Child Welfare Issues and Perspectives

CHILD WELFARE ISSUES AND PERSPECTIVES No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services.

CHILD WELFARE ISSUES AND PERSPECTIVES

STEVEN J. QUINTERO EDITOR

Nova Science Publishers, Inc. New York

Copyright © 2009 by Nova Science Publishers, Inc.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Child welfare issues and perspectives / editor, Steven J. Quintero. p. cm. Includes index. ISBN 978-1-60741-409-4 (E-Book) 1. Child welfare. I. Quintero, Steven J. HV713.C38285 2009 362.7--dc22 2008051260 Published by Nova Science Publishers, Inc.  New York

CONTENTS Preface

vii

Research and Review Studies Chapter 1

Kinship Care with Hispanic Children: Barriers and Obstacles to Policy and Practice Implementation Rebecca Gomez, Jodi Berger Cardoso and Sanna J. Thompson

Chapter 2

Children of Color in the Child Welfare System Jillian Jimenez and Ruth M. Chambers

Chapter 3

Ethical Issues in Child Welfare: An Overview for Mental Health Professionals Jeffrey H. Sieracki, Jessica A. Snowden, Amy M. Lyons and Scott C. Leon

Chapter 4

Chapter 5

Chapter 6

17

33

The Role of Parent-Adolescent Connection in Child Welfare: A Study of High School Students in Transylvania, Romania Laszlo Brassai and Bettina F. Piko

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Is it Better to Live in Rural or Urban Areas? A Worldwide Study on Child Health Aravinda Guntupalli and Daniel Schwekendiek

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Child Welfare Revised: The Case of the Communist Development Country North Korea Daniel Schwekendiek

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Chapter 7

Using Private Contracts to Create Adoptions from Foster Care Mary Eschelbach Hansen

Chapter 8

Child Custody Proceedings under the Indian Child Welfare Act: An Overview Kamilah M. Holder

Chapter 9

1

State and Family and Medical Leave Laws Jon O. Shimabukuro, Cassandra LaNel Foley and Tara Alexandra Rainson

113

127 135

vi Short Comm.

Index

Steven J. Quintero Psychopathic Personality Features and the Child Welfare System: Implications for Prevention of Problems over the Life-Course Michael G. Vaughn, Matt DeLisi, Kevin M. Beaver and John Paul Wright

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157

PREFACE Research suggests that placement in kinship care is directly linked to a decrease in the total number of displacement disruptions for children in the child welfare system. However, Hispanic children appear at a higher risk for non-kinship care placement. This book addresses such problems and policies on kinship care and barriers to implementation of child welfare policies with immigrant and mixed-status children. Child welfare is also closely related to parent-child connections. Thus, the parent-child connection is discussed as well as the authoritative/supportive parenting styles of the mother and father, which seem to protect adolescents against substance abuse. The rural-urban malnutrition rates of children living in up to 93 countries were examined and discussed. Political stability and how it affects the rural-urban malnutrition ratio, especially in democratic systems were also looked at. In addition, the human welfare system in North Korea was examined, for example, by looking at the heights of their children. Stature can assumed to be an appropriate indicator in many situations. Other such advantages and disadvantage indicators are discussed in this book. Finally, the organization of the delivery of social services to waiting children and the prospective adoptive families, which influence adoption creation are reviewed. Cross-section time-series estimates are supplemented with a new augmented fixed effects procedure to demonstrate that the use of contracts with private agencies bolsters adoption creation. Chapter 1 - Research suggests that placement in kinship care is directly linked to a decrease in the total number of placement disruptions for children in the child welfare system. Kinship care also results in improved stability and outcomes for children post-placement. In 2006, the Administration for Children and Families estimated that 19% (96,967) of children in foster care nationwide were Hispanic. Forty-six percent of all Hispanic children are placed in non-kinship foster care settings. Congregate care (e.g. group homes and other residential settings) is the second most common placement for Hispanic children. The statistics show that kinship care is highly utilized and successful for Hispanic children. This is due in large part to the family and cultural values of the Hispanic community. Despite a community culture and tradition that supports the values of kinship care, recent studies from Texas suggest that systemic factors may hindering kinship care for immigrants and children of immigrants. Current national statistics of Hispanic children in kinship care indicate that this placement option is highly supported by the Hispanic community. Unfortunately, when states

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with high Hispanic populations are examined more closely, it appears that recent immigrants and their children are at greater disadvantage concerning kinship care placements. Immigrant children and children growing up in mixed status families (those comprised of one or more foreign-born parents and one or more U.S. citizen children) have limited access to kinship care within the child welfare system. With the growing number of foreign born Hispanic children, the current research suggests that the rate of Hispanic immigrants and children in mixed-status families in the child welfare system will continue to increase. The lack of effective policies and practices with this population is a risk factor for disproportional service delivery in the future. To address this area of concern, this analysis addresses current policies on kinship care and barriers to implementation of child welfare policies with immigrant and mixed-status children. Psychological, developmental, and social consequences of kinship placement are explored. Due to the high concentration of foreign born populations, and its close proximity to the Mexican border, Texas served as a case example for this analysis. Chapter 2 - The disproportionate levels of ethnic minority children in the child welfare system have been a long standing concern. In recent years, however, due to increasing numbers of children in the foster care system, much more research has been conducted and our understanding of this issue has increased significantly. The current statistics are startling. This chapter will first review the prevalence and primary causes associated with disproportionality in the child welfare system between 2003-2008. Second, African American, Native American and Latino populations will be presented including relevant statistics, causes and if applicable, specific child welfare polices. This chapter will also discuss disproportionality and disparity for African American, Native American and Latino children in the child welfare system. It will also highlight the major causes of this problem and provide a critique of relevant policies. Chapter 3 - What are the ethical considerations that psychologists, psychiatrists, social workers, and other mental health professionals must take into account when working with the child welfare population? How does a child welfare professional juggle the demands of the child, biological parent(s), foster parent(s), and the courts while remaining responsible to the ethics of his or her profession? This chapter addresses ethical conflicts that might arise when psychologists and other mental health professionals assess, treat, or research children and adolescents in the child welfare system. This chapter reviews the child welfare system and the role of various professionals in child welfare, and a summary is presented of ethical guidelines from the American Psychological Association (APA), the American Psychiatric Association (APA), the National Association of Social Workers (NASW), and other ethics documents from related professions that pertain to this population. Although ethical codes and guidelines have been published by various organizations, the aim of this chapter is to synthesize this vital information and discuss the implications and controversies related to working with the child welfare population. Chapter 4 - Child welfare is closely related to parent-child connection. Adolescence is particularly a difficult transition period influencing child welfare. Problems between adolescents and their parents may be detected by indicators of child welfare, among others, adolescent substance us. This study presents the results of a research with a sample of Transylvanian youth (in Saint George, Romania). Data collection was going on in a sample of high school students and the study included items measuring frequencies of smoking, alcohol use and illicit drug use as well as aspects of familial influences of youth’s substance use (such

Preface

ix

as family structure, the quality of the relationship with parents, parental conflicts and the ways of coping with them). Based on a comparison of prevalence rates and frequency distributions, we may conclude that the initiation of substance use may be dated at around 1516 years of age. Regarding frequencies of smoking and alcohol use, most students have already tried or used them regularly. Gender, family structure, and conflicts with parents proved to be risk factors for all types of substance use. Based on the analysis of parent-child connection, authoritative/supportive parenting style of mother and authoritarian/hard parenting style of father seem to be protective against adolescent substance use. These results may highlight the role of cultural variations in child welfare since parenting efficacy may depend on the special cultural context. Chapter 5 - Several studies have emphasized and reemphasized the rural-urban divide in living standards. Yet, these studies focused on specific countries or sub-regions of the world. Conducting a worldwide comparison, we investigate rural-urban malnutrition rates of children living in up to 93 countries at the end of the millennium (1995-2001). An interesting comparative finding is that in 97% of the countries examined, more rural than urban children were stunted. On average, rural malnutrition rates are 10% points higher than urban ones. These differences become pronounced in Latin-America; while by far, the greatest disparity of a single country is found in China. Analyzing the causes, we find that political stability per se as well as political stability in specifically democratic systems significantly decreases the rural-urban malnutrition ratio. However, we could not establish a significant relation between disease environment and rural-urban divide in the standard of living. Chapter 6 - This article assesses human welfare in North Korea. Very little information is generally available on the North Korea, a country which has drastically sealed itself off from the rest of the world since its political formation, and can largely be described as a statistical terra incognita. Thus, when it comes to typical human welfare indicators like GDP per capita, life expectancy, infant mortality, literacy rates or the human development index of the United Nations, we here argue that they are either statistically unavailable, politically manipulated, full of measurement errors, or fail completely to capture human development as a consequence of communist market distortions in North Korea. Considering a totalitarian regime, we can receive a unique glimpse at nation’s human welfare state by looking at the heights of their children. Stature can assumed to be an appropriate indicator in many situations. As distinct from conventional performance indicators, anthropometric measurements are politically incorruptible and quite sensitive to human development. Moreover, as distinct from demographic and economic indicators, in order to obtain anthropometric variables, one is not dependent on theoretical assumptions or underlying data on the population and the economy. This is because as body height is measured physically, measurement errors become in fact negligible. Most importantly, in a Maslowian sense, height and weight account for physiological human needs, which can be supposed to play a primary role for the people living in a developing country like North Korea. Given these advantages (and the discussed disadvantages of conventional indicators), we here argue that stature seem to be the first-best indicator for child welfare in North Korea. In the year 2002, we find a gap of 13 cm between North and South Korean boys – largely reflecting socioeconomic disparities between the two Koreas. Chapter 7 Creating adoptions for children waiting in foster care is a good investment, but the number of adoptions created each year meets only a fraction of the need. This paper explores how the organization of the delivery of social services to waiting children and

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prospective adoptive families influences adoption creation. Cross-section time-series estimates are supplemented with a new augmented fixed effects procedure to demonstrate that the use of contracts with private agencies bolsters adoption creation. Contracts for recruitment and orientation of prospective adoptive parents are particularly effective. Chapter 8 - In 1978, Congress enacted the Indian Child Welfare Act (ICWA) in response to legislative findings of harm caused to Indian children, their families, and tribes by the high separation rate of Indian children from their homes and cultural environments. Congress addressed this situation by granting Indian tribes and Indian parents an enhanced role in determining when to remove Indian children from their homes and cultural environments. Specifically, the ICWA enumerates provisions for tribal jurisdiction and tribal intervention in state court proceedings concerning the custody, adoption, foster care placement, and termination of parental rights of Indian children. No bills amending the ICWA were introduced in the 109th Congress. Still, the debate over provisions of the ICWA remains an issue of concern. This CRS report provides an overview of some of the goals and provisions of the Indian Child Welfare Act. Chapter 9 - In 1993, Congress passed the Family and Medical Leave Act (“FMLA”) to “balance the demands of the workplace with the needs of families.” When the FMLA was enacted, it supplemented approximately 30 state statutes that provided some form of family and medical leave to employees who worked in those states. Although the FMLA and state family and medical leave laws are generally similar with regard to the availability of leave, they differ both in terms of coverage and scope. This article includes summaries of the family and medical leave laws of forty-five states and the District of Columbia. Laws pertaining to family and medical leave and maternity leave were not found in the codes of all 50 states. Summaries of the relevant leave statutes and regulations are organized in alphabetical order. Short Communication - The past ten years have witnessed a remarkable surge of research on psychopathy (i.e., psychopathic personality) in children and adolescents. Although possessing a long history in the psychological and psychiatric sciences (Vaughn & Howard, 2005), the downward extension of psychopathy to youth is fraught with numerous problems and prospects. One benefit may be the potential ability to identify and intervene with children who manifest behaviors and thoughts characteristic of psychopathy such as lack of empathy for others, a diminished capacity for self-control, and manipulative behavior. This is important given the robust criminological literature based on birth-cohort and longitudinal investigations that has established that approximately 5 to 10% of persons account for the majority of offending (DeLisi, 2005). Individuals with psychopathic personality features are responsible for a large share of not only crime but also drug abuse, family burden, and medical and judicial costs associated with this deleterious mix of personality traits. Thus, forestalling these life-course problems are of tremendous benefit to society at large, as well as to the children afflicted with these traits. This commentary will focus on the available research on psychopathic personality traits and children in the child welfare system. Salient issues and several new avenues for future research and early intervention are proffered.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 1

KINSHIP CARE WITH HISPANIC CHILDREN: BARRIERS AND OBSTACLES TO POLICY AND PRACTICE IMPLEMENTATION Rebecca Gomez, Jodi Berger Cardoso and Sanna J. Thompson University of Texas at Austin, TX

ABSTRACT Research suggests that placement in kinship care is directly linked to a decrease in the total number of placement disruptions for children in the child welfare system. Kinship care also results in improved stability and outcomes for children post-placement (Berrick, Barth, & Needell, 1994). In 2006, the Administration for Children and Families estimated that 19% (96,967) of children in foster care nationwide were Hispanic (U.S. Department of Health and Human Services, 2006). Forty-six percent of all Hispanic children are placed in non-kinship foster care settings (Wulczyn et al., 2007). Congregate care (e.g. group homes and other residential settings) is the second most common placement for Hispanic children. The statistics show that kinship care is highly utilized and successful for Hispanic children. This is due in large part to the family and cultural values of the Hispanic community (Bissell and Miller, 2003). Despite a community culture and tradition that supports the values of kinship care, recent studies from Texas suggest that systemic factors may hindering kinship care for immigrants and children of immigrants (Vericker, et al., 2007). Current national statistics of Hispanic children in kinship care indicate that this placement option is highly supported by the Hispanic community. Unfortunately, when states with high Hispanic populations are examined more closely, it appears that recent immigrants and their children are at greater disadvantage concerning kinship care placements (Vericker, et al., 2007). Immigrant children and children growing up in mixed status families (those comprised of one or more foreign-born parents and one or more U.S. citizen children) have limited access to kinship care within the child welfare system. With the growing number of foreign born Hispanic children, the current research suggests that the rate of Hispanic immigrants and children in mixed-status families in the child welfare system

2

Rebecca Gomez, Jodi Berger Cardoso and Sanna J. Thompson will continue to increase. The lack of effective policies and practices with this population is a risk factor for disproportional service delivery in the future. To address this area of concern, this analysis addresses current policies on kinship care and barriers to implementation of child welfare policies with immigrant and mixed-status children. Psychological, developmental, and social consequences of kinship placement are explored. Due to the high concentration of foreign born populations, and its close proximity to the Mexican border, Texas served as a case example for this analysis.

INTRODUCTION Historically, families and communities have found ways to support and care for neglected and maltreated children. Extended families, such as grandparents, have been especially valuable in providing care for these children and have become an essential safety net for children whose parents struggle to care for them. This tradition of kinship care has been particularly significant in communities of color who have historically placed an emphasis on the involvement of extended family as a primary source of support to parents (Casey Family Programs, 2004). Foramalized kinship care is a fairly new method of caring for the nation’s children. Beginning in the 1980’s, public child welfare agencies began to formally utilize extended families to care for children entering the child welfare system (Casey Family Programs, 2004). Since its inception, utilization of kinship care as a placement option by child welfare agencies has grown significantly (Geen, 2003). Although actual rates for private/informal kinship care arrangements are difficult to determine and monitor as state reporting varies by the accepted definition of kinship foster care, placement rates for children in kinship care vary widely across the United States. While studies indicate an increase in the number of kinship care placements, traditional non-kinship care placements remain about four times more frequent than kinship care placements (Urban Institute, 2008). Kinship care involves the placement of children in out-of-home care with relatives by informal and formal means. Children reside with and receive care from relatives or family friends in lieu of birth parents. Kinship care typically refers to biological relatives, but the definition of kin also encompasses adults with whom the child has a strong pre-existing bond, such as godparents or other close family relations and friends (Berrick & Barth, 1994; Dubowitz et al., 1994). Agencies and state systems, who are mandated to organize care for and protect children, give preference to relatives when it is necessary to place children away from their own biological parents (Hegar, 1993). State child welfare agencies vary in their definition of individuals who are designated as kin. Twenty-four states define kin as those related by blood, marriage, or adoption; twentytwo states provide a broader definition that includes individuals who have significant relationships with the child(ren) and may include neighbors and close family friends. Five states have no definition for the individuals designated as kin (Geen, 2003). Kinship care arrangements can take place under various structures, including informal, voluntary, and formal care. Informal or private kinship care occurs without involvement of formal child welfare agencies as arrangements are made unofficially by biological parents for the care of the child(ren) by a relative or close family friend. The biological parent retains legal custody of the child and maintains control concerning their child’s reunification to their

Kinship Care with Hispanic Children

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care. Without formal or legal support, this type of care creates difficulties for the kinship caregivers when attempting to carry out activities associated with formal institutions, such as enrolling the child in school or seeking medical treatment. Voluntary kinship care refers to placement of the child with relatives through the involvement of formal child welfare agencies, but without the state agency taking legal custody of the child. In these situations, the parent is typically unable or unwilling to care for the child, but the child does not formally enter state custody. These types of placements typically occur when child welfare agencies give parents the choice to voluntary place their child in the care of other family members in lieu of legally removing the child and placing them in traditional foster care. If it is determined by the child protective service worker that the parent has temporary or permanent inability to care for their child, but does not require the forcible removal of the child from the home, the child is removed for his/her own safety and a relative or family member is sought to care for the child. Formal kinship care involves legal removal of the child from the biological parents and the court places the child with family caregivers. Formal kinship care is a unique form of foster care that does not exclude relatives from the definition of foster parents. Kinship caregivers are granted physical custody of the child; however, the state retains legal custody and responsibility for the appropriateness of the placement. The child welfare agencies report to the court concerning the child’s well-being and are responsible for ensuring that foster care involved children are assessed for service needs, receive the services required to meet those needs, and facilitate parental visitation and reunification activities as ordered by the court.

KINSHIP CARE Policies in Kinship Care Federal policies have increased kinship care placements by providing financial support of caregivers. The 1950 amendment to the Social Security Act allowed eligible relatives to receive aid for themselves and the children under their care as part of the Aid to Families with Dependent Children (AFDC) program (Social Security Act, 1950). The current Temporary Assistance to Needy Families (TANF) program allows for grants to relatives caring for a child in a kinship placement, regardless of the relative’s income (Personal Responsibility and Work Opportunity Act, 1996). Title IV of the Social Security Act of 1962 established reimbursements to licensed foster parents but excluded kinship caregivers (Social Security Act, 1962). Although these programs have provided some financial assistance to relatives providing care for a family member’s child(ren), payment rates for these families are significantly less than those povided to licensed foster care providers (Geen, 2003). The courts also have been influential in increasing the number of kinship placements. In the 1979 court case, Miller v. Yuokim, the United States Supreme court ruled that relatives caring for children were entitled to federal foster care payments if they met the same licensing standards as non-relative foster care placements (Miller v. Youakim, 1979). The court, however, failed to provide similar financial support for relatives who did not meet state licensing requirements or children who were not eligible for federal foster care funds (e.g. non- citizen children).

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The Indian Child Welfare Act of 1978 and the Adoption Assistance and Child Welfare Act of 1980 (Adoption Assistance and Child Welfare Act of 1980) gave preference to relative caregivers as sources for foster care placements (Indian Child Welfare Act, 1978; Adoption Assistance and Child Welfare Act of 1980). These acts mandated that relatives receive priority over non-relative caregivers when a child is being placed. The Indian Child Welfare Act specifically stated that Native American children in foster care must be placed with extended family whenever possible and in placements that were nearest their home (Indian Child Welfare Act, 1978). The Adoption Assistance and Child Welfare Act of 1980 required that state child protective service agencies place children in substitute care settings that were the least restrictive possible (Adoption Assistance and Child Welfare Act of 1980). Prior to the passage of this Act, relatives and kin were rarely used as foster placements (United States General Accounting Office, 1999). Following the implementation of this Act, however, child welfare agencies identified kinship care as the least restrictive placement possible. This increased the numbers of children placed with relatives or kin (United States General Accounting Office, 1999). In addition, the Personal Responsibility and Work Opportunity Reconciliation Act required that states give priority to family members when placing children in out-of-home care (Personal Responsibility and Work Opportunity Reconciliation Act, 1996). Therefore, by 1996 almost all states had implemented specific policies giving preference to family members when placing children in out-of-home settings (Boot and Geen, 1999). In 1997, The Adoption and Safe Families Act was passed (Adoption and Safe Families Act, 1997). The purpose of the act was to increase permanency for children by implementing strict guidelines regarding the length of time children could remain in foster care. This Act gave special preference to kinship caregivers and allowed states to extend the time frame for termination in cases where the child was being cared for by a relative (Adoption and Safe Families Act, 1997). In addition, this Act acknowledged the possibility of kinship care as a permanent placement for a child and allowed federal reimbursement of states for payments to kinship caregivers when those caregivers met the same licensing standards as traditional foster placements (Adoption and Safe Families Act, 1997). On October 7, 2008 the Fostering Connections to Success and Increasing Adoptions Act of 2008 was signed into law (Fostering Connections to Success and Increasing Adoptions Act, 2008). This Act is expected to impact kinship placement in two ways. First, the Act changes policies for notifying potential relatives. The Act requires that states must exercise due diligence in attempting to notify all adult relatives within 30 days of removing a child from their parents custody (Fostering Connections to Success and Increasing Adoptions Act, 2008). Second, the Act provide additional federal funding for kinship guardianship programs. This means that if a state provides payments to relatives who are the legal guardianship of a child the federal government will partially reimburse the state for this expense (Fostering Connections to Success and Increasing Adoptions Act, 2008). To qualify for payments the relative must be a licensed foster parent and the child must qualify for foster care payments. Although this change in standards for reimbursement is a step toward assisting kinship care providers, many kinship care providers are prohibited from receiving reimbursements because they cannot meet specific foster care licensing criteria, such as space requirements, income guidelines, and background checks. In addition, some immigrant children do not qualify for foster care payments.

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History and Rationale for Kinship Care The number of children in state custody placed with kinship caregivers grew from 18% in 1986 to 31% in 1990 (United States Census Bureau, 2006). According to the U.S. Census, 2.5million children resided with family members other than their birth parents in 2005 (United States Census Bureau, 2006). This was a 55% increase from 1990 (United States Census Bureau, 2006). The Urban Institute estimates 1,760,000 children were in private kinship care, 140,000 were in voluntary foster care and 400,000 were in formal kinship care in 2002 (Urban Institute, 2006). Approximately half of children in kinship care are between the ages of 11 and 16; 59% live with grandparents, 19% live with aunts/uncles and 22% live with other relatives (Urban Institute, 2008). The growth in rates of children in kinship care can be attributed to several factors. First, federal mandates require that the least restrictive environment must be sought for out-of-home placements. Children must be placed in settings that do not limit their developmental needs and continued interaction with social and emotional supports. Utilizing family members as care givers often results in children remaining in the same school and neighborhood postremoval (United States General Accounting Office, 1999). Another reason for the increase in the growing prevalence of kinship care is related to the shortage of licensed foster parents and available foster homes, as well as the increases in the number of children requiring placement (Center for the Study of Social Policy, 1990a). It has become increasingly difficult for child protective agencies to maintain the number of foster parents needed to meet the demand for out-of-home placements. In addition, there is growing evidence of the value of kinship care placements in providing stability and permanency to children in foster care. Research has shown that nearly two-thirds of children in kinship care with family members were in stable settings three years after placement compared to only one-third of children in foster care who achieved this level of stability (Rubin, Downes, O'Reilly, Mekonnen, Luan, and Localio, 2008). Other research suggests that placement in kinship care is directly linked to a decrease in the total number of placement disruptions for children in the child welfare system (Berrick, Barth, & Needell, 1994; Jones & Chipungu, 2003; Prohn, 1994; United States General Accounting Office, 1999). Kin providers are more likely to live in the same communities as the child(ren), resulting in less disruption to the child’s life and improved stability and outcomes for children post-placement (United States General Accounting Agency, 1999). Thus, greater emphasis is being placed on identifying relatives rather than formal foster parents to provide temporary care for these children. Kinship care placements are now considered the most desirable placement option for children when they must be separated from their biological parents.

Kinship and Child Outcomes Child welfare agencies and case managers aim to maintain consistency in children’s lives after they have been removed from parental homes. Kinship placements appear to improve these outcomes as it has been well documented that children in kinship care experience fewer changes in placement than children in non-kinship care (Berrick et al., 1994; Jones & Chipungu, 2003; Prohn, 1994; United States General Accounting Office, 1999). They are also more likely to be placed with siblings, continue contact with biological parents (Jones &

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Chipungu, 2003), and eventually reunify with their parent(s) (Conway & Hutson, 2007). Moreover, research indicates that children in kinship placements feel more connected, loved, and supported by their caregivers, report higher levels of self-esteem, have stronger ties to extended social networks, and are more engaged in extracurricular activities than are children in formal foster care (Jones & Chipungu, 2003). Previous studies indicate that since children traditionally have an established relationship with family caregivers with whom they are placed, trauma and psychological harm are minimized (Gleeson and Craig 1994; National Commission on Family Foster Care, 1991). Kinship care may be less disruptive to the child’s life and may assist in building and improving existing family bonds and relationships (Iglehart, 1994). These children experience less separation anxiety or adjustment, greater attachment, and fewer conduct problems than children in traditional foster care. They are also more accepting of guidance from caretakers (relatives, godparents, friends, neighbors), which results in fewer behavior and psychological problems (Crumley and Little, 1997). Several differences between children placed in kinship care and those placed in traditional foster care settings have been identified. Children in kinship care are younger than those in traditional foster care (Berrick, Needell, and Barth 1995; Chipungu et al. 1998). Kinship care placement occurs more frequently in the Southern regions of the United States than in other regions (Harden et al. 1997) and African American children are more frequently placed in foster care than other racial and ethnic groups (Chipungu, 1994).

Profiles of Kinship Caregivers There are also significant differences between kinship caregivers and traditional foster families. Kinship caregivers tend to be poorer and face greater economic hardships; a higher proportion of these caregivers have incomes that are below the federal poverty level (Brooks and Barth 1998, Ehrle and Geen 2002, Zimmerman et al. 1998). Moreover, kinship caregivers are often less likely to have a high school diploma than traditional foster parents (Chipungu et al. 1998; Ehrle and Geen 2002; Zimmerman et al. 1998). Kim caregivers are typically single parents; only about 40% of these caregivers are married (Pecura, LeProh, and Nasuti 1999). In contrast, approximately 75%-90% of non-relative foster care parents are married (Dubowitz et al., 1994). Relatives who provide temporary or permanent care for family member’s child(ren) are as varied as the situations into which children are placed. They include grandparents, aunts, uncles, older siblings, and cousins. Some have found that 50-70% of children placed with relatives live with grandparents, usually the maternal grandmother (Dubowitz et al., 1994). Since many kinship care providers are grandparents, they are also older than traditional foster parents (Brooks and Barth 1998; Ehrle and Geen 2002, Testa 1999) and care for large sibling groups (Berrick et al. 1994). Kinship caregivers are more likely to view themselves as responsible for encouraging contact between the child and their parents; as a result, children in kinship placements have more contact with their biological parents (LeProhn and Pecora, 1994). These caregivers often feel more positive about the children in their care; however, they also report feeling a lack of support from the child welfare agencies in terms of material goods and support services (Davidson, 1997). With this limited support, kinship caregivers report greater

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psychological problems than do other caregivers, suggesting greater need for enhanced support services, such as respite and transportation services (Fuller-Thomson and Minkler 2000; Robinson, Kropf and Myers 2000). Despite the greater economic hardship often experienced by families who take on the responsibility of caring for another relative’s child(ren), placement in kinship care is often encouraged due to the psychological and social benefits to the child. Although placement with kinship caregivers appears to minimize adjustment problems and maintain family ties, these caregivers often receive limited support to mediate the economic difficulties exacerbated by the placement.

Supports for Kinship Caregivers Kinship caregivers experience different needs than traditional foster families in several key areas. As previously stated, they are more likely to be poor, older, have less education, and care for large sibling groups (Berrick et. al, 1994; Geen, 2003). Thus, the most salient issue for kinship caregivers is financial need. Contrary to traditional foster parents who must meet income requirements before being licensed, kinship caregivers have often experienced financial problems prior to placement and the addition of children requiring care only exacerbates these financial difficulties (Bissell and Miller, 2004). Kinship caregivers have needs for child care assistance (Geen, 2003). As these caregivers often must accept the placement of their relative’s child with limited advance notice and often have little time to organize their resources to meet the immediate needs of the child, locating and financing appropriate child care becomes a primary financial concern (Geen, 2003). Because caregivers often accept the placement of a relative’s child(ren) with little advanced notice, they typically do not have the necessary child care items, such as cribs, toys, clothing, etc. Moreover, they may not have adequate space to meet licensing requirements which disqualify them from receiving foster care assistance and reimbursements (Geen, 2003). Although kinship caregivers have significant needs, they are offered fewer services and supports than traditional foster families. A review of case records in New York City indicated a deficit in the supervision of kinship foster homes. Kinship care homes are perceived by many workers as needing less supervision than other non-relative foster care homes (Task Force on Permanency Planning for Foster Children Inc., 1990). Others have suggested that the lack of attention and support for kinship caregivers is due to an overloaded system that cannot monitor all foster placements (Geen, 2003). Caseworkers recognize that the emotional bond among kinship caregivers is more likely to result in appropriate care of a relative’s child, despite a lack of services. Therefore, caseworkers may be less likely to offer support services to these kinship care providers. On the other hand, it is possible that kinship care providers resent agency intrusion in their parenting and therefore, seek and receive fewer supports and services in an effort to remain autonomous (Iglehart, 1994). Many states utilize private foster care agencies to license and support traditional foster families; kinship caregivers do not have a role in these private agencies and are excluded from utilizing this support (Testa et al., 2001). Also, kinship caregivers may be less aware of available services and less likely to request services (Metzger, 2004). Some kinship caregivers also attempt to keep their difficulties from caseworkers because they are fearful of agency involvement. Some believe that the agency may infer that their needs mean they are not capable of caring for the child and will remove the child from their home.

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Even when needs are identified, few services are available to kinship caregivers. Traditional foster parents qualify for most services through the licensing process. These services vary by state but include monthly foster care payments, health coverage, clothing stipends, respite care, school supplies, and child care subsidies (Geen, 2003; National Resource Center for Family-Centered Practice and Permanency Planning, 2007). Most kinship caregivers are not licensed providers. Requirements, such as income-level standards, adequate living space for the number of people in the household, U.S. citizenship, among other factors, may disqualify kin providers from receiving financial assistance and resources (Geen, 2003). The most common benefit utilized by kin caregivers is welfare payments. Welfare payments are much smaller than foster care payments and not available to all kinship caregivers. In order to qualify for these benefits, caregivers must meet the poverty guidelines and prove they are related to the child. Kinship caregivers who cannot produce a valid birth certificate to prove their relationship with the child, such as non-related kin (neighbors, family friends, godparents) are not eligible to receive welfare assistance (Geen, 2003). Unlike traditional foster care parents, kinship caregivers may be required to accept placement with little advance notice. Because kinship care providers often accept the child during a period of crisis (Testa, 2001), these caregivers do not have the advantage of extensive preparation time required to include a new child into their family system. With many caregivers having little experience with the bureaucratic system of child welfare, the result is waiting an extended amount of time for services. For kinship caregivers that may qualify as a licensed foster care parent, the process can take up to a year to complete. During this time, these family providers must learn to juggle the plethora of needs required by the child. In addition to maneuvering a highly bureaucratic system, care givers must use creative means to care for the child while they await concrete services. One important resource for kinship caregivers is subsidized guardianship. Subsidized guardianship occurs when a child is permanently placed with a kinship caregiver (American Bar Association, 2008; Bissell and Miller, 2003; Children’s Defense Fund, 2004). This option allows relatives or kin to provide a permanent home for children in situations where adoption may not be appropriate (American Bar Association, 2008; Children’s Defense Fund, 2004). An example of when adoption may not be the best option is when the child is older and does not wish to be adopted, but is unable to return to their biological parents. In these situations, kinship caregivers may provide a permanent home for the child. Subsidized guardianship is also important in ensuring culturally appropriate services to minority children who are overrepresented in the child welfare system (Bissell and Miller, 2003). Subsidized guardianship provides funding for a relative to provide care and vary widely by state; they can be equivalent to federal foster care payments or less than child-only TANF grants (American Bar Association, 2008; Children’s Defense Fund, 2004). Sources of funding for kinship caregivers are also widely varied across the country. Some states fund their programs using federal money, while others utilize limited state and local funds (Bissell and Miller, 2003). Federal funding requires a caregiver to be a United States citizen, which precludes many immigrant family members from becoming caregivers. Currently, 35 states and the District of Columbia offer subsidized guardianship programs (American Bar Association, 2008; Children’s Defense Fund, 2004). The fifteen states that do not offer subsidized guardianship programs include: Alabama, Arkansas, Maine, Michigan,

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Mississippi, New Hampshire, New York, Ohio, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, and Wisconsin (Children’s Defense Fund, 2004).

HISPANIC CHILDREN AND THE CHILD WELFARE SYSTEM Approximately one in five children in the U.S. lives in an immigrant family (Capps, Fix, Ost, Reardon-Anderson, & Passel, 2004). Immigrant families consist of both immigrant and U.S. born second-generation children (those born in the U.S. with at least one parent not born in the U.S). According Beaver and D’Amico (2005), 76% of children in immigrant families are born in the United States and Hispanics account for the largest immigrant group in the United States (Beavers & D'Amico, 2005; Capps et al., 2004). According to the 2000 Census, 52% of children living in immigrant households were from Latin America or had a parent from Latin America; 39% of these households identified Mexico as their country of origin (Beavers & D'Amico, 2005). An additional 9% of Hispanic children were born to two U.S. born parents. Previous research has shown that foreign born and U.S. born children in immigrant families face a number of disadvantages. In 2000, children in immigrant families represented one-fourth of all children in the United States living in poverty (Beavers & D'Amico, 2005). The percentage of foreign-born children living in poverty was much higher (29%) than the poverty rates for second-generation children (20%). Moreover, poverty for children growingup in Mexican-origin families was higher than for other Central and South American countries. With 31% of children migrating from Mexico living in poverty and one out of every three immigrant children originating in Mexico, the rates of poverty and other vulnerabilities of this ethnic subgroup are alarming (Beavers and D’Amico, 2005). In the Hispanic culture there is a strong value placed on extended family relationships and geographic closeness. Familism, a construct commonly used to describe the collective relationship between nuclear and extended family networks (Padilla & Villalobos, 2007), can be viewed as a protective factor for maintaining family cohesion. Family expectations and obligations are shared collectively among its members (Padilla, et al., 2007) and care of children is one example of shared responsibility among family members (Casey Family Programs, 2004). Although the extended family is available when needed, and are often willing to care for the child into adulthood (Casey Family Programs, 2004), Hispanic immigrant children and children of immigrants may underutilize kinship care due to a variety of citizenship barriers. While there are no known national statistics indicating the specific number of immigrant families in child welfare affected by citizenship barriers, Vericker, Kuehn, & Capps (2007) found that first and second generation Hispanic children in Texas were most often placed in residential and congregate care as opposed to kinship care because of these barriers. These findings are particularly concerning due to the growing number of immigrants in the United States.

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Hispanic Children and Foster Care While the national rates of Hispanic children in foster care is relatively low, these children are concentrated in states with large Hispanic populations. The National Data Analysis System (2005) found that Hispanic children in out-of-home foster care were concentrated primarily in five states: California, Texas, New York, Arizona and Massachusetts (Child Welfare League of America, 2007). In 2006, the Administration for Children and Families estimated that 19% (96,967) of children in foster care nationwide were Hispanic (U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children and Youth and Families, & Children's Bureau, 2006). Reports by the Child Welfare League of America (CWLA, 2000) found that the number of Hispanic children in the foster care system doubled from 8% to 15% in 1990-1999. However, between 2000 and 2005, the proportion of Hispanic children entering foster care each year stabilized to 8-10% (Wulczyn, Chen, & Brunner Hislop, 2007). Hispanic children account for approximately 10% of first admissions into foster care, while 48% of first admissions are Caucasian and 36% are African American (Wulczyn, Chen, & Brunner Hislop, 2007). Once in foster care, Hispanic children stay in care for shorter amounts of time than do Caucasian or African American children. Although Hispanic children are less likely than white children to be involved in a child protective services investigation, they are more likely to be placed in foster care once the process has been initiated. Moreover, Hispanic children are less likely to be adopted than white children (Hill, 2007). A child may experience several types of placements once they are removed from the household. Similar to African American and Caucasian children, traditional foster care with non-kin caregivers is the most common type of placement for Hispanic children. Forty-six percent of all Hispanic children are placed in non-kinship foster care settings (Wulczyn et al., 2007). Congregate care (e.g. group homes and other residential settings) is the second most common placement for Hispanic children. Compared to percentages of Caucasian (19%) and African American (20%) children, Hispanic children are the highest proportion in congregate care (28%).

Hispanic Children and Kinship Care In 2005, there were approximately 116,509 children in kinship care in the United States; of these children, approximately 22,231 were Hispanic children (Child Welfare League of America, 2007). During 2000-2005, 24% of Hispanic children were in kinship care compared to 23% of African American children and 19% of Caucasian children (Wulczyn et al., 2007). From a national perspective, Hispanic children were more likely to be in kinship care or spend time in traditional foster care than children from other racial and ethnic backgrounds (Wulczyn et al., 2007). By the end of 2005, approximately 9,858 (69.3%) Hispanic children in kinship care exited foster care (Foster Care Dynamics Report, 2007). Approximately 8.5% of Hispanic children exiting kinship care were reunified with their parents compared to 8.2% of African American children and 6.8% of Caucasian children (Wulczyn et al., 2007). However, across all types of care, Hispanic children were much more likely to run away from placements than

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African American and Caucasian children (Wulczyn et al., 2007) and remained in foster care rather than be adopted (Bissell and Miller, 2003). Although national and state estimates of the number of Hispanic children in kinship care exist, these figures vary significantly across states. The statistics show that kinship care is highly utilized and successful for Hispanic children. This is due in large part to the family and cultural values of the Hispanic community (Bissell and Miller, 2003). Hispanic families have the highest rate of two-parent families in the United States and extended families are often relied upon for social and financial support (Bissell and Miller, 2003). Despite a community culture and tradition that supports the values of kinship care, recent studies from Texas suggest that systemic factors may hindering kinship care for immigrants and children of immigrants (Vericker, et al., 2007).

