Transcript Drug Endangered Children - International Society for Child Indicators

How Are Drug-Endangered Children
Faring? Mining Agency Records for
Measuring Well-Being
Presentation for:
1st International Society for Child Indicators Conference
June 28th, 2007 - Session 23
By
Sandra J. Altshuler, Ph.D., L.I.C.S.W.
Amber Cleverly-Thomas, M.S.W.
A Collaborative Response for Drug-endangered
Children: Empowering A Community to Protect
Children from Methamphetamine*
This project was supported by Cooperative Agreement Numbers 2003-JS-FX-K083 and 2005-JL-FX-K122 awarded by the Office of Juvenile Justice and
Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. The Spokane County DEC Team stewards are: Spokane County Sheriff’s
Office, Spokane Police Department, Spokane County Prosecuting Attorney’s Office, Child Protective Services (Washington Department of Social and Health
Services, Division of Children and Family Services), Partners with Families and Children—Spokane (formerly Casey Family Partners—Spokane), Lutheran
Community Services Northwest, Spokane School District 81, Educational Service District 101, Washington Department of Corrections, and Counseling
Resources for Youth and Families. Special thanks are extended to Esther Larsen, J.D., Karen Winston, M.S.W., and Kyle Bunge, M.S.W.
Spokane County DEC Partners
(see logic model also)
Spokane County Sheriff ’s Office
Spokane Police Department
Spokane County Prosecutor
Child Protective Services
Partners with Families and Children
Lutheran Community Services
Spokane School District 81
ESD 101
Department of Corrections
What is the Drug Endangered
Children (DEC) Program?




A collaborative effort to address the needs of children
identified as drug endangered.
A partnership among law enforcement, Child Protective
Services, prosecutors, and agencies providing services
to children.
Guidelines for the delivery of services to drug
endangered children.
A system for identifying and monitoring the well-being
of children identified as drug endangered.
Who is a
Drug Endangered Child?
Any child living in
an environment
where adults are
manufacturing,
selling, and/or
using drugs.
Evaluation Methodology
Research questions:
 What is the level of interdisciplinary
collaboration achieved by the Spokane County
DEC Team in its first year of functioning?
(see article included in packet)

To what extent are the needs of drug
endangered children being addressed?
Evaluation Methodology
Sources of data (includes administrators, line staff, and case records):
Spokane County Sheriff ’s Office
 Spokane Police Department
 Spokane County Prosecutor
 Child Protective Services
 Partners with Families and Children
 Lutheran Community Services
 Spokane School District 81

Evaluation Methodology
The Perry et al (2003) schema for assessing neglected
children includes 6 life domains, plus we added last 2:








Physical/medical
Trauma history
Developmental
Social/family
Mental health/emotional/behavioral
Cognitive/ academic: “school functioning”
Child welfare history
Demographics
Evaluation Methodology
Instrumentation—Measure of Physical/Medical Health
Was a “Kids Screen” completed by DCFS?
 Pediatric Exam

Height
 Weight
 Head Circumference


Does child have a “medical home” or
identified pediatrician?
Evaluation Methodology

Instrumentation—Measure of Trauma
Trauma Symptom Checklist for Children (ages 8-16) or
Trauma Symptom Checklist for Young Children (ages
3-12) (Briere, 1996)


parent or caretaker report, standardized, strong validity
Assesses levels of:







Anxiety
Depression
Anger
Posttraumatic stress
Dissociation
Sexual concerns
Aggression
Evaluation Methodology

Instrumentation—Measures of Development I
Battelle Developmental Inventory (ages 1-8) (Newborg
et al., 1984)



Parent/caregiver report, plus observation, time tests
standardized, strong validity
Assesses levels of:





Personal-social
Adaptive functioning
Total motor (gross and fine) skills
Total communication (expressive and receptive) skills
Cognition
Evaluation Methodology

Instrumentation—Measures of Development II
Ages and Stages Questionnaire
(Squires, Potter, & Bricker, 1999) (ages 4-60 months)



Parent/caregiver report
standardized, strong validity
Assesses levels of:





