goal of this program is to strengthen the preparation of BSW social workers intending to work in Title IV-E public child welfare agencies in Minnesota in non-metro areas. Title IV-E grant funds will contribute to the development and introduction of specific child welfare content into modules for required BSW courses or as specialized elective classes.

Students will be supported during their junior and senior years in the BSW program at the cooperating state universities at a rate of $1900 per semester. The grant will provide opportunities for faculty to work together on curriculum development.

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Pew Commission Report and Herger Bill

A key purpose of federal Title IV-E funding is to counteract the trend among states and counties toward deprofessionalization of public child welfare work. It has achieved marked success, in that the number of social work-educated BSW's and MSW's engaged in public child welfare services has significantly increased nationwide.

The Pew Commission on Children in Foster Care released its recommendations last fall, some of which made it into a bill introduced last year in Congress. Concerned about the lack of federal support for early intervention and alternatives to foster care under Title IV-E, the Commission recommended allowing states to reinvest the money they save from reducing foster care placements in other programs and de-linking eligibility for Title IV-E foster care and adoption assistance from the 1996 AFDC eligibility levels. Related to workforce development, the Commission suggested that a flexible source of funding be created that would support education and training because “children need skillful help to safely return home to their families, join a new family, or avoid entering foster care in the first place” (p.26). The Commission particularly noted the value of advanced social work training as the “best predictor of overall performance in social services” (p. 32).

For a full copy of the Pew Commission report, including its court oversight as well as financing recommendations, see www.pewfostercare.org/research/docs/FinalReport.pdf The Center is also doing its own analysis of Minnesota’s child welfare financing trends. The initial analysis should be done by this summer.

The bill, introduced by Representative Herger (CA) last year, adopts some but not all of the Pew Commission's recommendations. It would consolidate and cap administration and training, and cap funding for the foster care maintenance program. It eliminates the link to AFDC, but also reduces the federal funding match available to states. A similar concept is included in the President’s budget this year and is expected to be introduced again by Representative Herger, although few details are available at this time.

CASCW and School of SocialWork staff have been meeting with Minnesota’s congressional representatives and their staffs to let them know more about the Title IV-E Scholarship program, including the many accomplishments of its alumni. Representative Betty McCollum and Representative Martin Sabo met with Center and SSW staff. Senators Coleman and Dayton and Representative Ramstad’s staff also met with Center staff.

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The Meth Phenomenon: New Challenges for Child Welfare Professionals Rural Minnesota, Meth and Child Welfare

The production, sale and use of meth amphetamine has spread rapidly throughout rural areas in Minnesota. This highly addictive drug, produced by cooking mixtures of easily accessible household medications and chemicals, has created special challenges for public health, law enforcement and child welfare professionals.

Meth, as the latest entry into the substance abuse scene, has changed the face of child protection in rural counties as social workers strive to address overlapping concerns. Children in meth-related situations experience trauma on a continuum - from prenatal exposure, to neglect and environmental hazards, removal from their primary caregivers to the potential for multiple placements - and finally, termination of their parents' rights to care for them.

In fall of 2004, Esther Wattenberg, CASCW's Special Projects Coordinator, developed a forum in Little Falls, Minnesota, to explore the issues surrounding meth and child welfare. With support from The Initiative Foundation (a McKnight Foundation-funded organization that seeks to stimulate economic growth and community development in central Minnesota), two major presentations were offered. Barbara Knox, M.D. (Department of Pediatric and Adolescent Medicine, Mayo Clinic) presented, "Assessing Medical Risk: Crisis and Consequences." Michele Falllon (MSW, LICSW, Circle of Women and Baby Space, Irving B. Harris Training Center for Infant and Toddler Development, University of Minnesota) presented, "Drug-Endangered Children: Crafting a Response to Trauma."

The Scope of the Problem

A fully documented picture of Minnesota's meth problem has not yet emerged. A significant portion of meth activity is unreported. Overburdened law enforcement and child protection staffs are factors limiting the response systems. Probation caseloads related to meth have escalated, but precise numbers are not available. Yet, in 2004, the number of women entering Shakopee prison from rural counties on meth-related charges was highly disproportionate.