Hispanic Families and Barriers to Kinship Care Hispanic immigrant children and children of immigrants encounter a number of barriers to kinship care placement. Many immigrant families leave behind their social and family supports when they migrate to the United States (Salgado de Snyder, 1987; Sluzki, 1979). Thus, children in immigrant families may have fewer kin available to offer support. Mandated background checks are another barrier to kinship care placement for Hispanic children, especially those whose parents have recently immigrated to the U.S. In accordance with section XXII from the Keeping Children and Families Safe Act of 2003 (P.L. 108-36), all prospective foster care parents and other adult relatives and non-relatives living in the household must obtain a background check before a child can be placed in temporary or permanent custody (United States Department of Health and Human Services, 2003). Because background checks require a social security number for the prospective foster parent, many immigrant families cannot complete this requirement. In some cases, caseworkers and family members may identify a placement with relatives living in a foreign country. Although there is no federal legislation concerning placement of child(ren) in kinship care across international lines, child protection agencies have formed Memorandums of Understanding with many of the countries in Latin America. Caseworkers can request a home study in the country where the placement is intended. Despite this policy, current data collection and reporting make it difficult to ascertain how many home studies are requested and conducted in Mexico and Latin America. Several impediments specific to placements in Mexico have been identified. One difficulty is the reluctance of judges to place children outside of the United States. Judges are particularly hesitant to place children who are United States citizens outside of the country regardless of the parents or relatives country of citizenship (Gambrel, 2006). This reluctance is due to difficulties involved with obtaining a home study in a foreign country, the limited capacity to assess the quality of the home study, and the unknown credentials of the home study provider (Gambrel, 2006). Child welfare agencies also considers the medical and therapeutic needs of the child when placing a child outside of the United States (Texas Department of Family and Protective Services, 2008). The medical and psychological treatment environment can be difficult to assess due to different licensing and care standards for providers in countries outside the United States. Moreover, U.S. citizen children are not likely to have access to Medicaid,

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Social Security, and/or Children’s Health Insurance Program (CHIP), which may limit their access to medical and psychological services. The out-of-pocket costs of these services are more likely to cause financial hardship and may impede the caregiver’s ability to provide for the child(ren). Language barriers and lack of bilingual services create additional barriers for caseworks and family members. Language difficulties may inhibit biological parents from effectively identifying available options for kinship care. Furthermore, young immigrant children may have limited English proficiency. If placed in substitute care settings, these children may not be able to communicate. Differences in food, culture, and language can add unnecessary stress to the child’s experiences, especially if the environment is completely unlike the one from which they were removed.

POLICY RECOMMENDATIONS In general, kinship caregivers have special needs and challenges. They are generally less prepared at the time of placement, face financial hardship, are less educated and less likely to utilize formal support networks and services (Brooks and Barth 1998, Ehrle and Geen 2002, Zimmerman et al. 1998). Current national statistics of Hispanic children in kinship care indicate that this placement option is highly supported by the Hispanic community. Unfortunately, when states with high Hispanic populations are examined more closely, it appears that recent immigrants and their children are at greater disadvantage concerning kinship care placements (Vericker, et al., 2007). There is limited research available to explain this system failure. However, recent research suggests several possible factors limiting the use of kinship care for this group. Certainly problems with communication, as well as the lack of familiarity of the child welfare and court systems, create barriers for immigrant families and caregivers. In addition, policies that prohibit the use of federal funds for non-citizen children and prohibit adoption by non-citizen caregivers hinder kinship placement for this group. Finally, judges and caseworkers lack knowledge and comfort with foreign child welfare agencies and are reluctant to place children with kinship caregivers who are out of the country. To address these barriers to kinship care with Hispanic families, several policy changes are needed to support kinship care among Latino immigrant families. The first recommendation is to increase the number of bilingual caseworkers, which will insure quality and culturally competent services. The ability of service providers to communicate appropriately with immigrant families is essential to identifying all possible kinship placements early in the process. Another essential component to improving kinship care placements with immigrant families is strengthening agency liaisons that are knowledgeable of both the child welfare and immigration systems. Child welfare agencies are in a prime position to facilitate working relationships with the liaisons, judges and attorneys in the United States, Mexico and other Latin American countries. If judges are familiar with child welfare services in these countries, they will be better prepared to access the appropriateness of placement across the border. Thus, improving communication between key players, such as judges, caseworkers, families,

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and international child welfare organizations may improve and expand placement options for these children. Increased legal representation is another important policy change that would likely improve outcomes for children from immigrant families. Research suggests that parents who are represented by an attorney are more likely to identify and advocate for kinship placements (Pew Commission on Children in Foster Care, 2008). Representation may be especially crucial for immigrants who are concerned about their legal status and are unfamiliar with the United States court system. Current adoption laws that restrict non-U.S. citizens from adopting children are additional impediments to kinship placement for immigrant Hispanic families. These laws prohibit adoption by non-U.S. citizens regardless of the relationship to the child or the length of time the child has been placed with the family. Once possible kinship caregivers are identified, the courts should consider placement with the family regardless of the kinship caregiver’s citizenship status. Barring changes in federal adoption laws, these may be cases where the utilization of subsidized guardianship is appropriate. This would allow permanent placement and funding for kinship caregivers, which is ultimately in the best interest of the child. Finally, because immigrants and children of immigrants are more likely to live in poverty (Capps et al., 2004), access to financial programs is essential. Financial support to non-citizen children and caregivers are particularly limited as they do not qualify for federal funding and must rely on state and local funding. Despite the limited funding available, it is more cost effective for a state to provide subsidized guardianship support to a kinship caregiver than to pay for traditional foster care. Thus, from a financial and humanistic perspective, additional funding for family caregivers is warranted.

EXEMPLAR: KINSHIP CARE IN TEXAS Texas provides a unique opportunity to view kinship care due to its high prevalence of foreign-born residents (United States Census Bureau, 2006). Texas is also geographically important for studying issues related to immigrant families as it borders with Mexico, has a large Mexican immigrant population, and provides foster care services to a wide variety of other minority populations. Moreover, many of the barriers to kinship care, such as language, difficulty maneuvering the child welfare and court systems, citizenship and funding eligibility criteria, and reluctance to place children with kinship caregivers across international borders have been identified as concerns in Texas (Texas Department of Family and Protective Services, 2008; United States Department of Health and Human Services, 2003;Vericker, et al., 2007). According to the U.S. Census, approximately 36% of the population in Texas identify as Hispanic/Latino compared to the national average of 15% (United States Census Bureau, 2006). Texas is ranked seventh in the country for the total number of foreign-born residents (15.9%) and ranked third in the number of residents who speak a language at home other than English (33.8%) (United States Census Bureau, 2006). In 2005, 28,833 children were placed in non-kinship foster care and 6,504 children were placed in kinship care in Texas. Of those children placed in kinship care, 37% were Hispanic (Texas Department of Health and Human

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Services, 2004). Of that number, male and female children were nearly equally represented. Moreover, children ages one to five were most likely to be placed in kinship care than were children under age one, 6-10 years and 16-18 years of age (Child Welfare League of America). In a study linking Vital Statistics Data and Child Welfare Administrative data from Texas, researchers found that immigrant children and children of immigrants who came from Latin American countries were less likely to be placed in kinship care and more likely to be placed in group home settings than other populations of Hispanic children (Vericker, et al., 2007; Wulczyn et al., 2007). Although limited research is available to determine exactly why kinship care is underutilized with this population in Texas, it is likely that the barriers to placement described above impact the implementation of kinship policies. Like other states with large immigrant populations, Texas has a shortage of bilingual caseworkers. This shortage impedes communication and service provision to immigrant families. In addition, Texas is similar to many other states in that they do not provide legal representation to immigrant families from the beginning of a case. Families are only provided legal representation when their case has been considered and parental rights are at risk of termination (Texas Department of Family and Protective Services, 2007). At the point of termination, the child may have been in state care for twelve months. These impediments make it difficult to identify possible kinship placement early in the case and decrease the likelihood that kinship care placements will be identified. Kinship caregivers in Texas also face financial difficulties similar to those experienced nationally. However, immigrant families may experience even greater financial strain as they are more likely to experience poverty than non-immigrant families. Texas does not have a subsidized guardianship program. Kinship caregivers must rely on relative support programs that vary across regions in the state. These programs offer minimal economic support, and in many areas of the state, there is no financial support offered at all. Kinship caregivers who are struggling with poverty may not have access to any funding to enable them to care for the child. Due to its close proximity with Mexico, Texas has instituted specific policies and procedures to govern placement in a foreign country. The policy on placement in kinship care in a foreign country states that the caseworker should work with their supervisor to request a home study in the country where the placement is intended (Texas Department of Family and Protective Services, 2008). In working with Mexico, the Texas Department of Family and Protective Services must request a home study from Desarrollo Integral de la Familia in Mexico (Texas Department of Family and Protective Services, 2008). Since this process is often complex, the Texas Department of Family and Protective Services has designated three liaisons to assist with locating kinship care placements across the border (Texas Department of Family and Protective Services, 2008). The effective use of these policies depends on the relationship with the foreign government and familiarity and comfort with child welfare agencies in the foreign country. Texas experiences obstacles similar to those discussed nationally in establishing this important relationship. These difficulties decrease the likelihood that judges and child care workers will use international kinship care placements as a viable option. Finally, child welfare workers and judges are concerned with the difficulty associated in monitoring the safety of the child’s placement outside of the United States (Texas Department of Family and Protective Services, 2008). The Texas handbook emphasizes that caseworkers do not have

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legal authority outside of the United States. Once a child is placed in a foreign country, monitoring the placement and safety of the child is not within the jurisdiction of caseworkers (Texas Department of Family and Protective Services, 2008). In order, for caseworkers to be comfortable with placement they must establish a close working relationship with the child protection agency in Mexico. Despite having some policies and procedures to govern kinship care placements for immigrant children, Texas still has a disproportionately lower number of immigrant children who are placed with kinship caregivers (Vericker et al., 2007). This may be due to having limited resources, insufficient supports, and limited communication with Mexico. It is difficult in these circumstances for caseworkers to have the time and knowledge necessary to address the special needs of immigrant families and children. However, with the national growth of foreign born populations in the United States, more formal ways of addressing these difficulties are needed.

REFERENCES Adoption and Safe Families Act (1997). Beavers, L., & D'Amico, J. (2005). Children in Immigrant Families: U.S. and State-Level Findings from the 2000 Census: Annie E. Casey Foundation Population Reference Bureauo. Berrick, J. D., & Barth, R. P. (1994). Research on kinship foster care: What do we know? Where do we go from here? Children and Youth Services Review, 16(1-2), 1-5. Berrick, J. D., Barth, R. P., & Needell, B. (1994). A Comparison of Kinship Foster Homes and Foster Family Homes: Implications for Kinship Foster Care as Family Preservation. Children & Youth Services Review, 16(1-2), 33-63. Capps, R., Fix, M., Ost, J., Reardon-Anderson, J., & Passel, J. (2004). The Health and WellBeing of Young Children of Immigrants. Washington, D.C.: The Urban Institute. Casey Family Programs. (2004). Commitment to Kin: Elements of a support and service system for kinship care. Washington, DC: Casey Family Programs. Child Welfare League of America (2007). Retrieved 9-18-07, 2007, from http://ndas.cwla.org Child Welfare League of America. (2007). Special Tabulation of the Adoption and Foster Care Analysis Reporting System. Retrieved 9-18-07, 2007 from www.ndas.cwla. org/data_stats Conway, T., & Hutson, R. (2007). Is Kinship Care Good For Kids? Washington, D.C.: Center for Law and Social Policy. Dubowitz, H., Feigelman, S., Harrington, D., Starr, R., Zuravin, S., & Sawyer, R. (1994). Children in kinship care: How do they fare? Children and Youth Services Review, 16(12), 85-106. Fostering Connections to Success and Increasing Adoptions Act (2008). Gambrel, R. (2006). Child Protective Services Supervisor. In. (Ed.) Structure, and staffing of investigative units. San Antonio. Geen, R. (2003). Kinship Care: Making the Most of a Valuable Resource. Washington, D.C.: The Urban Institute.

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Hegar, R. L. (1993). Assessing attachment, permanence, and kinship in choosing permanent homes. Child Welfare, 72(4), 367-378. Hill, R. (2007). An Analysis of Racial/Ethnic Disproportionality and Disparity at the National, State, and County Levels. Seattle, Washington: Casey Family Programs. Iglehart, A. P. (1994). Kinship foster care: Placement, service, and outcome issues. Children and Youth Services Review, 16(1-2), 107-122. Jones, E. F., & Chipungu, S. (2003). The Kinship Report: Assessing the Needs of Relative Caregivers and the Children in Their Care. Washington, DC: Casey Family Programs. Padilla, Y., & Villalobos, G. (2007). Cultural Responses to Health Among Mexican American Women and their Children. Family and Community Health, 30(1), 24-33. Pew Commission on Children in Foster Care. (2008). Commission Recommendations. Retrieved April 27, 2008, from www.pewfostercare.org Prohn, L. (1994). Relative Foster Parents. Children and Youth Services Review, 16(1-2), 3363. Salgado de Snyder, N. (1987). Factors Associated with Acculturative Stress and Depressive Symptomology among Married Mexican Women. Psychology of Women Quarterly, 11, 475-488. Sluzki, C. M. D. (1979). Migration and Family Conflict. Family Process, 18(4), 379-390. Texas Department of Family and Protective Services. (2008). Child Protective Services Handbook. Texas Department of Health and Human Services. (2004). Department of Family and Protective Services External/Internal Assessment. Retrieved May 5, 2008, from http://www.hhs.state.tx.us/StrategicPlans/HHS05-09/final/pdf/Chapter08.pdf U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children and Youth and Families, & Children's Bureau. (2006). Adoption and Foster Care Analysis and Reporting System (AFCARS). Retrieved May 5, 2008 from www.acf.hhs.gov United States Census Bureau. (2006). American Community Survey. Retrieved April, 26, 2008, from: http://www.census.gov/acs/www/index.html United States Department of Health and Human Services. (2003). The Child Abuse Treatment and Prevention Act, as Amended by The Keeping Children and Safe Families Act of 2003: Including Adoption Opportunities and The Abandoned Infants Assistance Act. Washington D.C.: Administration for Children and Families, United States General Accounting Office. (1999). Foster care: Kinship Care Quality and Permanency Issues. Urban Institute. (2008). Children in Kinship Care. Assessing the New Federalism Retrieved June, 11, 2008, 2008, from www.urban.org/anf Vericker, T., Kuehn, D., & Capps, R. (2007). Latino Children of Immigrants in the Texas Children Welfare System. American Humane, 22(2), 20-40. Wulczyn, F., Chen, L., & Brunner Hislop, K. (2007). Foster Care Dynamics Report, 20002005: A Report from the Multistate Foster Care Data Archive. Chicago: Chapin Hill Center for Children at the University of Chicago.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 2

CHILDREN OF COLOR IN THE CHILD WELFARE SYSTEM Jillian Jimenez* and Ruth M. Chambers† Department of Social Work, California State University, Long Beach 1250 N. Bellflower Blvd, Long Beach, CA 90840, USA

ABSTRACT The disproportionate levels of ethnic minority children in the child welfare system have been a long standing concern. In recent years, however, due to increasing numbers of children in the foster care system, much more research has been conducted and our understanding of this issue has increased significantly. The current statistics are startling. This chapter will first review the prevalence and primary causes associated with disproportionality in the child welfare system between 2003-2008. Second, African American, Native American and Latino populations will be presented including relevant statistics, causes and if applicable, specific child welfare polices. This chapter will also discuss disproportionality and disparity for African American, Native American and Latino children in the child welfare system. It will also highlight the major causes of this problem and provide a critique of relevant policies.

INTRODUCTION The disproportionate levels of ethnic minority children in the child welfare system have been a long standing concern. In recent years, however, due to increasing numbers of children in the foster care system, much more research has been conducted and our understanding of this issue has increased significantly. The current statistics are startling: In the United States, * †

Tel: (562) 985-5237; E-mail: [email protected] Tel: (562) 985-5175; E-mail: [email protected]

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African American children represent 42% of the foster care system but only make up 15% in the general population. Native American children make up 2% of the foster care population but represent only 1% in the general community. Although Latinos are not overrepresented on a national level, 17 states have disproportionate higher levels of Latino children in foster care. Furthermore, compared to White children, ethnic minorities are more likely to be referred and investigated for child maltreatment, receive inadequate services while in the system, have longer stays in placement and are less likely to be reunified1. Despite national data that demonstrates no ethnic differences between child maltreatment and ethnicity, why do we see such high numbers of ethnic children and families involved in the child welfare system? Causes of this discrepancy include racial bias on the part of child welfare system, especially in professional decision makers, preponderance of community risk factors, including levels of poverty and other economic stressors such as homelessness, and the nature of government policies governing child welfare systems. This chapter will first review the prevalence and primary causes associated with disproportionality in the child welfare system between 2003-2008. Second, African American, Native American and Latino populations will be presented including relevant statistics, causes and if applicable, specific child welfare polices.

ETHNICITY AND CHILD WELFARE According to the National Child Abuse and Neglect Data System (NCANDS), African American, American Indian or Alaskan Native, and Pacific Islander children have higher rates of reported child maltreatment than do other children. In 2005, African American children had a reported maltreatment rate of 19.5 per 1,000 children, Pacific Islander children had a rate of 16.1 per 1,000 children, and American Indian and Alaskan Native children had a reported maltreatment rate of 16.5 per 1,000 children, compared with 10.8 per 1,000 nonHispanic white children, 10.7 per 1,000 Hispanic children, and 2.5 per 1,000 Asian children.2 It is important to note that these statistics are based on cases that are reported to child welfare agencies and found to be not as credible; earlier larger studies known as the National Incidence Studies of Child Abuse and Neglect, undertaken by the federal government in l980, l986 and l993, found no ethnic effect on child maltreatment. However, these large scale federal studies found an economic effect: poorer families were more likely to maltreat their children, regardless of ethnicity.3 The l993 National Incidence Study found that compared to

1

2

3

National Clearinghouse on Child Abuse and Neglect Information, National Adoption Information Clearinghouse. Racial disproportionality in the U.S. child welfare system: What we know. 2003-2005. http://www. hunter.cuny.edu/socwork/nrcfcpp/downloads/bib/Disproportionality_whatweknow.pdf. Retrieved on July 23, 2008. U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Child Maltreatment 2005 (Washington, DC: US Government Printing Office 2007). http://www.acf.hhs. gov/programs/cb/pubs/cm05/index.htm U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Child Maltreatment 2005 (Washington, DC: US Government Printing Office 2007). http://www.acf.hhs. gov/programs/cb/pubs/cm05/index.htm Robert Hill. Synthesis of Research on Disproportionality in the Child Welfare System: An Update. CaseyCSSPAlliance for Racial Equity in the Child Welfare System. October, 2006, http://www. racemattersconsortium.org/docs/BobHillPaper_FINAL.pdf. Retrieved May 11, 2008;

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children whose families earned $30,000 per year or more, children in families with annual incomes below $15,000 per year were more than 22 times more likely to experience some form of maltreatment. The statistics gathered in these National Incidence Studies are more accurate than the NCANDS reports, which depend solely on cases of child maltreatment that have been reported to Child Protective Service Agencies. The National Incidence Studies draw from a wider range of reporters who may or may not have interacted with the local child protective service agencies. The National Incidence Study design assumes that the maltreated children who are investigated by child protective services (CPS) represent only the “tip of the iceberg,” so while NIS estimates include children investigated at CPS, they also include maltreated children who are identified by a wide range of professionals in representative communities. These professionals, called “sentinels,” are asked to remain on the lookout for children they believe are maltreated during the study period.4 Thus while there are ethnic differences the children who are reported to CPS, there apparently is no ethnic difference established in actual maltreatment, according to these broader studies. Ethnicity has been found to be a strong predictor of investigation in cases of alleged physical abuse and neglect. While whites are more likely to be investigated in cases of sexual abuse, African Americans are twice as likely to be investigated for physical abuse and neglect as whites.5 Are reports of abuse more likely to be substantiated, that is, found to be correct, for African American children? Research suggests that this is indeed the case.6 National data also show that Native American families are more likely to be investigated for child maltreatment compared to White families. Using two national datasets (AFCARS, NCANDS) which included over 800,000 children, Hill found that the Native Americans/Alaska Native child population had twice their representation in the general population at investigation (1% and 2% respectively)7. Once maltreatment is found to be substantiated by the child welfare system, are there ethnic differences in whether children remain in their homes or are placed in foster homes? Are there any differences in length of time in placement and reunification rates for children of color? According to national data, African American children were much more

4

5

6

7

Andrea J. Sedlak & Diane D. Broadhurst, Executive Summary of the Third National Incidence Study of Child Abuse and Neglect. U.S. Department of Health and Human Services. l996. http://www.childwelfare. gov/pubs/statsinfo/nis3.cfm. retrieved May 10, 2008. Department of HHS. Fourth National Incidence Study of Child Abuse and Neglect. https://www.nis4.org/ nishome.asp. retrieved May 10, 2008. John Fluke, Ying-Ying Yuan, John Hedderson & Patrick Curtis. Disproportionate Representation of Race and Ethnicity in Child Maltreatment: Investigation and Victimization. Children and Youth Services Review. 25 Nos 5/6 2003. 359-373; Andrea Sedlack and Dana Schultz. Racial Differences in child Protective Service Investigation of Abused and Neglected Children at Risk of Maltreatment in the General Child Population, in Derezotes et al, 97-119; Brian Gryzlak, Susan Wells,, & Michelle Johnson. The role of race in child protective services screening decisions. In Dennete Derezotes et al. (Eds.) Race matters in child welfare: The overrepresentation of African American children in the system (pp. 63-96). Washington, DC: Child Welfare League of America, 2005. John Fluke, Ying-Ying Yuan, John Hedderson & Patrick Curtis. Disproportionate Representation of Race and Ethnicity in Child Maltreatment: Investigation and Victimization. Children and Youth Services Review. 25 Nos 5/6 2003. 359-373; Hill, 20-21. AFCARS, 2007, Hill, 2007). Robert Hill. Synthesis of Research on Disproportionality in the Child Welfare System: An Update. CaseyCSSPAlliance for Racial Equity in the Child Welfare System. October, 2006. http://www. racemattersconsortium.org/docs/BobHillPaper_FINAL.pdf. retrieved May 11, 2008.

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likely than white victims of abuse and neglect to be placed in foster care.8 Regional studies have also found that after controlling for gender, age and reason for referral, African American children were slower to exit foster care, and less likely to be reunited with their biological parents than white children.9 Native American children are three times more likely to be placed in foster care10, twice as likely to remain in care for over two years and less likely to be reunified with his/her family.11 Latino children (under the age of 5) are at a greater placement risk;12 enter the foster care system at greater numbers than other children,13 remain in placement rather than return home14 and are less likely to be reunified.15 Finally, children of color receive fewer services than white children while in the child welfare system.16 In a recent mixed method study of forty-eight child welfare State agencies, researchers found that African American families had extreme difficulty in receiving mental health, substance abuse treatment and/or family support services. The inability of the families to get these services resulted in the children being removed from the home, staying longer in care and not being reunified with their biological families.17 For Latino children in care, they were less likely to receive mental health services compared to Caucasian children18 and Native American caregivers were less likely to receive substance abuse and/or mental health treatment.19 8

U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Child Maltreatment 2005 (Washington, DC: US Government Printing Office, 2007). http://www.acf.hhs. gov/programs/cb/pubs/cm05/index.htm; 9 Sheila Ards, Samuel Myers, Allan Malkis. Racial Disproportionality in Reported and Substantiated Child Abuse and Neglect: An Examination of Systematic Bias. Children and Youth Services Review, 25, nos 5/6 2003, 375392.; Yuhwa Lu, John Landsverk, Elissa Ellis-Mcleod, Rae Newton, William Ganger, Ivory Johnson. Race, ethnicity and case outcomes in child protective services. Children and Youth Services Review, 26(5) 2004 447461; Hill, 24. 10 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. The AFCARS Report, Preliminary Estimates for FY 2006 as of January 2008 (14). http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report14.htm. Retrieved on July 20, 2008. 11 Washington State Racial Disproportionality Advisory Committee. Racial disproportionality in Washington State. 2008. http://www1.dshs.wa.gov/pdf/ca/RaceDispro1.pdf. Retrieved on July 19, 2008. 12 Mónica M. Alzate & James A. Rosenthal. Gender and ethnic differences for Hispanic children referred to child protective services. Children and Youth Services Review. In press 2008. 13 Sandra Stukes Chipungu & Tricia B. Bent-Goodley. Meeting the challenges of contemporary foster care. The Future of Children. 14 No. 1 2004. 75-93. http://www.futureofchildren.org/usr_doc/5-stukes.pdf. Retrieved on July 25, 2008 July 29, 2008. 14 Richard Barth. Effects of age and race on the odds of adoption versus remaining in long-term out-of-home care. Child Welfare, 76, 285–309. 1997. 15 Alice M. Hines, Peter Allen Lee, Laurie Drabble, Lonnie R. Snowden, & Kathy Lemon. An evaluation of factors related to the disproportionate representation of children of color in Santa Clara County’s child welfare system: Child family characteristics and pathways through the system, phase 2 final report. 2002. http://www.sjsu.edu/cwrt/Phase2/File1.pdf. Retrieved on July 15, 2008. 16 Hill, 28; Garland, A., Landsverk, J., & Lau, A. (2003). Racial/ethnic disparities in mental health service use among children in foster care. Children and Youth Services Review, 25(5/6): 491-507; Ruth McRoy. The Color of Child Welfare in Eds King Davis& Tricia B. Bent-Goodley. The Color of Social Policy. Alexandria, Va: Council on Social Work Education, 2004 ,36-65. 17 African American Children in Foster Care: Additional HHS Assistance Needed to Help States Reduce the Proportion in Care. GAO, July 2007. http://www.gao.gov/new.items/d07816.pdf. Retrieved July 28, 2008. 18 Elsa A. Ríos & Sandra Duque. Bridging the cultural divide: Building a continuum of support services for Latino families. New York: The Committee for Hispanic Children and Families, Inc. 2007. 19 Anne M. Libby, Heather D. Orton, Richard P. Barth, Mary Bruce Webb, Barbara J. Burns, Patricia Wood, & et al. Alcohol, drub, and mental health specialty treatment services and race/ethnicity: A national study of children and families involved with child welfare. American Journal of Public Health. 96 No. 4 2006. 628631.

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Many observers note that there is a class and ethnic bias in the reporting and investigation systems found in CPS systems across the country; poorer families, including families from some ethnic groups, are overrepresented, while middle and upper class families are underrepresented. If there is no significant ethnic difference in child maltreatment, as the National Incidence studies have found, then the fact some ethnic groups are overrepresented in the child protective service caseloads is due to systemic problems in child welfare oversight. What factors account for these differences? Some research suggests that differences in reporting exist; poorer communities have more surveillance in terms of who tends to report abuse; these include educational staff, law enforcement and social service personnel.20 Both public and private hospitals have been found to over report abuse among blacks and underreport it among whites. Controlling for actual injury due to abuse, another study found that children of color were more likely to be reported for physical abuse than white children, even when white children were injured by their caretakers. 21 African American women are more likely to be reported for abuse when their newborns test positive for drug use than white women. While some research did not find these ethnic discrepancies, the bulk of the research has found these discrepancies.22 Researchers have established a connection between family poverty and child neglect, with ethnic minority, low-income families more likely to be reported for neglect and the children of these families more likely to be placed in foster care.23 In a recent qualitative study conducted by the U.S. Children’s Bureau, administrators, supervisors and workers at nine child welfare agencies cited poverty as a key reason for the overrepresentation of minority children in the child welfare system.24 In a related study, child welfare officials in thirty-three states contended that poverty was a major factor in foster care placement for African American children.25 In a national conference that addressed the disproportionate numbers of Latino families in the child welfare system, child welfare advocates noted that “caseworkers and mandated reporters are often unable to distinguish between indicators of poverty and indicators of neglect, thus placing low-income Latino families at greater risk for child removal and foster placement”26

20

U.S. Department of Health and Human Services. (2005). Child maltreatment, 2003. Washington, DC: U.S. Government Printing Office. www.acf.hhs.gov/programs/cb/pubs/cm03/index.html. retrieved May 10, 2008. 21 W. Lane, David Rubin & Robert Monteith. Racial Differences in the evaluation of pediatric fractures for physical abuse. Journal of the American Medical Association, 288 (13), 2002, 1603-1609. 22 Hill,17-19; Alice Hines, Kathy Lemon, Paige Wyatt &Joan Merdinger,10-11; Yuhwa Lu, John Landsverk, Elissa Ellis-MacLeod, Rae Newton, William Ganger, & Ivory Johnson. (2004). Race, ethnicity and case outcomes in child protective services. Children and Youth Services Review, 26(5) 2004, 447-461. 23 Nancy A. Rodenborg. Services to African American Children in Poverty: Institutional Discrimination in Child Welfare? Journal of Poverty, 2004, 109-130. 24 U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, Washington, D.C.: U.S. Government Printing Office. Children of Color in the Child Welfare System: Perspectives from the Child Welfare Community. 2003 25 U.S. Government Accounting Office. African American Children in Foster Care: Additional HHS Assistance needed to help states reduce the proportion in care. 2007. 26 The Committee for Hispanic Children and Families, Inc. Creating a Latino child welfare agenda: A strategic framework for change. New York: Author. 2004, 9.

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AFRICAN AMERICAN CHILDREN IN THE CHILD WELFARE SYSTEM Although many ethnic disparities in child welfare services exist, the only group over represented in the child welfare system over the past 10 years has been African American children, who are also subjected to poorer treatment within those systems than are other children. African American families are more frequently reported for abuse and neglect of their children, despite the lack of clear evidence that African American children are subject to greater levels of maltreatment, and their children are more frequently removed from their homes. 27 More than one third of children placed outside the home were African Americans in 2006.28 Once in foster care, African American children and youth receive fewer visits from caseworkers and less mental health services than do other children. Studies have found that close to 40% of children in the child welfare system are African American, although they represent only 15% of the child population.29 Causes of this discrepancy which have been the subject of research, include racial bias on the part of child welfare investigators and professional decision makers, preponderance of community risk factors, including levels of poverty, and economic stressors, the nature of policies governing child welfare,30 and racial bias among child welfare workers.31

History of African Americans in the Child Welfare System In the nineteenth and for much of the twentieth century, African American children were raised under an entirely distinct set of circumstances than white children, in families who had a different view of childrearing. These differences were based on both African cultural roots and the oppression African American families endured under slavery and afterward. The social construction of parenting was very different in the African American community than in the white majority community. The unitary view of individual legal responsibility for children that characterized public child welfare law is opposed to the tradition of kin and community responsibility for child rearing in the African American community. Kinship care in these communities was partly a response to discrimination and economic hardship, but it 27

Andrea Sedlak &Dana Schultz. Racial Differences in Child Protective Services Investigation of Abused and Neglected Children. In Denette Derezotes, John Portner & Mark Testa. Race Matters in Child Welfare. New York: Child Welfare League, 2005, 97-110. 28 U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, Washington, D.C.: U.S. Government Printing Office, 2006; Tanya Coakley. Examining African American fathers’ involvement in permanency planning: An effort to reduce racial disproportionality in the child welfare system. Children and Youth Services Review. 30 (2008), 407-417. 29 Robert Hill. Synthesis of Research on Disproportionality in Child Welfare: An Update. October 2006, CaseyCSSP Alliance for Racial Equity in the Child Welfare System.http://www.aecf.org/media/PublicationFiles/ CW3622.retrieved July 30, 2008. 30 Hill, Synthesis of Research on Disproportionality; Brian Gryzlak, Susan Wells & Michelle Johnson. The Role of Race in Child Protective Services Screening Decisions in Dennete Derezotes, John Poertner & Mark Testa, Eds. Race Matters in Child Welfare. New York; Child Welfare League of America, 2005, 63-97; Nancy Rolock & Mark Testa. Is the Investigation Process Racially Biased? In Derezotes, Poertner & Testa, Eds. Race Matters, 119-131; Robert Goerge & Bong Joo Lee. The Entry of Children from the Welfare System into Foster Care: Differences by Race. in Derezotes, Poertner &Testa. Eds. Race Matters.173-187;Nancy Rodenborg. Services to African American Children in Poverty: Institutional Discrimination in Child Welfare? Journal of Poverty, 8 (3). 2004, 109-115..

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was also part of the African cultural heritage that continued to inform life in the slave quarters and during the late l9th and 20th century America. West African society featured an intensive kinship network where family relations were widespread and the responsibility for child rearing was collective. In Africa, and later during slavery, extended families shared responsibility for parenting tasks, including community surveillance and discipline, daily care and nurturance of children living with parents, and substitute care for children whose biological parents could not care for them. Substitute care was arranged informally by kinship networks, especially grandmothers. Sometimes, especially in Northern urban areas, fictive kin would assume responsibility for children when families were unable to or had moved away for find work. When parents returned, kin caretakers returned the children to them or joined with them in raising the child. This is one reason why African American families were reluctant to let their children be formally adopted; the idea that parental rights had to be terminated (necessary for legal adoption) was an unwelcome one, since boundaries of responsibility for children were fluid. The white model of closed adoption that dominated in the courts and child welfare system for decades was based on a fiction: adoptive parents acted as if they were the biological parents, even substituting another birth certificate for the original one. This denial of the biological parents’ connection to the child was unheard of in African American families, where the connection between parent and child was not denied, even in cases of informal adoption. Informal adoption of African American children by kin or fictive kin meant that children did not go to orphanages, which did not accept African American children in any case, nor were they adopted under the aegis of the formal legal public system. Because of the practice of informal adoption, few African American children became wards of the state before the l960s. This informal system of child welfare was a necessary substitute for the formal white system of child welfare. It drew on the strengths of communities tested by discrimination and economic deprivation. 32 It was not until the l960s that African American children were welcomed to private orphanages, which then were transformed into residential treatment centers when the federal government began to reimburse states for placement of foster children in these group homes. The overrepresentation of African American children in the child welfare system after l960 parallels their overrepresentation in the juvenile justice system, the subject of concern for over 40 years. 33 As we have seen, there are many decision points in child welfare system, from the first reports to child protective services through the decisions to place children in foster care or reunify them with their biological parents. Many different outcomes are possible for children in the child welfare system, including monitoring in the home, foster care, group homes and adoption. Are African American children overrepresented because child welfare practices at these decisions points are influenced by racism and or discrimination? Or are African American children more likely to be abused and thus more in need of child welfare services? The National Incidence studies discussed earlier seem to 31

32

33

Lawrence Berger, Marla McDaniel &Christina Paxson. Assessing Parenting Behaviors across Racial Groups: Implications for the Child Welfare System. Social Service Review,79, (4), 2005, 653-688. Jillian Jimenez. The history of child protection in the African American community: Implications for current child welfare policies. 28 (2006), 888-905. Dennete Derezotes and John Poetner. Factors contributing to the overrepresentation of African American children in the child welfare system. In Eds. Derezotes ,Poetner & Testa, Eds. Race Matters in Child Welfare, 1-25.

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indicate that their overrepresentation can be explained by over reporting of child maltreatment in African American families, underreporting of white children, and differences in investigation of cases and in substantiation rates. In fact the National Incidence studies discussed above acknowledged the high risk factors experienced by African American families in terms of low income, single parent status and welfare status, but still found lower incidence of child maltreatment in African American families compared to other groups with these same factors. Perhaps these risk factors are not as salient for African American families. Research suggests that mediating factors which reduce the risk may include the cultural strengths of African American families discussed above. If so, differences in treatment during the child welfare decision making process explain the disproportionality. 34

MULTIETHNIC PLACEMENT ACT In l994 Congress passed the Multiethnic Placement Act prohibiting the use of race, color or national origin to deny or delay children placement in ethnically diverse foster or adoptive homes. Combined with the Adoptions and Safe Families Act of l997 requiring that children who are not reunited with their parents be placed in adoptive homes, these two policies together serve to promote adoptions of ethnic minority children by white families. Critics argue that removing African American children from their families and giving them to white families to adopt is often a mistake because it strips children of their historical and cultural legacies. In 1972, the National Association of Black Social Workers had announced that it was opposed to adoptions that placed black children into white families (known then as transracial adoptions), a stance that had strong repercussions for child welfare policy until the Multi Ethnic Placement Act. The NABSW now focuses its efforts on encouraging adoptions within the African American community. 35 Ironically, most of the children who are considered examples of transracial adoptions over the past ten years are not from the United States, but from outside in the country. Adoption of foreign born children has increased dramatically to over 20,000 a year.36 The concept of transracial adoptions has lost its meaning since MEPA was passed and the need to widen the pool of adoptive applicants, especially for African American children, has emerged as a pressing policy issue.