Communication
Gross motor
Fine motor
Problem solving
Personal/Social
Evaluation Methodology
Instrumentation—Measure of Family History

Adverse Childhood Experiences (Felitti, et al., 1998)

Parent report of growing up with:









Recurrent physical abuse
Contact sexual abuse
Domestic violence
Recurrent severe emotional abuse
Parental substance abuse
Imprisoned parent
Parental chronic mental illness
Loss of at least one parent during childhood
DCFS report of female caregiver history of childhood
abuse or neglect
Evaluation Methodology
Instrumentation—Measure of Mental Health:
Emotional/Behavioral

Child Behavior Checklist (ages 4-18)
(Achenbach, 2003)



Parent/caregiver report
standardized, strong validity
Assesses levels of:



Emotional: “Internalizing Behavior”
Behavior: “Externalizing Behavior”
Assess domains of:









Anxious/depressed
Somatic complaints
Withdrawn
Attention problems
Aggressive behaviors
Sleep problems (1 ½ - 5 yrs)
Social problems (6 – 18 yrs)
Thought problems(6 – 18 yrs)
Rule Breaking behaviors(6 – 18 yrs)

Telesage (all ages) Mental Health
Management Outcomes System



Parent/caregiver report; client selfreport
Selected parts of variety of
standardized measures
Assesses domains of:





Hopefulness
Problem severity
Internalizing
Externalizing
Delinquency
Evaluation Methodology

Instrumentation—Measure of Mental Health:
Social Functioning
Ages and Stages Questionnaire: Social-Emotional
(Squires, Bricker, & Twombly, 2003) (ages 0-6)



Parent/caregiver report
standardized, strong validity
The child’s total score is compared with an empirically
derived cutoff point. If the child’s score is higher than
the cutoff, it suggests the child should be referred for
further mental health evaluation.
Evaluation Methodology
Instrumentation—Measurement of School Functioning

Mining of school data (ages 5-18)
Grades
 # of schools attended
 Attendance/Truancy history
 Discipline history
 Special Education Status and disability
 Retention history

Evaluation Methodology



Instrumentation—Measures of Child Welfare History
# of CPS referrals for each child, # accepted for
investigation
Assigned risk tag (0=no risk, 5=highest risk)
Reason for referral





Relationship of each referral reason to drugs
Parent’s drug of choice, including poly-drug use
#, length of previous out-of-home placements
Type of current placement (non-related, kinship, etc.)
Permanency plan and current legal status
Evaluation Methodology
Instrumentation--Demographics
Age (at time of referral to DEC program)
 Gender
 SES
 Ethnicity
 Was child placed with sibling?
 Family Structure at time of placement