Medical Risks

Barbara Knox outlined the medical risks for children exposed to meth:

  • mothers are more likely to neglect aspects of prenatal care;
  • premature birth, extreme irritability, abnormal reflexes;
  • greater vulnerability to chemical contamination due to children's higher metabolic and respiratory rates;
  • hazardous environmental conditions such as fires, explosions and extreme filth;
  • and serious neglect.

Medical Protocols

At this time, there is no state-wide effort to train medical professionals to effectively work with children who have been exposed to meth. However, all children discovered at the scene of a lab must be immediately assessed by an on-site pediatric health care professional. Medical care is provided for immediate concerns, toxicology tests are conducted, and a baseline exam determines follow-up treatment. Neurological development assessments for children are difficult to access, yet of tremendous importance for children exposed to meth. At this time, only the Mayo Clinic in Rochester, Minnesota, and the University of Minnesota-Twin Cities conduct such evaluations.

Trauma and Meth

Michele Fallon cautioned against the tendency to over-catastrophize the possible effects of children born to meth-using mothers or to children growing up in homes with meth labs. Studies on long-term effects are not available. Our knowledge of the effects of crack-cocaine on infants has informed us that all suffered to some degree, yet many grew to be resilient and functional. More attention must be paid to what we already know about children and substance abusing parents. She emphasized that time and skill will be required to deal with the traumatic impact on children who have observed and experienced the visible deterioration of their meth-addicted parents.

She encouraged professionals to work with each child at his or her developmental stage - rather than chronological age - as each child would have reacted differently to their experience of meth. In addition, the characteristics of trauma are demonstrated differently from child to child. Overall, each child would need to be provided with stability and the assurance of physical and emotional safety.

Responses to Trauma

Fallon outlined some common childhood responses to the trauma of a meth household:

  • eating disorders that may be related to socialization issues, such as eating at irregular intervals, not eating with others, not eating at a routine place;
  • and sleep disorders related to a need to stay alert for personal safety.

She encouraged sensitivity in the way that information is shared about children from meth households in order to avoid social stigma. For example, "teachers do not need to know that the child came from a 'meth' situation," Fallon said. Instead, one could share that the child has had a “traumatic experience.” In using such a communication style, others may demonstrate greater empathy toward the child’s grief and sorrow from separation and be more likely to provide appropriate systems of support.

Tasks for Child Protection

Esther Wattenberg offered a summary of tasks for child protection. In addition to the more common practices of maintaining a multi-disciplinary team, tracking substance abuse treatment toward permanency planning, and arranging visits between children in foster care and incarcerated parents, the following measures were recommended specific to working with children and families from meth environments:

  • devise protocols/strategies to limit trauma for children who must face decontamination procedures at the meth lab site;
  • assure child protection workers' safety;
  • provide medical and mental health consultations for foster parents and relative custodians;
  • develop a protocol for foster parents and kinship caregivers that answers these commonly asked questions:

    How do we protect ourselves when we have children from toxic lab sites?

    What protections should we take when there are other children in the home?

    What do we do with a child’s belongings?

    What information can we give to a new foster parent when a child has to be moved?

Issues for Foster Care

Special recruitment efforts are needed to identify foster parents experienced in dealing with medically fragile children.

In order for foster parents to provide nurturing care, they must see the neediness underlying children’s behavior. This requires training in attachment disorders and coping mechanisms of distraught children.

Public Policy Issues

In order to translate our early knowledge of meth and child welfare into a system that works for clients, the following issues need to be considered:

  • harm reduction through provision of medical and mental health services;
  • refinement of Family Group Decision-Making to ensure stability and permanence for the child, with special attention to imprisoned parents;
  • public/private information statutes. Presently, information from substance abuse and mental health files cannot be disclosed. Does this policy protect the civil rights of clients? Does it impair case plans?;
  • multi-system collaboration;
  • cost/reimbursement issues related to toxic cleanup, parents without health insurance, special needs foster care;
  • and perhaps most importantly develop resources that are available and accessible in rural communities.

