Differential Response with Lower Risk and Foreign-born Families: Understanding Risks, Services and Outcomes

Child abuse and neglect is a serious public health problem, whose prevention efforts are much needed to avoid a number of serious and irrevocable negative consequences. Currently, the majority of early prevention approaches are community based with fairly strict eligibility criteria. Public child welfare system has yet to settle on a clear paradigm for early prevention. As many states are considering extending their services to reports screened out of Child Protective Services (CPS), there is a need to better understand the utilization and effectiveness of such early preventative services. Additionally, changing American cultural landscape has presented challenges to the field in how to best address family needs and child safety of the foreign-born population. Parent Support Outreach Program (PSOP) is an early CPS response and service model to screened-out reports using Differential Response (DR) philosophy to identify family needs and strengths and provide them with services addressing those needs. Mixed methods design included a quasi-experiment using propensity score methods to compare families’ risk, services, and outcomes in PSOP (n=1,964) and standard DR (n=1,793) programs and between US-born (n=2,755) and foreign-born (n=1,002) population. In addition, qualitative interviews with program workers (n=15) were collected to examine workers’ perceptions about program and population differences. The quantitative data included longitudinal administrative child welfare service, unemployment insurance, and income maintenance as well as cross-sectional worker survey and the U.S. Census data. Subsequent screened-in and screened-out maltreatment reports, out of home placement, mental health and substance abuse services as well as economic well-being were the primary outcomes of interest. Compared to a standard DR program, PSOP served families had a higher or equal number of risk factors across most family functioning domains, except for substance abuse, problematic parenting, and prior CPS history. Face-to-face and other contacts with program workers were greater for PSOP than DR families involved in the assessment stage while DR provided more contacts for families receiving case management services. Poverty-related services were the most frequently received services by PSOP families. PSOP families experienced significantly fewer screened-in and screened-out CPS reports and out of home placements and received more adult mental health services than DR families. Null effects were found for the receipt of children’s mental health and adult substance abuse services as well as economic well-being outcomes. Programmatic effects varied by population socio-demographic subgroups while service factors moderated the relationship between risks and outcomes. There were significant differences in risks, services, and outcomes across racial, ethnic, and national groups. There is a great need for child welfare services to focus not only on child safety but also on risk factors observed for the family. By targeting risks prospectively and focusing on child well-being broadly, maltreatment prevention would take a much needed proactive focus in the child welfare policy. Strong support for PSOP effectiveness found in this study should inform other states’ efforts in extending services to the screened-out families. High number of risk factors and comprised well-being over time among the foreign-born population call for their active inclusion in the child welfare prevention programs, best administered through community partners