Evaluation Methodology
Data Analysis Plan

Univariate analyses



Exploratory analyses



Assess for normalcy
Simple descriptive summaries
Isolate any demographic variables that correlate with either enhanced or degraded
outcomes (appropriate to the measurement level of each variable)
To understand the natural history of the study participants, baseline values for
DEC participants will be examined from date of admission to the DEC program
to determine if characteristics of the population sample changed during the time
frame of the study (thereby hoping to reduce the need for a separate comparison
group and maximize the internal validity of the data collected).
Future analyses (dependent upon above results) to determine predictors
of outcomes (e.g, impact of ACEs, child welfare history, etc.)
Findings
Child Demographics I
Age, in months (at time of referral
to DEC)
M
SD
Min
Max
61.66
43.99
0
197
N
Percent
Number of children enrolled
399
Number of families
215
N/A or Missing
Gender
Male
219
54.9
Female
180
45.1
SES
399
Family Structure (at time of removal)
15
Mother Only
185
48.2
Two Parent Household
164
42.7
Mother / Paramour
22
5.7
Father Only
11
2.9
Father / Paramour
2
0.5
3.8
Findings
Child Demographics II
N
Percent
Ethnicity
N/A or Missing
6
White/Caucasian
274
68.7
African American
22
5.5
Hispanic/Latino
13
3.3
Native American
35
8.8
Bi-Racial/Tri-Racial
42
10.5
Asian/Pacific Islander
1
0.3
Other
6
1.5
1.5
Findings
Child Welfare History I
M
SD
Min
Max
Number of CPS referrals, per child
5.78
4.88
0
24
Number of referrals accepted for
investigation, per child (N=394)
3.81
2.86
0
14
Assigned Risk Tag (0-5)
4.54
0.75
0
5
Number of total O-O-H placements
1.44
1.19
0
7
Length of most recent O-O-H
placement (in months) (N=112)
6.63
10.87
1
52.42
Findings
Child Welfare History II
N
Percent
Reason for Referral
Physical abuse only
Sexual abuse only
Neglect only
Neglect and other abuse
Abandonment
Referral on sibling
14
3.6
4
1.0
320
81.6
17
4.3
5
1.3
32
8.2
Type of Current Placement
Non-relative foster care
151
38.5
Kinship foster care
125
31.9
8
2.0
63
16.1
7
1.8
38
9.7
In-home dependency w/ parents
Group home
Other (hospital)
Not placed into state custody
N/A or Missing
7
1.8
7
1.8
Findings
Child Welfare History III
N
%
Child has enrolled sibling in
DEC program
292
72.9
Child placed with sibling
immediately
184
71.6
Child placed with sibling within 30
days
192
77.7
One
107
49.3
Two
64
29.5
Three
25
11.5
Four
17
7.8
Five or more
4
1.9
N/A Missing
142*
35.6
152**
38.1
Number of enrolled children in
each family
* Of the 142 missing, 107 children did not have siblings, and 38 were never placed. There was an overlap of 15 children.
** An additional 10 children were returned home within one month.
Findings
Child Welfare History IV
N
Percent
Case Status
259
65.4
Dependent
201
77.6
Shelter care
15
5.8
Legally free (TPR)
34
13.1
Guardianship
6
2.3
137
34.6
Returned, dependency
dismissed
60
45.1
Returned, never
dependent
56
42.1
Adopted
17
12.8
CPS case open
CPS case closed
N/A or Missing
3
0.01
0
0.00
4
3.00
Findings
Child Welfare History V
N
Percent
Was primary referral reason due
to parental drug use?
N/A or Missing
10
Yes
281
72.2
No
108
27.8
Parent’s drug of choice
27
Meth Only?
195
52.4
Poly-Drug, including meth
and/or alcohol
115
30.9
Alcohol only
13
3.5
Other (heroin, cocaine,
prescription, marijuana)
49
13.2
6.7
Findings
Physical/Medical Findings
Yes
N/A or
Missing
No
N
Valid
%
N
Valid
%
N
Valid
%
Was KidScreen completed by DCFS?
240
67.0
118
33.0
41
10.3
Was a medical completed following
placement?
241
71.3
97
28.7
61
15.3
Was Growth WNL (Height/
Weight/Head Circumference)?
80
44.7
99
55.3
220
55.1
Findings
Trauma History I
TSCYC (35-110), t-scores* by
domain (N=40)
M
SD
Min
Max
Anxiety
64.67
19.00
40
110
Depression
68.27
18.44
41
110
Anger
67.18
17.44
41
110
Posttraumatic Stress
73.79
23.31
42
110
Dissociation
65.03
17.71
43
109
Sexual Concerns
64.62
23.60
46
110
*Domains excluding PTS: t-score less ≤ 64 is considered normal, 65-69 are potentially problematic,