Unfinished Tasks

The uncertain experiences in meth rehabilitation create problems in permanency planning, such as reconciling the uncertain pattern of treatment and relapse, with sharply reduced time for permanency decisions. Typically the pathway in treatment is 28 days in a treatment facility, sometimes followed by a period in a half-way house. The intensity of withdrawal behaviors and uncertain patterns of relapses require flexibility. Treatment plans are constrained by sources of payment (i.e., private insurance/ Medicaid/other). Generally, two to three years of tracking is required to chart response patterns, and tracking data is yet to be instituted.

As we wait to determine the success of these early approaches to meth, the interdisciplinary tasks at hand appear to be:

  • training doctors and medical staff, throughout the state’s emergency units in hospitals to assess the condition of a child exposed to meth;
  • training medical professionals to conduct neurological development assessments and provide consultation to child protection;
  • supporting studies on the use of drug courts, treatment effectiveness, and prevention strategies;
  • and perhaps focused attention on the impact of the meth phenomenon on rural adolescents. Fragmented reports exist on the escalating trend of cooking, selling and using among high school students in rural areas.

References

Knox, B. (2004). National protocol for medical evaluation of children found in methamphetamine drug labs (available from Dr. Knox at knox.barbara@mayo.edu).

Knox, B. (2004). Assessing medical risk: crisis and consequences. PowerPoint presentation, Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, MN.

Fallon, M. (2004). Drug-endangered children: crafting a response to trauma PowerPoint presentation, The Meth Phenomenon: What Do We Know?, Little Falls, MN.

Wattenberg, E. (2004). Notes from the Field I: A Summary of Observations on the Meth Phenomenon. The Meth Phenomenon: What Do We Know?, Little Falls, MN.

Wattenberg, E. (2004). Notes from the field ii: children in a meth-endangered environment: coping with the effects. The Meth Phenomenon: What Do We Know?, Little Falls, MN.

Fallon, M. (2004). The mental health needs of young children in placement.

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Child Welfare and Mental Health Screening

Mental health professionals believe that children’s social and emotional problems result from a mixture of genetic and environmental factors. Social workers often are not able to address genetic vulnerabilities, but one of the main responsibilities of child welfare workers is to assess the well-being of at-risk children in their environments.

Risk and resiliency research has shown that the more risk factors a child has in his or her environment, the more likely s/he is to experience social or emotional problems. Family problems that bring children to the child welfare system, such as abuse, neglect or parental drug use are major risk factors that may trigger social or emotional problems.

Recent research indicates that nearly half of all children who have completed child welfare investigations have clinically significant emotional or behavioral problems and that only one-fourth of those children receive services to address their problems. Also, while a disproportionate number of children of color are involved in the child welfare system, Latino and African American clients are less likely to receive mental health services while involved with child welfare systems than white children.

Addressing social and emotional needs early is not only beneficial to the child, but has been proven to decrease the likelihood of that child re-entering the public welfare/criminal system, and thus saving money in the long run.

Overview of Child Welfare Screening

In 2003, after much lobbying by social workers and other advocates for children’s mental health, the state legislature passed a law that mandates mental health screening for children who are involved with the juvenile justice or child welfare systems. Beginning on July 1, 2004, children ages 3 months to 18 years who come into contact with the child welfare system must be screened for mental health issues. This screen will determine if further mental health assessment is necessary. If the screen is positive, the child should be referred to a mental health professional for a diagnostic assessment. The child welfare system should work with the family to find appropriate services for children whose families do not have mental health insurance or cannot afford a diagnostic assessment. If a child is diagnosed with a mental health disorder, the worker should facilitate the enrollment of that child in appropriate mental health services.

The screening is a quick process that should be used to detect potential mental health problems. It not used to diagnose or to identify specific problems in children, but is used to identify children who need further evaluation.

The juvenile justice system has separate criteria for screening children who are 10-18 years old. In this article, we will focus only on screening as it relates to the child welfare system. If you would like more information on juvenile justice mental health screening, please see Minnesota Department of Human Services' (DHS) Bulletin #04-68-05.

Who Screens?