ADOPTION AND SAFE FAMILIES ACT The Adoption and Safe Families Act, passed into law in l997 introduced several new themes to child welfare practice. This policy represented an l80 degree turn away from family preservation and towards parental termination and adoption. The theory behind the policy was that children should have a limited amount of time in foster care before their permanent futures were decided and those who could not be safely returned should be legally severed from their families and adopted by other families. As a result of this sea change in federal 34

Richard Barth. Child Welfare and Race: Models of Disproportionality. In Derezotes, Poertner & Testa, 25-47. Dorothy Roberts. Shattered Bonds: The Color of Child Welfare. New York: Basic Books, 2002, 246-249. 36 Transracial Adoptions http://racerelations.about.com/od/parentingrace/i/transracialadop_2.htm. Retrieved May 19, 2008 35

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policy, the weight of the federal government came down fully against biological families, although the Act contained lip service about reasonable efforts to serve families. As opposed to helping families provide adequate care for children, ASFA put child welfare agencies in the position of planning for termination of their parental rights. Many states passed concurrent planning laws, mandating that child protective service workers develop two plans simultaneously when a child was removed: one to reunify children with families, one to terminate parental rights and find permanent adoptive homes. Under ASFA parents were given 12 months, rather than the l8 allowed under the l980 Act, to reunify with their children. ASFA allowed child welfare agencies to deny reunification services to families who committed certain kinds of abuse, including murder or manslaughter of another child, or other aggravated circumstances as determined by the state, including abandonment, torture, chronic abuse and sexual abuse.37 Clearly, ASFA was not targeted toward parents who were at risk for abusing children; there were no extra funds for services for families, instead the funds went to counties as incentives for finding permanent adoptive homes for children in foster care. For many states the federal law gave an excuse to states to deny reasonable efforts to many clients in the child welfare system. California, for example, has added fifteen conditions under which reunification services can be denied.38 ASFA puts the weight of federal law on the side of children’s rights and child safety, and away from efforts to help biological families develop the resources to care for their children adequately. While both goals could conceivably be met in a child welfare policy, to date they have not been. ASFA directly impacts the ability of African Americans families at risk for involvement with the child welfare system to access resources and services that would enable them to meet the needs of their children and therefore remain intact.

Legal Adoption One of the most controversial aspects of ASFA was its intention to promote legal adoption and termination of parental rights for children in the child welfare system. The history of collective informal efforts in African American communities to insure the protection and well-being of their children suggests that the public child welfare system, with its emphasis on unitary, singular responsibility for children was not a good fit with African American families. Contrasting formal, legal adoptions with informal adoption reveals the contractual relationship at the heart of legal adoption, which creates parenthood by law and replaces biological families with legally constructed ones. 39 In African American communities the idea of termination of parental rights and exclusion of biological parents from the child’s life is not culturally congruent, as discussed above. Parties to informal adoptions made room for the return or involvement of the biological parents, no matter how intermittent. Informal adoptions were part of a natural kinship strategy, not a legal contract creating a fictive parent child relationship. This tradition should be incorporated into child 37

Amy D’Andrade & Jill Duerr Berrick. When Policy Meets Practice: The Untested Effects of Permanency Reforms in Child Welfare. Journal of Sociology and Social Welfare, 33, (1), March,2006 31-52. 38 D’Andrade , 37. 39 J. Model. Kinship with strangers: Adoptions and interpretations of kinship in American culture. Berkeley: University of California Press, l994.

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welfare policy to encourage African American families to adopt children who are kin or non kin. Adoptions from foster care are promoted by the Adoptions and Safe Families Act and have increased since its passage. Adoptions of children with special needs are subsidized by states and the federal government, and adoption tax credits are given by the federal government to all adopting families. These policies have increased the pool of adoptive parents, many of whom were originally foster parents to the adopted child.40 More policies offering permanent adoption subsidies to families who adopt children from foster care would increase the number of adopted children. According to the most recent data available, 114,000 children in the United States foster care system were waiting to be adopted in 2005. During that same year, however, only 51,000 children were actually adopted. Older children and sibling groups are the least likely to be adopted. Children who are adopted are younger by an average of 2 years than those who are not adopted.41 Foster care adoptions increased 78 percent from 1996 to 2000, as a result of ASFA and earlier state initiatives. It is estimated that ASFA requirements and incentives have resulted in an additional 34,000 adoptions from 1998 to 2000 that would not have otherwise occurred. In 2000, the latest year for which national statistical information is available,42% of children adopted out of foster care were African American, 32% were white and l5% were Latino. Children under 6 years of age were more likely to be adopted than older children.42

Kinship Care ASFA encouraged kinship or relative care of children removed from their homes and allowed relatives to be reimbursed in the same way as non relative foster parents providing they received a foster care license from the state. Kinship care may seem like a natural fit for African American children in child welfare system, since it draws on the historical and cultural strengths of African American families. Indeed over the past 20 years more African American children than any other children have been in some form of kinship care. In 2002, of the 2.2 million children in kinship care, 43% were African American. Several types of kinship care exist; the most formal type is kinship foster care, where children are in state custody and then placed with relatives; other types include informal or voluntary kinship care, where families are not supervised by child welfare officials and not compensated at the foster care rate. Instead these families, who are not licensed, receive the lower TANF reimbursement. In 2004 more than half of the approximately 400,000 children in the more formal, supervised, kinship foster care were African American. 43 While kinship care is not a panacea for African American children, it stands on solid historical ground as the natural system that developed in African American communities to insure the welfare of children.

40

Child Welfare Information Gateway. Foster Parent Adoption, 2006. http://www.childwelfare.gov/pubs/f_fospro/ f_fospro.cfm. Retrieved May 24, 2008. Erica Zielewski, Karin Malm, Rob Geen & Steve Christian. Trends in U.S. Foster Care Adoption Legislation. Urban Institute,2006. http://www.urban.org/publications/411380.html.Retrieved Mat 23, 2008. 42 U.S. Department of Health and Human Services' Adoption and Foster Care Analysis and Reporting System (AFCARS), Report 6. 2001, http://www.acf.dhhs.gov/programs/cb/publications/afcars/june2001.htm, Retrieved May 20, 2008. 43 Rob Geen. The evolution of kinship care: Policy and Practice: The Future of Children, vol 14,Washington, D.C.: The Urban Institute, 2004, 115-129. 41

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Largely because of the lower rate of reimbursement for many kinship care families and the lack of services, children in this form of home care are thought to face more barriers and to fare less well than children in their own homes or in supervised foster placements. The economic deprivation experienced by many kinship families is one important reason for the difficulties faced by children placed there. On the other hand, advantages to kinship care include the family continuity and support it offers and the relative stability it offers children; children in kinship care are less likely to be moved than children in non relative foster care. However, depending on non reimbursed kinship care as a major policy meeting the needs of African American or any children is a flawed strategy, as it compounds the economic disadvantage experienced by minority families. Only when families have the economic and emotional resources to take on what is clearly an extra burden, should kinship placements be made.44 Federal and state funds should be provided for all families who take in children related or non- related, as should child welfare services. Why have kin been utilized as a low cost way to meet the needs of many African American children? Ambivalence over reimbursement of family members for care may be at the heart of the reluctance. However, socially just policies would mandate that both legal guardians and kin caregivers be reimbursed for their efforts to care for children, who would be placed in federally funded, non related foster homes should relatives to refuse to take on this responsibility. Redressing the financial inequities inherent in current kinship care policies is crucial to protecting and promoting the well being of African American children. Reimbursing all kin at the same rate as non-relatives and offering child welfare services to all children in kinship families are crucial first steps in promoting the welfare of African American children in kinship care.

Legal Guardianship As discussed above, African American families may not wish to become involved with permanent adoptions of their family members because of long standing cultural traditions that work against parental termination. Legal guardianship is an arrangement wherein kin or others assume legal custody of children whose birth parents may retain certain rights, such as the right to visitation, the right to consent to adoption and the responsibility for child support, may be more culturally congruent with African American communities. Yet legal guardianship may pose a financial hardship for many families, since in most cases the federal government does not subsidize the care of children in guardianship arrangements. Guardians of children eligible for TANF may receive compensation that is approximately one third to one half of the rate the federal government pays to foster parents, who also care for dependent children. The answer may lie in subsidized guardianship, where guardians (usually kin) are reimbursed at the higher foster care rate. These subsidized guardianships have been approved under a federal waiver in eight states, including Illinois. Research indicates that subsidized guardianships do result in permanency for African American children. In one study in Illinois, relatives in subsidized guardianship arrangements converted their informal arrangements into 44

Julie Miller-Cribbs and Naomi Farber. Kin Networks and Poverty among African Americans: Past and Present. Social Work 53, 1, January, 2008, 43-51; Jimenez,900-902;Carrie Jefferson Smith & Wynetta Devore. African American children in the child welfare and kinship system: from exclusion to over inclusion. Children and Youth Services Review, 26, May 2004, 427-446.

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formal, open adoptions in greater numbers than in non subsidized guardianships; these adoptions accounted for 58% of all adoptions in the state of Illinois in l999.45 Making subsidized guardianship available in all states would increase the options for permanency with kin for African American children in the child welfare system. According to a report issued by the GAO in 2007, states have expressed a strong desire to be allowed to use federal child welfare funds to provide subsidies to legal guardians.46 This would appear to be the next important federal policy needed to insure that African American children in the child welfare system receive the full measure of social justice they deserve.

INDIAN CHILDREN IN THE CHILD WELFARE SYSTEM Native American families who encounter the child welfare system also experience racial disparities within the child welfare system. Overall, this population comprises 1% of the general child population but constitutes 2% of the foster care population. Research studies have shown that Native American families are more likely to be reported, investigated and as a result have more substantiated reports of child maltreatment than White children. In terms of placement, Native American children are three times more likely to be placed in foster care.47 In looking at state level data, Native American children were 1.73 times more likely to be recommended for out of home placement in Minnesota; in Alaska, 51% of the foster care population consist of American Indian and Alaskan Native children, but only account for 20% in the general child population. Native Indian children who lived in Washington State experienced overrepresentation at all stages in the child welfare system. Compared to Caucasian children, Native Indian children were more likely to be referred to CPS be placed outside the home, experienced longer placement stays (over two years) and were less likely to be reunified with their families.48 In terms of child welfare services, Native Indian caregivers are less likely to receive substance abuse and/or mental health treatment. In a national sample of American Indian caregivers, 22% were identified as having a substance abuse or mental health problem at time of investigation. Only 15% received a formal assessment, approximately 25% were offered services and only 12% actually received the services.49

45

46

47

48

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Mark Testa. The Changing Significance of Race and Kinship for Achieving Permanence for Foster Children. In Eds. Derezotes ,Poetner & Testa, Eds. Race Matters in Child Welfare,231-241. African American Children in Foster Care: Additional HHS Assistance Needed to Help States Reduce the Proportion in Care. GAO, July 2007. http://www.gao.gov/new.items/d07816.pdf. Retrieved July 28, 2008. Robert B. Hill. Disproportionality of minorities in child welfare: Synthesis of research Findings. http://www.racemattersconsortium.org/docs/whopaper4.pdf. Retrieved on July 25, 2008; United States Census Bureau. 2003. Characteristics of American Indian and Alaska Natives by tribe and language: 2000. Part 1,89. http://www.census. Gove/prod/cen2000phc-5-pt1.pdf. Retrieved May 21, 2008. Erik P Johnson, Sonja Clark, Matthew Donald, Rachel Pedersen, & Catherine Pichotta. Racial disparity in Minnesota’s child protection system. Child Welfare. 86 No. 4 2007. 5-20. Robert B. Hill. An analysis of racial/ethnic disproportionality and disparity at the national, state, and country levels. http:// www.aecf.org/~/media/PublicationFiles/Bob%20Hill%20report%20natl%20state%20racial%20disparity%202 007.pdf. Retrieved on July 25, 2008. National Indian Child Welfare Association. Time for reform: A matter of justice for American Indian and Alaskan Native children. Philadelphia, PA: The Pew Charitable Trusts. 2007. Anne M. Libby, Heather D. Orton, Richard P. Barth, Mary Bruce Webb, Barbara J. Burns, Patricia Wood, & et al. Alcohol, drub, and mental health specialty treatment services and race/ethnicity: A national study of

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Indian Child Welfare Act In l978 Congress recognized the cultural assault on American Indian identity represented by the large number of placements of American Indian children outside tribal areas with white families. Citing a longstanding government campaign to place these children in white institutions that began in the early 20th century, the Senate held hearings in which witnesses testified that from one quarter to one third of American Indian children had been separated from their families by child protective services. Infants were particularly at risk for adoption by whites. Witnesses blamed culturally biased standards of child rising for the high number of removals, mostly on grounds of neglect or “social deprivation.”50 Congress declared that the continued existence of tribes, along with tribal sovereignty were both threatened by the actions of state child protective service workers. Under the new law child protective service agencies were mandated to make active efforts to guarantee that American Indian children remain with their families and to turn cases of child endangerment over to tribal courts, who would make decisions regarding the welfare of American Indian children. The law applies to foster placements, termination of parental rights, and adoptions. The ICWA defines "Indian child" as a child who is a member of a federally recognized Indian tribe, or is eligible for membership in such a tribe and the biological child of a member. The Multiethnic Placement Act of l994 exempts Indian children from its provisions, in keeping with the goals of the Indian Child Welfare Act. States are allowed to oppose transfer to a tribal court in cases where good cause exists, including the non existence of such a tribal courts. However state agencies must make every effort to locate the tribe to which the child may belong, even if this is not immediately apparent. The Act establishes a minimum federal standard if a state wished to remove American Indian children from their home. It is more difficult for child protective service agencies to place Indian children outside their homes, and these placements are with Indian homes wherever possible. In spite of clearly stated federal intention, lack of state compliance with this Act is a problem; some states decline to enforce it. While some states have passed their own laws to support the federal law, in other States Indian children have been removed from their homes and placed in non-Indian foster or adoptive homes.51 Since the federal government did not allocate funds to tribes to implement ICWA, there is little recourse in cases of state indifference to the Act, and even cooperative state child welfare agencies may find limitations in how tribes can supervise their child welfare responsibilities. The federal government still has not allocated funds for tribal child welfare services.52 As a result of these factors, ICWA has not been not fully implemented. Indian children continue to be at risk for removal on grounds of child neglect, due to the high poverty rates experienced by the American Indian families. In 2000, 22% of American Indian children lived below the poverty level in the United States. Recent policy changes may put these families at greater risk for child removal. Families on economically marginalized

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children and families involved with child welfare. American Journal of Public Health. 96 No. 4 2006. 628631. Roberts, 248-250.Madeleine Kurtz. The Purchase of Families into Foster Care: Two Case Studies and the Lessons they Teach. Connecticut Law Review 26 (1994), 1453-1475. Andrea Wilkins. The Indian Child Welfare Act and the States. The National Conference of State Legislatures, 2004. http://www.ncsl.org/programs/stcatetribe/icwa.htm. Retrieved May 21, 2008. Ann MacEachron & Nora Gustavsson. Contemporary Policy challenges for Indian Child Welfare. Journal of Poverty.9 (2) 2005, 43-61.

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reservations and rural areas have long depended on welfare, since there are few employment opportunities in these areas. Poverty in reservation families may be exacerbated by the 5 year time limit for receiving TANF and pressure for permanency through adoption and parental termination may undermine the goals of the ICWA in families who are not returned to tribal jurisdictions and are subject to the oversight of state child protective service agencies.53

LATINO CHILDREN IN THE CHILD WELFARE SYSTEM Latino families who encounter the child welfare system also experience racial disparities within the child welfare system. Although research studies on this population are severely lacking, current research suggests the Latino children are overrepresented in several states and counties, and at different stages within the child welfare system. Compared to White children, research studies have shown that Latino children (under the age of 5) are at greater placement risk;54 are entering the foster care system at greater numbers than other children, 55 remain in placement rather than return home, and are less likely to be reunified.56 Also, the Adoption and Foster Care Analysis and Reporting System (AFCARS, 2005) provided national trend data (2000-2005) for the Latino population and found that Latino children who entered the foster care increased from 15% in 2000 to 18% in 2005.57 Using the Minority Overrepresentation Index (created by the Office of Juvenile Justice and Delinquency Prevention (OJJDP)) and the U.S. Department of Health and Human Services Child welfare Outcomes Annual report data, Dougherty58 found significant overrepresentation for the Latino population in the foster care system. With the criteria of 1.0 and over considered to be overrepresentation, seventeen states (ranging from 1.0 to 1.9) fell into this category. These numbers are compared to White children who are sufficiently underrepresented in forty-eight states (0.0 to 0.9). In New York City, the number of Latino children in foster care increased 7.4% from 2000 to 2005; however, in 2006, the number increased by 61.4%. In looking more closely at the data, 18 community districts had been identified as “high need” based on the number of children in placement. Nine of the districts had 37% of its children in foster care, “17 of the 18 high need districts were areas where Latinos account for more than half of all residents

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United States Census Bureau. 2003. Characteristics of American Indian and Alaska Natives by tribe and language: 2000. Part 1,89. http://www.census. Gove/prod/cen2000phc-5-pt1.pdf. Retrieved May 21, 2008. 54 Mónica M. Alzate & James A. Rosenthal. Gender and ethnic differences for Hispanic children referred to child protective services. Children and Youth Services Review. In press 2008. 55 Sandra Stukes Chipungu & Tricia B. Bent-Goodley. Meeting the challenges of contemporary foster care. The Future of Children. 14 No. 1 2004. 75-93. http://www.futureofchildren.org/usr_doc/5-stukes.pdf. Retrieved on July 25, 2008 July 29, 2008. 56 Alice M. Hines, Peter Allen Lee, Laurie Drabble, Lonnie R. Snowden, & Kathy Lemon. An evaluation of factors related to the disproportionate representation of children of color in Santa Clara County’s child welfare system: Child family characteristics and pathways through the system, phase 2 final report. 2002. http://www.sjsu.edu/cwrt/Phase2/File1.pdf. Retrieved on July 15, 2008. 57 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. The AFCARS Report, Preliminary Estimates for FY 2006 as of January 2008 (14). http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report14.htm. Retrieved on July 20, 2008. 58 Susan Dougherty. Practices that mitigate the effects of racial/ethnic disproportionality in the child welfare system. Seattle, WA: Casey Family Programs, 2003.

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who are not proficient in English.”59 In New Mexico, Latino children consist of 51.8% of the population, but 55.4% are in the foster care system. This can be compared to White children who make up 31.3% of the population but only 29.1% are in the foster care system.60 In California, where more than 13 million Latinos comprise 36% of the state’s population, the number of Latino children in the child welfare system is much higher than in the rest of the nation, although not disproportionate with their numbers in the state population.61 In looking for current national research that addresses the effects of policies, in particular, Adoption and Safe Family Act (ASFA) on the Latino population, is unknown. In a national study that examined how foster care outcomes may have changed since the passage of this legislation, the researchers noted that “changes in foster care outcomes cannot be identified due to the lack of comparable pre and post-ASFA data.”62 The reason for this is because States have only been required to collect demographic data on children in foster care and adoptive families since 1995. Before 1995, States were not mandated to provide this type of information to the federal government. In addition, Wulczyn63 notes that while the data collection process has improved greatly over the years, it takes approximately five to ten years to complete adoptions relative to reunification and exists. In other words, it takes a significant length of time to know how the adoption process is impacted or changed by ASFA. There have been two State studies recently that deserve attention. McWey, Henderson, and Tice examined 168 court cases that resulted in parental right termination. The results indicated that parents were more likely to have their parental rights terminated after ASFA (100%) than before ASFA (79%).64 The second State study compared pre and post ASFA outcomes with a sample of 1, 900 women (71.9% White, 5.2% Black, 2.5% Latino, 5.8% Native American, 0.1% Asian) who were involved in the child welfare system and received substance abuse treatment. The results indicated that post ASFA children were in foster care shorter periods of time (although the average was 421 days), placed in permanent environments quicker and were more likely to achieve adoption.65 However, the primary reason for these outcomes have more to do with how the State prepared for and implemented ASFA than the actual policy effects. For example, a significant amount of coordination between child welfare, substance abuse treatment providers and the courts was completed prior to ASFA, this State also did not institute expedited permanency plans. That is, in the 59

Elsa A. Ríos & Sandra Duque. Bridging the cultural divide: Building a continuum of support services for Latino families. New York: The Committee for Hispanic Children and Families, Inc. 2007. 1. 60 New Mexico Race Matters Coalition. Child welfare in New Mexico. 2007. http://www.nmvoices.org/attachments/ racemattersfactsheets/child_welfare_fact_sheet.pdf. Retrieved on July 25, 2008. 61 Wesley Church, Emma Gross & James Baldwin. Maybe ignorance is not always bliss: The disparate treatment of Hispanics within the Child Welfare System. Children and Youth Services Review. 27, 2005. 1278-1292. 62 U.S. Government Accounting Office. Foster Care: Recent Legislation Helps States Focus on Finding Permanent Homes for Children, but Long-Standing Barriers Remain. 2002. 3. http://www.gao.gov/new.items/d02585.pdf. Retrieved on June, 10, 2008. 63 Fred Wulczyn, Kristen Hislop, Lijun Chen. Adoption Dynamics: An update on the Impact of the Adoption and Safe Families Act. Chicago. Chapin Hall. 2005. http://www.chapinhall.org/article_abstract.aspx?ar= 1384&L2=61&L3=130. Retrieved on July 10, 2008. 64 Lenore M. McWey, Tammy L. Henderson, and Susan N. Tice. Mental Health Issues and the Foster Care System: An Examination of the Impact of the Adoption and Safe Families Act. Journal of Marital and Family Therapy, 195-214, 2006. 65 Anna Rockhill, Beth Green and Carrie Furrer. Is the Adoption and Safe Families Act Influencing Child Welfare Outcomes for Families with Substance Abuse Issues? Child Maltreatment, 2007, 7-19.

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current legislation, States are given an option to “fast-track” families; meaning that if child welfare workers think that reunification is not viable, then the parents are offered services. The majority of these women did receive substance abuse services. The findings of this study demonstrate that States can enhance services and achieve positive outcomes regardless of federal mandates.

CONCLUSION This chapter discussed disproportionality and disparity for African American, Native American and Latino children in the child welfare system. It also highlighted the major causes of this problem and provided a critique of relevant policies. It is clear from this review that additional research is required in three general areas. The first one is centered on prevalence. While research has indicated how many African American children are reported, investigated, placed in out of home care and either reunified with their families or adopted, the same cannnot be said for Native Americans, Latino and Asian populations. These issues need to examined in future child welfare research. The second line of research should focus on how ASFA has impacted these ethnic minority groups. What are the outcomes of ASFA for families from these ethnic groups? Is this policy producing positive effects for these populations? What effects does ASFA have on their communities? The third area of research should examine how TANF have impacted families who are involved in the child welfare system. Professionals, researchers and scholars predicted that child maltreatment cases would dramatically increase because of welfare reform legislation. However, only a few studies have been conducted with inconclusive results. There must be more research focus on whether or not a family who receives welfare benefits will be more likely to be involved in the child welfare system. Children of color have not been empowered by federal policies over the past two decades. Both TANF and ASFA have taken away rights from economically marginalized children of color; TANF by limiting the federal aid their families can receive and ASFA by putting the weight of the federal government behind termination of parental rights and adoption. Child maltreatment is the result of multiple risk factors, including poverty, substance abuse, domestic violence, social isolation and community factors including high unemployment.66 Many of these problems are experienced disproportionately by African American, Latino and American Indian families. The child welfare system is reinforcing these inequalities by punishing families without adequate services related to the causes of child maltreatment. While protecting children and keeping them safe is necessarily the primary goal of child welfare, the needs of vulnerable children should be meet within their family structure whenever possible. The policies in the United States today render this goal impossible to reach.

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Ruth McRoy. The Color of Child Welfare, in Eds. King E. Davis and Tricia Bent-Goodley. The Color of Social Policy. Alexandria, VA :Council on Social Work Education. 2004, 37-63.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 3

ETHICAL ISSUES IN CHILD WELFARE: AN OVERVIEW FOR MENTAL HEALTH PROFESSIONALS Jeffrey H. Sieracki, Jessica A. Snowden, Amy M. Lyons, Scott C. Leon Loyola University, Chicago, IL, USA

ABSTRACT What are the ethical considerations that psychologists, psychiatrists, social workers, and other mental health professionals must take into account when working with the child welfare population? How does a child welfare professional juggle the demands of the child, biological parent(s), foster parent(s), and the courts while remaining responsible to the ethics of his or her profession? This chapter addresses ethical conflicts that might arise when psychologists and other mental health professionals assess, treat, or research children and adolescents in the child welfare system. This chapter reviews the child welfare system and the role of various professionals in child welfare, and a summary is presented of ethical guidelines from the American Psychological Association (APA), the American Psychiatric Association (APA), the National Association of Social Workers (NASW), and other ethics documents from related professions that pertain to this population. Although ethical codes and guidelines have been published by various organizations, the aim of this chapter is to synthesize this vital information and discuss the implications and controversies related to working with the child welfare population.

Keywords: Child welfare, ethics, substitute care, child custody

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INTRODUCTION Jason is a 10-year-old who lives with foster parents because his biological mother was deemed unfit to parent. His biological mother has had numerous drug related arrests and Jason and his siblings were adjudicated as being neglected. Although her parental rights have not been terminated, the dependency court is moving towards termination of parental rights and his mother has limited visits with Jason. Jason has been having problems at school, and school personnel request that a case study evaluation be conducted. As part of his case study evaluation, Jason is psychologically and cognitively assessed by a psychologist. The Department of Children and Family Services (DCFS), the child protection agency in the state in which Jason resides, provides consent for the case study evaluation; however, upon hearing of the assessment, Jason’s mother argues that she should have been involved in the decision to test and that the assessment should not have been conducted without her knowledge. Furthermore, she wants to block the school from receiving the results from the evaluation, as she is concerned of the stigma that Jason would face if he was labeled or if he is placed in special education. Should the psychologist ethically not have tested Jason until consent was obtained from the biological mother? Now that the tests are complete, should the psychologist release the results to the school, to his foster parents, or to his mother? Maria is a 5-year-old who is currently placed in temporary foster care. Her biological uncle sexually abused Maria over a period of several months, and the courts have not determined whether her mother was aware of the abuse and if it is safe for her to return to her biological family. Therefore, she has been removed from her biological parents, with a longterm goal of family reunification. Maria has been seeing a licensed clinical social worker for several weeks now in order to process her understanding and feelings regarding the abuse. However, Maria’s foster mother is also interested in receiving updates of therapy. The foster mother has functioned as an advocate for Maria and is very concerned about her well-being. From both an ethical and legal perspective should the social worker give updates of therapy to the foster mother despite the fact that she is not her legal caregiver? Jamal is an 11 year old who currently lives in a residential treatment center for boys with behavioral and emotional disorders. He has had numerous arrests for acts ranging from petty theft to assault. His parents are chronic drug abusers and their parental rights have been terminated. The State is now Jamal’s legal guardian. A researcher is studying the relation between antisocial acts and personality in juvenile offenders and wants to include Jamal in his research study. He has obtained informed consent from his university and from the Department of Family and Protective Services, the protection agency in the state in which Jamal resides. Although Jamal is interested in participating in the study, his caseworker does not believe that the study would be good for him psychologically and thinks that he is only interested in participating for the incentive (a $10 giftcard). She believes that it might cause him to become more aggressive and antisocial. Should the researcher include Jamal in his study despite the fact that his caseworker does not believe that the study would be beneficial? The above hypothetical scenarios illustrate the complexities of working with children and adolescents in the child welfare system. Indeed, there are many unique ethical, legal, and clinical issues that arise when working with this population. Jason’s scenario describes a dilemma that a professional might face when conducting an assessment; Maria’s case is related to therapy; and Jamal’s vignette pertains to researching youth in the child welfare

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system. This chapter will discuss ethical, legal, and clinical issues within these domains, and how ethics and legality overlap in the child welfare sphere. The process of child protective services, removal from the home, and transition to an out of home placement often involves psychologists, psychiatrists, social workers, and other mental health professionals. These individuals may work as part of a treatment team that meets regularly with the child, they may be brought in as consultants, or they may contact the child with the purpose of soliciting research participation (Isaacs-Giraldi, 2002). Regardless of the amount of involvement in the child’s treatment, professionals that work with children and adolescents should be aware of both the state and federal laws and the ethical principles related to the treatment of children in state custody and transitioning into state custody. Training programs offered at job sites and academic institutions often discuss ethical issues; however, these seminars or classes do not always focus on child welfare. Although many clinicians and researchers are certainly well-versed in this topic, ethical considerations in child welfare are an area of such importance that a review is appropriate regardless of level of knowledge. First, this chapter will briefly explore the history of the child welfare system and the role that mental health professionals play within the system. Next, a review of ethics in social services and the ethical guidelines relevant to working with children in the child welfare system will be discussed in terms of the overall ethics code and specific guidelines relevant to child welfare for psychology, psychiatry, social work, professionals serving as researchers, and other related disciplines. This section will also include brief overviews of the role of the various professionals in the child welfare sphere. Finally, ethical issues related to the biological parent and the foster parent will be addressed, and the ethical dilemmas discussed in the opening paragraph will be reexamined. Although ethical codes and guidelines have been published by various organizations, the aim of this chapter is to synthesize this vital information and discuss the implications and controversies related to the child welfare population.

AN OVERVIEW OF CHILD WELFARE Stretching back to the time before independence from England and continuing to present day, communities within the United States placed the responsibility of caring for orphaned, abused, and neglected children on their local or state government (Pecora, Whittaker, Maluccio, 1992). Although the federal government has enacted legislation pertaining to the ways in which the states must operate their child protection services, it remains the responsibility of the state to handle these services. States create their own child welfare laws and enforcement agencies and vary slightly regarding specific child welfare policies and practices. The following paragraphs will present a brief overview of the history of important legislation in child welfare at the state and national level. For these purposes, the state of Illinois and the Illinois Department of Children and Family Services (DCFS) will be discussed in order to provide an example of a state child protection organization. Out of home placements for children and adolescents have existed for several centuries, and the foster care model used in the United States today has existed for several decades (Terpstra & McFadden, 1993). After the publication of The Battered Child Syndrome in 1962

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(Kempe, Silverman, Steele, Droegemueller, & Silver, 1962), a book which documented the effects of physical abuse on young children and garnered widespread attention in the mainstream media, individual states began to shift the focus of their child service division away from finding placements for orphaned youths to reporting physical abuse. For example, largely due to the influence of the book, The Child Abuse Reporting Act of 1965, which required physicians to report physical abuse, became law in the state of Illinois. By the end of the 1960's, every state had a law on the books regarding reporting child abuse (Pecora et al., 1992). In the state of Illinois, the Child Abuse Reporting Act became the Abused and Neglected Child Reporting Act in 1975, which required physicians practicing within the state to report not only suspected physical abuse, but also suspected neglect (Gittens, 1994). Prior to the 1970s, the federal government did not play a direct role in the child protection realm. However, recognizing the extreme importance in protecting maltreated children and the potential problem with non-uniform laws within the states regarding child abuse reporting, the Child Abuse Prevention and Treatment Act was passed at the national level in 1974 (Public Law 93-247). The act required each state to adopt specific procedures to prevent, identify, and treat victims of child maltreatment and provided federal funding for a range of child services and research. Later, the Adoption Assistance and Child Welfare Act (AACWA) of 1980 (Public Law 96-272) was created in order to promote family reunification as opposed to multiple foster care placements (Downs, McFadden, & Costin, 2000; Gittens, 1994; Pardeck, 2002). This federal act allowed the Illinois DCFS and other state’s child protection services to focus more on permanency planning by providing subsidies for hard to place children. In addition, AACWA required an investigation of all reports of child maltreatment within 24 hours, and focused on placing children in the least restrictive environment. Under AACWA many children in the state of Illinois and other states spent their entire childhood in foster care waiting to be reunited with their family (Gittens, 1994). As a result, in 1997 the federal government passed the Adoption and Safe Family Act (ASFA) (Public Law 105-89). ASFA focused less on family reunification and more on finding a permanent home for children that was in the best interest of the child, regardless of whether that home was a return to the biological parents (Hannett, 2007). Due to the focus on permanency, the adoption of ASFA led to the reduction of children in the child welfare system. Despite the decrease of children in the child welfare system, in 2002, 532,000 children were in the foster care system nationally (Children's Defense Fund, 2005). As a result of these laws, DCFS and similar agencies throughout the United States investigate initial reports of child abuse and/or neglect. After investigating, a report is determined to be substantiated (i.e., there is evidence of abuse and/or neglect) or unsubstantiated (i.e., there is no evidence of abuse and/or neglect). While more than 65% of children who are investigated nationally remain in their homes (Downs et al., 2000), if the findings of the investigation indicate that the child is at risk for immediate harm, the state may decide to take temporary protective custody of the child. In Illinois, in order to ensure that an individual has a right to due process, within two days of removing a child from their parent’s home, a temporary custody hearing takes places to determine if it is in the best interest of the child to remain in DCFS custody. If DCFS retains custody of the child, a case plan is developed to determine what needs to be done before the child returns home (e.g., parenting classes, drug treatment, etc.). After the case plan is developed, an adjudicatory hearing occurs where the court decides whether the

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parents abused and/or neglected the child in the past. If evidence is present, a dispositional hearing is scheduled. It is there that the court decides if the child should remain in substitute care or if the child should return home. Throughout the child’s time in care, he or she receives a permanency hearing at least every six months where the permanency goals, such as returning home or having parental rights terminated, are discussed. In addition, the parent’s progress towards the case plan is evaluated and what rights the biological parent has towards the child (e.g., visitation) are determined. Through the permanency hearings, if the conditions related to the out of home placement do not improve (as often assessed by parental compliance with rehabilitation programs), the state may move toward termination of parental rights. When parental rights are terminated, the biological parent no longer has the aforementioned rights related to their child. During the course of this process, mental health professionals are frequently asked to make contributions to decisions of child placement. At the beginning of state involvement, they may be asked to perform a court ordered psychological evaluation of the child or the biological parents and testify before the court on the appropriateness of various placement decisions. However, the role of the mental health professional does not end with assessing the appropriateness of placement decisions. Children and adolescents in the child welfare system display an increased rate of emotional and behavioral disturbances, and 40% to 85% of this group are estimated to have an emotional disorder and/or substance use problem (Burns et al., 2004; Garland et al., 2001; Glisson & Green, 2006; Molin & Palmer, 2005; The American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA), 2002a). In recent years, increased attention has been given to assessing whether children in foster care and residential care have their emotional, behavioral, and developmental needs met by the services that they receive. After the publication of an influential report which indicated that nearly two- thirds of children in need of services were either not provided with services or placed in inappropriately restrictive settings (Knitzer, 1982), policymakers have stressed communication between agencies and streamlining delivery of mental health services to children and adolescents. Although new types of interventions and methods of service delivery have been implemented throughout the United States (i.e., the System of Care model of service delivery, the treatment foster care movement, and wraparound community services) (Chamberlain & Smith, 2005; Eber & Nelson, 1997; Stroul & Freidman, 1986), the effectiveness of these models in real world settings relative to “treatment as usual” is often negligible (Bickman, Noser, & Sommerfelt, 1999). Mental health professionals work in the continued attempt to improve service delivery to this population. Improving child welfare services also involves seeking a better understanding of the client base and treatment from a global perspective. Therefore, professionals in the mental health field frequently seek to conduct research on the child welfare population and the interventions that they receive. These researchers may already be working as members of the treatment team or they may not have had any prior contact with their research participants prior to engaging in the research.

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ETHICS IN SOCIAL SERVICES Ethics is a branch of philosophy dealing with moral problems and judgments (Koocher & Keith-Spiegel, 1998). White (1988) defines ethics as the evaluation of human actions; thus, behavior is evaluated as good or bad, right or wrong, or acceptable or unacceptable according to a moral principle or ethical guideline. Ethical codes date back to about 400 B.C. with the Hippocratic Oath, the first generated code of ethics for professionals (Koocher & KeithSpiegel, 1998). A code of ethics ensures the public that professionals are trustworthy and competent by maintaining a balance between professional privilege with responsibility and a commitment to consumer welfare. Although ethical codes vary by occupation, most ethics codes share several themes: (1) to promote the welfare of consumers served, (2) to maintain competence, (3) to do no harm, (4) to protect confidentiality and privacy, (5) to act responsibly, (6) to avoid exploitation, and (7) to uphold the integrity of the profession through exemplary conduct. General criminal and civil law do not protect consumers from unethical conduct (Koocher & Keith-Spiegel, 1998). Although morals and laws have a similar purpose in outlining rules of conduct in a socially acceptable manner, many issues of morality cannot be sanctioned or enforced by laws. The result, therefore, is that the relationship between ethics and the law is complicated and occasionally incongruent. Sometimes unethical conduct is civilly actionable or criminal. For example, a psychologist convicted of a felony can lose licensure and be expelled from state and national associations. Differences among state legal statutes also cause discrepancies. Having sexual intimacies with a psychotherapy client, for example, is a criminal offense in some states but not in others. In addition, there are many ethical guidelines that are not in violation of any criminal or civil law (e.g., being unfamiliar with the reliability and validity of an assessment technique one is using, participating in the misapplication of research findings, continuing to teach despite a serious emotional condition that compromises professional ability, failing to inform clients that their therapist is an intern). Thus, ethics codes are necessary in order to protect consumers from unethical conduct and ensure the best possible care.

ETHICAL CONDUCT IN CHILD WELFARE: CODES AND GUIDELINES There are ethical codes of conduct specific to all of the major mental health professions in the United States (psychologists, psychiatrists, social workers, etc.). The following section will review these documents, and discuss how these various codes are utilized in the real world. Ethical codes create a uniformed standard of conduct by which professionals must maintain. Failure to meet the standards of the ethical codes could result in disciplinary action including, but not limited to, termination of membership in the professional organization and suspension of licensure (American Psychological Association, 2002). Although many sections of the American Psychological Association (APA) Ethics Code are particularly relevant to working in the child welfare sphere, the majority of the document does not specifically discuss this vulnerable population. In addition, the central ethical documents of other professions, such as psychiatry, and social work, also do not directly discuss child welfare. However, ethics codes are intentionally created to be broad, in order to increase their

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applicability across the wide spectrum of professional roles that mental health professionals fulfill. In addition, it is noted in the introduction of the APA Ethics Code that the document is not meant to be an exhaustive list of standards. In addition to the Ethics Code, guidelines for performing evaluations in child welfare matters have also been published by the APA (APA, 1999). Unlike the ethical codes, the guidelines are aspirational and not mandatory or relatively exhaustive. The following sections review the APA Ethics Code and guidelines that are particularly relevant in working with this population from the perspective of a psychologist. Following this discussion, the ethics codes of several related disciplines that work with children and adolescents in child welfare will be summarized.

