Information package for child welfare agency administrators

Office of Planning, Research and Evaluation, Administration for Children and Families.

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
May 9, 2012

Child Well-Being Spotlight

Children with Substantiated and Unsubstantiated Reports of
Child Maltreatment are at Similar Risk for Poor Outcomes

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For more information on the well-being of
children in the child welfare system, see:
http://www.acf.hhs.gov/programs/opre/
abuse_neglect/nscaw/

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Percent at risk for a Problem

In substantiated cases of maltreatment, child protective services determine whether abuse or neglect can be proven,
with credible evidence, to have occurred. Less than one in five investigated reports are substantiated. This decision—
whether abuse can be substantiated—is important because it has implications for how much a child and family are
involved with the child welfare system and what
services they receive. According to estimates from
Well-Being Indicators by Substantiation Status
the National Survey of Child and Adolescent
Well-Being (NSCAW), children with unsubstanti45
42.3
38.8
ated reports of abuse or neglect experience the
40
33.4
same risk of negative outcomes as children with
35
31.7
substantiated reports.1,2 Children in both groups
30
23.3
were at risk for severe developmental and cogni25
20.7
20.8
19.4
tive problems, as well as emotional or behavioral
20
problems and substance use disorders.3 These
15
data suggest the role of child protective services
10
5
as a gateway for referrals and receipt of services to
0
all children who come into contact with the child
welfare system.

Substantiated

Not Substantiated

1

Percentages are from the National Survey of Child and Adolescent Well-Being II (NSCAW
II). Baseline data collection began in 2008-2009. The study includes 5,873 children ranging
from birth to 17.5 years old at the time of sampling.

2

Developmental problems were defined based on children birth to 5 years old having a
diagnosed mental or medical condition that has a high probability of resulting in developmental delay (e.g., Down syndrome) and/or being 2 standard deviations below the mean
in at least one developmental area or 1.5 standard deviations below the mean in two areas.
Areas included cognitive development based on the Battelle Developmental Inventory,
2nd edition or Kaufmann Brief Intelligence Test (K-BIT), communication development
based on the Preschool Language Scales, 3rd edition, and adaptive development based
on the Vineland Daily Living Skills. Children 1.5 to 17 years were considered to be at
risk for a behavioral/emotional problems if either (1) a caregiver reported an elevated
score (>1.5 standard deviations above the mean) on the Total Problems, Internalizing, or
Externalizing scales of the Child Behavior Checklist (CBCL); (2) an adolescent reported
an elevated score (>1.5 standard deviations above the mean) on the Total Problems,
Internalizing, or Externalizing scales of the Youth Self-Report; (3) a teacher reported an
elevated score (>1.5 standard deviations above the mean) on the Total Problems, Internalizing, or Externalizing scales of the Teacher Report Form; (4) a clinically significant score
was obtained on the Child Depression Inventory, or (5) a clinically significant score was
obtained on the PTSD scale of the Trauma Symptoms Checklist. Children 4 to 17 years old
were considered to be at risk for a cognitive problem or low academic achievement if they
had a score 2 standard deviations or more below the mean for the K-BIT or Woodcock-

Johnson III (considered a cognitive need). Risk of a substance abuse problem was defined
by a Total score of 2 or more on the CRAFFT substance abuse screening test. A CRAFFT
total score of 2 or more is highly correlated with having a substance-related diagnosis and
the need for substance abuse treatment.
3

Comparisons between children with substantiated/indicated and unsubstantiated reports
control for child’s gender, age, main type of maltreatment, placement, household poverty,
and risk factors reported by caseworkers (low social support and high stress in the family).

Source: The National Survey of Child and Adolescent Well-Being II (NSCAW II) is the
second nationally representative sample of children reported to child protective services
sponsored by the Administration for Children, Youth and Families (ACF). The survey
collects data by administering questionnaires to a representative sample of the population
through face-to-face interviews with caseworkers, children, caregivers, and teachers.
The Child Well-Being Spotlight may be copied without permission. Suggested citation:
Casanueva, C., Dolan, M., Smith, K., & Ringeisen, H. (2012). NSCAW Child Well-Being
Spotlight: Children with Substantiated and Unsubstantiated Reports of Child Maltreatment are
at Similar Risk for Poor Outcomes. OPRE Report #2012-31, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department
of Health and Human Services. Find this report and those on similar topics online at:
http://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/

Office of Planning, Research and Evaluation, Administration for Children and Families.