and ≥ 70 are clinically significant. For PTS: t-score ≤ 64 is considered normal, 65-69 are “often
associated with at least one elevated PTSD symptom cluster,” and ≥ 70 suggest relatively severe
posttraumatic disturbance (Briere, 1996)
Findings
Trauma History II
TSCYC: Results of T-test analysis of
changes in levels of trauma
symptoms (N=25)
M
SD
t (df)
Anxiety
-8.48
14.13
3.00 (24)**
Depression
-8.92
16.93
2.60 (24)**
Anger
-5.72
16.48
1.74 (24)
Posttraumatic Stress
-10.52
17.55
3.00 (24)**
Dissociation
-6.08
19.10
1.60 (24)
Sexual Concerns
-5.60
20.86
1.30 (24)
**p = .01
Findings
Developmental Assessment I
BDI (0-100), by domain
Percentile
Range
M
SD
Min
Max
Personal-Social (N=102)
31.34
27.33
1.0
99.9
Adaptive Functioning (N=101)
29.39
28.86
.04
99.9
Total Motor Skills (N=121)
33.29
31.68
0.4
98.0
Communication (N=121)
35.14
28.51
1.0
98.0
Cognition (N=121)
26.24
26.40
0.1
99.0
Overall BDI Score
27.19
27.86
0.1
97.0
Findings
Developmental Assessment II
Yes
N/A or
Missing
No
Children qualifying as having
“developmental deficiencies”*
N
Valid
%
N
Valid
%
N
Valid
%
Personal-Social (N=114)
27
23.7
87
76.3
285
71.4
Adaptive Functioning (N=101)
34
29.8
80
70.2
285
71.4
Total Motor Skills (N=121)
35
26.5
97
73.5
267
66.9
Communication (N=121)
28
20.9
106
79.1
265
66.4
Cognition (N=121)
39
29.5
93
70.5
267
66.9
Overall BDI Score
37
33.3
74
66.7
288
72.2
*Z-score of 1.5 or below indicates a performance deficit (Newborg, Stock, Wnek, Guidubaldi, Svinicki., 1984)
Findings
Developmental Assessment III
BDI: Results of T-test analysis of
changes in Z-scores
M
SD
t (df)
Adaptive
-1.00
1.25
-3.18 (15)**
Personal-Social
-0.74
1.31
-2.11 (13)*
Communication
-0.93
1.30
-2.94 (16)**
Motor Skills
-1.13
1.27
-3.55 (15)**
Cognition
-0.50
1.18
-1.77 (16)
Overall BDI
-1.01
1.25
-3.02 (13)**
*p = .05
**p = .01
Findings
Developmental Assessment IV
ASQ, by domain (n=69)
Concern
Indicated
No Apparent
Concern
N
%
N
%
Communication
24
34.8
45
65.2
Gross Motor
14
20.3
55
79.7
Fine Motor
19
27.5
50
72.5
Problem Solving
19
27.5
50
72.5
Personal/Social
21
30.4
48
69.6
Findings
Family Assessment
ACES (for mothers, by family)
(N=217)
N
Percent
N/A Missing
Recurrent Physical Abuse (N=)
217
Contact Sexual Abuse (N=)
217
Domestic Violence (N=)
217
Recurrent Severe Emotional
Abuse (N=)
217
Parental Substance Abuse (N=)
217
Imprisoned Parent (N=)
217
Parental Chronic Mental Illness
(N=)
217
Loss of at least one parent during
childhood (N=)
217
Findings
Mental Health: Social Emotional
Yes
N/A or
Missing
No
Ages & Stages Questionnaire:
Social Emotional
N
Valid
%
N
Valid
%
N
Valid
%
Was ASQ:SE administered?
64
33.3
128
66.7
207
51.9
Did ASQ:SE indicate need for further
mental health evaluation?
27
42.2
37
57.8
0
0.0
Findings
Mental Health: Emotional/Behavioral Assessment I
N
Percent
CBCL or TRF completed*
N/A Missing
45**
18.8
Yes
142
72.8
No
53
27.2
M
SD
Min
Max
Total Problems
55.55
13.05
25
98
Externalizing
55.34
14.49
28
95
Internalizing
55.03
11.59
29
80
T-scores for CBCL/TRF
(0-100) (n=121)
* Based on CBCL data from the 240 Kidscreens completed by Children’s Administration.
** These children were too young for the CBCL/TRF.
Findings
Mental Health: Emotional/Behavioral Assessment II
Normal
Child Behavior Checklist
Borderline
Clinical
N
%
N
%
N
%
93
64.1
18
12.4
34
23.4
96
66.2
17
11.7
32
22.1
97
66.9
11
7.6
37
25.5
Emotionally reactive (1½ - 5 yrs) (N=83)
60
72.3
15
18.1
8
9.6
Anxious/depressed
111
82.8
13
9.7
10
7.5
127
94.8
6
4.5
1
0.7
102
76.1
6
4.5
26
19.4
108
81.2
9
6.8
16
12.0
104
77.6
8
5.5
22
15.2
68
90.6
1
1.3
6
8.0
36
75.0
8
16.7
4
2.8
Thought problems (6-18 yrs) (N=47)
41
87.2
3
6.4
3
6.4
Rule breaking behavior (6-18 yrs) (N=48)
32
66.7
4
8.3
12
25.0
Total Problems
Internalizing
Externalizing
(N=145)
(N=145)
(N=145)
Syndrome Scales
(N=134)
Somatic complaints
Withdrawn
(N=134)
(N=134)
Attention problems
Aggressive behavior
(N=133)
(N=134)
Sleep problems (1½ - 5 yrs)
Social problems (6-18 yrs)
(N=75)
(N=48)
Findings
Counseling Services I
N
Percent
Number of DEC clients who