PSYCHOLOGISTS Role of the Psychologist in Child Welfare According to the American Psychological Association (APA), “The field of Clinical Psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical Psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socioeconomic levels” (APA, 2008). The primary charge of Clinical Psychology is to use science to establish, disseminate, and apply empirically supported psychological treatments and psychological assessments. In the field of child welfare, clinical psychologists are utilized to perform psychological assessments and to serve as expert witnesses in child protection cases. In addition, they frequently serve as therapists for children and adolescents in the child welfare system.

Ethical Code of Psychologists and Common Ethical Challenges The fundamental document guiding the clinical psychologist’s ethical standards is called the Ethical Principles of Psychologists and Code of Conduct (APA, 2002). This document consists of five general principles and ten sections of ethical standards specific to different domains (i.e., human relations, research, and teaching). Although the Codes of Conduct do not specifically discuss working with children that are in the child welfare system, there are a few general principles and codes that are of particular relevance to working with this population. The general principles of justice and respect for people’s rights and dignity are ideals that psychologists strive for in their conduct. The child’s basic human rights and dignity can be compromised as a result of repeated or inadequate placements. Keeping fairness and justice at the forefront is especially important in the domain of child welfare; children can not advocate for themselves and it is sometimes up to psychologists to ensure that they receive fair and just treatment. Psychologists are expected to protect confidential information that they obtain during their professional relationship with their clients. Confidentiality can often be challenging

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when the child is in out of home care. The child custody courts could request psychologists to testify, and biological parents without legal custody might demand the information. Before starting the professional activities, psychologists should discuss with the child’s legal guardian the principal of confidentiality and the limits of confidentiality, including the possibility of having records subpoenaed and the psychologist being called in to testify before the courts. To the extent that is developmentally appropriate, the child should also be included in this conversation. In most states, psychologists are required to break confidentiality in certain circumstances; when someone that they are engaged in a professional relationship with is a danger to themselves, a danger to others, or when a child is put in danger. Given the very nature of out of home placement, it is likely that many of the children that the psychologist will work with have been previously put in harms way. However, the duty to break confidentiality and report can become quite complicated for psychologists (Kalichman, 2002). Breaking confidentiality almost always significantly impacts treatment. Kalichman (p. 43) notes that “on the one hand, I feel I must report quickly if a child is in danger. But on the other hand, reporting disrupts treatment, ruins relationships among family members, and the child protection system often acts punitively, even if the family is making therapeutic progress”. Despite these roadblocks to treatment, the protection of the child is most important, and the duty to report helps to protect the child. Psychologists and other professionals must remember this if they are ever conflicted about the duty to report. Regardless of the nature of their involvement in the child welfare domain (i.e., as a researcher, clinician, expert witness in a child protection hearing, etc.), psychologists first and foremost strive to do what is in the best interest of the child (APA, 1999). While they make every effort to keep the child’s best interest in mind, they must continue to follow the ethical codes of conduct of their profession, even in situations in which these two values might conflict (APA, 2002). For example, suppose that a multidisciplinary treatment team believes that it would be in the best interest of a child to sever parental rights and enroll the child in a state-run residential program. A psychologist that conducted an intellectual and psychological assessment on this child might be tempted to draw conclusions that would favor this option. However, if the conclusions were not warranted based on the data obtained in the assessment, this would be a breach of the Ethics Code. In addition to the Ethics Code, which govern the field of psychology in general, the APA Committee on Professional Practice and Standards (COPPS) and the APA Board of Professional Affairs (BPA) have also developed guidelines for psychologists in child protection cases (APA, 1999). As opposed to the Ethics Code, which must be followed at all times and are considered mandatory, the guidelines are meant to be aspirational of desired behavior or conduct. The creators of the guidelines point out that they are intended to raise standards of professional practice and are not always applicable across situations. In addition, they are not to be used as a legal document in legal matters. They primarily refer to situations in which the psychologist is conducting evaluations in child protection matters (as opposed to acting in other roles such as therapist or researcher). Psychologists are often asked to perform assessments or evaluations that influence child welfare decisions; the guidelines were created to aid in this endeavor. The following section will highlight several of the guidelines that are particularly relevant to multidisciplinary professionals that work in child welfare (see Table 1 for a complete list of the guidelines).

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Table 1. Guidelines for Psychological Evaluations in Child Protection Matters 1. The purpose of the evaluation is to provide relevant, sound results or opinions, in maters where a child’s health or welfare may have been harmed. 2. The child’s interest and well-being are paramount. 3. The evaluation addresses the psychological and developmental needs of the child and/or parent that are relevant to child protection issues. 4. Psychologists conducting evaluations are professional experts who strive to maintain an unbiased, objective stance. 5. The serious consequences of assessment in child protection matters place a heavy burden on psychologists. 6. Psychologists gain special competence. 7. Psychologists are aware of bias and engage in nondiscriminatory practice. 8. Psychologists avoid multiple relationships. 9. The scope of the evaluation is determined by the nature of the referral question. 10. Psychologists must obtain informed consent from all adult participants and, if appropriate, the child participant. 11. Psychologists inform participants about limits of confidentiality. 12. Psychologists use multiple methods of data gathering. 13. Psychologists properly interpret assessment data. 14. Psychologists only provide opinions in child protection matters after conducting an evaluation adequate to support their conclusions. 15. Recommendations are based on whether the child has been or may be harmed, 16. Psychologists clarify financial arrangements. 17. Psychologists maintain appropriate records. American Psychological Association, 1999.

As discussed previously, “the child’s interest and well-being are paramount” (Guideline #2). The state is intervening on the best interest of the child, and psychologists should not lose sight of this fact. Psychologists are often contracted by child welfare agencies to perform assessments. These assessments can have a profound impact on the treatment plan and living situation of the child. When conducting psychological evaluations, the guidelines postulate that the assessments should specifically address the needs of the child that are relevant to the child protection issues (Guideline #3). Therefore, psychologists should tailor their assessments to the individual and to the individual’s prior traumas (i.e., physical, sexual, or emotional abuse, neglect, etc.). Although psychologists may be hired by particular “sides” in the child welfare case, they must remain unbiased and objective (Guideline #4). If the psychologist is unable to remain unbiased, than he or she should consider withdrawing from the case. The psychologist serves as the “expert witness”; although they may be asked to testify by a particular party, they should not be expected to blindly agree with the position of that party. Instead, as discussed previously, they should tailor their treatment recommendations to the best interest of the child. When performing an assessment they should rely on scientific knowledge when making judgments and, during testimony, explain the reasons behind their decisions based on the assessment.

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Several of the guidelines are also represented in some way or another in the more formal Ethics Code. For example, in conducting child welfare evaluations, the psychologist avoids multiple relationships (Guideline #8). Multiple relationships occur when a psychologist is in more than one professional role with the same person. Although the ethical standard of multiple relationships is discussed in the Code, due to the likelihood of the situation occurring in child protection cases it is also singled out in the guidelines. For example, a psychologist that administers therapy to the child or the family should not also conduct the formal psychological evaluation. Other guidelines that are also extensions of more formal codes of conduct include gaining specialized competence (Guideline #6), refraining from engaging in biased or discriminatory behavior (Guideline #7), obtaining informed consent (Guideline #10), maintaining confidentiality (Guideline #11), properly interpreting test results (Guideline #13), and clarifying financial arrangements (Guideline #16). The guideline of obtaining informed consent deserves special mention. As the first vignette highlights, this can be a thorny issue when the child is in out of home care or transitioning placements. In the opening vignette, the evaluation was performed at the request of the school, however; evaluations are often performed at the request of the courts, the child protection agency, or an attorney. Regardless of the individual or agency that requests the evaluation, the informed consent should clearly articulate the nature of the evaluation and to whom the results will be provided. Depending on the child’s ability level, the psychologist should also explain to the child the reasons why they are being evaluated, and how the results are used. Therapy, like assessment, requires an informed consent to treatment before services can begin. In many cases, regardless of the nature of the services performed, the informed consent does not have to be obtained from the biological parent. The informed consent should be read and completed by the legal guardian. It should also be noted that a referral of evaluation by a caseworker or alternative legal guardian does not represent informed consent. The provider of services does not have a legal obligation to inform the biological parent. A survey of polices of 24 mental health agencies in Massachusetts found that most did not require parents to participate or be informed of assessment or treatment (Molin, 1988). However, although the formal policies did not require parental consent, many agencies in the Massachusetts survey discussed the importance of involving the biological parent when appropriate (i.e., when not detrimental toward the child, when the biological parent is making a concerted effort to regain custody by complying with the courts requests, etc.). Regarding psychological treatment, clinical psychology has been instrumental in bringing new interventions to practicing mental health professionals and advocating that interventions used in the “real world” have demonstrated empirical support (e.g., Chambless & Hollon, 1998). Usually this means that an intervention has been documented to be effective in terms of improved clinical outcomes. Several research methodologies may be employed to accomplish this goal, including the randomized clinical trial (RCT) and the quasi-experiment; the RCT is considered the “gold standard” in terms of research evidence in support of an intervention because it uses a control group and is required before an intervention can be termed “efficacious” (Chambless & Hollon, 1998). While not explicitly stated in the APA ethics code, many psychologists consider it appropriate and ethical to employ only those interventions that have demonstrated empirical support. It is beyond the scope of this chapter to detail the psychological interventions that have accrued appropriate empirical support for child welfare populations, so only a brief description is offered here. Parent training programs (including Parent Child Interaction

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Therapy, The Incredible Years, and The Triple-P Positive Parenting Program) include curricula elements that provide education, coaching, and training to parents with troubled youth. Since youth in substitute care have often been removed from their homes due to the parental substance abuse and dependence, substance abuse interventions often become a crucial component of many permanency plans. Motivational Interviewing for substance abusing parents focuses on identifying the individual’s current level of motivation to stop using drugs and alcohol, and attempts to engage and overcome barriers to change. Multidimensional Treatment Foster Care is primarily a behavioral intervention program for delinquent youth. MTFC focuses on contingency management, improved communication, and close supervision. Finally, Trauma-focused cognitive behavioral therapy uses relaxation, stimulus control, cognitive restructuring and a variety of other established cognitive behavioral strategies to manage the symptoms of trauma that are so common among maltreated youth in the child welfare system.

PSYCHIATRY Role of the Psychiatrist in Child Welfare In practice, psychiatry is the discipline primarily responsible for conducting and disseminating research on drug therapies, making psychiatric hospital admission decisions, which are often involuntary, in support of the individual’s, or community’s safety, and for managing the individual’s psychotropic treatment regime. In the child welfare system, a psychiatrist would most likely be the individual responsible for prescribing psychotropic medication to the child or adolescent in the system. Many of the ethical dilemmas that psychiatrists face involve these vital professional responsibilities, dilemmas which can become even more heightened among the vulnerable and historically disenfranchised child welfare population.

Ethical Codes of Psychiatrists and Common Ethical Challenges The ethical codes of medical fields, including psychiatry, are listed in a document entitled The Principles of Medical Ethics (American Psychiatric Association, 2006). Many of these basic principles overlap with the American Psychological Association Ethical Code; for example, the basic preamble of the medical code calls for respect of the patient’s rights and maintaining the dignity of the patient. Confidentiality of patient records is also paramount. It is noted that if a psychiatrist is legally deposed, he or she should only discuss the facts that are relevant to the particular situation, and avoid offering speculation as fact. When in doubt, the psychiatrist should error on the side of protecting the confidentiality of the patient. This could be particularly relevant in serving as an expert witness in a child welfare hearing, in which invasive and personal questions may be asked. The amount of psychotropic medications given to youth began to increase in the 1980s and nearly skyrocketed in the 1990s, a situation which remains true today. For example, there was a three fold increase in the use of psychotropic drugs prescribed to youth between 1987

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and 1996 (Zito et al., 2000). More and more of these medication regimens had limited scientific support, leading the American Academy of Child and Adolescent Psychiatry in 1999 to claim that “…data on safety and efficacy of most psychotropics in children and adolescents remain rather limited and are in sharp contrast with the advances and sophistication of the adult field. In child and adolescent psychiatry, changes in clinical practice have, by far, outpaced the emergence of research data and clinical decisions are frequently not guided by a scientific knowledge base.” (Vitiello, Bhatara, & Jensen, 1999; p. 501). Therefore, an ongoing ethical dilemma for the profession of psychiatry involves balancing the needs of a population of youth and their families who are suffering with mental illness and the ethical responsibility to practice medicine on a large scale that is scientificallybased. This dilemma has been clearly recognized by the child psychiatry profession, as reflected in a 2001 policy statement: “It is important to balance the increasing market pressures for efficiency in psychiatric treatment with the need for sufficient time to thoughtfully, correctly, and adequately, assess the need for, and the response to medication treatment.” (American Academy of Child & Adolescent Psychiatry (AACAP), 2001) Further, the Pediatric Psychopharmacology Initiative calls for all clinical trials to be made public, even when they fail to demonstrate a benefit. For the practicing psychiatrist, it is an ethical imperative to know the scientific literature and the costs and benefits of any regimen. The issue of psychotropic medication overuse receives frequent attention in the popular media, but these reports often fail to acknowledge that the child welfare population is among the most medicated youth populations in the United States today. For example, a recent study of the Texas child welfare system found that almost 35% of the youth in Texas’ foster care system were being treated with psychotropic medications; a full 40% of these youth were treated with regimens consisting of 3 or more psychotropic medicines (AACAP, 2008). In an effort to address this issue, many state child welfare agencies have instituted policies to monitor psychotropic utilization. These include: the development of medication monitoring guidelines and initiatives, the development of policies that make it easier to gain a second opinion, and the development of vetted and trusted “preferred” provider networks. Physicians are one of the few professionals who are publicly entrusted with the right to temporarily take custody of another person; this happens when a patient is “committed” involuntarily as a result of being a threat to themselves or others. As such psychiatrists and other physicians are bound by strict ethical and professional guidelines when making a decision to involuntarily admit a patient. The following four guidelines serve as considerations the physician must assess before involuntarily admitting the youth: (1) The disorder prevents the youth from making treatment decisions, (2) If the youth does not receive treatment, he or she may be at risk of harming him/herself or others (3), The parents give consent to involuntary treatment on the youth’s behalf if they are able to do so. Otherwise, consent may be required in accordance with state laws. In most child welfare cases, the state Legal Guardian gives consent, and (4) The involuntary treatment proposed is in accordance with appropriate state laws

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SOCIAL WORKERS Role of the Social Worker in Child Welfare Social workers perform many roles within the child welfare system. In general, social workers are responsible for “mediation of the forces driving the tensions between organizational levels” (O’Brien, 2004, p. 107). In the child welfare sphere, these forces may include administration, juvenile court system, prosecuting attorneys, police, agency policies and procedures, the child abuse industry, and education, among others. Social workers in the child welfare system must often cope with conflicting loyalties to those they serve. Thus, ethical dilemmas may occur and ethics must be taken into consideration. When private matters become public issues, such as in child abuse and neglect cases, social workers are expected to intervene. They have a duty to investigate allegations and take appropriate action on behalf of the public, while at the same time helping individuals or families with their private troubles. For example, social workers are expected to protect children, alter family life so that children are safe, and recognize and change social injustices within the child welfare system. Because the child welfare system often involves the court, social workers have a unique role to fulfill in this domain. In addition to acting as an extension of the court, social workers must keep the court process operating (O’Brien, 2004). Responsibilities include investigating abuse and neglect reports, developing case material, writing petitions, preparing and presenting evidence, following through on orders of the court, and providing court services. Although social workers are expected to provide expertise in court proceedings, social worker discretion is controlled through an informal check and balance process.

Ethical Codes of Social Workers and the Common Ethical Challenges According to the National Association of Social Workers (NASW) Code of Ethics (1996), social workers must adhere to broad ethical principles which are based on the core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. The six ethical principle are: (1) social workers’ primary goal is to help people in need and to address social problems, (2) social workers challenge injustice, (3) social workers respect the inherent dignity and worth of the person, (4) social workers recognize the central importance of human relationships, (5) social workers behave in a trustworthy manner, and (6) social workers practice within their areas of competence and develop and enhance their professional expertise. In addition to these principles, it is important for social workers to be aware of culture, values, beliefs, and styles of working with people and how they may influence interactions with children, parents, families, and other professionals (Brittain & Hunt, 2004). In addition to the ethical principles listed above, the NASW Code of Ethics also includes ethical standards for social workers. Some of the standards are enforceable guidelines for professional conduct, whereas others are aspirational. These standards concern: (1) social workers’ ethical responsibilities to clients, (2) social workers’ ethical responsibilities to colleagues, (3) social workers’ ethical responsibilities in practice settings, (4) social workers’

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ethical responsibilities as professionals, (5) social workers’ ethical responsibilities to the social work profession, and (6) social workers’ ethical responsibilities to the broader society. The ethical principles and standards set by the NASW provide helpful guidelines for social workers to follow while working in the child welfare system. Nonetheless, ethical problems still exist and below represent some of the most problematic. Client selfdetermination, or “the practical recognition of the right and need of clients for freedom in making their own choices and decisions” (Biestek, 1957, p. 103) is the basis of a frequent ethical dilemma. Social workers must respect the client’s right to self-determine his or her present and future; however, this right is often restricted when working in the child welfare system due to obligations to society or other legal situations (O’Brien, 2004). For example, a biological parent may exercise his or her right to decline services (e.g., a parenting course) but the court may limit this right though legal orders (e.g., mandating a parenting course in order to receive custody). Thus, social workers must be respectful of the client’s wishes while abiding by court orders. Social workers may also get caught up in this ethical dilemma by imposing his or her standard of what is right for the client, a concept known as paternalism. Although paternalism may not always be negative (i.e., a child’s right to protection takes precedence over a parent’s right to parent), social workers may be violating client selfdetermination in certain circumstances, including withholding information from the client, deliberately opposing the client’s wishes, and manipulating clients by providing misinformation to them. The ethical dilemma, therefore, is that the client’s right to selfdetermination may be bounded by the social worker’s belief that he or she knows what is best for the client when this may not be the case. A second common ethical situation that social workers face when working in the child welfare system deals with the issue of informed consent. As discussed in previous sections, informed consent is essentially a fundamental attitude of working with clients respectfully (O’Brien, 2004). In helping clients make informed decisions, social workers must discuss options with the client and what the potential outcome may be for each option. In doing so, social workers may believe they can predict the outcome of a particular choice for the client when in actuality there is no way to predict with absolute certainty. One of the most important aspects of informed consent in child welfare is informing clients of their due process rights, with possible outcomes. The right to be informed about one’s due process rights is probably the most basic ethical standards that social workers can follow, and also one that can become problematic. For example, the social worker may be helping the client to oppose recommendations that he or she is making to the court for the parent’s child. Not being fully informed can have deleterious effects on the relationship between the social worker and client. Fiduciary relationships are the legal foundation of the social worker’s relationship with clients and are another common focus for ethical problems (O’Brien, 2004). Because the client is dependent upon the social worker to provide accurate and vital information to the court in addition to well-thought out recommendations, he or she is expected to be trustworthy, clear about boundaries while working with clients, and responsible for maintaining this fiduciary relation. According to the NASW, the exception to this is that the social worker’s fiduciary responsibility to the larger society supersedes loyalty to the client under certain circumstances. When working with a child welfare population, dilemmas regarding this exception often arise. For example, the child welfare system aims to protect children from maltreatment; however the child is dependent upon his or her parents and lives

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within a family and community. Therefore, the issue of fiduciary relationships may become ethically challenging for social workers. Because social workers in the child welfare system must often face the unique difficulty of representing diverse interests (e.g., child, parent, court, social work agency), ethics is an important issue that must be addressed. The standards and guidelines set by the NASW Code of Ethics represent guiding principles for social workers to adhere by in order to avoid ethical conflicts. It does not, however, force a choice on who the social worker is representing nor do they provide guidance to workers who believe they must decide whose interests they represent (Stein, 1998). Thus, the primary task of social workers is to try and reconcile conflicting views in order to prevent ethical dilemmas from occurring.

RESEARCHERS Role of Researchers in Child Welfare When professionals make claims about outcomes in child welfare, the efficacy of a particular treatment, and other statements, they should have evidence to support their assertions. Scientific, controlled, systematic research helps to provide this evidence. Research in child welfare may be conducted by a multitude of professionals using a multitude of possible methods. Some of the areas that are most frequently researched in child welfare include, outcomes of children in the system, placement decisions in child welfare, levels and types of psychopathology in the population, and cultural and social factors related to child welfare placements. Although the results of specific research is beyond the scope of this chapter, there are several sources that summarize various aspects of child welfare research (Barth, Berrick, & Gilbert, 1994; Maluccio, Ainsworth, & Thoburn, 2000; Pecora et al., 1992)

Ethical Codes of Researchers and the Common Ethical Challenges The ethical issues that arise when working with children in the child welfare system have been given only limited consideration (Molin & Palmer, 2005). Because research may be conducted by several professions, there is not a single ethics document that applies to all researchers in child welfare. However, most of the ethics documents (APA ethics codes; medical ethics, etc.) have sections related to research. Conducting research with children in general can be complicated due to their vulnerability to exploitation and their limited ability to decline participation (Gustavsson & MacEachron, 2007). Children who are wards of the state require even more protection when participating in research and matters may become extremely complex. Researchers must consider the risks and benefits of participation for the child to ensure that the risks do not outweigh the benefits. Informed consent is one ethical issue that is particularly problematic with this population (Bogolub & Thomas, 2005). Because several adults may play a role in the child’s life, it is sometimes uncertain who must give consent for the child to participate in research. There is variation among the legal necessity of birth parent consent for participation, although it is recommended by research texts (e.g., Marshall & Rossman, 1999; Padgett, 1998). The

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National Association of Social Workers (NASW) Code of Ethics states that if an individual is incapable of providing informed consent an “appropriate proxy” is necessary. For children, therefore, an appropriate proxy may or may not be the birth parent. Overall, the literature suggests that a case can be made for bypassing informed consent from the biological parent in research with children in the child welfare system. In addition, in many states the biological parent cannot legally consent if the child is in out of home care. Although there may be many adults in the child’s life, there may not always be an adult that has the child’s best interest in mind. When conducting research with children, the benefits of participation must outweigh the risks. In order to ensure that children are fully protected, the institutional review board (IRB), a committee at universities and other places in which research is conducted, requires that every child in the child welfare system be appointed an independent advocate (Gustavsson & MacEachron, 2007). The advocate reviews the research procedures, ensures the participants are fully informed, evaluates all possible risks, secures safeguards, and informs participants of their right to withdraw from the research. Although an advocate is required before an IRB will approve the research, compliance with this regulation remains inconsistent. Because the child’s best interest is always paramount, the use of an independent advocate who appreciates the vulnerable position of these children is a necessary component of the research process.

OTHER ETHICS CODES AND GUIDELINES The American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA) have published several documents related to the needs of children in out of home care (AACAP & CWLA, 2002a, 2002b). Although these documents do not discuss ethical principles specifically, they offer recommendations for best practice. One policy statement discusses the screening and assessment process of children in out of home placement, while the other addresses more general issues that relate to this population. Similar to the goals of the system of care framework for service delivery (Stroul & Friedman, 1984; Stroul & Friedman, 1994), the AACAP and CWLA advocate for services that are child focused, family centered, and culturally competent. Whenever possible, children and their families should be kept intact. When the child welfare system becomes involved, the policy statement recommends conducting an initial mental health and substance use screening within 24 hours of placement into the child welfare agency, followed by a more comprehensive assessment. The goal of the initial screening is to identify the children in urgent need of mental health services (AACAP & CWLA, 2002b). In addition, interventions for combating the stress of removal from the family should be implemented based on the individual needs of the child. For example, caregivers may need mental health and alcohol or drug services. Repeated individualized reassessment throughout the course of treatment and contact with child welfare is also stressed. In addition to the American Psychological Association and American Psychiatric Association, other professional organizations have their own policies in place regarding out of home care, child welfare, and/or noncustodial parents. However, not all of the professions specifically address the child welfare population. The professional guidelines of The American School Counselors Association (ASCA) primarily address issues related to divorce

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and separation, as opposed to child welfare (Wilcoxon & Magnuson, 1999). The National Association of Public Child Welfare Administrators guidelines were created for agencies working with children and families experiencing domestic violence (Foley, Berns, Test, Bragg, & Schecter; 2001). The guidelines describe the relationship between domestic violence and child mistreatment, and makes recommendations for child protection agencies. The recommendations are similar to those proposed by the APA, including tailoring the services to the child’s developmental level and maintaining confidentiality.

ETHICAL OBLIGATIONS TO THE BIOLOGICAL PARENTS AND FOSTER PARENTS Permanency is the ultimate goal of the child welfare system. Psychologists and other mental health professionals work with the courts to decide if the working goal for achieving permanency is reunification with the biological parent(s) or moving toward adoption and, therefore, severing parental rights. Due to shared history and established family bonds, reunification is often the preferred option, assuming that the reunification is in the child’s best interest (Sanchirico & Jablonka, 2000). However, professionals working with children in placement must often weigh obligations to the parent with the long-term safety and wellbeing of the child. Because reunification is a desired outcome in many cases, professionals have advocated that unless parental rights have been terminated, the parent should be informed and aware of the progress of his or her child, even if they are not required to be informed (Molin, 1988). Of course, there are situations in which the parent is not allowed to be involved in treatment planning. If the parent is not allowed to participate in the treatment process, he or she should be informed of the reasons why they are excluded, and the steps necessary to increase the likelihood of involvement (Molin & Palmer, 2005). In addition, when a psychological evaluation is ordered, parents should be explained the purpose of the evaluation and how the subsequent treatment will be conducted. They should also be informed when a treatment plan is modified. Again, the involvement of the parent depends on the extent to which he or she is committed to the process. Foster care parents are also an integral part of the treatment team. Mental health providers may be unclear about their relationship and obligations to foster care parents. Depending on the circumstances, if they are interested, foster care parents should be informed of treatment decisions, although they are also not legally required to be informed. The Massachusetts survey of mental health agencies found that, similar to biological parents, most agencies encouraged but did not require foster care parents to be involved in the treatment process (Molin, 1988). The treatment foster care movement has stressed the importance of involvement of the foster caretaker (Chamberlain & Smith, 2005; Reddy & Pfeiffer, 1997). It is primarily a skills-based and behavioral approach to treatment that teaches both parents and youth how to communicate effectively with one another and create consistent expectations for positive reinforcement. In addition to treatment decisions, if the child poses behavioral risks that could spill over into the home environment, than the foster parent should be informed. Similar to biological parents, these rights are not absolute, and in circumstances in which extended involvement of the foster parent is contraindicated, they may not be involved in treatment.

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Finally, professionals working with both biological and foster parents have an obligation to respect the families' cultural values. Critics of child welfare policies have argued that the "best interest" standard is often based on middle-class values and may be seen as a vehicle for placing children into more educated or affluent families (Westman, 1991). Cultural and class differences regarding parental discipline should also be considered by the professionals working with the families (Freeman, 1997).

ETHICAL DILEMMAS IN PRACTICE: THE OPENING VIGNETTES In the first vignette, a psychologist was assessing a 10 year old that was living in a foster home. Firstly, the psychologist performing Jason’s assessment should always keep his best interests at the forefront of her decision making. If, after reviewing the results of the evaluation and discussing the case with the child’s teacher and foster parents, the psychologist believes that an individualized education plan (IEP) would be in the best interest of the child then she has an ethical duty to recommend this option to the school. Because the state is the legal guardian, Jason’s mother does not have the right to block the school from receiving the evaluation. Depending on the involvement of Jason’s mother and her feelings toward the child welfare system, the decision to not inform her of the evaluation likely made the situation more contentious. However, as long as the State has temporary custody of Jason, his mother cannot intervene in decisions involving his schooling or treatment. In the second vignette, a licensed clinical social worker was treating a 5 year old with a history of sexual abuse. The girl is in foster care and her foster mother is interested in receiving updates on her treatment progress. As discussed previously, from a legal perspective, the foster mother is not required to be informed of treatment progress. However, following the ethical principle of acting in the child’s best interest, it is likely in Maria’s best interest for the foster mother to receive occasional updates, especially if she is acting as an advocate for her foster child. This would also allow the social worker an opportunity to convey any recommendations that he or she might have for parenting and/or the family environment. In the third vignette, a researcher is interested in recruiting a 11 year old with a history of psychopathology for participation in a research study. The parental rights have been terminated and the State is the formal guardian. As discussed previously, when conducting research with children in general, safeguards must be put into place in order to ensure that the risks do not outweigh the benefits. The child welfare population in particular can be a vulnerable subset. In this situation, if the caseworker believes that participating would have negative consequences for Jamal, then ethically the researcher should respect the wishes of the caseworker. The researcher could attempt to meet with the caseworker to discuss the study and any potential benefits and risks; however, ultimately the wishes of the caseworker should be followed. Taking these extra precautions and working with the many adults that are involved in the child’s life is necessary in order to keep his best interests at the forefront.

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CONCLUSIONS The child welfare system is designed to keep the best interests of the child at the forefront. Psychologists and other professionals that work with children and families that are in the system should be aware of their ethical responsibilities to the child, biological parent, foster parent, and other members of the treatment team. Several codes in the APA Ethical Codes of Conduct are relevant in working with this population, such as informed consent and confidentiality. In addition, APA, the Child Welfare League of America, and several other professional organizations have also published guidelines and policy statements for use in child protection matters. In the scenarios presented at the start of the chapter, and in other child welfare scenarios that are likely to involve multiple stakeholders, an approach to assessment and treatment that keeps the best interest of the child in mind and follows proper ethical conduct is imperative in working with children in child welfare.

REFERENCES American Academy of Child and Adolescent Psychiatry. (2001). Prescribing Psychoactive Medication for Children and Adolescents policy statement. Retrieved July 9, 2008 from http://www.aacap.org/cs/root/policy_statements/prescribing psychoactive_medication_for_children_and_adolescents. American Academy of Child and Adolescent Psychiatry and Child Welfare League of America. (2002a). AACAP/CWLA Foster Care Mental Health Values Subcommittee policy statement. Retrieved May 3, 2007 from http://www.aacap.org/page.ww? section=Policy+Statements&name=AACAP%2F CWLA+Foster+Care+Mental+Health+ Values+Subcommittee American Academy of Child and Adolescent Psychiatry and Child Welfare League of America. (2002b). AACAP/CWLA policy statement on mental health and substance use screening and assessment of children in foster care. Retrieved May 3, 2007 from http://www.cwla.org/programs/bhd/mhaacapcwlapolicy.doc American Psychiatric Association. (2006). The principles of medical ethics with annotations especially applicable to psychiatry. Retrieved December 19, 2007 from http://www. psych.org/psych_pract/ethics/ppaethics.cfm. American Psychological Association. (2008). About Clinical Psychology. Retrieved July 9, 2008 from http://www.apa.org/divisions/div12/aboutcp.html. American Psychological Association. (1999). Guidelines for psychological evaluations in child protection matters, American Psychologist, 54, 586-593. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct, American Psychologist, 57, 1060-1073. Barth, R.P., Berrick, J.D., & Gilbert, N. (1994). Child Welfare Research Review. New York: Columbia University Press. Bickman, L., Noser, K., Summerfelt, W.T. (1999). Long-term effects of a system of care on children and adolescents. Journal of Behavioral Health Services and Research, 26, 185202. Biestek, F.P. (1957). The Casework Relationship. Chicago, IL: Loyola University Press.

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Bogolub, E.B. & Thomas, N. (2005). Parental consent and the ethics of research with foster children. Qualitative Social Work, 4, 271-292. Burns, B.J., Phillips, S.D., Wagner, H.R., Barth, R.P., Kolko, D.J., Campbell, Y., et al. (2004). Mental health needs and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 960-970. Brittain, C. & Hunt, D.E. (2004). Helping in Child Protective Services: A Competency Based Casework Handbook (2nd ed.). New York: Oxford University Press, Inc. Chambless, D.L. & Hollon, S.D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7-18. Children’s Defense Fund (2005). Child Abuse and Neglect Fact Sheet. Retrieved online from http://www.childrensdefense.org/childwelfare/abuse/factsheet2005.pdf. Chamberlain, P. & Smith, D.K. (2005). Multidimensional treatment foster care: A community solution for boys and girls referred from juvenile justice. In Hibbs, E.D. & Jensen, P.S. (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (pp. 557-573). Washington, D.C.: American Psychological Association. Downs, S., McFadden, E.J., & Costin, L.B. (2000). Child welfare and family services: Policies and practice. (Sixth edition). Boston, MA: Allyn & Bacon. Eber, L., & Nelson, C.M. (1997). School-based wraparound planning: Integrating services for students with emotional and behavioral needs. American Journal of Orthopsychiatry, 76, 385-395. Foley, R., Berns, D., Test, G., Bragg, H.L., & Schecter, S. (2001). Guidelines for public child welfare agencies service children and families experiencing domestic violence. Washington, D.C.: American Public Health Services Association. Freeman, M. (1997). The Moral status of children: Essays on the rights of the child. The Hague: Netherlands: Kluwer Law International. Garland, A.F., Hough, R.L:., McCabe, K.M., Yeh, M., Wood, P.A., & Aarons, G.A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 409-428. Gittens, J. (1994). Poor relations: The children of the state in Illinois, 1918-1990. Urbana, IL: University of Illinois Press. Glisson, C. & Green, P. (2006). The role of specialty mental health care in predicting child welfare and juvenile justice out-of-home placements. Research on Social Work Practice, 16, 480-490. Gustavsson, N.S. & MacEachron, A.E., (2007). Research on foster children: A role for social work. Commentary for the National Association of Social Workers. Hannett, J.R. (2007). Lessening the string of ASFA: The rehabilitation-relapse dilemma brought about by drug addiction and termination of parental rights. Family Court Review, 45, 524-537. Issacs-Giraldi, G. (2002). The psychologist as consultant in the child welfare system. In Ribner, N.G. (Ed.) The California School of Professional Psychology handbook of juvenile forensic psychology (pp. 579-607). San Francisco, CA: Jossey-Bass. Iwaniec, D. & Hill, M. (2000). Child welfare policy and practice: Issues and lessons emerging from current research. London: Kingsly.

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Kalichman, S. (2002). Mandated reporting as an ethical dilemma. In: Ethics, Law, & Policy (2nd edition), pp. 43-63. Washington, D.C.; American Psychological Association. Kempe, C.H., Silverman, F.N., Steele, B.F., Droegemueller, W., & Silver, H.K. (1962). The battered-child syndrome. JAMA, 181, 17-24. Knitzer, J. (1982). Unclaimed children: The failure of public responsibility to children and adolescents in need of mental health services. Washington DC: Children's Defense Fund. Koocher, G.P. & Keith-Spiegel, P. (1998). Ethics in Psychology: Professional Standards and Cases (2nd ed.). New York: Oxford University Press. Maluccio, A.N., Ainsworth, F., & Thoburn, J. (Eds.) (2000). Child Welfare Outcome Research in the United States, the United Kingdom, and Australia. Washington D.C.: CWLA Press. Marshall, C. & Rossman, G. (1999). Designing Qualitative Research (3rd ed.). Thousand Oaks, CA: Sage. Molin, R. (1988). Treatment of children in foster care: Issues of collaboration, Child Abuse and Neglect, 12, 241-250. Molin, R. & Palmer, S. (2005). Consent and participation: Ethical issues in the treatment of children in out-of-home care, American Journal of Orthopsychiatry, 75, 152-157. National Association of Social Workers. (1996). Code of Ethics. Retrieved online from http://www.socialworkers.org/pubs/Code/code.asp O’Brien, T.M. (2004). Child Welfare in the Legal Setting: A Critical and Interpretive Perspective. New York: The Haworth Press. Padgett, D. (1998). Qualitative Methods in Social Work Research. Thousand Oaks, CA: Sage. Pardeck, J.T. (2002). Children's rights: Policy and practice. Binghampton, N.Y.: Haworth Press. Pecora, P.J., Whittaker, J.K., Maluccio, A.N. (1992). The Child Welfare Challenge: Policy, Practice, and Research. NY:Aldine de Gruyter. Reddy, L., & Pfeiffer, S. (1997). Effectiveness of treatment foster care with children and adolescents: A review of outcome studies. Journal of the American Academy of Child and Adolescent Psychiatry, 36 ,581-588. Sanchirico, A., & Jablonka, K. (2000). Keeping foster children connected to their biological parents: The impact of foster parent training and support. Child and Adolescent Social Work, 17, 185-203. Stein, T.J. (1998). Child Welfare and the Law (revised edition). Washington, D.C. CWLA Press Stroul, B.A., & Friedman, R.M. (1986). A system of care for children and youth with severe emotional disturbances. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. Stroul, B.A. & Friedman, R.M. (1994). A system of care for children and youth with severe emotional disturbances. (Revised Edition). Washington, D.C.: Georgetown University Child Development Cetner, CASSP Technical Assistance Center. Terpsta, J., & McFadden, E.J. (1993). Looking backward: Looking forward: New directions in foster care. Community Alternatives: International Journal of Family Care, 5, 115133. Vitiello, B., Bhatara, V.S., & Jensen, P.S. (1999). Introduction: Current knowledge and unmet needs in pediatric psychopharmacology. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 501-502.

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Westman, J.C. (1991). The legal rights of parents and children. In J.C. Westman (Ed.) Who speaks for the children?: The handbook of individual and class advocacy (pp. 45-64). Sarasota, FL: Professional Resource Exchange, Inc. Wilcoxon, S.A., & Magnuson, S. (1999). Considerations for school counselors serving noncustodial parents: Premises and suggestions, Professional School Counseling, 2, 275279. White, T.I. (1988). Right and wrong: A brief guide to understanding ethics. Englewood Cliffs, NJ: Prentice Hall. Zito,J.M., Safer, D.J., DosReis, S., Gardner, J.F., Boles, M., et al. (2000). Trends in the prescribing of psychotropic medications to preschoolers. Journal of the American Medical Association, 283, 1025-1030.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 4

THE ROLE OF PARENT-ADOLESCENT CONNECTION IN CHILD WELFARE: A STUDY OF HIGH SCHOOL STUDENTS IN TRANSYLVANIA, ROMANIA Laszlo Brassai and Bettina F. Piko Psychopedagogical Consulting Center, Kovasna County, Romania and University of Szeged, Hungary

ABSTRACT Child welfare is closely related to parent-child connection. Adolescence is particularly a difficult transition period influencing child welfare. Problems between adolescents and their parents may be detected by indicators of child welfare, among others, adolescent substance us. This study presents the results of a research with a sample of Transylvanian youth (in Saint George, Romania). Data collection was going on in a sample of high school students and the study included items measuring frequencies of smoking, alcohol use and illicit drug use as well as aspects of familial influences of youth’s substance use (such as family structure, the quality of the relationship with parents, parental conflicts and the ways of coping with them). Based on a comparison of prevalence rates and frequency distributions, we may conclude that the initiation of substance use may be dated at around 15-16 years of age. Regarding frequencies of smoking and alcohol use, most students have already tried or used them regularly. Gender, family structure, and conflicts with parents proved to be risk factors for all types of substance use. Based on the analysis of parent-child connection, authoritative/supportive parenting style of mother and authoritarian/hard parenting style of father seem to be protective against adolescent substance use. These results may highlight the role of cultural variations in child welfare since parenting efficacy may depend on the special cultural context.