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
September 18, 2012

Child Well-Being Spotlight

Caregivers of Children Who Remain In-home After a Maltreatment
Investigation Need Services
Children’s well-being depends on the capacity of their family to nurture and care for them. Caregivers facing multiple
difficulties, including intimate partner violence, substance abuse, and poor mental health, are challenged to provide the
quantity and quality of care that supports healthy child development and well-being. The vast majority (86%) of children
who have received a report of child abuse
or neglect remain in-home following a
maltreatment investigation.1 However, data
from the National Survey of Child and
Adolescent Wellbeing (NSCAW) indicate
that many in-home caregivers experience
a range of problems that could affect their
ability to care for their children effectively.2
Compared to adults nationally, in-home
caregivers in NSCAW have much higher
rates of substance abuse, intimate partner
violence, and major depression.3-5 These
data show that families may have a great
need for services, even in cases where children are not removed from the home. Child
protective services plays an important role
as a gateway for referrals and receipt of services to caregivers of all families who come
into contact with the child welfare system.
For more information on the well-being of
children and their caregivers in the child
welfare system, visit: http://www.acf.hhs.
gov/programs/opre/abuse_neglect/nscaw/.

U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2011). Child Maltreatment 2010.
Available from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can.
2
Percentages are from the baseline of the National Survey of Child and Adolescent Well-Being II
(NSCAW II). Baseline data collection began in 2008–2009. The study includes 5,776 caregivers of
children ranging from birth to 17.5 years old at the time of sampling, of whom 3,636 are in-home
caregivers.
3
Depression in caregivers was assessed with the Composite International Diagnostic Interview Form,
Short-Form (CIDI-SF). National comparison data are from the 2007 National Comorbidity Survey
Replication, which used the long form of the CIDI to assess depression among U.S. adults 18 years
old or older. The proportion shown is the proportion of adults who experienced major depression
in the past 12 months.
4
Physical intimate-partner violence was reported by female caregivers using the Conflict Tactics
Scale. National comparison data are from the 1995–1996 National Violence Against Women Survey.
5
Caregivers were determined to be “in need of alcohol or substance abuse services” when they met
any one of four criteria: (1) caseworker report of a parent’s alcohol or drug problem at the time of
investigation, (2) AUDIT Total score >5, indicating the presence of hazardous drinking, (3) DAST1

20 Total score 2–4 or 5 or higher, or (4) the parent’s self-reported need (“a lot” or “somewhat”) for
alcohol or substance abuse services in the past year, if she or he had not received a substance abuse
service. National comparison data are from the 2009 National Survey of Drug Use and Health.
Source: The National Survey of Child and Adolescent Well-Being II (NSCAW II) is the second
nationally representative sample of children reported to child protective services sponsored by the
Administration for Children, Youth and Families (ACF). The survey collects data by administering
questionnaires to a representative sample of the population through face-to-face interviews with
caseworkers, children, caregivers, and teachers.

The Child Well-Being Spotlight may be copied without permission. Suggested citation:
Wilson, E., Dolan, M., Smith, K., Casanueva, C., & Ringeisen, H. (2012). NSCAW Child
Well-Being Spotlight: Caregivers of Children Who Remain In-home After a Maltreatment
Investigation Need Services. OPRE Report #2012-48, Washington, DC: Office of Planning,
Research and Evaluation, Administration for Children and Families, U.S. Department
of Health and Human Services. Find this report and those on similar topics online at:
http://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/

Office of Planning, Research and Evaluation, Administration for Children and Families.

NatioNal Survey of Child aNd adoleSCeNt Well-BeiNg
August 15, 2012

Child Well-Being Spotlight

Children in Out-of-Home Placements Receive More Psychotropic
Medications and Other Mental Health Services than Children Who
Remain In-Home Following a Maltreatment Investigation
Recent research has shown that foster children are more likely to use psychotropic medications than children on Medicaid
who are not in the foster system, and are more likely to use multiple psychotropics at once. Based on NSCAW II, Wave 2
data, this spotlight examines psychotropic medication use, alone and in combination with other services, among children
involved with the child welfare system.1
High levels of unmet mental health service
Use of specialty mental health (MH) services2 separately and in
needs still remain among children in the
combination with psychotropic medications3 at NSCAW Wave 2,
among children meeting clinical criteria for a mental health need4
child welfare system, despite similar findings published almost a decade ago from the
Out of home
In-home
NSCAW I study. One third to one half of
n=1,057
n=314
children meeting clinical symptom criteria
did not receive any specialty services in the
21.5
Meds + Specialty MH services
past 18 months. Psychotropic medications
33.1
30
Specialty MH services only
were used alone, in absence of any other
58.2
service, by a larger percentage of children
18.5
Meds only
living out of home (9.4%) than children
9.4
No services
27.5
living in-home (1.8%) (differences in level
1.8
of mental health need were not taken into
account in this comparison).
5,6,7