A previous barrier to mental health screening was the high cost of hiring mental health professionals to screen children and interpret scores. The tools that are used today for the child welfare children’s mental health screening were designed to be easy enough for parents to “administer” the screening tool. With minimal training, mental health practitioners, correctional professionals, and social services professionals could then quickly interpret the results. Although they are designed to be uncomplicated, not just anyone may score and interpret the test results. Minnesota statute 245.4871(14) states that only those who are trained in the use of the approved instruments may conduct the screenings.

Who Is Screened?

Because the screening process is critical for enhancing the mental health of this population, virtually all children who come into contact with the child welfare system should be screened. According to the DHS Bulletin (#04-68-05), children ages 3 months to 18 years old should be screened if they fall into the following categories:

  • children receiving child protective services: traditional and Alternative Response child protection case management clients;
  • children for whom parental rights have been terminated: guardianship adoption case management clients;
  • or children in out-of-home placements: for 30 days or more and not in a Minnesota DHS SSIS children’s mental health work group.

Who Is Not Screened?

In order to make practical use of limited time and resources, some children are exempt from screening. Children are exempt from screening if:

  • the case is resolved in less than 30 days;
  • the child has been screened within the past 180 days;
  • the child has had a diagnostic assessment in the past 180 days;
  • the child is under the care of a mental health professional;
  • or if a guardian/parent prevents the screening in writing. The

Screening Tools

The screening tools need to be easy for parents to understand and answer, easy to score and interpret, and sensitive enough to distinguish children who need further assessment from those who do not. The Children’s Mental Health Screening Law states that the screening “shall be conducted with a screening instrument approved by the commissioner of human services according to criteria that are updated and issued annually…”. Therefore, staff at the Minnesota Department of Human Services spent much time and effort to find appropriate instruments that would fit the above-mentioned criteria. Currently there are two screening tools that may be used in child welfare cases by county child welfare workers: 1) the Ages and Stages Questionnaire: Social Emotional and 2) the Pediatric Symptom Checklist.

Ages and Stages Questionnaire: Social Emotional (ASQ:SE)

Jane Squires, Diane Bricker and Elizabeth Twombly, early intervention researchers at the University of Oregon, developed this tool for children ages 3 months to 60 months. There are a number of tests that are divided by age range, with questions that are specific to the age group. Caregivers fill out the questionnaire and a professional scores it. The questionnaire kit may be purchased for $125, which includes a detailed handbook, explaining how to score and interpret results. The kit also allows that unlimited copies may be made of the instrument.

Pediatric Symptom Checklist (PSC-35)

Dr. Michael Jellinek and Dr. Michael Murphy, child psychiatry staff at Massachusetts General Hospital and Harvard Medical School researchers, designed this 35-question tool for children ages 6 through 16. Parents or other caregivers can fill it out; then it is scored by a social service professional. This tool is free and can be downloaded at the following website: http://www.mgh.harvard.edu/allpsych/pediatricsymptomchecklist/psc_order.htm 

Training Information

The Minnesota Department of Human Services provided training on these tools in May of 2004 and in January, 2005. A videotape of these trainings is available in CASCW. Please call the Center to schedule a viewing time. Further trainings will be scheduled in the fall and spring each year and routinely offered through the Minnesota Child Welfare Training System.

More Information

"Resources Related to Children's Mental Health Screening"- an annotated bibliography that offers summaries, quick facts, and relevant web links is available as a pdf here.

References

Burns, B.J, Phillips, S., Wagner, H, Barth, R, Kolko, D., Campbell, Y. &Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Child and Adolescent Psychiatry, 43 (8), 960-970.

Garland, A. & Besinger, B.A. (1997) Racial/Ethnic differences in court-referred pathways to mental health services for children in foster care. Children and Youth Services Review, 19, 651.

Jackson, Y. K. (1996). Stress and resilience in children: Testing protective models. Dissertation Abstracts International, 57, 3B, 2154.

Minnesota Department of Human Services. (2004). DHS implements child welfare and juvenile justice mental health screening. Bulletin #04-86-05 (available online at: http://www.dhs.state.mn.us/main/groups/publications/documents/pub/DHS_id_002181.hcsp)

Minnesota State Statute 234.4871(14)

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CASCW Seminar: Children's Mental Health Screening

In response to the new requirement for mental health screening for child welfare and juvenile justice populations, CASCW arranged a seminar at the School of Social Work on October 21, 2004. MSW students in St Paul, Moorhead and Rochester viewed the seminar via ITV. Speakers were Bill Wyss, Children’s Mental Health Consultant in the Chemical and Mental Health Division of the MN Department of Human Services (DHS), and Rosemary Cyr, supervisor of children’s services for Wright County.