received counseling services (at LCS)
115
28.8
Number of Counseling Closures
68
65.9
Treatment completed
22
32.4
Discharge at Clients request
8
11.8
Discharge against agency advise
5
7.4
Failure to return
13
19.1
Moved away
10
14.7
Other
8
11.8
Discharge at Clinician Request
2
2.9
Reasons for case closure
N/A or Missing
0
0
Findings
Counseling Services II
M
SD
Min
Max
19.29
21.82
1
107
Number of Case Management
Contacts (N=111)
7.10
12.76
0
57
Number of Therapeutic Aide
Contacts (N=111)
3.98
11.57
0
57
Therapeutic Aide Units (in 30
minute increments) (N=111)
114.63
86.77
3
241
Number of Individual Sessions
(N=111)
Findings
School Functioning I
Max
M
SD
Min
N
%
N/A or Missing
Grade at Placement
Number of Schools Attended
Number of Grades Repeated
Does student qualify for special
education?
Yes
No
Is student still enrolled in District
81?
Yes
No
Findings
School Functioning II
M
Number of Days Enrolled
School Year Prior to Placement
School Year At Time of Placement
School Year Following Placement
Number of Excused Absences
School Year Prior to Placement
School Year At Time of Placement
School Year Following Placement
Number of Unexcused Absences
School Year Prior to Placement
School Year At Time of Placement
School Year Following Placement
SD
Min
Max
Findings
School Functioning III
M
Number of Excused Tardies
School Year Prior to Placement
School Year At Time of Placement
School Year Following Placement
Number of Unexcused Tardies
School Year Prior to Placement
School Year At Time of Placement
School Year Following Placement
Number of Days Absent Due to
Suspension
School Year Prior to Placement
School Year At Time of Placement
School Year Following Placement
SD
Min
Max
Findings
School Functioning IV
M
Becca / AttendanceActions
School Year Prior to Placement
School Year At Time of Placement
School Year Following Placement
Disciplinary Actions (not
including attendance actions or
out-of-school suspensions)
School Year Prior to Placement
School Year At Time of Placement
School Year Following Placement
SD
Min
Max
Findings
Law Enforcement Activities I
Yes
N/A or
Missing
No
N
Valid
%
N
Valid
%
N
Valid
%
Did law enforcement file an AEP at
time of referral or placement?
286
72.6
108
27.4
5
1.3
Was AEP filed as a result of parental
arrest?
86
30.1
200
69.9
113
28.3
Was the child’s parent arrested (by
child)?
122
30.8
274
69.2
3
0.8
Was at least one parent arrested (by
family)?
62
29.1
151
70.9
2
0.9
Was the arrest drug-related (by
child)?
106
86.9
16
13.1
277
69.4
Was the arrest drug-related (by
family)?
54
87.1
8
12.9
153
71.2
Findings
Law Enforcement Activities II
N
Percent
Which parent was arrested (by
child)?
Mom / mother figure
75
70.8
Dad / father figure
16
15.1
Both parental figures
15
14.2
Which parent was arrested (by
family)?
Mom / mother figure
32
59.3
Dad / father figure
12
22.2
Both parental figures
10
18.5
N/A or Missing
277
0.0
161
74.9
Findings
Prosecution I
N
Percent
Was mother’s case referred for prosecution? (N=42)
Yes
30
71.4
No
11
26.2
Pending
1
2.4
Was father’s case referred for prosecution? (N=22)
Yes
17
77.3
No
5
2.3
Pending
0
0.0
Was mother charged with a felony? (N=31)
Yes
31
100.0
No
0
0.0
Was father charged with a felony? (N=17)
Yes
17
100.0
No
0
0.0
N/A or Missing
173
80.5
193
89.8
184
85.6
198
92.1
Findings
Prosecution II
N
Percent
What was the outcome of the mother’s case? (N=30)
Convicted by plea
15
50.0
Found guilty
4
13.3
Not adjudicated
2
6.7
Dismissed
3
10.0
Pending
4
13.3
Referred (e.g. drug court)
2
6.6
What was the outcome of the father’s case? (N=17)
Convicted by plea
12
70.6
Found guilty
0
0.0
Not adjudicated
0
0.0
Dismissed
0
0.0
Pending
4
23.5
Referred (e.g. drug court)
0
0.0
Other
1
5.9
N/A or Missing
185
86.0
198
92.1
Evaluation Limitations
Secondary Data Analysis: did not to introduce
any new instruments for data collection, above
and beyond what DEC partners already collect
 Difficulty in accessing data from partners
 This study occurred in Spokane, Washington,
and may not be generalizable to other areas or
regions