8,9,10

For more information on the well-being of children and their caregivers in the child welfare system, visit:
http://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/.
Percentages are from the National Survey of Child and Adolescent Well-Being II (NSCAW II). Data
are from the first follow-up Wave (Wave 2), conducted in 2008-2010, approximately 18 months
after the baseline assessment. The NSCAW II study includes 5,873 children ranging from birth to
17.5 years old at the time of sampling. At Wave 2, they ranged from 16 months to 19 years old.
2
Specialty mental health services includes the following: outpatient drug or alcohol clinic, mental
health or community health center, private mental health professional, in-home counseling or crisis
services, treatment for emotional and substance abuse problems, therapeutic nursery, psychiatric
unit in hospital, detox or inpatient unit, hospital medical inpatient unit, residential treatment center
or group home, hospital emergency room for emotional and substance abuse problems, family
doctor mental health service, school-based mental health service.
3
Caregivers were asked to give the total sum and individual names of psychotropic medications the
child was currently taking. The total sum of (nonspecific) psychotropics reported by the caregiver
is reported here.
4
Children were considered to have a mental health need if they met any of the following criteria: (1)
Total Problem, Internalizing, or Externalizing T scores were equal or greater than 64 on either the
Child Behavior Checklist , Teacher Report Form, or Youth Self Report from the Achenbach System
of Empirically Based Assessment, a global assessment of child emotional and behavioral functioning, (2) a clinically significant score on the Children’s Depression Inventory, indicating whether
children 7 years old and older may have diagnosable depression, or (3) a clinically significant score
on the posttraumatic stress disorder (PTSD) scale of the Trauma Symptoms Checklist, indicating
whether children 8 years old and older may have diagnosable PTSD. The data presented are from
the 36% of the children in the total NSCAW sample who met the criteria.
5
The in-home group includes children who were living with biological parents, adoptive parents, or
in informal kin care settings. The in-home group includes children who were eligible for Medicaid
and children who were not eligible for Medicaid. Medicaid eligibility may impact access to services.
6
Within the specialty MH services only category, 3.1% received only primary care, 21.5% received
only school-based mental health services, and 2.3% received only primary care and school-based
mental health services.
1

Within the meds + specialty MH services category, 18.4% received meds + only primary care, 6.9%
received meds + only school-based mental health services, and 2.6% received meds + only primary
care and school-based mental health services.
8
The out-of-home group includes children who were living in a formal kin care setting, foster care, a
group home, or a residential treatment center. Rates of psychotropic use were substantially higher
for children in group homes and residential treatment centers, compared with children in formal
kin and foster care, which may have somewhat inflated mean levels of use in the out-of-home
group.
9
Within the specialty MH services only category, 3.6% received only primary care, 2.6% received
only school-based mental health services, and no children received only primary care and schoolbased mental health services.
10
Within the meds + specialty MH services category, 1.4% received meds + only primary care, 1.1%
received meds + only school-based mental health services, and 8.5% received meds + only primary
care and school-based mental health services.
7

Source: The National Survey of Child and Adolescent Well-Being II (NSCAW II) is the second
nationally representative sample of children reported to child protective services sponsored by the
Administration for Children, Youth and Families (ACF). The survey collects data by administering
questionnaires to a representative sample of the population through face-to-face interviews with
caseworkers, children, caregivers, and teachers.

The Child Well-Being Spotlight may be copied without permission. Suggested citation:
Stambaugh, L.F., Leslie, L.K., Ringeisen, H., Smith, K., & Hodgkin, D. (2012). NSCAW
Child Well-Being Spotlight: Children in Out-of-Home Placements Receive More Psychotropic
Medication and Other Mental Health Services than Children Who Remain In-Home Following a
Maltreatment Investigation. OPRE Report #2012-43, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health
and Human Services. Find this report and those on similar topics online at: http://www.acf.
hhs.gov/programs/opre/ abuse_neglect/nscaw/