Keywords: child welfare, adolescence, familial influences, parental conflict, substance use

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INTRODUCTION Assuring child welfare should be based on child risk assessment and child protection (Ryan, Wiles, Cash, & Siebert, 2005). The role of family is particularly important in child welfare since familial problems may have an influence on the child health and welfare in many ways (Brannen, Dodd, Oakley, & Storey, 1993). For example, the unemployment and financial strains of family may increase the child abuse risk (Berger, 2004). The poor parentchild connection also may influence children’s health and welfare through a number of processes, such as generating psychosomatic health problems and substance use. This is particularly true during the years of adolescence. Adolescence is a critical period of the lifecycle in terms of child welfare, particularly years of the high school period, when there is a drastic increase in frequencies of substance use (Hawkins, Catalano, & Miller, 1992). Social influences are among the key factors to determining adolescent substance use, most strikingly, the peer group effect has been found to be a dominant risk factor (Gilvarry, 2000; Piko, 2001; Schneider, Levenson, & Schnoll, 2001; Poikolainen, 2002; Bahr, Hoffmann, & Yang, 2005). However, analyzing only the peer group effect without taking the parental effect into account may withdraw us from getting a deeper insight into adolescent substance use and their welfare (Piko, 2000a). Based on all these relationships, we may conclude that the role of social influences is not so simple as it seems. Adolescence is a restructuring period of social network and support system when both striving for autonomy and a need for close relationships are present (Piko, 1998). In modern society, identity formation during socialization is sometimes not easy due to a prolonged period of adolescence (Arnett, 2000). In this period of life, the initiation of successful peer group relations is also necessary to processes of individuation. Normative beliefs concerning close friends and siblings may play an important role in the catalysis and support of intentions to initiate substance use (Scott, Thombs, & Tomasek, 2005). Whereas in early adolescence, a rebellious attitude towards parents is more frequent, in late adolescence, a more balanced attitude tends to appear in which both peers and parents play a different influential role (Piko, 2000a; Piko & Fitzpatrick, 2003). All these processes have an impact on frequencies of substance use or other type of problem behavior, such as depressive symptomatology. A number of studies draw our attention to mutual influences of the role of parents and peers (Wood, Read, Mitchell, & Brand, 2004). Actually, it is not possible to draw a barrier between the roles of parents and peers. As Lau, Quadrel and Hartman (1990) have found, health promoting behaviors are more affected by parents than peers from childhood up to the college years. In relation to this, Bailey and Hubbard (1990) have argued that a good relationship with parents may serve as a protection against early adolescent marihuana use. Similar results were found by Fleming and colleagues (2001) in connection with pre- and early adolescent smoking initiation. The peer group effect seems to become a dominant predictor only in late adolescence. In terms of child welfare, many doubts have been voiced about whether the family would survive as an institution and continue to be an important agent in the socialization of youth. Prior research has shown that the most important factor in fostering resiliency and invulnerability for adolescents is bonding to a caring adult, often found in a parental relationship (Dryfoos, 1998). Family environment is not an unitary dimension. Rather, it is a

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multidimensional construct comprised of heterogeneous psychological and social factors. Parental monitoring, parental style, family connectedness, parent-child communication and family structure have been identified as influences of adolescent health behavior (Vazsonyi, 2003). Adolescents desire parental presence and control in their lives (Ungar, 2004). Parental control is a strong influence among the protective factors against adolescent substance use which is a part of the parental monitoring practice (Li, Stanton, & Feigelman, 2000). In opinion of DiClemente and colleagues, parental monitoring refers to adolescents’ perception of their parents’ knowledge of whom they are with and where they are spending their time when they are not at home or attending school. Certain aspects of parental monitoring and control functions may decrease levels of adolescent substance use. For example, when parents set a curfew or they know where their children are when they are going out with peers are typical aspects of the parental monitoring system (Piko & Fitzpatrick, 2002). This is because these aspects of parental practices help develop a positive attitude towards order and a wellbalanced behavioral control during adolescence (Deković, 1999; Hawkins, Catalano, & Miller, 1992; Piko & Fitzpatrick, 2003). On the other hand, parental monitoring may moderate the effects of peer influences (Beck, Boyle, & Boekeloo, 2004; Coley, Morris, & Hernandez, 2004; Dorius et al., 2004; DeVore & Ginsburg, 2005). Simons-Morton et al. (2001), Wood, Read, Mitchell and Brand (2004), for example, have pointed out that whereas deviant peers elevate the risk of adolescent substance use, the authoritative parental practice (that is, demanding but responsive parenting behavior) may serve as a protection against harmful risk behaviors. Parental involvement has moderated pre-influenced drinking behavior in a sample of late adolescents. Adolescents, whose parents take care of their children’s activities and experiences, tend to avoid from smoking and alcohol use. Adalbjarnardettir and Hafsteinsson (2001), completed views of Gray and Steinberg (1999), argued that it was necessary to overstep focus on single dimension of parent-child relationship in exploring its influence on adolescent substance use. For example, we should recognize the importance of studying various dimensions of parenting style. Based on this opinion, the authors demonstrated that adolescents from autoritative and even authoritarian families tended to report lower levels of legal as well as illicit drug use than adolescents from neglectful and indulgent families. Recent research results (e.g., Castrucci & Gerlach, 2006) also reinforced that authoritative parenting was associated with a reduction in the odds of adolescent current cigarette smoking. Evidently, besides parental control, the parents’ personal activities and views – such as drug-related attitudes and behavior – may consistently moderate the protective effects of parenting (DiLorio, Dudley, & Soet, 2004, Piko & Fitzpatrick, 2002; Piko, 2001). Parental smoking contributes to the onset of daily smoking in their children even if parents practice a good family management otherwise, for example, hold norms against teen tobacco use, and do not involve their children in their own tobacco use (Bailey, Emmett, & Ringwalt, 1993; Hill et al., 2005; Jackson et al., 1997) and alcohol use (Nash, McQueen, & Bray, 2005). Harakeh and colleagues (2004) demonstrated that quality of the parent-child relationship and parental attitudes affected adolescents’ smoking behavior indirectly, whereas parental smoking behavior had a direct effect. In research reported by Adalbjarnardettir and Hafsteinsson (2001), 14-year-old adolescents were more likely to have experimented with smoking and drinking if their parents smoked (46% versus 17%, OR=3.85) or drinked (63% versus 42%, OR=1.61). Not only parental substance use but a too negative parental attitude

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may also elevate early risk for substance use as indexed by intentions to use drugs (Myers, Newcomb, Richardson, & Alvy, 1997). These findings are similar to another study (Distefan et al., 1998) which found that parental substance use, from a social learning point of view, was an example of a deviant parent norm. Barnes and colleagues (2000) found in their longitudinal study that adolescents raised in supportive families seemed to be receptive to parental monitoring which was related to a lower likelihood of alcohol misuse. Besides the control function, parent-child connectedness and communications are even more important in relation to substance use (Ackard, NeumarkSztainer, Story, & Perry, 2006). This is particularly true in case of adolescent drug abuse (Bahr, Hoffmann, & Yang, 2005), and smoking (Tilson, McBride, & Lipkus, 2005). Ackard and colleagues (2006), for example, demonstrated a significant relationship between parentchild connectedness and a broad range of serious behavioral and emotional health risk behaviors – substance use, unhealthy weight control, suicide attempts, body dissatisfaction, low self-esteem, and depression – in a diverse sample of boys and girls. As a consequence, connectedness and communication seem to be independent functions of parental practices referring to the quality of the parent-child relations more than the monitoring function. For youth, feeling connected to their families is an important social support resource, and many do turn to parents for information and guidance (Ackard et al., 2006). Another study demonstrated that parental warmth might deter adolescent involvement in problem behavior (Fletcher, Steinberg, & Williams-Wheeler, 2004). As Parker and Benson (2004) have pointed out, adolescents who perceive their parents as supportive are less likely to use drugs and alcohol. Finally, we should also mention that family support may withdraw adolescents from negative peer influences (Buysse, 1997). These findings support the role of the attachment theory in suggesting that supportive relationships provide adolescents with a coherent schema, a map that allows them to interpret the environment in an adequate way. Parental availability and discussions of problems create a trust for adolescent development (Erginoz et al., 2004). Distefan (1998), for example, found that adolescents who communicated with parents about serious problems in their lives were less likely to progress from experimentation to established smoking. Stephenson, Henry and Robinson (1996) demonstrated that teens who experienced the unity of their family in problem solving and stress management, were less likely to use substances as a mode of coping with stress. The security of connectedness seems to act as a base for protection during adolescence, even more than the closeness of relationship (Schneider, Atkinson, & Tardif, 2001). Parental influences, however, are not always protective. A number of studies have found that adolescents living in single-parent families are at a greater risk for substance use than are teens residing in traditional two-parent families (Ellickson, Tucker, Klein, & McGuigan, 2001; Hoffman & Johnson, 1998; Thomas, Farrell, & Barnes, 1996). The nonintact family structure may elevate the risk of adolescent problem behavior, due to the inadequacy of parental control (Demuth & Brown, 2004; Fitzpatrick, 1998). In addition, the intactness of family cannot guarantee the harmonious relations within the family, that is, familial conflicts also may elevate the risk of adolescent problem behavior (Formoso, Gonzales, & Aiken, 2000; Reti et al., 2002). Based on previous research results, the World Health Organization (1999) emphasize the role of familial problems and the nonintact family structure in adolescent problem behavior, among others, substance use. Recent studies also emphasize that not only the nonintact family structure elevates the risk but the reconstructed type as well, sometimes in a greater level (Ackerman et al., 2001; Harland et al., 2002).

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Being beaten by a parent or child abuse may also contribute to adolescent emotional problems and problem behavior (Piko & Fitzpatrick, 2003). Neglectful family practice may lead to adolescents’ inconsiderate behavioral decisions, for example, regarding substance use, although they are not prepared to make such decisions (Radziszewska et al., 1996). There should be a balance between control and connectedness, namely, besides the unfavorable social climate and nonsupporting/neglectful parental practices, the overprotective parental practices may also help develop bad social skills and substance use among adolescents (Jackson, Henriksen, & Foshee, 1998). We should also mention the role of natural mentors in prevention. Natural mentors are adults – not necessarily a family member – who help neutralize the harmful familial effects. Among others, grandparents or other relatives, teachers, physicians or other acquaintances may act as a natural mentor for adolescents (Zimmerman & Bingenheimer, 2002). This means that support from other adults may have a protective effect on adolescent health behavior. In a word, there should be a balance between risk and protective factors to a healthy development. Among girls, protective factors may be stronger, whereas among boys, there is a higher tendency to turn to substance use when facing risky familial processes such as conflicts or divorce (Formoso, Gonzales, & Aiken, 2000; Hops, Davis, & Lewin, 1999). Based on the literature review, we may conclude that parental influence in adolescent substance use is rather complex. The radical change from socialism to capitalism in east european countries has brought about changes at a variety of levels. At this time, the social change into a consumer culture has become a dominant reality, particulary among youth. Unfortunately, this phenomenon is often combined with a consumerist or hedonist lifestyle which, as a consequence, is often associated with elevated levels of substance use (Piko & Piczil, 2004). Furthermore, the development of a market economy has made people face increasing socioeconomic differences along with a number of social problems. In this psychosocial context, stressful events and the lack of economic and social resources may undermine family management. We know that family management skills can buffer the effects of difficult environments and thus prevent adolescent substance use. Therefore, some aspects of the parent-child relationships may reflect actual cultural influences of primary socialization. All these processes seem to be important factors in relation to adolescent substance use. The main goal of the present study has been two-fold: 1., First, to detect prevalence (frequency levels) and sociodemographic background of substance use in an adolescent population in the Transylvanian region of Romania; and 2., Second, to map certain aspects of parent-child relations (such as the quality of parent-child relation or coping with problems between parents and children) associated with adolescent substance use. We must also note here that in Romania, these problems are relatively underinvestigated except for some previous studies (e.g., Florescu, 2004; Kovács, 2001). However, these papers are not available for an international audience.

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METHODS Participants and Procedures Data were collected from high school students (grades 9-12) using a randomly selected sample in Saint George, Transylvania, Romania. The total number of students sampled was 292 (every 15th student was invited to participate). Of the questionnaires distributed, 290 were returned and analyzed, the response rate was 99.3 percent. The age range of the respondents was between ages of 14 to 20 years (Mean = 16.0 years, S.D. = 2.2 years) and 57.2 percent of the sample was female and 42.8 percent was male. Data were collected during the fall semester of 2003, using a self-administered questionnaire. Parents were informed of the study with their consent obtained prior to data collection. A standardized procedure of administration was followed. Trained psychologists distributed the questionnaires to students in each class after briefly explaining the study objectives and giving the necessary instructions. Students completed the questionnaires during the class period. The questionnaires were anonymous and voluntary.

Measures The self-administered questionnaires contained items on substance use, some basic sociodemographics as well as parental practices. Three types of substance use were measured: smoking, alcohol and illicit drug use (Kann, 2001). In each case, lifetime and monthly prevalences were measured. Regarding lifetime prevalence of smoking, the following categories were applied: Once or twice (1), 3-5 times (2), 6-9 times (3), 10-19 times (4), 20-39 times (5), more than 40 times (6). Regarding monthly frequencies of smoking, the following categories were applied: less than 1 cigarette per week (1), less than 1 cigarette per day (2), 1-5 cigarettes per day (3), 6-10/day (4), 1120/day (5), more than 20/day (6). Regarding lifetime prevalence and monthly frequencies of alcohol use, the following categories were applied: Once or twice (1), 3-5 times (2), 6-9 times (3), 10-19 times (4), 2039 times (5), more than 40 times (6). Regarding illicit drug use, two categories were applied: ever tried (1) and not tried (2). Among familial measures, the family structure (that is, intactness) was measured (whether intact, nonintact or reconstructed). In addition, two variables were measured (Jackson, Henriksen, & Foshee, 1998). First, the following question was asked. “How would you describe the relationship with your mother/father?” Responses could be ranked on a 6point scale: very good (1) good (2), fair (3), poor (4), very poor (5) and no relationship (6). Regarding familial conflicts, the following three questions were asked: 1. “Do you sometimes get into conflicts with your parents?”; 2. “How do you solve conflicts in your family?”; and 3. “With whom do you talk about your problems in your family?” Response categories regarding the first question were: yes (1) and no (2). In relation with the second question: “We talk about problems and try to find a solution together” (1), “We do not talk about problems” (2), ”Dispute” (3), “Verbal aggression” (4), “Physical aggression” (5), “We talk

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about problems but avoid from displaying them to other family members” (6). Responses for the third question were: with mother (1): yes/no, with father (2): yes/no. SPSS for MS Windows Release 11.0 program was used in the calculations with a maximum significance level of .05. Besides frequency levels, the analyses consisted of Chisquare tests.

RESULTS Substance Use in the Sample 28.2% of the students did not report, whereas 71.8% of them reported smoking in the past (lifetime prevalence). Most of them had smoked cigarette once or twice (23.4%) and 40 or more times (22.4%). Thirty-three percent of the students also smoked during the past month. There was a relationship between the lifetime and monthly prevalences: 48.6% of those who had ever smoked a cigarette also smoked during the past month. Thus, this was the percentage of actual smokers. Most of them smoked 1-5 pieces per a day (10.3%). Among the students, 83.1% of them had ever drunk alcohol, most frequently once or twice (21.8%). Fifty-four percent of them also drank alcohol during the past month, most often once or twice (34.5%). According to the monthly prevalence of alcohol use, only 1 student (0.4%) reported daily drinking, whereas 8.3% of them reported weekly alcohol use. Most of the actual drinkers (that is, those who reported alcohol use during the past month) are occasional drinkers. Among the respondents, 5.5% of them had ever used an illicit drug, most frequently once or twice (76.7%). The lifetime and monthly prevalence was the highest in terms of marijuana use (lifetime: 2.4%, monthly: 0.3%) which was followed by steroids and amphetamines (12%).

Substance Use according to Age The mean age of trying a substance is between 15-16 years of age which is also the time when students usually start high school studies. Regarding smoking and alcohol use, there is a strong increase in the levels of substance use at the age of 15, whereas regarding illicit drug use, the increase may happen at the age of 16 years (Table 1). There is a statistically significant difference between two age cohorts (15-year-old students and 16-year-old students) in both lifetime and monthly prevalences of smoking. A similar difference can be detected in illicit drug use regarding lifetime prevalence. Regarding alcohol use, however, no statistical difference can be justified between these age-cohorts. Comparing lifetime prevalences, most of them prefer smoking and alcohol use once or twice, or 40 or more times. In relation to monthly prevalences, most of them drink alcohol once or twice and smoke 1-5 cigarettes a day. The regular alcohol use (that is, minimum weekly use) tends to increase by age (Table 1).

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Laszlo Brassai and Bettina F. Piko Table 1. Lifetime and monthly prevalences and frequencies of smoking, alcohol and drug use according to age

Lifetime and monthly prevalence of smoking Lifetime prevalence (%) Monthly prevalence (%) - Once or twice in the last month (%) - Minimum 40 or more times in the last month (%) - 1-5 cigarettes in the last month (%) Lifetime and monthly prevalence of alcohol use Lifetime prevalence (%) Monthly prevalence (%) - Once or twice in the last month (%) - 3-9 times in the last month (%) - 10-39 times inthe last month (%) Lifetime and monthly prevalence of drug use Lifetime prevalence (%)

Year 14

Year 15

Year 16

Year 17

Year 18

59.9 19.6 27.5 7.8 9.8

55.2 19 25.9 10.3

75.8 35.6 20.7 24.1 8.0

80.4 46.4 21.4 33.9 21.4

83.3 47.2 25 38.9 16.7

75.0 44.0 38.0 4.0 2.0

82.8 48.3 36.2 10.3 1.7

84.1 59.1 35.2 20.4 3.4

89.1 50.0 29.6 18.5 1.9

91.6 66.7 36.1 27.8 2.8

9.2

12.3

41.5

18.5

18.5

Substance Use according to Gender Table 2 shows the levels of substance use according to gender in light of lifetime and monthly prevalences. Among those who had ever smoked there were more boys (76.6%) than girls (65.6%). In contrast with this, among those who smoked during the past 30 days, the proportion of girls (33.1%) was nearly the same as the proportion of boys (33.0%). Regarding lifetime prevalences, boys reported smoking once or twice, or 40 or more times most frequenty, whereas girls reported smoking 10-19 times most frequently. The amount of smoked cigarettes during the past 30 days was 1-5 pieces among boys, and less than 1 piece among girls. All in all, girls showed higher occurrence of being a smoker in their lifetime, whereas boys showed higher occurrence of being a smoker during the past 30 days (Table 3). Table 2. Substance user status in the sample Smoking yes Lifetime prevalence Boys Girls Monthly prevalence Boys Girls

Alcohol use yes no

no

Illicit drug use yes no

95(76.6%) 109(65.6%)

29(23.3%) 57(34.3%)

109(87.9%)* 132(79.5%)

15(12.1%) 34(20.5%)

31(25%) 34(20.5%)

93(75%) 132(79.5%)

41(33%) 55(33.1%)

83(77%) 111(66.9%)

63(50.8%) 90(54.2%)

61(49.2%) 76(45.8%)

2(1.6%) 0(0%)

122(98.4%) 166(100%)

Note: Row percentages, Chi-square test: *p<.05.

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Table 3. Frequencies of smoking in the sample

Boys Lifetime prevalence* 1-2 times 3-5 times 6-9 times 10-19 times 20-39 times More than 40 times Monthly prevalence* Less than 1 cigarette/week Less than 1 cigarette/day 1-5 cigarettes/day 6-10 cigarettes/day 11-20 cigarettes/day More than 20 cigarettes/day

Smoking Girls

35(51.5%) 10(37%) 5(55.6%) 5(25%) 7(46.7%) 33(50.8%)

33(48.5%) 17(63%) 4(44.4%) 15(75%) 8(53.3%) 32(49.2%)

7(41.2%) 5(29.4%) 14(76.4%) 11(61.1%) 2(16.7%) 2(100%)

10(58.8%) 12(70.6%) 16(53.3%) 7(38.9%) 10(83.3%)

Note: Row percentages; Chi-square test: *p<.05.

More boys than girls had drunk alcohol in their lifetime (p<.05). During the past 30 days, more girls than boys drank alcohol once or twice (p<.05) (Table 2 and Table 4). Among those who were occasional drinkers, that is, drank alcohol only once or twice, there were 33.7% boys and 66.3% girls (Table 4). Among boys, the proportion of drinking showed a well balanced picture. This means that whereas girls tended to be occasional drinkers, boys tended to be both occasional and regular drinkers. Table 4. Frequencies of alcohol use in the sample

Boys Lifetime prevalence 1-2 times 3-5 times 6-9 times 10-19 times 20-39 times More than 40 times Monthly prevalence* 1-2 times 3-5 times 6-9 times 10-19 times 20-39 times More than 40 times Note: Row percentages; Chi-square test: *p<.05

Alcohol use Girls

29(46%) 18(34%) 11(42.3%) 17(41.5%) 15(53.6%) 19(63.3%)

34(54%) 35(66%) 15(57.7%) 24(58.5%) 13(46.4%) 11(36.7%)

34(33.7%) 14(43.8%) 11(78.6%) 5(83.3%)

67(66.3%) 18(56.3%) 3(21.4%) 1(16.7) 1(100%)

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Laszlo Brassai and Bettina F. Piko Table 5. Substance user status according to the types of family structure

The type of family structure/Substance use Lifetime prevalence Intact Nonintact Reconstructed Monthly prevalence Intact Nonintact Reconstructed

Smoking (Number/%)

Alcohol use (Number/%)

Illicit drug use (Number/%)

No

Yes

No

Yes

No

Yes

71(30.5) 6(20) 2(10.5)

162(69.5) 24(80) 17(89.5)

33(14.3) 6(20) 1(5.3)

198(85.7) 24(80) 18(94.7)

188(79)* 6(20) 8(42.1)

50(21) 24(80) 11(57.9)

162(69.2)* 16(53.3) 9(47.4)

72(30.8) 14(46.7) 10(52.6)

107(46.1) 11(37.9) 10(52.6)

125(53.9) 18(62.1) 9(47.4)

Note: Row percentages; Chi-square test: *p<.05

Substance Use according to the Type of Family Structure The frequencies of smoking and alcohol use were the highest among those living in reconstructed families when considering lifetime prevalences. The frequency of smoking during the past 30 days was most common among students living in reconstructed families, whereas the frequency of alcohol use was most common among nonintact families, although this difference was not statistically significant (Table 5). Likewise, monthly illicit drug use was more common among students living in nonintact families.

Substance Use in Light of the Relationship with Parents Those who reported a good relationship with mother tended to report ever smoking in their lifetime. However, this was not the case in relation to monthly prevalence, whereas those reported a good relationship with mother tended to avoid from smoking. A similar association may be detected in terms of alcohol use, particularly when taking lifetime prevalence into account. Illicit drug use was more common among those who reported a poor relationship with their mother (Table 6). Altogether, all types of substance use were more common among those who had a poor relationship with their mother. Smoking was most common among those who reported that they had no relationship with their father. In relation to alcohol use, poor or fair relationships also matter. Likewise, illicit drug use was most common among students reported a poor relationship with their father (Table 7). Both Table 6 and Table 7 suggest that a good relationship with parents seems to be protective, whereas poor relationship (or the lack of relationship in case of father) seems to be a risk factor.

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Table 6. Substance user status according to the relationship with mother Relationship with mother/ Substance use Lifetime prevalence Good/very good Fair Poor/very poor No relationship Monthly prevalence Good/very good Fair Poor/very poor No relationship

Smoking (Number/%) No Yes

74(30.3) 5(16.2) 1(25)

171(69.6)* 16(53.4) 1(25)

Alcohol use (Number/%) No Yes

171(69.7) 26(83.8) 4(100) 3(75)

38(15.8)* 1(3.3)

75(30.4) 14(46.6) 5(100) 3(75)

119(48.8) 9(20.1)

2(50)

1(33)

204(84.2) 30(96.7) 5(100) 2(50)

Illicit drug use (Number/%) No Yes

197(78.8)* 23(74.2) 2(40) 3(75)

53(21.2) 8(25.8) 3(60) 1(25)

125(51.2) 22(70.9) 5(100) 2(66)

Note: Row percentages; Chi-square test: *p<.05

Table 7. Substance user status according to the relationship with father Relationship with father/ Substance use

Smoking (Number/%) No

Lifetime prevalence Good/very good Fair Poor/very poor No relationship Monthly prevalence Good/very good Fair Poor/very poor No relationship

Yes

Alcohol use (Number/%) No

Illicit drug use (Number/%)

Yes

No

Yes

176(80.8)* 26(68.5) 5(45.4) 12(75)

42(19.2) 12(31.5) 6(54.6) 4(25)

61(28.7) 10(26.4) 4(36.4) 3(18.8)

152(71.3) 28(73.6) 7(63.6) 13(81.2)

34(16.2) 2(5.3) 2(12.5)

177(83.8) 36(94.7) 11(100) 14(87.5)

149(69.4) 22(59.5) 6(54.6) 8(50)

66(30.6) 15(40.5) 5(45.4) 8(50)

107(50.5)* 9(23.7) 5(45.4) 6(37.5)

105(49.5) 29(76.3) 6(54.6) 10(62.5)

Note: Row percentages; Chi-square test: *p<.05

Substance Use in Light of the Occurrence of Parental Conflicts Table 8 suggests that parental conflicts may contribute to all types of substance use, although this relationship is not significant in terms of illicit drug use. However, the relationship is significant regarding smoking (lifetime prevalence) and alcohol use (lifetime and monthly prevalences).

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Laszlo Brassai and Bettina F. Piko Table 8. Substance user status in light of the occurrence of parental conflicts

Conflicts with parents/ Substance use Lifetime prevalence No Yes Monthly prevalence No Yes

Smoking Number/%) No Yes

Alcohol use (Number/%) No Yes

34(37.8)** 45(23.4)

56(62.2) 147(76.6)

22(25)*** 18(9.4)

66(75) 174(90.6)

63(69.2) 124(64.6)

28(30.8) 68(35.4)

52(59.7)** 76(39.3)

35(40.3) 117(60.7)

Illicit drug use (Number/%) No Yes

74(79.5) 178(79.8)

19(20.5) 45(20.2)

Note: Row percentages; Chi-square test: *p<.05 ** p<.01, *** p<.001

Substance Use in Light of Talking about Conflicts with Parents Talking about conflicts with mothers was most common among those who reported smoking and drinking (both lifetime and monthly prevalences). However, talking about problems with fathers was most common among those who avoided from substance use. Table 9. Substance user status in light of verbal coping (talking about conflicts) with parents With whom do they talk about conflicts?/ Substance use Lifetime prevalence With mother No Yes With father No Yes Monthly prevalence With mother No Yes With father No Yes

Smoking (Number/%) No Yes

Alcohol use (Number/%) No Yes

Illicit drug use (Number/%) No Yes

20(19.6)* 59(37.7)

82(80.4) 121(67.3)

2(2.2)** 28(15.7)

90(97.8) 150(84.3)

76(73) 147(79.4)

28(27) 38(20.6)

63(27.6) 16(29.6)

165(72.4) 38(70.4)

29(12.8) 11(20)

196(87.2) 44(80)

176(76.1) 47(84)

55(23.9) 9(16)

62(60.1)* 59(51.7)

41(39.9) 55(48.3)

34(34)** 86(47.8)

66(66) 94(52.2)

80(35.1)* 39(70.9)

148(64.9) 16(29.1)

97(42.9)* 31(57.4)

129(57.1) 23(42.6)

Note: Row percentages; Chi-square test: *p<.05 ** p<.01

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Substance Use in Light of Coping Strategies during Parental Conflicts Both in terms of lifetime and monthly prevalences, those reported smoking, drinking and illicit drug use tended to avoid from talking about problems with mothers or applied verbal aggression (p<.05) (Table 10 and Table 11). Table 10. Substance user status (lifetime prevalence) in light of coping strategies during parental conflicts Coping strategies/Substance use With mother 1. We talk about problems and try to find a solution together 2. We do not talk about problems

Smoking (Number/%) No Yes

Alcohol use (Number/%) No Yes

Illicit drug use (Number/%) No Yes

No

12(17.9)

55(82.1)* 9(13.2)

59(86.8)* 48(68.6)

Yes

68(31.3)

149(68.7) 32(15)

182(85)

No

76(28.4)

192(71.6) 35(13.2)

230(86.8) 212(77.7) 61(22.3)

Yes

4(25)

12(75)

11(64.7)* 13(76.5)

No

61(27.9)

158(72.1) 29(13.4)

188(86.6) 175(78.5) 48(21.5)

Yes

19(29.2)

46(70.8)

53(81.5)

4. Verbal aggression

No

69(32.1)

146(67.9) 31(14.7)

180(85.5) 44(20.1)

175(79.9)

Yes

11(15.9)

58(84.1)* 10(14.1)

61(85.9)* 21(29.6)

50(70.4)*

5. Physical aggression

No

79(29.2)

192(70.8) 38(14.1)

231(85.9) 215(77.6) 62(22.4)

Yes

1(7.7)

12(92.3)* 3(23.1)

10(79.9)

6. We talk about problems but avoid from displaying them to other family members With father 1. We talk about problems and try to find a solution together 2. We do not talk about problems

No

71(28.4)

179(71.6) 37(14.9)

312(85.1) 200(78.1) 56(21.9)

Yes

9(26.5)

25(73.5)

29(87.9)

No

46(30.7) 104(69.3)

25(16.9) 123(83.1)

119(77.3) 35(22.7)

Yes

34(25.4) 100(74.6)

16(11.9) 118(88.1)

106(69.3) 30(30.7)

No

62(27.9) 160(72.1)

29(13.1) 192(86.9)

177(78.3) 49(21.7)

Yes

18(29)

12(19.7) 49(80.3)

48(75)

No

61(27.9) 158(72.1)

29(13.4) 188(86.6)

175(78.5) 48(21.5)

Yes

19(29.2) 46(70.8)

12(18.5) 53(81.5)

50(76.6)

3. Dispute

3. Dispute

44(71)

6(35.3) 12(18.5)

4(12.1)

22(31.4)*

177(80.5) 43(19.5)

50(74.6)

10(76.9) 25(73.5)

4(23.5) 17(25.4)

3(23.1) 9(26.5)

16(25) 17(25.4)

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Laszlo Brassai and Bettina F. Piko Table 10. Continued

Coping strategies/Substance use 4. Verbal No aggression Yes 5. Physical aggression

Smoking (Number/%) 64(27.1) 172(72.9)

Alcohol use (Number/%) 32(13.7) 202(86.3)

Illicit drug use (Number/%) 188(78.3) 52(21.7)

16(33.3)* 32(66.7)

9(18.7)* 39(81.3)

61(21.9)* 217(78.1)

No

76(27.8) 197(72.7)

39(14.4) 32(85.6)

37(74)

13(26)

Yes

4(36.4)* 7(63.7)

2(18.2)* 9(81.8)

4(33.3)*

8(66.7)

77(29.4) 185(70.6)

36(13.8) 224(86.2)

206(77.4) 60(22.6)

3(13.6)

5(22.7)

19(79.2)

6. We talk about No problems but Yes avoid from displaying them to other family members

19(86.4)

17(77.3)

5(20.8)

Note: Row percentages; Chi-square test: *p<.05

Physical aggression (being beaten by the mother) may go together with smoking during the lifetime. Talking about problems with father increased the lifetime prevalence of substance use which was not the case in terms of monthly prevalence (p<.05). In addition, verbal and physical aggression from father were related to a lower frequencies of substance use among adolescents. In a word, authoritative/supportive parenting style of mother and hard/authoritarian parenting style of father seem to be protective against adolescent susbtance use.

DISCUSSION The main goal of the present study has been to detect frequencies and sociodemographic influences of substance use in an adolescent population in Saint George, Transylvania, Romania. In addition, we also aimed at detecting certain aspects of parent-child relations (such as the quality of parent-child relation or coping with problems between parents and their children) in association with adolescent substance use. We must also note here that to our best knowledge, these psychosocial problems have not yet published for an international audience since this is a relatively underinvestigated field of research in Romania, except for some previous studies (e.g., Kovács, 2001; Florescu, 2004). Based on the findings of the present study, some special characteristics of frequencies may be described. The lifetime prevalence of smoking was 71.8%, whereas the monthly prevalence was 33.8%. Those who reported smoking during the past month tended to smoke 1-5 cigarettes per day most often. A national representative sample reported lifetime prevalence of 68.2%, whereas the occurrence of daily smokers was 22.8% (Florescu, 2004). We may conclude that levels of smoking in our sample in Saint George were slightly higher than results the national representative sample. The frequencies of smoking in Hungarian samples were similar to these findings (69.2%), although the proportion of those who were daily smokers was slightly higher (Piko, 2000b).

