Does formal integration between child welfare and behavioral health agencies result in improved placement stability for adolescents engaged with both systems

When children receive child protective services, caseworkers seek to ensure safety in the least disruptive manner possible while building family capacity for independence. Although the primary reason for removals from home is caregivers' inability to ensure safety, child behavior is often a contributing factor, especially for adolescents (Aarons et al., 2010; Glisson & Green, 2006). Behavioral health care for adolescents is often part of the services intended to keep families together while ensuring safety. Integration between child welfare and behavioral health providers should support family preservation through better coordination of services. The purpose of the current study was to test how ties between child welfare agencies and behavioral health care providers affected placement stability for adolescents engaged with both systems, specifically those who were able to remain with their families after maltreatment investigations had been completed. Thus, this study extends child welfare research by examining how integration with providers may help one important sub-group of children stay at home, or return more quickly if a removal does subsequently occur. Removal of children from home has sometimes been linked to positive outcomes, especially for those at the greatest economic disadvantage (Lemmon, 2006). However, out of home placements have more frequently been linked to behavioral health problems (Doyle, 2007; Lawrence, Carlson, & Egeland, 2006; Ryan & Testa, 2005). This risk increases with subsequent moves (Ryan & Testa, 2005), especially for older children (Rubin, O'Reilly, Luan, & Localio, 2007).Recently researchers have traced the impact of placement instability as far as an increased rate of adult criminality (DeGue & Spatz Widom, 2009). Since the passage of the Adoption Assistance and Child Welfare Act of 1980 (Public Law 96-272), child welfare agencies have made increasing efforts to keep children with their families (Frankel, 1988; McCroskey & Meezan, 1998). The primary strategy for improving family stability is to support caregivers in changing their own behavior. However, child behaviors are a significant predictor of placement changes for older children involved with child welfare (Aarons et al., 2010; Barber, Delfabbro, & Cooper, 2001). Addressing children's behavioral health may thus both directly improve their well-being and enable them to stay with their families, or at least achieve permanence more quickly after a removal from the home. Adolescence appears to be a particularly vulnerable period to be removed from home. In a national sample of children engaged with child welfare, adolescents had a lower risk of initial out-of-home placement in the first eighteen months after engagement with child welfare than slightly younger children, but a far higher risk of removal in the subsequent eighteen months (Aarons et al., 2010) as well as greater rates of continuing placement instability (Becker, Jordan, & Larsen, 2007; Rubin et al., 2007) Research in other settings has found adolescents with behavioral problems to have elevated risk of placement breakdown (Barber et al., 2001; Oosterman, Schuengel, Wim Slot, Bullens, & Doreleijers, 2007). The current study focused on the majority of those adolescents engaged with child welfare, who have been allowed to remain with their families after the completion of a maltreatment investigation and initiation of child protective services. In the 1999/2000 cohort of the National Survey of Child and Adolescent Well-Being used in the current study, two-thirds of adolescents receiving child welfare services two – to- six months after investigation were still in the home. Preliminary analyses indicated that these adolescents were in lower risk families than those who had been removed from their homes at that point. For instance, 17% of adolescents initially receiving in-home child welfare services had parents with mental health problems, vs. 42% of those who were out of home ( p <0.01), and 8% of those in home had a caregiver with a drug abuse problem compared to 19% for adolescents placed out of home (p<0.01). Although all children engaged with child welfare are vulnerable, remaining at home both indicates relatively low risk within this population and a key source of continuity important to continued well-being. The core of in-home child protection is facilitation of whatever services each family needs combined with continued monitoring for progress toward independent assurance of child safety. Often such case management entails initiation of mental health care for children (Leslie et al., 2005). Such services can help adolescents with behavioral disturbances function more successfully at home (Clarke, Schaefer, Burchard, & Welkowitz, 1992) and reduce the likelihood of out of home placement(Glisson & Green, 2006).If the child is subsequently removed from home, counseling may improve placement stability by addressing by pre-existing behavioral health problems as well as the additional stressors of separation. Our interest was in both what might help adolescents at home stay with their families and, for those who were later removed, what might reduce their subsequent placement instability.