The target populations for the mental health screening include the child welfare population of children ages 3 months to 8 years who are receiving child protection services, are guardian adoption case management clients, or are in out-of –home placement for 30 days or more. The juvenile justice population included in the new law includes children ages 10 to 18 years where there is a judicial finding of delinquency, there is a court order for the child continued in detention, and for children found to have committed a juvenile petty offense for the third or subsequent time. The discussion at this seminar concentrated on the child welfare population.

Bill presented an overview of the 2003 legislation (effective July 1, 2004) that amended the Minnesota Comprehensive Children’s Mental Health Act and Minnesota Juvenile Code. In addition, he explained the implementation efforts by DHS, including training, research, and selection of screening instruments, and work with task forces and counties in these efforts. The intention of the legislation is to integrate children’s mental health screening into current social work practice, promote the use of effective and efficient mental health screening instruments, facilitate referral of children for diagnostic assessments, and make funds available to the counties for screening and uncompensated mental health services. Students were given several handouts: a copy of the DHS Bulletin (#04-68-05, April 23, 2004), which explains the implementation of screening; a copy of the legislation mandating the screening; and a copy of one of the screening instruments, the Pediatric Symptom checklist (PSC), and information on its reliability, validity and use. Rosemary Cyr (a 1998 MSW/child welfare alumna from the School of Social Work) talked about the training about mental health screening she has done in Wright County. She has been instrumental in establishing collaboration with other counties and agencies (e.g., public health) in order to try to provide greater continuity of care with families they serve.

Several students who work in county child welfare services discussed their use of mental health screening instruments with children and parents since the law went into effect. In general, they have found the process to be positive for both the workers and the families: parents felt involved with the screening process and appreciated learning more about their children, whether or not there were mental health issues of concern. Other discussion concerned the availability of mental health services in some counties, in the cases in which children would be referred for assessment and diagnosis after an initial screening.

CASCW plans follow-up discussions on this topic, which touches on a number of policy and practice issues in the mental health services provided families and children at risk. Bill Wyss and DHS are planning to provide more training for county workers in January, and CASCW staff expects to survey counties about their experience implementing the new law.

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New Title IV-E MSW Students Expand Range of Cultural Expertise

The M.S.W. students who applied and were admitted to the Title IV-E Child Welfare Scholarship Program for 2004-05 are an experienced and diverse group. Of the 40 people accepted for the program, 42% have had at least two years work experience in public child welfare at the county or state level. The range of Minnesota counties represented is great: Anoka, Cass, Dakota, Hennepin, Le Seuer, Mille Lacs, Olmsted, Ramsey, Rice, Winona, and Wright, and a county in Alaska. Two people have worked at Minnesota's Department of Human Services. Other professional experiences of our accepted applicants include work at the Southside Family Nurturing Center, Reuben Lindh, Alexandra House, Community Action Program, Wilder Social Adjustment Program for South East Asians, Vietnamese Family Services, as well as in chemical dependency counseling and the guardian ad litem system.

Of the 25 new IV-E students, about one-third are from non-metro areas, most (72%) attend weekend classes, and 44% have B.S.W. degrees. About 68% of these students identify with non-Caucasian origins: African American, Hispanic/Latino, Somali, Cambodian, Sri Lankan, Nepalese, Japanese, Vietnamese, and Native American. (All are U.S. citizens.) This represents CASCW's most diverse new IV-E MSW student cohort. We look forward to the knowledge and experience that they will bring to the School of Social Work and the child welfare field.

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Alumni News

We are pleased to share news of Title IV-E alumni contributions to the field of child welfare. Updates on current activities should be sent to tcrudo@umn.edu.

After working for several years at the Professional Association of Treatment Homes (PATH) in Eau Claire, Jeanne Nutter (MSW, 2004) has become a Family Services Unit Supervisor for Clark County, Wisconsin.

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