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Table 11. Substance user status (monthly prevalence) in light of coping strategies during parental conflicts Coping strategies/Substance use

With mother 1. We talk about problems and try to find a solution together 2. We do not talk about problems 3. Dispute 4. Verbal aggression 5. Physical aggression 6. We talk about problems but avoid from displaying them to other family members With father 1. We talk about problems and try to find a solution together 2. We do not talk about problems 3. Dispute 4. Verbal aggression 5. Physical aggression 6. We talk about problems but avoid from displaying them to other family members

Smoking (Number/%) Yes No

Alcohol use (Number/%) Yes No

No Yes No Yes No Yes No Yes No Yes No Yes

33(47.8) 155(71.8) 180(67.2) 8(47.1) 146(66.4) 42(64.6) 151(70.2) 37(52.9) 179(65.8) 9(69.2) 186(66.7) 20(60.6)

36(52.2)* 68(28.2) 88(32.9) 9(52.9) 74(33.6) 23(35.4) 64(29.8) 33(47.1)* 93(34.2) 4(30.8) 84(33.3) 13(39.4)

24(36.4) 112(51.6) 146(51.6) 8(50) 99(45.6) 30(45.5) 101(47.2) 28(40.6) 122(45.2) 7(53.8) 112(44.8) 17(51.5)

42(36.6)* 105(48.4) 121(45.3) 8(50) 118(54.4) 36(54.5) 113(52.8) 41(59.4)* 148(54.8) 6(46.2) 138(55.2) 16(48.5)

No Yes No Yes No Yes No Yes No Yes No Yes

98(64.9) 90(67.2) 148(66.4) 40(64.5) 146(66.4) 42(64.6) 157(66) 31(66)* 181(66.1) 7(63.6)* 176(67.2) 12(52.2)

35(35.1) 44(32.9) 76(33.6) 22(35.5) 74(33.6) 23(35.4) 81(34) 16(34) 93(33.9) 4(36.4)* 86(32.8) 11(47.8)

65(43.3) 69(51.9) 102(46.2) 27(43.5) 99(45.6) 50(45.5) 107(45.7) 22(44.9)* 148(54.4) 5(45.5)* 117(45) 12(52.2)

85(56.7) 64(48.1) 119(53.9) 35(56.5) 118(54.4) 36(54.5) 127(54.3) 27(55.1) 124(45.6) 6(54.5) 143(55) 11(47.8)

Note: Row percentages; Chi-square test: *p<.05

Experimentation with smoking increased by age, for example, the occurrence of smoking among students aged between 14-15 years was below 20%, whereas it was above 75% after the age of 16 years. Besides age, gender also proved to be a significant influencing sociodemographic factor. Whereas girls reported a higher smoking in their lifetime, boys reported smoking more frequently during the past 30 days. These tendencies are similar to previous data (e.g., Tyas & Pederson, 1998). Similar to smoking levels, the occurrence of alcohol use showed even more changes by age, particularly in terms of weekly consumption there was a drastic increase between the ages of 16-18 years. These levels were lower among girls as compared to results from another study which reported drinking patterns of youth living in Cluj Napoca, Romania. However, the levels of drinking among boys were higher

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than they were among boys living in Cluj Napoca (Kovacs, 2001). On the other hand, these findings were similar to the results of Hungarian samples (Piko, 2000b). The occurrence of (ever) experimentation with an illicit drug was 5.5% in this sample, most frequently marijuana. In comparison with a sample of youth living in Cluj Napoca, the rate (4.5%) was slightly higher, but much lower than data from Hungarian samples (21.5%) (Piko, 2000b). There is no difference, however, in the mean age of experimentation which is about 16 years of age. In comparison with US samples, Johnston and colleagues (2005) analyzed data of a national sample and found that the lifetime prevalence of substance use in 10th grade students was 35.1% in case of marihuana, 64.2% in case of alcohol and 40.7% in case of cigarette use. The monthly prevalences were the following: 15.9% in case of marihuana, 35.2% in case of alcohol and 16% in case of cigarette use (Johnston et al., 2005). Findings indicate that both lifetime and monthly prevalences of cigarette and alcohol use are lower among 10th grade students in the US than they are in Romanian adolescent samples. Inversely, among US adolescents, the lifetime prevalence of marihuana use was much higher than it was found among Romanian adolescents. These trends in adolescent substance use are in concordance with previous results established in cross-cultural perspective raised by other investigators (e.g., Vazsonyi, 2003). According to the type of family structure, living in a reconstructed family, in addition to living in a nonintact family, was the most important risk factor for adolescent substance use. These findings are in concordance with previous international studies (Ackerman et al., 2001; Ellickson, Tucker, Klein, & McGuigan, 2001; Demuth & Brown, 2004; Fitzpatrick, 1998; Harland et al., 2002; Hoffman & Johnson, 1998; Thomas, Farrell, & Barnes, 1996). Previous investigations (Beck, Boyle, & Boekeloo, 2004; Coley, Morris, & Hernandez, 2004; Deković, 1999; DeVore & Ginsburg, 2005; Dorius, et al., 2004; Formoso, Gonzales, & Aiken, 2000; Hawkins, Catalano, & Miller, 1992; Piko & Fitzpatrick, 2003; Reti et al., 2002) demonstrated significant, enduring, and protective influences of positive parenting practices on adolescent development. In particular, parental monitoring, open parent-child communication, supervision, and high quality of the parent-child relationship deter involvement in high-risk behavior, such as substance use. Authoritative parenting generally leads to the best outcomes for teens (Castrucci & Gerlach, 2006). A good relationship with parents seems to act as a protection, whereas a poor relationship may help develop substance use (Baily & Hubbard, 1990; Lau, Quadrel, & Hartman, 1990; Piko, 2000a; Simons-Morton et al., 2001). Our findings support previous results that the role of a good relationship with parents is indeed protective, whereas a poor relationship or the lack of relationship may be associated with adolescent substance use. Another main point – besides the quality of relationships – is the presence or absence of parental conflicts and the ways how the students and their parents handle these problems within the family. Previous studies also draw our attention to the role of parental conflicts in adolescent substance use (Formoso, Gonzales, & Aiken, 2000; Reti et al., 2002). In our study, the presence of conflicts went together with a higher levels of substance use regardless the type of substance or duration of time studied. The ways of coping with these conflicts, however, might act in a different way, whether the students talked about problems with their father or mother. Talking about problems with mothers was associated with higher levels of substance use, whereas talking about problems with fathers was associated with lower levels of substance use. These findings are similar to another study published by Ackard and colleagues (2006) which draws our attention to altering roles of mother and father in

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socialization (Piko, 1998). This means that the role of father is more rational, demanding and instrumental in support, whereas the role of mother is more emotional and permissive (Bem, 1974). In addition, these results also revealed that those who had experienced verbal or physical aggression with a parent (for example, being beaten by the father) also reported lower levels of substance use. Consequently, authoritative/supportive parenting style of mother but authoritarian/hard parenting style of father seem to be protective against adolescent substance use. The role of mother may be linked to protective aspects of attachment (Schneider, Atkinson, & Tradif, 2001). The role of father, on the other hand, may be linked to monitoring and controlling functions of parental practices (Deković, 1999; Hawkins, Catalano, & Miller, 1992; Jackson, Henriksen, & Foshee, 1998; Piko & Fitzpatrick, 2003). Cultural factors may also contribute to this special aspect of parental attitude. A cultural approach may open a perspective for understanding the social and health transformations and child welfare taking place in East-European (post-socialist) countries in which frequencies of tobacco use and alcohol consumption are significantly higher as compared to West European countries. Several studies (Cockerham, 2005; Cockerham, Snead, & Dewaal, 2002, Gillmore et al., 2004) identified deficits of parent-child relationship and ineffective parenting as important social determinants of the health-damaging lifestyle practices in the former socialist nations. Altogether, in Cockerham’s health lifestyle theory, excessive alcohol consumption, heavy smoking, unhealthy dietary habits, and the lack of health-promoting exercise contribute to an unhealthy lifestyle pattern. Our results may highlight the role of cultural variations in child welfare since parenting efficacy may depend on the special cultural context. Although the authoritarian parenting style in western society is associated with negative psychosocial outcomes, this effect may be modified by the given culture (Dwairy, 2008). Namely, the authoritarian parenting style, emphasizing parental control and the child’s obedience, restricts the autonomy of the child in terms of behavioral decisions regarding substance using behavior as well. This control may be associated with the role of father in this culture, whereas the role of mother rather reflects an authoritarian parenting style. Our findings provide further data on the role of parental and familial factors in adolescent substance use. Bahr and his colleagues (2005) argued that not only individual factors but also their constellations were significant influences of adolescents’ decision to use drug. Due to the special characteristics of the sample (that is, a sample of youth from an East-European country), the generalizability of our findings may be limited. There are some additional limitations. Because of the cross-sectional study design, our results cannot provide a causeand-effect relationship among the study variables. Additionally, the current study of parental/familial influences is based on youth’s self-reports, although previous studies recommend children’s self-reports which reflect their valid perceptions of parental monitoring (Gray & Steinberg, 1999). Future research should also consider longitudinal study designs and more sophisticated statistical analyses for better understanding the role of parental influences in adolescent substance use as an indicator of child welfare.

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living conditions, lifestyles and health. American Journal of Public Health, 94, 21772187. Gray, M. R., & Steinberg, L. (1999). Unpacking authoritative parenting: Reassessing a multidimensional construct. Journal of Marriage and the Family, 61, 574-587. Harakeh, Z., Scholte, R.H.J., Vermulst, A.A., deVries, H., & Engels, R.C.M. (2004). Parental factors and adolescents’ smoking behavior: An extension of The Theory of Planned Behavior. Preventive Medicine, 39, 951-961. Harland, P., Reijneveld, S.A., Brugman, E., Verloove-Vanhorick, S.P., & Verhulst, F.C. (2002). Family factors and life events as risk factors for behavioural and emotional problems in children. European Child & Adolescents Psychiatry, 11, 176-184. Hawkins, J.D., Catalano, R.F., & Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64-105. Hill, K.G., Hawkins, D.J., Catalano, R.F., Addott, R.D., & Guo, J. (2005). Family influences on the risk of daily smoking initiation. Journal of Adolescent Health, 37, 202-210. Hoffman, J. P., & Johnson, R. A. (1998). A national portrait of family structure and adolescent drug use. Journal of Marriage and the Family, 41, 392–407. Hops, H., Davis, B., & Lewin, L.M. (1999). The development of alcohol and other substance use: A gender study of family and peer context. Journal of Studies on Alcohol, 13S, 2231. Jackson, C., Henriksen, L., & Foshee, V.A. (1998). The authoritative parenting index: Predicting health risk behaviors among children and adolescents. Health Education & Behavior, 25, 321- 339. Jackson C., Henriksen, L., Dickinson, D., & Levine, D.W. (1997). The early use of alcohol and tobacco: Its relation to children’s competence and parents’ behavior. American Journal of Public Health, 87, 359-364. Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2005). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2004. National Institute on Drug Abuse. Kann, L. (2001). The Youth Risk Behavior Surveillance System: Measuring health-risk behaviors. American Journal of Health Behavior, 25, 272-277. Kovács, L. (2001). Youth’s alcohol and drug use in Cluj Napoca (Kolozsvári fiatalok alkoholfogyasztása és droghasználati szokásai). Addictologia Hungarica, 9, 250-272. (in Hungarian). Lau, R.L., Quadrel, M.J., & Hartman, K.A. (1990). Development and change of young adults’ preventive health belief and behavior. Influence from parents and peers. Journal of Health and Social Behavior, 31, 240-259. Li, X., Stanton, B., & Feigelman, S. (2000). Impact of perceived parental monitoring on adolescent risk behavior over 4 years. Journal of Adolescent Health, 27, 49-56. Myers, H.E., Newcomb, M.D., Richardson, M.A., & Alvy, K.T. (1997). Parental and family risk factors for substance use in inner-city African-American children and adolescents. Journal of Psychopathology and Behavioral Assessment, 19, 109-131. Nash, S.G., McQueen, A., & Bray, J.H. (2005). Pathways to adolescent alcohol use: Family environment, peer influence and parental expectations. Journal of Adolescent Health, 37, 19-28

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Parker, J.S., & Benson, M.J. (2004). Parent-adolescent relations and adolescent functioning: Self-esteem, substance abuse, and delinquency. Adolescence, 39, 519-530. Piko, B.F., & Piczil, M. (2004). Youth substance use and psychosocial well-being in Hungary`s post-socialist transition. Administration and Policy in Mental Health, 32, 6371. Piko, B.F., & Fitzpatrick, K.M. (2003). Depressive symptomatology among Hungarian youth: A risk and protective factors approach. American Journal of Orthopsychiatry, 73, 44-54. Piko, B.F., & Fitzpatrick, K.M. (2002). Without protection: Substance use among Hungarian adolescents in high-risk settings. Journal of Adolescent Health, 30, 463-466. Piko, B. (2001). Smoking in adolescence: Do attitudes matter? Addictive Behaviors, 26, 201217. Piko, B. (2000a). Perceived social support from parents and peers: Which is the stronger predictor of adolescent substance use? Substance Use and Misuse, 35, 617-630. Piko, B. (2000b). Smoking among adolescents and young adults: From attitudes to behavior (Dohányzás serdülő- és ifjúkorban: az attitűdtől a magatartásig). Addictologia Hungarica, 8, 206-214. (in Hungarian). Piko, B. (1998). Social support and health in adolescence: A factor analytical study. British Journal of Health Psychology, 3, 333-344. Poikolainen, K. (2002). Antecedents of substance use in adolescence. Current Opinion in Psychiatry, 15, 241-245. Radziszewska, B., Richardson, J.L., Dent, C.W., & Flay BR. (1996). Parenting style and adolescent depressive symptoms, smoking, and academic achievement: ethnic, gender, and SES differences. Journal of Behavioral Medicine, 19, 289-305. Reti, I.M., Samuels, J.F., Eaton, W.W., Bienvenu., O.J., Costa Jr., P.T., & Nestadt, G. (2002). Influences of parenting on normal personality traits. Psychiatry Research, 111, 55-64. Ryan, S., Wiles, D., Cash, S., & Siebert, C. (2005). Risk assessments: Empirically supported or values driven? Children and Youth Services Review, 27, 213-225. Schneider, R.K., Levenson, J.L., & Schnoll, S.H. (2001). Update in addiction medicine. Annals of Internal Medicine, 134, 387-395. Schneider, B.H., Atkinson, L., & Tardif, C. (2001). Child-parent attachment and children’s peer relations: A quantitative review. Developmental Psychology, 37, 86-100. Scott, O.R., Thombs, D.L., & Tomasek, J.R. (2005). Relations between normative beliefs and initiation intentions toward cigarette, alcohol and marihuana. Journal of Adolescent Health, 37, 75-87. Simons-Morton, B., Haynie, D.L., Crump, A.D., Eitel, P., & Saylor, K.E. (2001). Peer and parent influences on smoking and drinking among early adolescents. Health Education and Behavior, 28, 95-107. Stephenson, A.L., Henry, C., & Robinson, L.S. (1996). Family characteristics and adolescent substance abuse. Adolescence, 31, 59-77. Thomas, G., Farrell, M. P., & Barnes, G. M. (1996). The effects of single-mother families and nonresident fathers on delinquency and substance abuse in black and white adolescents. Journal of Marriage and the Family, 58, 884-894. Tilson, E.C., McBride, C.M., & Lipkus, I.M. (2004). Testing the interaction between parentchild relationship factors and parent smoking to predict youth smoking. Journal of Adolescent Health, 35, 182-189.

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Tyas, S.L., & Pederson, L.L. (1998). Psychological factors related to adolescent smoking: a critical review of literature. Tobacco Control, 7, 409-420. Ungar, M. (2004). The importance of parents and other caregivers to the resilience of highrisk adolescents. Family Process, 43, 23-41. Vazsonyi, A.T. (2003). Parent-adolescent relations and problem behaviors: Hungary, the Netherlands, Switzerland and the United States. Marriage and Family Review, 35, 161187. Wood, M.D., Read, J.P., Mitchell, & R.E., Brand N.H. (2004). Do parents still matter? Parent and peer influences on alcohol involvement among recent high school graduates. Psychology of Addictive Behaviors, 18, 19-30. World Health Organization (1999). Risk and protective factors affecting adolescent health and development. Report of technical consultation. Geneve, Switzerland. Zimmerman, M.A., & Bingenheimer, J.B. (2002). Natural mentors and adolescent resiliency: A study with urban youth. American Journal of Community Psychology, 30, 221-243.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 5

IS IT BETTER TO LIVE IN RURAL OR URBAN AREAS? A WORLDWIDE STUDY ON CHILD HEALTH Aravinda Guntupalli University of Southampton, United Kingdom

Daniel Schwekendiek Seoul National University, Republic of Korea

ABSTRACT Several studies have emphasized and reemphasized the rural-urban divide in living standards. Yet, these studies focused on specific countries or sub-regions of the world. Conducting a worldwide comparison, we investigate rural-urban malnutrition rates of children living in up to 93 countries at the end of the millennium (1995-2001). An interesting comparative finding is that in 97% of the countries examined, more rural than urban children were stunted. On average, rural malnutrition rates are 10% points higher than urban ones. These differences become pronounced in Latin-America; while by far, the greatest disparity of a single country is found in China. Analyzing the causes, we find that political stability per se as well as political stability in specifically democratic systems significantly decreases the rural-urban malnutrition ratio. However, we could not establish a significant relation between disease environment and rural-urban divide in the standard of living.

1. INTRODUCTION According to the Rural Poverty Report 2001 some three quarters of the poor live in rural areas and a majority of the poor depend primarily on agriculture and related activities for their livelihood (IFAD 2001). Moreover, the poor and rural rarely have the same voice in decisionmaking as the better-off and urban. Thus, in the world we live in, being raised in a village or city seems to make a big difference in the quality of life.

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Several studies have emphasized and reemphasized the rural-urban divide in living standards (Lipton 1977, Duncan and Howell 1992, Menon et. al. 2000, Ruel 2000, Smith et. al. 2005). A lot of studies suggest that more children from rural areas suffer from malnutrition compared to urban areas. There are a number of case studies on rural-urban disparities of a specific country. For example, based on a 1990 survey of seven provinces in China, Shen et al. (1996) found that 38 percent of rural children had moderate stunting compared with 10 percent of urban children. These differences were related to differences in the socio-economic development between the rural and urban population. According to Micklewright and Ismael (2001), prevalence of child malnutrition is roughly three times higher in rural than in urban areas of Uzbekistan. Graham (1997) studied the growth characteristics of children from four villages in Northern Peru and compared them to poor children from capital city with a special focus on gender differences in urban and rural areas. They found that rural and urban girls did not differ much in height whereas rural boys did not catch up with urban boys. Interestingly, based on a survey - conducted at the peak of the North Korean famine of the 1990s – Schwekendiek (2008) showed that residence in neither rural nor urban counties significantly mattered for the height outcomes of children, though urban children were found to suffer more from malnutrition compared to their rural counterparts. Beyond these, there are some studies on selected sub-regions of the world. A study by Corral et al. (2000) on 16 countries located in Latin America and the Caribbean (LAC) found more rural than urban dwellers malnourished, though the difference for some countries is rather small. A study by Sahn and Stiefel (2003) for 24 African countries showed that standards of living in rural areas lag far behind urban areas. Smith et. al. (2005) found that socio-economic conditions in terms of caring practices playing an important role in 36 developing countries. In summation, previous research has focused on case studies or is merely offering evidence on sub-regions of the world. What has been lacking so far is addressing rural-urban inequalities in living standards on a worldwide scale. This is an astonishing fact, as ruralurban disparities are commonly used in various research fields, yet a complete global picture is missing. We therefore resort to the Global Database on Child Growth and Malnutrition – an excellent database to have a larger picture. Specifically, we have information on malnourished children living in rural and urban areas across the world. Above all, we consider malnutrition rates derived from height and weight measurements of children as an indicator for the general well-being in different countries (Micklewright and Suraiya 2001). There are two aims of this paper. Firstly, we give an overview of the data by showing malnutrition rates (in absolute and relative terms) of children living in rural and urban areas to describe the extent of rural-urban health inequality in the world. Our second objective is to test relevant determinants of rural-urban malnutrition. The former differs from the latter inasmuch as we first concentrate on descriptive findings of the data by answering the question where differences in the health status of children based on their residence can be observed; and to investigate in a worldwide comparison, if people living in urban areas are healthier. Concerning our second goal, we there mainly try to answer why there is worldwide variation in the health status of children based on their residence by testing a number of relevant explanatory variables related to nutrition, disease environment, work load, political liberty; and a set of macro-economic, demographic and regional control variables.

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The remaining parts of the paper are divided into introduction and discussion of the data employed. In section 3, we discuss about different indicators of malnutrition and their applicability that is followed by a presentation on the rural-urban descriptive findings on child malnutrition (section 4). Finally, in section 5, we show our regression results followed by concluding remarks of our main findings (section 6).

2. DATA 2.1. Malnutrition Data The Global Database on Child Growth and Malnutrition (henceforward referred to as ‘the database’) is maintained by the WHO. Initiated in 1986, the United Nations and the German Government funded a three-year-project to build up a worldwide nutritional surveillance database in order to characterize the nutritional status of children in different countries (De Onis and Blössner 1997, 2003). To the present, the database is kept updated regularly - so far, over 800 anthropometric surveys were added. Data was basically taken from three sources: published articles, governmental statistics, or reports by NGOs and UN agencies. To ensure standardization of the huge variety of material worldwide available, prior to inclusion in the WHO database, each survey had to pass basic criteria such as population based and probabilistic sampling, minimum sample size, standardized raw data based on the NCHS-reference population and standardized measurement techniques (De Onis and Blössner 2003). Furthermore, enforcing quality control, all data was checked for inconsistencies and consequently removed where necessary. For our analysis, we first had to determine which surveys to select from the database. Primarily, we only considered national representative surveys and discarded all sub-national assessments that were usually based on selected regions like provinces or districts. Even though these local surveys make up over 50% of the database, it does not make sense using this information in a worldwide comparative study as regional conditions will strongly bias the specific anthropometric findings for that country. On top of that, since the main purpose of this paper is to paint with a broad brush rather than following developments of specific countries over time, we had to limit ourselves to evidence at one point of time: panel data would have been interesting to answer more questions of dynamic rural-urban differences but for many countries in the world, there is only information available for one year. Therefore, we made a strict cross-sectional study where our reference year is 2000 (end). There are two reasons for this. Firstly, we realized that most of the surveys were completed by the year 2000 because in many countries, the United Nations carried out surveys under the year 2000 goal of the World Summit Declaration for the welfare of women and children. Secondly, from a historiographical point of view, let us provide evidence on the worldwide health status at the end of the last millennium - as a quick and convenient cross-sectional yardstick for further studies. Hence, for every country where we found data, we selected that survey conducted closest to the reference year. As seen in Figure 1, most of them were carried out in the late 1990s. Eventually, our data compiled from the database runs from 1995 to 2001 – that is, we

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likewise excluded surveys conducted before. This gives us up to 93 countries for which we found information on rural-urban malnutrition in the database. Furthermore, surveys in the WHO database generally target toddlers and children; and there are varying ranges of the age the respondents had at their measurement. Using z-score standardization based on the NCHS reference group makes it possible to compare these groups (WHO 1986, 1995). However, comparing large differing age groups throughout surveys might induce certain distortions: the NCHS standardization, which is based on the US population, assumes that all children in the world genetically follow the same growth pattern which might not be the case for all ethnic groups. However, Habicht et. al. (1974) investigated that these different genetic growth potentials do hardly matter, if at all, for young children up to 5 years of age. Therefore, it should be mentioned that the dominant age group in the WHO surveys runs from 0-4.99 (i.e. children who completed 0-59 months). In our analysis, children under 5 years of age represent 97% of the surveys. In summation, the selection of the sample age groups in the countries should not pose a problem here.

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60

40

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0 1970

1980

1990

Year of Survey Figure 1. Frequencies of surveys by year.

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2.2. Data Discussion As mentioned above, the general quality of data is excellent, so we will not discuss sampling procedures or other technical issues which should not be problematic here. However, the WHO data certainly has some shortcomings, and we hold it necessary to explicitly address three of these. First and foremost, dividing the world into rural or urban is a simple and dichotomous concept. It implies an extreme data reduction. The WHO database does not offer information on the size of any selected village nor metropolitan area. Yet, let us bear in mind that the size of the districts examined does not really matter, as we compare national or intra-country disparities in child health: we do not compare the city size of, say, Mumbai to Luxembourg, but the rural countryside in India to rural areas in Luxembourg. In doing so, we primarily juxtapose rural versus urban children within each country to see on a global scale if there are fundamental differences in the quality of life caused by their residence. Also, there are no quantitative cut-offs given for the classification of urban versus rural areas. Rural-urban classifications are qualitatively, mostly historically, given. They are generally based on 3rd level administrative units which are districts (of 2nd level counties that generally belong to 1st level provinces). For an international comparison, this does not become a problem per se since these administrative units can be found in virtually every country, and thus they can be compared to each other. Yet, these classifications might not compare well if, within the country, a former rural district might have changed to an urban one; or vice versa. Even though governments keep reclassifying administrative units, one should not vouch for the accuracy of their information provided. Briefly, as we are aiming to have a broad global picture, we have to limit ourselves to paint in black and white, which is rural or urban, to produce the complete and global picture we hoped to get. Second, the data does not account for inter-regional commuters. Classifications into rural or urban are based on the child’s place of residence. Some parents might reside in one area and commute to another to make a living. Thus, the rural-urban income gap might not be localized for some children in the sample. Yet, most of the other socio-economic influences like child caring facilities, sanitary installations, hospitals and such will certainly be localized; in particular, because we are dealing with pre-school children. As it is rather likely that parents who reside in rural areas commute to towns to make a living (and rarely vice versa), the standard of living, proxied by the household income, of some rural children might be overestimated. However, in a later section of this paper, we will get a very clear and consistent picture of the disadvantaged situation in the rural areas of the world. It does not make sense that commuting might have caused this contradictory result. So it can be assumed that these effects are rather small or randomly distributed in the samples. From a geopolitical perspective, our data is not representative for all regions. In general, even though the WHO database is one of the most comprehensive information systems on nutritional indicators, it neglects some sub-regions of the world. What is most striking is that few high-income countries are included in the database: in Europe, many countries of the EU are missing. Few of the Northern American countries are represented; and in Eastern-Asia, high-tech countries such as Japan and South Korea are excluded. Ironically, for these countries there is generally plenty of statistical information available, but specifically data on child growth is lacking because for “most countries data is not available in the required standardized format” (De Onis and Blössner 1997). We also had to reject a number of surveys

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especially from high-income countries because they had been conducted far before the 1990s (Figure 1). As a consequence, our dataset only includes two developed countries, which are Australia and Gaza. Most of the countries represented in our dataset are developing (53%) and least developed countries (35%); or countries in transition (10%). So it should be mentioned that our cross-country study does not reflect the situation in high-income countries at all. However, the situation of most children in the world is quite well reflected in our analysis since more than 3/4 of the total world population is represented. Moreover, child malnutrition in most of the missing countries is not really a problem of undernutrition, but overnutrition, which certainly has other causes and cures; and would be far beyond the scope of this paper. A complete list on our data coverage classified by country name is given in Table 1. The reported years refer to the end of the year in which the respective survey was conducted. UN sub-regions are indicated in parenthesis. Table 1. Data coverage by country Country

Year Continents and Subregions

Rural/Urban Ratio Wasting Stunting Underweight Afghanistan 1997 Asia (South-central Asia) X X X Albania 2000 Europe (Southern Europe) X X X Algeria 2000 Africa (Northern Africa) X X X Angola 2001 Africa (Middle Africa) X X X Armenia 2001 Asia (Western Asia) X X X Australia 1996 Oceania (Australia- New Zealand) X X X Azerbaijan 2000 Asia (Western Asia) X X X Bangladesh 2000 Asia (South-central Asia) X X X Benin 2001 Africa (Western Africa) X X X Bolivia 1998 LAC (South America) X X X Bosnia and Herzegovina 2000 Europe (Southern Europe) X X X Botswana 2000 Africa (Southern Africa) X X X Brazil 1996 LAC (South America) X X X Burkina Faso 1999 Africa (Western Africa) X X X Burundi 2000 Africa (Eastern Africa) X X X Cambodia 2000 Asia (South-eastern Asia) X X X Cameroon 1998 Africa (Middle Africa) X X X Central African Republic 1995 Africa (Middle Africa) X X X Chad 2000 Africa (Middle Africa) X X X China 2000 Asia (Eastern Asia) X X X Colombia 2000 LAC (South America) X X X Comoros 2000 Africa (Eastern Africa) X X X Congo, Dem. Rep. 1995 Africa (Middle Africa) X X X Costa Rica 1996 LAC (Central America) X X X Côte d'Ivoire 1999 Africa (Western Africa) X X X Djibouti 1996 Africa (Eastern Africa) X X X Dominican Republic 2000 LAC (Caribbean) X X X Ecuador 1998 LAC (South America) X X

Is it Better to Live in Rural or Urban Areas? Egypt, Arab Rep. El Salvador Eritrea Gabon Gambia, The Georgia Ghana Guatemala Guinea-Bissau Guinea Guyana Haiti Honduras India Indonesia Iran, Islamic Rep. Iraq Jordan Kazakhstan Kenya Korea, Dem. Rep. Kyrgyz Republic Lao PDR Lesotho Liberia Libya Macedonia, FYR Madagascar Malawi Malaysia Mali Mauritania Mexico Mongolia Morocco Mozambique Myanmar Namibia Nepal Nicaragua Niger Nigeria Pakistan

2000 Africa (Northern Africa) 1998 LAC (Central America) 2002 Africa (Eastern Africa) 2001 Africa (Middle Africa) 2000 Africa (Western Africa) 1999 Asia (Western Asia) 1999 Africa (Western Africa) 2000 LAC (Central America) 2000 Africa (Western Africa) 2000 Africa (Western Africa) 2000 LAC (South America) 2000 LAC (Caribbean) 2001 LAC (Central America) 1999 Asia (South-central Asia) 1995 Asia (South-eastern Asia) 1998 Asia (South-central Asia) 2000 Asia (Western Asia) 2002 Asia (Western Asia) 1999 Asia (South-central Asia) 2000 Africa (Eastern Africa) 2000 Asia (Eastern Asia) 1997 Asia (South-central Asia) 2000 Asia (South-eastern Asia) 2000 Africa (Southern Africa) 2000 Africa (Western Africa) 1995 Africa (Northern Africa) 1999 Europe (Southern Europe) 1997 Africa (Eastern Africa) 2000 Africa (Eastern Africa) 1999 Asia (South-eastern Asia) 2001 Africa (Western Africa) 2001 Africa (Western Africa) 1999 LAC (Central America) 2000 Asia (Eastern Asia) 1997 Africa (Northern Africa) 1997 Africa (Eastern Africa) 2000 Asia (South-eastern Asia) 2000 Africa (Southern Africa) 2001 Asia (South-central Asia) 2001 LAC (Central America) 2000 Africa (Western Africa) 1999 Africa (Western Africa) 2001 Asia (South-central Asia)

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X X X X X X X X X X X X X X

X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

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Country Peru Romania Rwanda São Tomé and Principe Senegal Serbia and Montenegro Somalia South Africa Sri Lanka Sudan Syrian Arab Republic Tanzania Timor-Leste Togo Tunisia Turkey Turkmenistan Uganda Ukraine Uzbekistan Vietnam West Bank and Gaza Yemen, Rep. Zambia Zimbabwe

Year Continents and Subregions 2000 LAC (South America) 2000 Europe (Eastern Europe) 2000 Africa (Eastern Africa) 2000 Africa (Middle Africa) 2000 Africa (Western Africa) 2000 Europe (Southern Europe) 2000 Africa (Eastern Africa) 1999 Africa (Southern Africa) 2000 Asia (South-central Asia) 2000 Africa (Northern Africa) 2000 Asia (Western Asia) 1999 Africa (Eastern Africa) 2002 Asia (South-eastern Asia) 1998 Africa (Western Africa) 1997 Africa (Northern Africa) 1998 Asia (Western Asia) 2000 Asia (South-central Asia) 2001 Africa (Eastern Africa) 2000 Europe (Eastern Europe) 2002 Asia (South-central Asia) 2000 Asia (South-eastern Asia) 1996 Asia (Western Asia) 1997 Asia (Western Asia) 2002 Africa (Eastern Africa) 1999 Africa (Eastern Africa)

X = indicator available; LAC = Latin America and the Caribbean; continents and classification.

X X X X X X X X X X X X X X X X X X X X X X X X X

Rural/Urban Ratio X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

sub-continents according to UN

2.3. Socio-economic Data A discussion about child malnutrition is incomplete without appropriate explanatory variables. Child malnutrition is a complex issue that cannot be easily determined. Yet, the interaction between child growth and the socio-economic environment is generally well known. Heights and weights basically measure the net-nutritional status of children, where child malnutrition leads to stunting or underweight. In this context, child malnutrition is simply a manifestation of low net-nutritional status. So stunting or underweight are an indicator for low net-nutritional status, where net-nutrition = gross nutrition - energy consumption. In this equation, gross nutrition reflects food availability in both quantity and quality. Energy is specifically absorbed by diseases, heavy work load and other stress factors i.e. that gross nutritional inputs are first distributed to physical maintenance before being used

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for body growth. Along with the WHO global database on child growth and malnutrition, we here used a set of socio-economic variables to capture the effects of the right side of the netnutritional equation. As a proxy for gross nutritional intake, we used calorie and protein indicators. FAO (Food and Agriculture Organization) data helped in filling this gap by giving additional information regarding kilo calories per person per day and protein consumption per person per day of the corresponding year in the WHO database. Furthermore, energy consumption indicators were taken from the World Bank (World Bank Indicators on CD-ROM 2000; World Bank Indicators 2001). Data comprises variables like immunization ratios (of measles in %), infant mortality, and labor force of females (in %). GDP per capita, agricultural value added (in % of the GDP), percentage of rural population as a proxy for urbanization, fertility rate, and percentage of female population were used as macro-level control variables. These were also taken from the World Bank. In addition to this, we wanted to incorporate political information to understand whether democratic or autocratic systems seem to reduce rural-urban disparities through policy making decision processes. We therefore resorted to data on Political Regime Characteristics and Transitions reliably prepared by Monty G. Marshall and Keight Jaggers. Their data is commonly used in research and is available under http://www.cidcm.umd.edu. The dataset is also known as Polity IV. We here made use of the variable Polity. Polity falls between +10 and –10, where a score of +10 indicates high democracy and –10 high autocracy. We also added the variable durability which indicates the number of years since the last (3-point or greater) regime change. It is a measure for political stability which, we assume, might have effects on rural-urban disparities in the political long-run.

3. INDICATORS OF MALNUTRITION From the database, we use information on child malnutrition in terms of stunting, wasting and underweight. We focus on the relative difference of rural-urban malnutrition rates and take the ratio of the percentage of rural malnutrition divided by the percentage of urban malnutrition; and multiply this ratio by 100. This represents our indicator for rural-urban inequalities in health: a country’s score over (below) 100 shows that more (less) rural children have suffered from malnutrition than their urban counterparts. We first consider all of the three indicators stunting, wasting and underweight for the descriptive part. Stunting here is defined as percent of children falling below -2SD for height for age (HAZ). Underweight is defined as percent of children falling below -2SD for weight for age (WAZ); and wasting is defined as percent of children falling below -2SD for weight for height (WHZ). Though we have information on all the three indicators of malnutrition, we exclusively focus on stunting in our main analytical part. Stunting or chronic malnutrition, reflected by deficits in height per age, is a stable indicator in terms of short term fluctuations and does not change in a short period of time as we focus on long-term factors including insufficient protein and energy intake, frequent infection, and poverty. Unlike weight related indicators, height is not influenced by outbreak of diarrhea which is very important in a cross-sectional study where we have no control on

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seasonality in food availability, short-term nutritional stress and disease outbreak. Use of wasting and underweight can not help us in understanding the short term or acute consequences of nutritional stress. The use of -2 Z-scores as a cut-off implies that 2.3% of the reference population will be classified as malnourished. Though there is discussion about using this, for our study this will not pose any problem as we are actually understating the rates using these -2 Z-score. Even though using -3 Z scores can give information about severe malnutrition, we do not use it here to focus on one analysis; and also because we might lose some countries where no data on severe malnutrition was reported. In the same vein, the use of -1 Z scores as an indicator for mild undernutrition is sometimes recommended - for instance in the case of some Latin American countries. However, the global database does not include this kind of specific information. In conclusion, in this paper, we will neither provide evidence on severe nor mild malnutrition; but limit ourselves to the -2 Z-score cut-off points, which are recommend to generally assess moderate nutritional stress within populations (WHO 1986, 1995); and to cover as many countries as possible. We strongly believe that childhood stunting leads to a significant reduction in the quality of life experienced later-on. A follow-up study over two decades on Guatemalan infants found that small adult sizes resulted from childhood stunting (Martorell et al. 1992). Therefore, it can be assumed that stunted children might also become stunted adults especially in less developed countries where catch-up growth in later life is often negligible. On top of that, childhood stunting is generally associated with negative effects on brain development, as healthy children clearly have an advantage in cognitive and educational performance (UNICEF 2001). In this light, the social costs of child malnutrition are immense. Comprehension of child malnutrition, analysis of its causes, and early intervention will substantially reduce these disadvantages.

4. CHARACTERIZATION OF THE RURAL-URBAN DISPARITIES Are more rural or urban children suffering from malnutrition in the world? Judging from Figure 2, where we illustrated the absolute values of malnutrition stratified by area, we can clearly see an asymmetric pyramid: Throughout most (sub-) regions and given any of the three indicators, more rural urban children seem to suffer from malnutrition. The world average rural-urban gap based on HAZ values is 10% points; and these rural-urban disparities become less pronounced if we move to the short term indicators WAZ values (7% point gap) and WHZ values (1% point gap). For further analysis, we mapped relative chronic malnutrition rates of countries to locate rural-urban disparities in the world-regions (Figure 3). Wherever our indicator for rural-urban disparities falls below 100, we used a hatched pattern. By visual inspection, it is clear that there are just very few countries where more urban children are suffering from malnutrition. These countries are Australia, Gaza and Costa Rica. Australia and Gaza are the only economies classified as ‘developed countries’ in our dataset. Thus, income-specific circumstances might have caused this result; which seems to be calling for further research on rural and urban malnutrition of children living specifically in developed countries. Further outliers are Afghanistan in Asia and Bosnia Herzegovina in Europe, where there is rather low

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disparity. Only in 3 out of 93 countries, rural children enjoyed a better standard of living. Thus, in 96.8% of all societies, being raised in rural areas is a clear disadvantage as children have a higher chance of becoming stunted there. Though the evidence of rural-urban disparity is expected, we did not expect to find these striking levels of disparity. Moreover, we did not expect a regional pattern. These disparities become pronounced in LAC countries which might also be of interest as previous research has not revealed this extreme inter-continental disparity in a worldwide comparison. This is a very clear result which we would not have anticipated to that extent. Urban

OCEANIA TOTAL: WAZ OCEANIA TOTAL: HAZ OCEANIA TOTAL: WHZ Polynesia:: WAZ Polynesia:: HAZ Polynesia:: WHZ Australia- New Zealand: WAZ Australia- New Zealand: HAZ Australia- New Zealand: WHZ LACTOTAL: WAZ LACTOTAL: HAZ LACTOTAL: WHZ South America: WAZ South America: HAZ South America: WHZ Central America: WAZ Central America: HAZ Central America: WHZ Caribbean: WAZ Caribbean: HAZ Caribbean: WHZ

WAZ

Asia

EUROPETOTAL: WAZ EUROPETOTAL: HAZ EUROPETOTAL: WHZ Southern Europe: WAZ Southern Europe: HAZ Southern Europe: WHZ Eastern Europe: WAZ Eastern Europe: HAZ Eastern Europe: WHZ ASIA TOTAL: WAZ ASIA TOTAL: HAZ ASIA TOTAL: WHZ South-eastern Asia: WAZ South-eastern Asia: HAZ South-eastern Asia: WHZ Eastern Asia: WAZ Eastern Asia: HAZ Eastern Asia: WHZ Western Asia: WAZ Western Asia: HAZ Western Asia: WHZ South-central Asia: WAZ South-central Asia: HAZ South-central Asia: WHZ

Africa

Europe

LAC

Oceania

All

Rural WORLDTOTAL: WAZ WORLDTOTAL: HAZ WORLDTOTAL: WHZ

AFRICA TOTAL: WAZ AFRICA TOTAL: HAZ AFRICA TOTAL: WHZ Western Africa: WAZ Western Africa: HAZ Western Africa: WHZ Southern Africa: WAZ Southern Africa: HAZ Southern Africa: WHZ Northern Africa: WAZ Northern Africa: HAZ Northern Africa: WHZ Middle Africa: WAZ Middle Africa: HAZ Middle Africa: WHZ Eastern Africa: WAZ Eastern Africa: HAZ Eastern Africa: WHZ

HAZ WHZ

60

50

40

30

20

10

0

Percent

10

20

Figure 2. Absolute prevalence of child malnutrition in rural-urban areas.

30

40

50

60

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Aravinda Guntupalli and Daniel Schwekendiek

Notes: Indicator for Rural-Urban Disparities = (% of Chronic Malnutrition in Rural Children / % of Chronic Malnutrition in Urban Children) x 100. Figure 3. Relative prevalence of chronic child malnutrition in rural-urban areas.

The world’s largest disparity of a single country is found for China, where 20.2% of the rural population was suffering from malnutrition compared to only 2.9% of urban dwellers. As shown in Figure 4, this is by far the largest country outlier in the world. In our regressions analysis, we therefore dropped China. There have already been some investigations on the country outlier China. We can borrow findings from Jeanneney and Hua (2001), who found that due to a high share of tradable goods produced in rather urban than rural areas, the real depreciation of the Chinese currency raised the urban bias. Ravallion and Chen’s research (2004) show that poor people in China are affected by the taxation of farmers and the inflation rate. In their study, they view that rural economic growth is important to reduce the national poverty. Most importantly, rural-urban migration is hard in China as households must have a ‘hukou’ (residence permission) in order to regularly reside in an urban area and only high skilled people can purchase ‘blue stamp kukou’ which is difficult for most rural people to obtain (Chan and Zhag, 1999). In sum, rural people in China have less amenities like housing, education and infrastructure compared to their urban counterparts which is reflected in the rural-urban ratio in malnutrition. Given the special situation in China which is also depicted by Figure 4, it seems to be thoroughly justified to remove this significant country outlier from our regressions. Furthermore, it is safe to say that in general, more rural children living on the Asian and (Eastern) European continent seem to suffer from malnutrition than their urban counterparts. The only world region where we find a rather mixed picture is the African continent (Figure 3). However, we can observe an intra-continental tendency: there are high rural-biased disparities in Eastern Africa, whereas the midwest of the continent seems to be less affected (Figure 3) – an interesting result calling for further investigations.