Further Information
Regarding DEC Projects
 Ongoing
collaborative efforts
National DEC Alliance and alliances in other states
and regions
 Website for Washington state:
www.wadecalliance.org
 Washington State DEC Alliance

Sustainability of the DEC Project
 Translating
promising practices into
policy changes
 Research/evaluation
presented to
demonstrate measurable outcomes
 Outcomes drive changes in policy
Sustainability of the DEC Project

National commitment
Advocate for policy changes and funding for
therapeutic foster care, quality day care, good health
care, and safe housing
 Market prevention through a strong national media
campaign
 Advocate for policy changes to strengthen the child
protective service system

DEC Contacts

Spokane County Sheriff ’’s Office
Esther Larsen, J.D., Project Director
1100 West Mallon
Spokane, WA 99206
(509) 477-5709
[email protected]

Partners with Families and Children
Karen Winston, M.S.W.
Project Coordinator
613 South Washington
Spokane, WA 99204
(509) 473-4830
[email protected]

Lutheran Community Services NW
Heike Lake, M.S.W.
210 West Sprague Avenue
Spokane, WA 99201
(509) 747-8224
[email protected]

Department of Children and Family Services
Amber Cleverly-Thomas, , M.S.W.
DEC Service Coordinator
1313 North Atlantic, Suite 2000
Spokane, WA 99201
(509) 362-2537
[email protected]

Educational Service District 101
Astri Zidack
4202 South Regal
Spokane, WA 99223
(509) 789-3800
[email protected]

Project Evaluation
Sandra J. Altshuler, Ph.D., L.I.C.S.W.
Counseling Resources for Youth & Families
108 N. Washington
Spokane, WA 99201
(509) 326-1668
[email protected]
Information and photos provided by:
Spokane Police Department
Spokane County Sheriff ’s Office
Child Protective Services
Partners with Families and Children
National Alliance for Drug Endangered Children
This project was supported by Cooperative Agreement No. 2003-JS-FXK083 &
2005-JL-FX-K122 awarded by the Office of Juvenile Justice and
Delinquency Prevention, Office of Justice Programs, U.S. Department of
Justice.
Points of view or opinions in this document are those of the authors and
do not necessarily represent the official position or policies of the
U.S. Department of Justice.