We spend a lot of time thinking about teams here at the Traumatic Stress Studies (TSS) Group, particularly the impact that multidisciplinary teams can have in responding to trauma and violence in our communities.
I had a chance recently to talk about the study findings with Tiffany Madrid, the Director of Legislative Affairs and Policy for Colorado’s Child Protection Ombudsman (CPO) and Dr. Kristin Klopfenstein, the Director of the Colorado Evaluation and Action Lab, who supported our research.
You can read more about our conversation here, or take a look below!
by Adi Rosenthal, 3rd Year Graduate Student, TSS Group
Each year in the United States, about 3.5 million children are the center of child abuse or neglect investigations. These children are arguably our country’s most vulnerable. Often, the well-being of these children can be supported by providing services to their caregivers based on families’ needs.
Unfortunately, caregivers involved in child welfare say they receive fewer services than they want and need, and they face barriers to accessing those services.
Many researchers have examined the mental health service needs of families involved in child welfare, but caregivers’ needs reach beyond psychological. Families also have physical health needs, such as medical care and access to healthy food; school-based needs such as tutoring, extra-curriculars, and testing for learning disorders; basic needs such as food, clothing, shelter; and needs related to social support from their friends and community.
Caregivers face numerous barriers in getting these needs met, including skepticism about services and fear of judgement as well as external barriers, such as lack of financial resources and services not being available.
Unfortunately, measures that get at families’ diverse needs and barriers haven’t been available, leaving researchers and service providers unable to formally assess the caregivers’ needs, and in turn, address them.
The TSS Group set out to create a measure of service needs and barriers across service areas, which we’re calling the Checklist of Service Needs and Barriers (C-SNAB). We drafted items for this measure based on previous research about families’ needs. The measure included several areas: basic needs (such as clothing, diapers, and other non-food items, paying bills, housing), physical health (such as medical care, access to healthy food, insurance), school-based services (such as tutoring, extra-curriculars, and testing for learning disorders), mental health (such as therapy for child or caregiver, substance use treatment, parenting support), and social support (such as mentorship, support from a religious or cultural community). The measure also includes a checklist of barriers for caregivers to indicate what makes access to services challenging. This checklist includes logistic barriers (such as not having a computer or transportation), structural barriers (such as services not being available or not being affordable), and barriers related to stigma or uncertainty about services.
Next, we asked 32 caregivers of children involved in abuse or neglect investigations to fill out C-SNAB in order to examine how well the measure, designed based on past research, picked up on the day-to-day barriers and needs facing caregivers.
Here’s what we learned.
The C-SNAB seemed to capture the breadth of needs and barriers families faced. Nearly all (94%) of the caregivers interviewed had at least one unmet service need. On average, caregivers reported experiencing 4 unmet service needs.
Caregivers commonly reported needs across more than just one service area. Basic needs showed up most frequently, followed by physical health, school-based needs, mental health needs, and social support.
Caregivers had the greatest unmet needs in the basic needs category, which included things like needing help paying bills or rent, getting diapers or clothing, and fixing things that are broken in their home or neighborhood. In fact, 50% of caregivers reported having unmet basic needs. This fits with past research that has shown families involved in child welfare investigations are disproportionality from low socioeconomic groups. This suggests that when families show up for child abuse investigations, they are likely to have high levels of economic needs.
Needs weren’t the whole story. Families faced many barriers – an average of seven, in fact! Most commonly, caregivers reported not being able to afford services, not being sure how to obtain them, not having enough time, and lack of availability of services in their community.
Families described facing the greatest barriers in their efforts to get school-based, medical, and mental-health services. Accessing these kinds of services require navigating complex organizations, such as school boards and administrators, insurance companies, and often numerous different healthcare providers. This finding suggests that caregivers may benefit from warm hand-offs between providers and help navigating these complicated systems. Early and hands-on coordination of services could have a meaningful impact on the trajectories and wellbeing of families and children.
Our work on this new measure indicates that caregivers involved in child abuse and neglect investigations have many unmet needs, which was not surprising given the sheer number of barriers they faced. Preliminary analyses suggest that the C-SNAP was an efficient and useful tool for gathering information about their needs and barriers.
This study has potentially important implications at this moment in time, when communities are grappling in new ways with how systems fail people of color. Families from Black Indigenous People of Color communities have long histories of being treated differently in child welfare and other systems. For example, twice as many black children in the child welfare system are placed in foster care compared to white children, even when the cases are similar. For black and minoritized caregivers, expressing their service needs could mean being blamed for those needs or invoke fear that their needs will be used against them or reinforce “disparaging stereotypes about Black family unfitness and need for white supervision”
We hope that the C-SNAB’s inclusion of service needs AND barriers conveys to families that difficulties aren’t reflective of something about them; rather, barriers to getting their family’s needs met are real and worthy of attention. Supporting caregivers by reducing barriers and meeting their service needs is a critical path to improving child wellbeing and safety. Accurate assessment of these needs and barriers is a critical step.
Acknowledgments: This research was supported by a grant from the Colorado Evaluation and Action Lab to Anne DePrince and Julia Dmitrieva. Thank you to the project’s government partners as well as the Traumatic Stress Studies Group for making this work possible.