Is it Better to Live in Rural or Urban Areas?

(% rural / % urban malnourished children)x100

700,00

89

China

600,00

500,00

400,00

300,00

200,00

100,00

0,00

Africa

Asia

Europe

LAC

Oceania

Continent Figure 4. Boxplot of rural-urban disparity rates based on HAZ.

5. DETERMINANTS OF RURAL-URBAN DISPARITIES Departing from the above mentioned basic equation on net nutrition equaling gross nutrition less energy consumption, we now run the regressions. The equation for regression 1 (Table 2) is: (% malnutrition rurali/% malnutrition urbani)x100 = a0 + a1 (caloriesi per capita per day) + a2 (proteinsi per capita per day) + a3 (immunization ratioi) + a4 (female labor force ratioi) + a5 (polityi) + a6 (durabilityi) + a7 (polityi x durabilityi) + dummies continenti + ui; (i=1,…..,N); where i represents the country, a1 and a2 capture the gross-nutritional effect; a3 and a2 the energy consumption effects caused by diseases and labor; a5 and a6 additional political impacts we wanted to control for.

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Aravinda Guntupalli and Daniel Schwekendiek Table 2. Regression analysis based on HAZ Rural/Urban Rural/Urban Rural/Urban Malnutrition Ratio Malnutrition Ratio Malnutrition Ratio 1 Coeff.

Constant

2 p-value

Coeff.

3 p-value

Coeff.

p-value

113.8

0.02

110.41

0.04

134.52

0.07

Calories per capita

0.25

0.13

0.24

0.05

0.21

0.15

Proteins per capita

-0.03

0.83

0.1

0.33

0.11

0.34

0.09

0.47

0.03

0.83

Gross Nutrition

Disease Environment Immunization in % (Measles) Infant mortality Work Load Labor force female in %

0.18

0.08

0.17

0.09

1.2

0.23

Democracy Index (Polity IV) Durability Index

0.08 -0.3

0.51 0.00

0.08 -0.3

0.52 0.00

0.09 -0.26

0.46 0.04

Democracy x Durability

-0.28

0.04

-0.28

0.05

-0.31

0.06

Political Impact

Continents LAC (ref.) Africa Asia Europe

-79.16 0.00 -75.23 0.00 -110.08 0.00

-80.13 0.00 -75.55 0.00 -110.18 0.00

-75.47 -77.36 -108.78

0.00 0.00 0.00

Oceania

-131.69 0.00

-134.32 0.00

-130.92

0.00

GDP per capita

-0.06

0.53

Agricultural value added in % of GDP

0.1

0.43

Rural population in %

-0.01

0.95

Fertility rate

-0.11

0.59

0.55 7 70

0.00

Controls

adj. R² F N

0.58 10.1 73

0.00

0.58 10.1 73

0.00

Note: Standardized coefficients reported except dummies and constant; shadowed area: signficance on the 10% level; Dependent Variable: (% rural malnutrition/% urban malnutrition) x100.

As explained in an earlier section, our dependent variable is the rural-urban disparity ratio of malnutrition as an indicator for the gross nutritional status by residence. The coefficients a2 and a3 capture the gross nutritional inputs. As proteins and calories are multicollinear, we dropped proteins in our later analysis because proteins seem to be less important than calories

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91

(regression 1,, Table 2). One explanation could be that breastfeeding mothers seem to require rather calories than proteins to restore energy since we are dealing with infants and pre-school children. Furthermore, in regression 1, we used immunization ratios to see if the disease environment matters.. Finally, we also tried infant mortality. Like height development, this is another health-output variable, and because of causality issues that cannot be really solved in a cross-section, one should not over-interpret the results. We therefore ran a separate regression (regression 2, Table 2), and similar to previous regressions, we do not find a significant effect of the disease environment. Thus, it may be concluded that diseases do not matter for the rural-urban health disparities, and which is contrary to the ‘disease dominates’ hypothesis frequently advocated in studies on health. Beyond this, we controlled for the work load. Now, as there pre-school children being up to 5 years of age do not work, we entered female labor because we hypothesized that working mothers resume work early on after pregnancy. In urban areas, this might be because they fear to lose their job – in rural areas, women have to work in the fields or in the household, while they have to carry their baby on the back. Also there are hardly child-caring facilities in rural areas nearby. Thus, working mothers seem to be a double physical burden for children specifically living in rural areas. Our analysis confirms this relation (Table 2, regression 1): a higher labor force of females increases the rural-urban malnutrition ratio. However, we have to take this result with extreme caution as from a policy perspective this result is a pessimistic one in terms of improvement of women’s health through employment opportunities. Moreover, there is a need to classify both rural and urban work by sector before making a bigger interpretation of this result. It is obvious that most of the work rural women do is unpaid and unnoticed. Hence, surveys are not able to capture rural employment figures efficiently. Urban employment is relatively conspicuous compared to rural employment. Most importantly, we used political variables for the first time to capture impact of politics on rural-urban disparity in child health. We were primarily interested in the relation between democratization and rural-urban disparities in the short and long run. Our prior expectation was that democratic governments seem to improve living standards in rural areas to decrease social unrest. Furthermore, we also hypothesized that political stabilization per se might matter irrespective of the nature of the political system. Even a totalitarian government might have interests in leveling rural-urban living standards to prove its legitimating. To control for political systems in the short run, we used the polity variable that has been explained in an earlier section of this paper. To see if there is an effect of democratization on rural-urban disparities in the long run, we introduced an interaction dummy between democratization and durability. Whereas we did not see a statistical significant effect for polity, we consistently find a negative effect for the interaction dummy (regression 1-3), Table 2): in particular, the longer democratic systems are in power, the lower the disparities between rural and urban areas. Thus, democratic governments seem to improve living standards in rural areas in the long run. Beyond this, we also quite consistently find that political durability per se decreases the rural-urban gap. Political stability, regardless of the nature of the political system, also improves rural child health – policy decision makers seem to aim at leveling living standards in the long run to ensure their re-election or to keep social unrest down.

92

Aravinda Guntupalli and Daniel Schwekendiek Table 3. Correlation Matrix calories proteins Immuni- infant female polity Duraper per zation in % mortality labor bility capita capita rate force in %

calories per 1 capita proteins per capita immunization in % infant mortality rate female labor force in % polity durability gdp per capita agricultural va in % rural population in % fertility rate

gdp Agricul- rural fertility per tural va popurate capita in % lation in %

0.83

0.4

-0.58

-0.44 0.07 0.35

0.27 -0.48

-0.53

-0.59

1

0.46

-0.58

-0.23 0.06 0.27

0.24 -0.43

-0.47

-0.57

1

-0.65

-0.25 -0.01 0.24

0.1

-0.45

-0.66

1

0.28 -0.14 -0.29 -0.12 0.63

0.63

0.83

1

-0.5

0.1

-0.25 0.08 0.4

0.47

0.1

1

-0.14 0.05 -0.21

-0.12

-0.21

1

-0.02 -0.29

-0.2

-0.25

1

-0.07

-0.09

-0.21

1

0.67

0.51

1

0.55

1

Above this, we used a set of regional dummies to roughly control for unobservable and continent-specific impacts like culture, climate, religion and some inequality related variables. Our regression analysis (table 2) reveals our previous descriptive findings. Compared to LAC, where we found the highest continental disparity, Africa, and Asia significantly have lower disparities. In Europe and Oceania it is indeed significantly lowest. Last but not least, in regression 3 (Table 2), we entered a set of macro-level variables controlling for an economy’s structural characteristics. On a macro-economic level, we wanted to see if the level of income matters (GDP per capita). We also tested if the country is characterized by a rather agricultural economy (agricultural value added), which would favor rural areas as they might have primary access to food production and such. Beyond, we looked for demographic impacts like the share of urbanization proxied by rural population in %, and the fertility rate which increases the number of children per household and might disproportionably be a disadvantage for urban households where space is scarce. Yet, from a statistical point these variables do not determine rural-urban health disparities, so we did not focus on them and only show the results in regression 3. For our regressions, we found data for 70 to 73 countries. Multicollinearity does not bias our findings. As mentioned above, we found a strong relation between calories and proteins (Table 3) and we dropped proteins as it is does not come out significant in regression 2 and 3. Judging from Table 3 where we show the collinearity matrix for the independent variables,

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we additionally only detect a strong relation between fertility and infant mortality which does not become problematic as we do not enter them jointly in our regressions given the overall causality issue of infant mortality. All in all, we are able to explain 55% to 58% of the total variance with our specified models

6. CONCLUDING REMARKS Until the close of 19th century, mortality was much higher in cities than in rural areas in both Europe and the US (Johanson, 1964). But the progress in science and medicine, education of masses, infrastructure improvement altered the scenario by improving the urban health conditions all over the world. Later rural areas in the developed world also enjoyed most of the benefits of the urban areas whereas rural areas in developing countries could not grasp this growth. Based on our findings we can say that in the case of Africa, Asia and Latin America there is still a large disparity in child nutrition between rural and urban areas. Even though a couple of studies pointed out the rural-urban divide in the world, a global pictures has been thoroughly missing. For the first time, making a worldwide comparison, our most important finding is that in 97% of all countries examined, rural children seem to be disadvantaged. It is also extremely interesting to study the regional patterns in terms of ruralurban disparity in child health. On the global scale, we moreover could relate continental and national outliers. Our paper supports findings from various studies that point out the high rural-urban divide in China. So the ratio of urban to rural income in China was also cited as extremely high by the World Bank (1997). In this vein, we here can relate China as the largest and significant world outlier in rural-urban disparities. Concerning the inter-continental outlier LAC, our study also finds that Ecuador, Peru and Bolivia have higher malnutrition rates compared to other countries in that region. Though Latin America is doing well compared to other Asia and African countries in terms of overall malnutrition, it is worst in terms of rural-urban disparity. The Caribbean is better-off compared to Central and South American countries in terms of rural-urban malnutrition. South American countries - Peru, Brazil and Bolivia – show the highest rural-urban disparity. Though we cannot confirm the study by Godoy et. al (2005), where they found a weak correlation between income inequalities and anthropometric indicators in Bolivia, we can re-confirm the existence of a high rural-urban disparity of malnutrition in overall Latin America (Ruel, 2000) and relate it to the world’s highest intercontinental rate at the end of the millennium. In this context, Finan et al (2005) emphasize that poverty in Mexico can be reduced in rural areas by increasing better access to land along with provision of education, public goods and infrastructure. For Africa; our main findings are that there are mixed results for the rural-urban disparities. Rural areas particularly located in the midwest of Africa seem to suffer less from malnutrition than the rest of the continent – a result calling for further investigation. Furthermore, departing from the general net-nutritional equation, incorporating gross nutrition and energy absorption, we here found that supply of calories, not proteins, and work load of females increase the rural-urban malnutrition ratio. However, the significance of calories on rural-urban gap is valid for regression 2 only and hence must be taken with caution. These results suggest that specifically urban dwellers seem to benefit from nutritional

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and infrastructure improvements: in rural areas, relatively higher self-subsistence in food and childcare seems to have a negative impact on the child health - whereas in urban areas, better food provisions and child-caring facilities for working women seem to have a positive influence. Interestingly, we did not find any statistically significant effect for the disease environment which we carefully measured with a health input proxy immunization, and with the health output proxy infant mortality. For the ongoing ‘disease dominates’ discussion, we here have to conclude that rural-urban health disparities are statistically not affected by disease environment per se, gross nutrition and work load of mothers seem to have much higher explanatory power. Last but not least, controlling for political impacts, our study revealed that rural children – relative to urban ones - seem to benefit from political stability. Introducing an interaction dummy between political durability and democratization, we have shown that specifically democratic and stable systems show lower rural-urban disparities. For further research, we encourage additional studies that include information on famine years, food prices, civil wars and such. On top of that, as stressed by Morales (2004), information on culture, ethnicity and topography can help in getting a complete picture of child malnutrition. Though we found more children suffering in rural areas, we want to emphasize that policies in the developing countries must not neglect the urban poor. For instance, Menon et al. (2000) - using 11 demographic health surveys - found that urban poor cannot be ignored in developing countries as poor urban dwellers likewise suffer from bad health conditions. Developing countries must not only aim at the overall reduction of malnutrition but also at decreasing rural-urban disparities. After all, the final goal of all countries in the world is to improve child health - irrespective of where they live.

BIBLIOGRAPHY Bhargava, Alok (2003). Family Planning, Gender Differences and Infant Mortality: Evidence from Uttar Pradesh, India. Journal of Econometrics, 112(1), pp. 225-240. Bhargava, Alok, Sadia Chowdhury and K.K. Singh (2005). Healthcare infrastructure, Contraceptive Use and Infant Mortality in Uttar Pradesh, India. Economics and human Biology, 3(3), pp. 388-404. Chan, Kam Wing and Li Zhang (1999). The Hukou System and Rural–Urban Migration in China: Processes and Changes. China Quarterly, 160, pp. 818–855. Coral, Leonardo, Paul Winters and Gustavo Cordillo (2000). Food Insecurity and Vulnerability in Latin America and the Caribbean. Working Paper series in Agriculture and Resource Economics. De Onis, Mercedes and Monika Blössner (1997). WHO Global Database on Child Growth and Malnutrtion. (Geneva: WHO). De Onis, Mercedes and Monika Blössner (2003). The World Health Organization Global Database on Child Growth and Malnutrition: Methodology and Applications. International Journal of Epidemiology, 32, pp. 518-526. Duncan, Alex and John Howell (eds) (1992). Structural Adjustment and the African Farmer (Portsmouth: Heinemann).

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Finan, Frederico, Elisabeth Sadoulet, Alain de Janvry (2005). Measuring the Poverty Reduction Potential of Land in Rural Mexico. Journal of Development Economics, 77(1), pp. 27-51. Godoya, Ricardo, Elizabeth Byron, Victoria Reyes-Garcia, Vincent Vadez, William R. Leonard, Lilian Apaza, Tomás Huanca, Eddy Perez, David Wilkie (2005). Income inequality and adult nutritional status: Anthropometric evidence from a pre-industrial society in the Bolivian Amazon. Social Science and Medicine, 61(5), pp. 907-915. Graham, M. (1997). Food Allocation in Rural Peruvian Households: Concepts and Behavior Regarding Children. Social Science and Medicine, 44(11), pp. 1697-1709. Habicht, Jean-Piere, Reynaldo Martorell, Charles Yarbrough, Robert M. Malina and Robert E. Klein (1974). Height and Weight Standards For Preschool Children. How Relevant are Ethnic Differences in Growth Potential? The Lancet, pp. 611-615. International Fund for Agricultural Development (IFAD) (2001). Rural Poverty Report (Oxford: Oxford University Press). Jeanneney, S. Guillaumont and P. Hua (2001). How Does Real Exchange Rate Influence Income Inequality Between Urban and Rural Areas in China? Journal of Development Economics, 64, pp. 529–545. Johanson, Gwendolyn Z. (1964). Health Conditions in Rural and Urban Areas of Developing Countries. Population Studies, 13(3), pp. 293-309. Lipton, Michael (1977). Why Poor People Stay Poor: Urban Bias in World Development (Cambridge: Harvard University Press). Martorell R., J. Rivera, H. Kaplowitz, E. Pollitt (1992). Long-term consequences of growth retardation during early childhood, in: M. Hernandez and J. Argente (eds.) Human Growth: Basic and clinical aspects, (Amsterdam: Elsevier Science Publishers, pp. 43149). Menon, Purnima, Marie T. Ruel, and Saul S. Morris (2000). Socioeconomic Differentials in Child Stunting are Consistently Larger in Urban Than in Rural Areas. FCND Discussion Paper No. 97. Micklewright, John and Suraiya Ismael (2001). What Can Child Anthropometry Reveal About Living Standards and Public Policy? Review of Income and Wealth, 47(1), pp. 6580. Morales, Bolivia Rolando, Ana Maria Aguilar, and Alvaro Calzadilla (2004). Geography and culture matter for malnutrition. Economics and Human Biology 2, pp. 373–389. Ravallion, Martin and Shaohua Chen (2004). China’s (Uneven) Progress Against Poverty. World Bank Policy Research Working Paper 3408. Ruel, Marie T. (2000). Urbanization in Latin America: Constraints and opportunities for child feeding and care. Food and Nutrition Bulletin, 21(1). Sahn, David and David Stifel (2003). Urban-Rural Inequality in Living Standards in Africa. Journal of African Economies, 12(4), pp. 564-597. Schwekendiek, Daniel (2008). The North Korean standard of living during the famine. Social Science and Medicine 66(3):596-608. Shen, Tiefu, Jean-Pierre Habicht, and Ying Chang (1996). Effect of Economic Reforms on Child Growth in Urban and Rural Areas of China. The New England Journal of Medicine, 335(6), pp. 400-406.

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Smith, Lisa, Marie T, Ruel, and Aida Ndiaye (2005). Why is Child Malnutrition Lower in Urban Than Rural Areas? Evidence from 36 Developing Countries. World Development, 33(8), pp. 1285-1305. Sunder, Marco (2002). Rivalry over Family Resources in the Land of Plenty: The Physical Stature of Children in the United States. Working Paper. UNICEF (2001). The State of The World’s Children (Geneva: UNICEF). WHO (1986). Use and Interpretation of Anthropometric Indicators of Nutritional Status. Bulletin of the World Health Organization, 64(4), pp. 929-941. WHO (1995). Physical Status: The Use And Interpretation of Anthropometry. (Geneva: WHO). Wolfe, Barbara L. and Jere R. Behrman (1982). Determinants of Child Mortality, Health, and Nutrition in a Developing Country. Journal of Development Economics, 11, pp. 163-193. World Bank (1997). Sharing Rising Incomes: Disparities in China. A World Bank Country Study. (The World Bank, Washington, DC). World Bank (2000). World Development Indicators on CD-Rom. World Bank (2001). World Development Indicators. Washington, D.C.: The World Bank.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 6

CHILD WELFARE REVISED: THE CASE OF THE COMMUNIST DEVELOPMENT COUNTRY NORTH KOREA Daniel Schwekendiek Seoul National University, Republic of Korea

ABSTRACT This article assesses human welfare in North Korea. Very little information is generally available on the North Korea, a country which has drastically sealed itself off from the rest of the world since its political formation, and can largely be described as a statistical terra incognita. Thus, when it comes to typical human welfare indicators like GDP per capita, life expectancy, infant mortality, literacy rates or the human development index of the United Nations, we here argue that they are either statistically unavailable, politically manipulated, full of measurement errors, or fail completely to capture human development as a consequence of communist market distortions in North Korea. Considering a totalitarian regime, we can receive a unique glimpse at nation’s human welfare state by looking at the heights of their children. Stature can assumed to be an appropriate indicator in many situations. As distinct from conventional performance indicators, anthropometric measurements are politically incorruptible and quite sensitive to human development. Moreover, as distinct from demographic and economic indicators, in order to obtain anthropometric variables, one is not dependent on theoretical assumptions or underlying data on the population and the economy. This is because as body height is measured physically, measurement errors become in fact negligible. Most importantly, in a Maslowian sense, height and weight account for physiological human needs, which can be supposed to play a primary role for the people living in a developing country like North Korea. Given these advantages (and the discussed disadvantages of conventional indicators), we here argue that stature seem to be the first-best indicator for child welfare in North Korea. In the year 2002, we find a gap of 13 cm between North and South Korean boys – largely reflecting socioeconomic disparities between the two Koreas.

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1. THE QUESTION OF THE STANDARD OF LIVING Wie geht es? Ça va? Annyeong haseyo? In virtually every language in the world, you will find such a phrase which in English translates into ‘How are you?’. What at first seems to be an empty phrase is in fact deeply rooted in almost all cultures of the world both linguistically and historically, and therefore seems to be a basic inquiry of mankind. Indeed, asking about the quality of life is an all-encompassing question, as it might touch all the spheres of economic, social and political life which affect individuals. In this article, what we are basically doing is raising this question. However, what makes our inquiry quite challenging is that the people whom we confront with this universal question - namely the North Koreans - live in one of the most secluded places on earth. Philosophical and methodological issues aside, totalitarian North Korea is known to be a ‘hermit kingdom’ from where little reliable information and, more importantly, hardly any quantitative data has emerged. Unlike other countries under communism, Pyongyang has not released regular statistics for decades. Still today, North Korea seals itself off from the rest of the world while brutally oppressing its people, making it almost impossible to directly ask a North Korean: ‘How are you?’ without severely endangering the life of the interviewee. The purpose of this study is to investigate child welfare in North Korea in a socioeconomic context. We focus on the anthropometric indicators of height, which has been shown to be very powerful indicator of human well-being. Although our study has many interdisciplinary features by combining insights from human biology, medicine, health economics and development policy, we primarily see it in the tradition of the anthropometric literature. Specifically, we will introduce the concept of the biological standard of living which was originally developed and established in the field of economic history. However, we do not apply any historical data on North Korea here. Instead, by making use of recent data, we seek to address issues of present relevance and investigate the ongoing humanitarian crisis in North Korea. In doing so, we can show by descriptive means how well North Korean children perform in terms of anthropometric living standard indicators on a comparative global scale. As our study focuses on analysing human welfare in North Korea per se, we completely refrain from any political discussion on debatable issues such as the human rights situation, the legitimacy of the totalitarian system, and economic or political sanctions against the communist regime. However, we daresay that the descriptive research insights found here may help to understand the humanitarian situation in North Korea much better. The remainder of this article is arranged as follows: in the next section, we will introduce theoretical and, to a certain degree, philosophical concepts which have been developed to assess the quality of life. Afterwards, we will discuss some established human welfare indicators by comparing the available data on North Korea to selected countries. We then suggest anthropometric variables, specifically stature, as an appropriate proxy for child welfare in North Korea. Finally, we will discuss some potential shortcomings of stature.

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2. SYSTEMIZING HUMAN WELFARE Let us come back to the initially raised question: How are you? As we saw, people all over the word are preoccupied with this ultimate question. Yet giving a universal answer is not an easy task at all. For instance, one person might answer: ‘I am fine. I just won 100 dollars in the lottery.’ Another might respond: ‘I am fine because I got promoted in my job.’ Still others might simply be happy because they are looking forward to the upcoming weekend. What becomes clear is that the answer lies in eye of the beholder, i.e. it is largely a matter of personal preference. What contributes to human welfare in general? From a systematic point of view, Lasswell and Kaplan (1950) attempted to provide evidence on this by identifying the four ‘welfare values’ of well-being, wealth, skill and enlightenment; as well as the four ‘deference values’ power, respect, rectitude and affection. The latter group represents valued (sociopolitical) relations between humans; the former - being of more interest in the context of human welfare indicators - represent generally valued attributes of human beings. Well-being here refers to the health and safety of the organism; wealth to income and thus the services and goods consumed by the individual. Skill means proficiency in arts, crafts, trade, and profession; and enlightenment implies knowledge about individual and social relations. What is noteworthy about these ‘welfare values’ is that material needs like health, safety and income are named first in the list, preceding immaterial needs like proficiency and knowledge. However, since Lasswell and Kaplan opted for a rather philosophical systematization of human needs, they did not intend to weigh these values at all: No assumptions will be made here as to the comparative intensity with which these values are held, or the importance assigned to them by various persons and groups. In some form and to some degree, these values no doubt always play a role, and political scientists, ancient and modern, have seen in them the element of invariance which makes a political science possible.

Using common sense, one might easily agree that health, wealth, self-realization and access to information should be an essential part of our human utility function. Yet, in applied research, we are rarely able to measure all of the above values due to data constraints. Also, for analytic purposes, we would like to focus on just one – the most important – welfare value. Therefore, a relative ranking of human preferences might be of interest. Abraham Maslow has set up a hierarchy of human values which is commonly known as ‘Maslow’s hierarchy of needs’ (Maslow, 1943). Interestingly, irrespective of Lasswell and Kaplan, Maslow identifies more or less similar human welfare values. However, he explicitly assigns ranks to them. Maslow basically establishes five levels of human needs which comprise physiological needs, safety needs, the need for love and belongingness, the need for esteem, and the need for self-actualization, with physiological needs being the first and selfactualization being the last need humans will strive for. Physiological needs in a Maslowian sense are human biological needs and include food, water, oxygen, and body temperature; in addition, they are regarded as the strongest needs because they are a necessary condition for the realization of the remaining levels. Therefore, people will always seek to fulfill physiological needs first before attempting to satisfy any further level. Once biologically satisfied, people will steer their attention towards personal security which may include safety

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from violence or unemployment, health, property, etc. After this, an individual will aim at love and belongingness which refers to emotional and social relations in life. Once these needs are met, the wish for esteem will emerge, i.e. individuals will aspire to attain selfrespect and respect from others in (private or professional) life. Finally, the need for selfactualization will play a role. According to Maslow, individuals have specific abilities and carrying out the task they are best able to perform will lead to the ultimate stage of human satisfaction. Generally, what can be derived from both Kaplan and Lasswell’s and Maslow’s concepts of human welfare is that physical maintenance on the one hand, and intellectual or social challenges on the other hand are considered an integral part of our life values (Table 1). Here, Maslow clearly states that physical needs will have to be satisfied first, i.e. human thoughts and behaviour are primarily controlled by the needs for food, water and then shelter as opposed to the striving for intellectual and social acknowledgement. Besides that, the two concepts strikingly resemble each other in their identification of human welfare components (Table 1). However, one might argue whether income (Lasswell and Kaplan) or safety (Maslow) should be pointed out separately or not. Bearing these theoretical systematizations in mind, we will now discuss some commonly established welfare indicators - with a special focus on North Korea. Table 1. Systematizations of human welfare Maslow's 'hierarchy of needs' physiological needs safety love and belongingness esteem self-actualization

Manifestations

Lasswell and Kaplan's Manifestations human 'welfare values' food, water, homeostatis, well-being health, safety sexual activity security from violence, wealth income, consumption property, unemployment emotional and social skill proficiency relations self-respect, respect from enlightenment knowledge, information others private and professional self-realization

Source: Maslow (1943); Lasswell and Kaplan (1950).

3. HUMAN WELFARE INDICATORS IN NORTH KOREA First of all, let us emphasize that it is difficult, if not impossible to accurately estimate North Korea’s performance in the economic, social or educational sector due to a lack of data. The last statistical yearbook issued by North Korea dates back to 1965. Therefore, North Korea seems to be a statistical terra incognita when it comes to conventional welfare indicators. For instance, macroeconomic data for the Democratic People’s Republic of Korea (DPRK) are largely lacking in international databases (Table 3). And even if some information on human development in North Korea is available, it usually comes directly

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from Pyongyang, seems to be inconsistent and has thus been a likely subject of political manipulation, as will be shown below. In addition to this, we do not even know the exact population size of North Korea to calculate per capita figures, for example. Bearing these heavy limitations in mind, let us nevertheless attempt some gross comparisons of the few available human welfare indicators for North Korea. For our brief, cross-sectional comparison around the year 2000, we selected South Korea and Japan as North Korea’s direct geographical neighbors, China as a similar East-Asian country under communism, India and Bangladesh as developing countries in Asia, and the USA and (West-)Germany as typical benchmarks for international comparisons (Table 3). Starting out with physiological needs which have been identified as a main component of the quality of life, average income - as a necessary precondition for being able to afford adequate food and health care - is likely the most commonly established indicator for assessing human welfare. It is particularly employed in welfare economics, yet there is also considerable debate about whether it succeeds in measuring human development or not. Average income is commonly proxied by per capita gross domestic product (GDP) - or sometimes gross national product (GNP) - and given in terms of purchasing power parity. It measures the economic performance of a country as defined by the market value of the goods and services produced in a specific year. From a theoretical point of view, it may be assumed that the higher the average income, the ‘richer’ the nation and the better the quality of life of the people living there. However, one possible criticism against using average income as a main welfare indicator is that it largely fails to reflect the actual economic situation of individuals, since it does not take into account the actual income distribution within society. Although a large array of indicators measuring the variation of income exists in the literature, the problem is that for North Korea, we do not even have reliable information on income. Yang (1999) reports that North Korea’s per capita GNP was claimed to be 2,200 dollars by the communist government, 1,040 dollars based on an estimation of the International Institute of Strategies Studies in the early 1990s, and 736 dollars according to South Korea in 1982. Methodological discussions on the calculation aside, there is no estimation of North Korea’s income distribution, as it evidently does not make sense to estimate this if we do not even have reliable information on national income. Without paying too much attention to further methodological problems, let us very briefly turn to the second systematic drawback which arises from treating economic income as a welfare indicator: it systematically neglects nonmonetary activity. As Sen (1988) quite well illustrates: The GNP captures only those means of well-being that happen to be transacted in the market, and this leaves out benefits and costs that do not have a price-tag attached to them.

This may become an issue especially in the case of developing countries - North Korea might fall into this category - where volunteer and non-monetary labor, black-market activity or barter frequently play a role. Also, for North Korea, even if we had statistical information on its economic activity, we would hardly be able to measure North Korea’s actual economic value-added, as people living in that Stalinist country are not driven and rewarded by material incentives, payrolls or ‘price-tags’, but by political and hence non-monetary sticks and carrots. Besides this, the rate of unemployment within a country might be an appropriate proxy for the standard of living. It is not only a macroeconomic indicator, but also an indicator of

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(economic) safety. However, data is likewise completely lacking for North Korea (Table 3). Even when reasonably assuming that the North Korean unemployment rate is rather low, this would still not yield evidence on human welfare in North Korea. That is because communist countries in particular succeed in trimming down their unemployment rate by making use of labor-intensive mass mobilizations, which would hardly affect a household’s income, however. As a further proxy for physiological needs, let us focus on health indicators as mainly used in development economics. Concerning life expectancy at birth, North Korea put this figure at 73 years in 1999 (Table 3). This figure does not seem plausible, as it would be only four years below that of highly-developed countries like Germany or the USA. Also, note that South Korea, an economically prosperous country and OECD member, likewise reports a life expectancy of 73 years. However, South Korea’s economic performance has been reported to be 14.720 dollars (Table 3), and - taking into account the aforementioned guestimation reported in Yang (1999) - the average income in North Korea is 1.040 dollars.1 The fact that the two Koreas show the same life expectancy while exhibiting an economic gap of about 14:1 might cast serious doubt on the correctness of North Korea’s figure reported for its health sector. In fact, if we look at other developing countries in Asia, India or Bangladesh show a life expectancy of 58 or 56 years, which we would expect for North Korea, too.2 Alternatively to life expectancy at birth, let us take a look at infant mortality rates. Here, North Korea reports an infant mortality rate of 23 deaths per 1000 life births (Table 3). Compared to China – officially also under communism - this seems to be too low, though not completely exaggerated. However, in the developing country of India, for example, infant mortality was found to be 70. This seems to provide evidence that infant mortality rates are neither reliably reported nor reliably calculated by North Korea. Apparently, the only health indicator which seems plausible on a comparative scale is North Korea’s rate of chronic child malnutrition (Table 3), where the DPRK performs similar to developing countries like India and Bangladesh. More importantly, chronic child malnutrition is commonly based on the indicator height, so that by directly looking at anthropometric measurements, we may find an immediate indicator of human welfare in North Korea. Note that height as a welfare proxy will be discussed in detail in a later section of this paper. Moving away from physiological welfare indicators, let us take a closer look at intellectual human development in North Korea. Adult literacy rates, for instance, are reported to be 100% for North Korea (Table 3). Apparently, this seems to be too high for a developing country, with India and Bangladesh only reporting rates of 58% and 56%. South Korea puts its literacy rate at 99%, which would indicate a slightly lower prevalence of general education in the southern and economically better-off part of the peninsula. In the same vein, China reports to have a literacy rate of just 84%. Given this, North Korea’s figure seems to be too high. However, this does not necessarily have to be the case, as the 1

2

Note that the North Korean figure comprises both GNP and the South Korean GDP. However, as there were hardly any North Koreans working overseas or foreigners working in North Korea at that time, North Korea’s GNP and GDP will hardly differ. Hence, it may be assumed that North Korea’s per capita GNP can roughly be compared to South Korea’s GDP per capita. As we will see later on, North Korea’s child malnutrition rate as an alternative health indicator resembled that of India or Bangladesh around the year 2000. Therefore, these three countries might roughly be comparable from a human development perspective.

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communist system relies on literacy for reasons of political indoctrination. As distinct from Beijing, Pyonyang also maintains a closer grip on its people, so that differences in general education between these two communist countries seem to make sense.3 Most importantly, this might cast doubt on the usefulness of taking education as a human welfare indicator in the context of North Korea, as it is a result of totalitarianism where there is free (and compulsory) education for all on the one hand - and on the other hand, virtually no freedom to choose what one would like to read or express. Ironically, if we focused only on literacy rates as a proxy for human welfare, we would indeed find North Korea to be a perfect and most desirable place to live – which clearly shows the practical limitations of this welfare indicator. It is also noteworthy that because of general data problems for North Korea, it does not make sense to consider composite indices of human well-being. It is not for nothing that the United Nations refrain from reporting a Human Development Index (HDI) for North Korea (Table 3), as all three and equally weighed components - life expectancy, education (literacy rate and gross school enrollment rates) and economic income - are either completely unavailable or, as in the case of literacy, absolutely inappropriate for measuring human welfare in this country. Furthermore, political liberty, or safety in a Maslowian sense, might be of concern for the measuring of human development in the DPRK. According to Freedom House which regularly rates all countries on a scale from 1 to 7, with 1 indicating the highest degree and 7 the lowest degree of freedom, North Korea can be characterized as politically not free. In terms of both political and civil rights, the DPRK scores 7, indicating that there is no liberty and safety from the totalitarian regime in Pyongyang at all (Table 3). Developing countries like India or Bangladesh perform better in terms of freedom; and even communist China has a better score in civil liberties than North Korea. In a similar vein, the Polity IV index, measuring a country’s autocratic or democratic performance, finds North Korea at –9 on a scale from +10 for perfect democracy to –10 for complete autocracy (Table 3), whereas communist China was placed at –7. Therefore, it may be concluded that personal freedom, being an integral part of the concept of human welfare, is lowest in North Korea. It is important to note that although safety seems to be an appropriate indicator of the humanitarian situation in North Korea, it plays a secondary role in the human hierarchy of needs (Maslow, 1943). Thus, we would like to focus on physiological indicators as immediate proxies for the standard of living here. This is because we are dealing with a developing country where the needs for food, water and health play a dominant role. To cut a long story short, economic indicators do not seem to be appropriately capturing human well-being in North Korea, as economic incentives, monetary signals and business links are largely distorted due to the nature of the totalitarian system. More importantly, from a statistical point of view, reliable macroeconomic data are lacking for North Korea, making it almost impossible to accurately assess the economic standard of living of the country’s people. When it comes to common health indicators like life expectancy or infant mortality, we provided evidence that officially reported figures are not very credible when comparing North Korea to other countries in the region and the world. North Korea’s performance in the educational sector seems to be plausible. However, this indicator fails to capture the effect of human development in North Korea, as it reflects political indoctrination more than a 3

As can be seen in table 3, there is less civil liberty and democratization in communist North Korea than in communist China.

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universal right to information. Beyond this, freedom and democracy indicators do seem appropriate for measuring safety aspects of the standard of living in North Korea. Yet they cannot necessarily be regarded as the main component of human welfare. Therefore, a direct indicator for measuring the quality of life is needed.

4. STATURE AS A HUMAN WELFARE INDICATOR It may be generally accepted that no indicator or composite index is able to measure human welfare perfectly.4 However, we here would like to suggest stature as an appropriate indicator in many situations – and specifically in the context of North Korea. As distinct from the foregoing performance indicators, anthropometric measurements are politically incorruptible and quite sensitive to human development. Moreover, as distinct from demographic and economic indicators, in order to obtain anthropometric variables, one is not dependent on theoretical assumptions or underlying data on the population and the economy. This is because as body height is measured physically, measurement errors become in fact negligible. Most importantly, in a Maslowian sense, height and weight also account for physiological human needs, which can be supposed to play a primary role for the people living in a developing country like North Korea. Given these advantages (and the discussed disadvantages of conventional indicators), anthropometric measurements seem to be an excellent proxy for the quality of life in North Korea. In addition to this, some other advantages of height are summarized in Steckel (1995). According to Richard Steckel, stature fulfils all requirements of an indicator of the living standard: first, height is a timeless indicator, as it is applicable to all historical periods and years. Second, it represents global preferences, as nutrition and health represent basic human values. Third, unlike GDP per capita, height is an output indicator accounting for the distributional effect on individuals. Fourth, understanding height measurements does not require statistical know-how, and calculating or transforming data is not necessary. Fifth and last, stature can be used for international comparisons. In general, who uses anthropometric data? Based on Jürgens et al. (1990), let us identify the research fields that apply such data (Table 2). In doing so, we can quite well explain where our data come from and how they are to be interpreted. Ergonomic anthropometrics, for example, makes use of anthropometric data to adapt clothes and seats for the textile and automobile industries (Table 2). From this kind of source, we have borrowed data to investigate heights and weights in South Korea (Table 3). Such data are generally based on a nationally representative sample in order to adapt bulk commodities to consumers living in a specific country. The largest collection of anthropometric material comes from anthropological anthropometricians who investigate ethnic differences between groups (Table 2). However, these researchers frequently base their arguments on field studies, where the individuals or groups selected might not be representative of the whole society. Furthermore, height and weight data are applied in sport anthropometrics and medical anthropometrics, 4

Composite indicators may certainly reflect the quality of life in a more complex way. However, apart from the problem of deciding which indicator to select, there is a large debate on the weight assigned to the subindicators. Also, due to incomplete data availability, the more indicators are used, the more measurement errors arise.

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where case studies and individual histories of patients are of research concern (Table 2). A further field of research is forensic anthropometrics. Here, height is used for the biometrical (re-)identification of individuals. Data is often retrieved from prisoners and sometimes from passport records. Last but not least, anthropometric data is extensively employed in economics, where two major fields of research have emerged (Table 2). Firstly, in development anthropometrics, stature and weight are used for health surveillance in developing countries. For instance, the United Nations are interested in such data to assess the health status of children - who quite sensitively reflect the nutritional situation of a country - and to determine the amount of international food aid needed. In a similar vein, development economists make use of such data to include a nutritional component in their analysis. Secondly, stature is applied in economic-historical anthropometrics, where anthropometric measurements are considered as an indicator of the standard of living in the past. Since for this study, we basically take data from development anthropometrics and apply a concept that originated in economic-historical anthropometrics, let us briefly review the differences here. The former takes stature as a proxy for the nutritional status of a population in a contemporary developing country. Research in this area is focused on malnutrition as one component of human well-being. In this light, nutritional variables become the core of the analysis of heights, which in turn are seen primarily as an indicator of malnutrition. Most importantly, from a methodological point of view, development economists are not very much interested in the level of the height variable itself. Rather, since researchers focus on the prevalence of malnutrition, they simply and dichotomously count the number of malnourished individuals in the sample (based on international cut-offs) while discarding the (metric) level information of stature. As this implies an extreme data reduction, differentiated information on the better-off individuals in the sample is largely lost. In contrast to this, economichistorical anthropometrics makes use of the idea that stature can be seen a proxy for the biological standard of living (in the past), which is determined by underlying socioeconomic mechanisms. Height is thus considered a metric variable, as it provides detailed information on the life of the individuals in the sample. In this context, height is not used as an indicator of malnutrition, which would put the focus on the worse-off individuals, but as an indicator of overall human welfare, which takes into consideration all dimensions of life of the society. Therefore, in economic-historical anthropometrics, (gross) nutrition is an important component, but not the only factor contributing to human growth. As distinct from the research on malnutrition (stressing the term nutrition), in economic-historical research, heights are seen as a proxy for net-nutritional status, which is quite well depicted by the following energy balance equation given by Srinivasan (1992): I=M+A+S+W

(1.1)

In this fundamental equation which is valid for any physical or biological process, the aggregated inflows of energy (I) – such as food intake and body reserves - will have to be equal to the sum of all outflows, depicted by the right hand side of the equation, where M consists of metabolic energy expenditure, A relates to physical activity such as labor or recreation, and W refers to extra bodily wastes to overcome illnesses etc. S represents the (positive or negative) net additions to bodily stores to ensure the identity of the equation. Thus, M can be expressed as:

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Daniel Schwekendiek Table 2. Applied anthropometry in research

Applied Field ergonomic anthropometrics

Purpose adapting consumer goods

anthropological anthropometrics

Frequent sources of data surveys for the textile and automobile industries, books of tailors and carpenters field studies of anthropologists

anthropological research on the definition and differences of ethnic groups medical anthropometrics documentation of etiopathology medical records of patients sport investigations on the performance of Measurements of athletes anthropometrics athletes forensic anthropometrics biometric identification of individuals passports, measurements of convicts development economics health surveillance, investigations on food and nutrition surveys anthropometrics the prevalence of malnutrition economic-historical estimating the (biological) standard of records of military recruits, anthropometrics living in the past entrance examinations in schools Source: Adapted from Jürgens et al. (1990).

M = F [(I – S) – (A + W)]

(1.2)

The metabolic energy expenditure M includes the components of biological maintenance and, more importantly, biological growth. Thus, growth becomes dependent on the aggregate energy inflow less energy spent on physical labor and extraordinary bodily wastes. Similarly, the separation of net-nutritional versus gross nutritional components is reflected by the following equation given in Coll (1998): H = F (N,D,L,M)

(1.3)

where H refers to average height, N represents gross nutritional intake, D is the disease environment, L refers to child labor and M to biological maintenance necessities. However, when examining average heights in a stable climatic environment, M can be neglected giving the following basic relation: H = F (N,D,L)

(1.4)

Given this, H can be considered as a net-nutritional manifestation of gross nutritional intake, disease environment, and work load. Particularly researchers who use height as an indicator of the health and wealth status of a nation resort to the concept of the biological standard of living – a term originally suggested by John Komlos (Komlos, 1985) and applied and established in economic history (Komlos and Baten, 1998). In order to outline the basic idea of this approach, let us consider figure 1 which specifies the underlying mechanisms of human growth. Height (and weight) are a manifestation of underlying socioeconomic conditions among a population. Macroeconomic conditions can be assumed to be mediated to the household level, which in turn affects an

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individual’s - and particularly a child’s - standard of living. The definition of socioeconomic conditions can vary largely. As mentioned above, there can be no doubt that food availability is an important, though not a monocausal, factor influencing human growth. However, the more interesting story may not be how much food an individual consumed, but why the person was able to consume that particular amount of food, and why others were not. In this light, the underlying socioeconomic mechanisms shaped by macro and micro-level institutions ranging from the climate over cultural traditions to the political system of a country become of special concern (figure 1). Table 3. Welfare indicators in selected countries Human welfare Indicator

North South China Korea Korea

Economy GDP per capita (PPP in current n/a $), 2000 Unemployment, 1997 n/a

India

Bangla- Japan USA Ger- Source desh many

14720 3740

2730

1540

2.7

3

n/a

n/a

25280 33960 25100 World Bank (1999; 2001) 3.2 5 11.1 World Bank (1999, 2001)

Health Infant mortality, 1999

23

5

33

70

58

4

7

5

Life expectancy, 1999

73

73

70

63

59

80

77

77

Child malnutrition in % (based on height-for-age), 2000

45.2

n/a

14.2

44.9 44.6 (1999)

5.6 2.0 n/a (1978- (19881981) 1994)

100

99

84

58

n/a

n/a

0.890 0.730

0.577 0.510

0.939 0.940 0.912 UNDP (2006) (1995)

7

2

7

2

3

1

1

1

Civil liberties, 2000*

7

2

6

3

4

2

1

2

Democratization, 2000** Anthropometry Child stature in cm (boys age 6-7), 2002

-9

8

-7

9

6

10

10

10

109

122

n/a

n/a

n/a

n/a

n/a

n/a

Education Adult literacy rate, 1995-1999 Composite Indicator Human Development Index, 1999 Political Liberty Political rights, 2000*

56

n/a

n/a

UNICEF (2001) UNICEF (2001) WHO Global Database on Child Malnutrition UNICEF (2001)

Freedom House Freedom House Polity IV Schwekendiek (2008)

* A rating of 1 indicates the highest degree of freedom and 7 the least amount of freedom. ** A rating of 10 indicates the highest degree of democracy and -10 the least amount of democracy.

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Source: Adapted from Moradi (2005). Figure 1. Underlying mechanisms of height and weight manifestations.

It should be emphasized that we focus on the anthropometric indicator of height throughout our discussion. Weight measurements are of less interest here. Height measurements are commonly preferred when conducting research on the standard of living in a country, as weight can only be regarded as a short-term indicator. It should also be mentioned that we primarily apply data of North Korean pre-school children. Following Riley (1994), height seems to be a better indicator of nutritional status than weight when individuals are still growing. Based on this concept, how well does North Korea perform in terms of child welfare? Unfortunately, as seen in Table 3, height data is largely unavailable for many countries in the world. Such information does not appear in national yearbooks or is published by the national statistical offices. However, based on Schwekendiek (2008), let us make a comparison between the two Koreas – South and North – for which data was retrieved. In 2002 North Korean boys (6.50 to 7.49 years of age) were 109 cm tall, whereas their South Korean peers were 122 cm tall – accounting for a height gap of about 13 cm. This clearly reflects substantial differences in underlying socioeconomic living standards between the communist development country North Korea and the OECD membership country South Korea. In sum, given that North Korea represents a statistical terra incognita, has a totalitarian government that manipulates data for political reasons, and is a developing country where physiological needs can be assumed to play a pivotal role in everyday life, we here suggested stature as the first-best indicator for assessing human welfare. Also, unlike economic or demographic indictors, height has hardly any systematic drawbacks, as will be elaborated on in the following.

5. DISCUSSIONS ON STATURE Let us raise some concerns about height as a proxy for the welfare of a nation. On the one hand, Brinkman et al. (1997) have clearly identified an expected strong and negative

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correlation between average income and stunting in 147 countries. They also estimate that some 55 percent of the variance of stunting across countries can be explained by GDP per capita alone. On the other hand, history provides some examples of non-matching anthropometric and economic outcomes, thus casting doubt on the usefulness of stature as an overall indicator of a society’s welfare. The ante-bellum puzzle and early-industrial growth puzzle seem to be the most prominent cases in point: in a time when per capita GDP increased rapidly, the average stature of people decreased in fact (Komlos, 1996; 1998; Margo and Steckel, 1983).5 What is striking is that such diverging patterns can be observed predominantly for early periods of massive economic transformation, such as at the beginning of industrialization in Europe or the USA. In this light, these anomalies seem to be a consistent exception to the rule (Baten, 2000). It should be emphasized that in North Korea, such rapid and fundamental modernization processes did not occur in the 1990s – hence, this will not pose a problem for our study. Besides this, is height always an appropriate indicator of the welfare of a nation? Apart from research on undernutrition, comparing highly developed nations to each other may be complicated, as high-end consumption patterns, including aspects of overnutrition, could become an issue here. In this context, the perhaps most contradictory finding is that the USA are the most developed nation economically, whereas biologically, US-Americans are not found to be the tallest (although the fattest) people in the world (Komlos and Baur, 2004). Also, being tall does not necessarily imply a better life. A study by Waaler (1984) found a Ushaped relation between stature and mortality among Norwegian men, so that being extremely tall might even be a biological disadvantage. For all of these reasons, it may be argued that the welfare indicator height should be applied either to historical societies or to developing countries (Brinkman et al., 1997). As a common denominator of these two research fields (Table 2), it may be stated that in all situations where Maslowian physiological needs are not met, stature seems to become an unbiased and sensitive indicator of human welfare. Newcomers to the use of anthropometric indicators frequently presume that genes matter strongly in determining human size. And yet, while genes do indeed matter for the individual, the genetic effect is clearly cancelled out when taking the average population into consideration. Also, as noted by Eveleth and Tanner (1990): Two genotypes which produce the same adult height under optimal environmental circumstances may produce different heights under circumstances of deprivation. Thus children who would be the taller in a well-off community would be smaller under poor economic conditions.

Similarly, in a study of monozygotic twins who were separated at birth and raised under quite contrary circumstances - thus controlling for same genotype - the adult height of the twins differed by more than 8 cm (Tanner, 1990). Moreover, the Korean peninsula is another intriguing example, since the North and South Korean political experiment shows the extreme effects (13 cm for boys, age group 6-7) of the environment on a homogenous population (Table 3). Also, adoption studies of overseas Koreans point towards the huge environmental impact on height and the relatively small influence of genes (Lien et al., 1977; Winick et al., 5

According to John Komlos, these anomalies are, in the main, due to rising relative prices of food or increasing differences in income.

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1975). In a similar vein, an enormous growth spurt and secular trend of heights can be observed for South Korea (Gill, 1998). Today, South Koreans stand almost as tall as Italians reflecting enormous nutritional, epidemiological and economic improvements in the Republic of Korea (ROK) over the past few decades.6 For all these reasons, it should be clear that genes are far from fixedly determining human growth, while the environment can be assumed to play a much more important role in explaining variations in Korean heights. Another frequently raised concern is the small-but-healthy hypothesis, arguing that human beings can be small in stature while being in good health (Beaton, 1989). According to this hypothesis, human beings might adapt to environmental stress during their growth period by reducing their physical size, as small bodies require less energy for maintenance. If this were true, height measurements would become biased. Additionally, if smaller people were indeed thoroughly healthy, classifying individuals as ‘undernourished’ based on their height outcome might become problematic. However, the overall effect of a hostile environment would be covered either way. As a matter of causality, underlying socioeconomic conditions would lead to the phenomenon of stunting – hence the validity of stature as an overall welfare indicator would not be affected by this. Most importantly, the small-but-healthy hypothesis has not been proven empirically and is now voiced only by a rather small and diminishing group of scholars. All in all, given the context of North Korea, stature evidently seems to have a number of advantages as an indicator of human welfare, while there are only a few drawbacks that will bias our findings for this country.

6. CONCLUSION In this article, we assessed human welfare in North Korea. Coming back to our initially raised question of the quality of life, it seems almost impossible to ask a North Korean ‘how are you?’ under a totalitarian regime which maintains a close grip on its population. However, even though we cannot interview the people living in one of the most isolated countries in the world directly, we can receive an ‘incorruptible’ glimpse at their human welfare state by looking at their heights of their children. Because very little information is generally available on the DPRK, a country which has drastically sealed itself off from the rest of the world since its political formation, anthropometric data have become quite helpful in addressing these issues relating to a statistical terra incognita. Thus, when it comes to typical human welfare indicators like GDP per capita, life expectancy, infant mortality, literacy rates or the human development index of the United Nations, we argued above that they are either statistically unavailable, politically manipulated, full of measurement errors, or fail completely to capture human development as a consequence of communist market distortions in North Korea. Above all, height outcomes can be considered an excellent proxy for the standard of living in many situations: in a Maslowian sense, stature directly reflects physiological needs like food, health and the wealth of a nation - which can be supposed to be the primary determinant of human welfare in a developing country such as North Korea. Moreover, unlike GDP per capita which is the most common indicator of the welfare of a nation, height is an output indicator and is thus able to capture the distributional effect of welfare. 6

Korean face sizes are becoming smaller. See: Dong-A Ilbo. Nov. 30, 2004.

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REFERENCES Baten J. 2000. Heights and real wages in the 18th and 19th centuries: An international overview. Jahrbuch fuer Wirtschaftsgeschichte 1:61-76. Beaton G. 1989. Small but healthy? Are we asking the right question? European Journal of Clinical Nutrition 43:863-875. Brinkman H-J, Drukker J, Slot B. 1997. GDP per capita and the biological standard of living in contemporary developing countries. Research Memorandum GD-35. Coll S. 1998. The relationship between human physical stature and GDP (some experiments with European time series). In: Komlos J, Baten J, editors. The biological standard of living in comparative perspective. Stuttgart: Franz Steiner. Eveleth P, Tanner J. 1990. Worldwide variation in human growth. Cambridge: Cambridge University Press. Gill I. 1998. Stature, consumption, and the standard of living in colonial Korea. In: Komlos J, Baten J, editors. The Biological Standard of Living In Comparative Perspective. Stuttgart: Stuttgart. p 122-138. Jürgens H, Aune I, Pieper U. 1990. International data on anthropometry. Geneva: International Labor Office. Komlos J. 1985. Stature and nutrition in the Habsburg Monarchy: The standard of living and economic development. American Historical Review 90:1149-1161. Komlos J. 1996. Anomalies in economic history: Reflections on the antebellum puzzle. Economic History 56:202-214. Komlos J. 1998. Shrinking in a growing economy? The mystery of physical stature during the industrial revolution. Economic History 58:779-802. Komlos J, Baten J, editors. 1998. The biological standard of living in comparative perspective. Stuttgart: Steiner. Komlos J, Baur M. 2004. From the tallest to (one of) the fattest: the enigmatic fate of the American population in the 20th century. Economics and Human Biology 2:57-74. Lasswell H, Kaplan A. 1950. Power and society. New Haven: Yale University Press. Lien N, Meyer K, Winick M. 1977. Early malnutrition and "late" adoption: a study of their effects on the development of Korean orphans adopted into American families. American Journal of Clinical Nutrition 30:1734-1739. Margo R, Steckel R. 1983. Heights of native born northern whites during the antebellum period. Journal of Economic History 43:167-174. Maslow A. 1943. A theory of human motivation. Psychological Review 59:370–396. Moradi A. 2005. Ernährung, wirtschaftliche Entwicklung und Bürgerkriege in Afrika südlich der Sahara (1950-2000). Inaugural Dissertation. University of Tuebingen, Department of economics. RiIey J. 1994. Height, nutrition and mortality risk reconsidered. Interdisciplinary History 24:465-492. Schwekendiek D. 2008. Height and differences between South and North Korea. Biosocial Science (Forthcoming). Sen A. 1988. The concept of development. In: Chennery H, Srinivasan TN, editors. Handbook of developent economics. Amsterdam: Elsevier.

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Srinivasan TN. 1992. Undernutrition: concepts, measurement and policy impications. In: Osmani S, editor. Nutrition and poverty. Oxford: Clarendon Press. p 97-120. Steckel R. 1995. Stature and the standard of living. Journal of Economic Literature 33:19031940. Tanner J. 1990. Foetus into man. Cambridge: Harvard University Press. UNDP. 2006. Human development report 2006. New York: Palgrave Macmillan. UNICEF. 2001. The state of the world’s children. Geneva: UNICEF. Waaler H. 1984. Height, weight and mortality. The Norwegian experience. Acta medica scandinavica 679:1–59. Winick M, Meyer K, Harris R. 1975. Malnutrition and environmental enrichment by early adoption. Science 190:1173-1175. World Bank. 1999. World development indicators on CD-Rom. World Bank. 2001. World development indicators on CD-Rom. In. Washington DC: The World Bank. Yang SC. 1999. The North and South Korean political systems. New Jersey: Holly.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 7

USING PRIVATE CONTRACTS TO CREATE ADOPTIONS FROM FOSTER CARE Mary Eschelbach Hansen Department of Economics, American University, District of Columbia, USA Center for Adoption Research, University of Massachusetts Medical School, Massachusetts, USA

ABSTRACT Creating adoptions for children waiting in foster care is a good investment, but the number of adoptions created each year meets only a fraction of the need. This paper explores how the organization of the delivery of social services to waiting children and prospective adoptive families influences adoption creation. Cross-section time-series estimates are supplemented with a new augmented fixed effects procedure to demonstrate that the use of contracts with private agencies bolsters adoption creation. Contracts for recruitment and orientation of prospective adoptive parents are particularly effective.

INTRODUCTION More than a half million children are currently in foster care in the United States (US DHHS, 2006a). While most of the children will return to their families of origin, over 100,000 will never be able to return home. Less than half of these “waiting” children will be adopted in any given year; the others will continue to wait for a safe and permanent family. Federal law, particularly the Adoption and Safe Families Act [ASFA] (P.L. 105-89, reauthorized by P.L. 108-145), holds adoption to be the preferred alternative for providing a permanent family for most children who cannot be reunited with their families of origin. Adoption improves physical, psychological, and behavioral health, and related educational and employment outcomes, relative to the alternative of long-term foster care (see recent reviews by Rushton, 2004; Triseliotis, 2002; van Ijzendoorn, 2006; and Hansen, 2007).

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1999 2000 2001 2002 2003 2004

Waiting Children 2,632 2,576 2,552 2,406 2,301 2,282

Adoptionst/Waitingt-1 \(%) 61 72 49 44 47

Source: Author’s calculations from US DHHS (2006a).

Although local and state child welfare agencies are responsible for the placements of the children in their care, Congress has actively promoted adoption since the late 1970s. Between 1980 and 1996, federal adoption promotion focused on the provision of tax and subsidy incentives directed towards adoptive parents. ASFA created the Adoption Incentive Program, one of many outcome-oriented, federally-administered programs instituted under the Clinton administration. The Adoption Incentive Program consists of monetary bonuses to state child welfare agencies for increases in adoptions, and it imposes financial penalties on states that keep children in foster care for long periods of time. States responded to federal incentives to create adoptions by increasing the post-adoption financial supports offered, in turn, to families (Hansen, 2006a). Prospective adoptive families appear to be sensitive to postadoption supports (Hansen and Hansen, 2006), so that the combination of incentives to states and incentives to families doubled adoptions from foster care in the late 1990s; see figure 1. However, the number of adoptions created for children waiting in foster care has leveled off at about 50,000 for the last several fiscal years. Adoption creation could be stymied by a shortage of available adoptive families, yet surveys indicate that interest in adoption is strong and that a sizeable number of adults who express interest in adoption consider adopting children who wait in foster care (Chandra et al., 1999, Harris Interactive, 2002). In the past few years states have tried to cut back on postadoption financial support (Eckolm, 2005; NACAC, 2003). The decisions of prospective adoptive families are sensitive to the willingness of the state to secure post-adoption funds to protect the family against financial risk associated with agreeing to raise a child with significant special needs (Hansen and Hansen, 2006); therefore, cutting adoption subsidies may cut adoption creation. Define adoption creation as the number of adoptions finalized in a fiscal year relative to the number of waiting children at the end of the previous fiscal year, expressed as a percent of waiting children. The rate of adoption creation was high in the late 1990s and early 2000s, as shown in table 1. This has been attributed to states’ efforts to clear a backlog of cases (Hansen, 2006b). A large increase in the percentage of adoptions completed by kin and foster parents indicates many long-term placements were converted into adoptions (US DHHS, 2006a; Hansen, 2006c). In recent fiscal years, adoption creation has fallen along with adoptions in aggregate. That is, the slowdown in adoptions is not accounted for by a decline in waiting children. This paper explores how the organization of the delivery of social services to waiting children influences adoption creation. Specifically, I find that the use of contracts with private agencies increases adoption creation.

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USING CONTRACTS FOR PUBLIC SERVICES Private contracting, especially for municipal services, was widespread and growing as the twentieth century ended (Florestano and Gordon, 1980; Pool and Fixler, 1987). There is a large literature on the appropriate use of private contracts in the provision of public services (Lipsky and Smith, 1989), and perhaps an even larger literature exists on measuring the outcomes of private contracting (Fernandez and Fabricant, 2000). The quality of services provided through private contracts likely depends on the way bids are solicited and contracts are written (Hart et al., 1997; Shetterly, 2000), but most studies show that private contracting for municipal services such as garbage collection is cheaper than direct government provision of services (for example, McDavid, 1985), although private contracts are not preferred by all stakeholders (Dilger et al., 1997). The results of studies of the outcomes of private contracts in public health and mental health are mixed. While there may be a cost savings (for example, Schlesinger et al., 1986, Clark et al., 1994), William Shonick and Ruth Roemer (1982) and George Avery (2000) note that positive outcomes of privatization of hospitals may depend on the size of the market. The decision to pursue private contracts may not be made solely on the basis of a cost/benefit analysis; it appears that administrators’ ideology influences the decision (Keane et al., 2001). In the aftermath of litigation over lapses in the public provision of child welfare services, many state and local jurisdictions privatized all or part of their child protective and child welfare services (Nightingale and Pindus, 1997; Kinnevy, 2002). Cooperation between private and public agencies remains “complex, involving differences among public and private cultures, the blending of formal and informal services, and conflicting strategies with regard to client services” (Kinnevy, 2002: 53; see also Blank, 2000; Van Slyke, 2003; Zullo, 2006). In case studies, the use of private contracts seems to be related to efficient delivery of adoption services. Erwin Blackstone, Andrew Buck, and Simon Hakim (2004) argue that private administration of adoption services improved efficiency and may have reduced cost in Kansas, Michigan, and Illinois. Thelma Smith-McKeever and Ruth McRoy (2005) show that 70 percent of African American families served by private agencies had previously, and unsuccessfully, attempted to adopt through a public agency. Many post-adoption services are also provided by private agencies (Mack, 2006), although there is little evidence to date regarding the success of private versus public provision in this area.

ORGANIZATIONAL BARRIERS TO ADOPTION CREATION Whether private or public, the successful provider of adoption services must overcome three organizational problems: the problem of many tasks, the problem of hierarchical structure, and the problem of multiple principals.

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The Problem of Many Tasks State legislatures delegate a wide range of responsibilities to child welfare agencies. They must respond to reports of child abuse and neglect; they must place children on an emergency basis; they must find and train families who are willing to serve as foster parents; they must work with families of origin; they must create adoptions. When the responsibility for many tasks is delegated by a principal to an agent, the effectiveness of any incentive depends upon whether the tasks are complements or substitutes in the cost function of the agent. A simple example following Holstrom and Milgrom (1999) and using a quadric formulation of the costs incurred by the agency is useful for understanding the problem of many tasks in child welfare service. Assume there are two tasks: emergency placement (e) and adoptive placement (a). The agency’s costs are

C (e, a) = e 2 + 2λea + a 2 where − 1 < λ < 1 . If λ < 0 , then emergency and adoptive placements are complements in cost; it costs less to do both tasks than to do only one. If λ > 0 , the tasks are substitutes; it costs more to do both tasks together than to do them separately. The Adoption Incentive Program, which again is the federal incentive to states to create adoptions, should have its greatest effect when the agency groups together tasks that are complementary in costs to adoption tasks, and keeps tasks that are substitutes in cost separate from the provision of adoption services. Agencies can use a system of specialists to separate the tasks. Alternatively, contracting for specific services with private agencies solves the problem of multiple tasks by creating a one-to-one correspondence between agents and tasks, effectively rendering emergency and adoptive placements substitutes in cost.

The Problem of Hierarchical Structure The Adoption Incentive Program creates a bonus system for states, but to earn bonuses states must find ways to induce cooperation from local jurisdictions to claim federal bonuses. Individual local child welfare agencies and front-line social workers may consider free-riding on other jurisdictions and other social workers viable. A similar phenomenon is observed in the administration of asylum applications in Europe (Holzer, Schneider, and Widmer, 2000). Contracting for private services creates a transparent monitoring mechanism that solves the problem of hierarchical structure.

The Problem of Multiple Principals The front-line social worker may see adoption as a problem of multiple principals, each trying to influence the task he values most. For example: Congress and the Department of Health and Human Services (DHHS) want more finalized adoptions; the local supervisor wants to avoid any negative publicity; the association of social workers to which she belongs emphasizes race-sensitive placement; families want speedy placements. Each principal

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rewards the tasks that he values and, at best, offers no reward for completion of tasks that he does not value. If, again, the tasks are complements in the cost function of the agent, then the effects of incentives offered by different principals are unproblematic. If the tasks are substitutes in the cost function, however, there is substantial weakening of the effect of incentives. Returning to the quadratic formulation of cost above, the optimal incentive is now inversely related both to λ and to the number of principals (Bernheim and Whinston, 1986; Dixit, 1997; Holstrom and Milgrom, 1999). This implies that a given level of incentive will be more effective in organizations in which social workers have contact with a smaller number of principals. Again, private contracting for delivery of specific services can solve the problem. As discussed above, existing evidence about the outcomes of private contracts for child welfare services is based upon case study. This is because consistent, national data on adoptions did not exist before 1995. Further, only recently have surveys of state child welfare administrators provided information on the types of private contracts that states use.

DATA AND METHODS The Adoption Incentive program created by ASFA provided an incentive for data collection. To qualify for incentive payments, states had to document increases in adoptions. Effectively states were required to come into compliance with a federal rule issued in December 1993 requiring the submission of data on adoptions with state agency involvement. The data collection system is known as the Adoption and Foster Care Analysis and Reporting System (AFCARS). Prior to implementation of AFCARS, only voluntary systems existed for collection of child welfare data. States are now required to submit information about all children in foster care and information about children whose adoptions were finalized after any state agency involvement. The public agency may have placed the child for adoption, or it may have contracted with a private agency to achieve adoptive placement. In a few cases, public agency involvement may be limited to processing claims for adoption subsidy funds only. States are encouraged, but not required, to submit data for all other adoptions including adoptions through tribal agencies, private agencies, and independent adoptions. Here attention is limited to the cases with state agency involvement that are reported in AFCARS. The Children’s Bureau publishes tabulations on the Web (US DHHS, 2006a, for example) and in an annual outcomes report. Table 1, again, shows the decline in adoption creation evident in the AFCARS data from 2000 to 2004. The number of waiting children in the average state fell from 2,632 in fiscal year 1999 to 2,282 in 2004. In 2000, states created adoptions for 61 percent of children who were waiting at the end of fiscal year 1999. In 2001, states created adoptions for 72 percent of children waiting at the end of 2000. But in fiscal years 2002 through 2004, states created adoptions for less than half of waiting children.

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Data on Adoption Service Contracting A 2002 survey of state adoption administrators sponsored by the Packard Foundation provides detail about the adoption services contracted out by the states (Wilson et al., 2005). The survey asked states to identify the extent of private contracts in eight service areas: recruitment of foster and adoptive parents, orientation of foster and adoptive parents, processing of applications to foster or adopt, completion of the homestudy for prospective adoptive parents, training of foster and adoptive parents, matching prospective adoptive parents with waiting children, facilitating placement of children into families, and provision of post-placement services such as counseling. Forty states responded to the survey, but not all states were able to provide information about all of the types of contracts. The data from the survey were merged with AFCARS administrative data. The variation in the state average of adoption creation by the extent of contracting is shown in table 2. The average number of adoptions created was higher when contracting was used in the provision of recruitment, orientation, application, homestudy, and training and post-placement services. The greatest difference is between states with no private contracts and states with at least some contracts; a dummy variable indicting the use of contracts will be used in the next section to measure contracting. Table 2. Adoptions Created by Contract Amount

Recruitment Standard Dev. No. of States Orientation Standard Dev. No. of States Application Standard Dev. No. of States Homestudy Standard Dev. No. of States Training Standard Dev. No. of States Matching Standard Dev. No. of States Placement Standard Dev. No. of States Post-Placement Services Standard Dev. No. of States

No Contracts 23 23 5 10 22 6 30 26 10 39 26 2 35 38 4 48 43 13 50 42 13 37 32 5

Sources: US DHHS (2006), Wilson et al (2005).

Some Contracts 50 54 20 47 54 16 48 57 15 47 40 11 49 55 19 49 55 17 47 52 17 44 46 15

Most Contracted 41 26 3 59 44 5 67 47 8 48 55 19 44 31 5 38 30 4 35 28 2 53 51 7

All Contracted 52 41 6 54 41 6 46 28 2 29 16 1 52 40 6 27 4 1 27 4 1 53 48 7

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Only modest correlations ( ρ < .3 ) exist between the use of contracts for one type of services and most other types of services. The greatest correlation was between contracts for recruiting and orientation and matching and placement services. Contracts for these services were combined in the creation of the dummy variables. Other influences on adoption creation include total resources available for adoption assistance subsidies to families and the total budget for administration of adoption. The Urban Institute’s survey of child welfare administrators for 2000 and 2002 provide information about state spending on adoption assistance subsidies (Scarcella et al., 2004). Forty nine states and the District of Columbia responded to the 2002 survey.

Estimation Strategy Consider first the pooled cross-section time-series model of the form

Ait = α + C i β + X it Φ + ω t + ε it , where Ait is adoption creation in state i in year t. The parameters to be estimated are α , β and

Φ . The final two terms are the year-specific, and “usual” residuals. Elements of Xit are control variables. Controls include adoption subsidy expenditures, adoption administration expenditures, and the federal medical assistant percentage, which controls for relative economic position of the state. Elements of Ci describe organizational structure in state child welfare agencies, here described by the use of private contracts. Such a parsimonious model is likely to suffer from omitted variable bias; it is desirable to use a fixed effects framework to obtain unbiased estimates. However, the existence of private contracting is measured at only one point in time, and must be assumed not to have changed over the relatively brief time period studied here. Because the measure of contracting does not vary over time its effect cannot be disentangled from the state effect in the usual fixed effect framework. An augmented panel regression procedure called fixed-effect vector decomposition solves this problem (Pluemper and Troeger 2007).1 The model is

Ait = α + X it ϕ + C i γ + vi + ω t + u it , which is the same as a usual fixed effects model, with the addition of a term including the vector of the dummies indicating the existence of contracting, Ci. The state-specific fixed effect vi is assumed to be correlated with at least one element of X and one of C. Fixed effect vector decomposition is a three-stage estimation procedure. The first stage estimates the usual fixed effects model. The within-estimator identifies the state effect as the part of the mean of the state adoption creation rate that cannot be explained by the timevarying variables: 1

Random effects with the Hausman-Taylor (1981) procedure yields same-signed results, but the magnitudes of the coefficients are sensitive to specification. Further, the state effect is unlikely to be the outcome of a random process.

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vˆi = ai − xiϕ . The second stage of the procedure estimates (by OLS) the effect of the time-invariant cvariables on the fixed effects,

vˆi = φ + ci γ + υ i , where

φ is a constant term and υ i is an error term. This stage brings to mind an Oaxaca

decomposition of differences in wage rates into the part that can be explained by differences in independent variables and the part that cannot be explained. In the third stage, the results from the second stage estimation are included in a pooled OLS re-estimation of the model, so that

ait = α + xit ϕ + ci γ + υ i + u it . The inclusion of υ i in the final stage accounts for the part of the original state effect that is due to still-omitted variables. The coefficient on υ i is expected to equal one after correction for heteroscedasticty or serial correlation. Note that the choice to use private contracts is assumed to be orthogonal to the unexplained unit effects. If this assumption does not hold, then some omitted variable bias remains. It is thus nearly always the case that “researchers face a choice between using as much information as possible and using an unbiased estimator” (Pluemper and Troeger, 2007: 129). Thomas Pluemper and Vera Troeger use Monte Carlo simulations to show that fixed effect vector decomposition has nicer finite sample properties than alternatives already discussed for estimating the effect of timeinvariant variables using panel data.

EXPLAINING ADOPTION CREATION Table 3 shows the pooled cross-section time series results (columns 1 and 2) alongside the results of the fixed effect vector decomposition (column 3). A log-log specification allows coefficients to be interpreted as elasticities. The existence of private contracting alone explains 19 percent of the variation in adoption creation in the states from 2000 to 2004. Using private contracts to provide orientation and recruiting appear to be especially effective ways to bolster adoption creation. Private contracts in these two areas nearly double adoption creation even in the simple cross-section time-series regression in the first column of table 3. Training contracts increase adoption creation by nearly as much, but without controls for the federal matching rate, the size of subsidy payments, and the size of administrative costs, the effect of training contracts is not statistically significant. Controlling for expenditures on adoption assistance subsidies and adoption administration, as well as for economic conditions in the state as captured by the federal medical assistance percentage, boosts the explanatory power of the model even as it reduces

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the number of observations by limiting the study to the years 2000 and 2002.2 Orientation, recruiting, and training have large and statistically significant positive effects on adoption creation. In the specification in column 2 of table 3, using orientation and recruiting contracts increases adoption creation by nearly 180 percent; using training contracts increases adoption creation by 145 percent. The signs on the controls are as expected and are generally consistent with previously published studies (Hansen and Hansen, 2006): poorer states have higher federal medical assistance percentages and lower rates adoption creation. States that support adoptive families more generously with adoption assistance payments create more adoptions (Avery and Mont, 1992). Overall spending on the administration of adoption does not predict adoption creation. After correcting for omitted variable bias through the fixed effect vector decomposition procedure, all of the types of contracts have statistically significant effects on adoption creation. Orientation and recruiting contracts remain the most effective method of boosting adoption creation: using these contracts increases adoption creation 245percent. Using training contracts increases adoption creation 86 percent. Using contracts to complete application and homestudy tasks both increase adoption creation by about 40 percent. Returning to table 1, these results indicate that the average state could have achieved a greater rate of adoption creation in 2003 than it did in 2000 by using private contracts in these areas. Table 3. Determinants of Adoption Creation Cross-Section, Time Series (1) FMAP Ln (Adoption Subsidy Payments) Ln (Adoption Administration Costs) Orientation or Recruiting Contracts Application Contracts Homestudy Contracts Training Contracts Matching or Placement Contracts R2 N

0.977** (0.323) 0.161 (0.218) 0.117 (0.200) 0.950 (0.449) -0.244 (0.237) 0.189 153

(2) -0.028 (0.018) 0.396* (0.233) -0.197 (0.177) 1.767** (0.438) 0.094 (0.339) 0.097 (0.285) 1.454* (0.811) -0.440 (0.352) 0.512 53

Fixed Effect Vector Decomposition (3) -0.162** (0.018) 1.050** (0.147) -0.111 (0.066) 2.445** (0.162) 0.396** (0.113) 0.391** (0.120) 0.860** (0.309) -0.799** (0.158) 0.902 53

Robust standard errors in ( ). ** indicates p<.05; * indicates p<.10 Constant term and year effects estimated but not reported. Sources: Authors calculations from US DHHS (2006a), Scarcella et al (2004) and Wilson et al (2005).

2

States dropped do not differ in a statistically significant way from states retained in the estimation.

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60,000 50,000 40,000 30,000 20,000 10,000 0

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Source: US DHHS (2006a). Figure 1. Adoptions from Foster Care.

In all three specifications, matching or placement contracts are negatively associated with adoption creation. More detailed investigation is beyond the scope of this paper, but likely represents negative selection. For example, states that use private contracting for matching and placement may have larger populations of harder-to-place children.

CONCLUSION Creating adoptions for waiting children has a significant payoff for states. An adoption from foster care costs state and federal government about $115,000, but saves the government about $258,000 in child welfare and human service costs, netting a savings of $143,000 (Barth et al 2006, adjusted for inflation to 2000 dollars). Mary Hansen (2008) estimates that each adoption of a waiting child nets between $88,000 and $150,000 in private benefits and $190,000 to $235,000 in total public benefits (in constant 2000 dollars). That is, each dollar spent on the adoption of a child from foster care yields between 2 and 3 dollars in benefits to society. Of course, the benefits of adoption are realized later, while the expenditures are made today. Federal adoption expenditures grew from less than $400,000 in fiscal year 1981 to $1.3 billion in fiscal year 2002 (Dalberth et al., 2005). State expenditures have grown nearly as much. Since 2000, fiscal stress has led several states to attempt to cut post-adoption spending (North American Council on Adoptable Children [NACAC], 2003; Eckholm, 2005). Some of the cuts have been blocked by the courts, which have made it clear that adoptive parents have legal standing to protect their children’s entitlements (E.C. v. Blunt (05-0726-CV-W-SOW)

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and A.S.W. v. Oregon (also known as A.S.W. v. Mink, 424 F. 3d 970 (9th Cir. 2005)). These decisions effectively require states and the federal government to consider other ways to cut the cost of providing permanent families for waiting children. This paper shows that states that may reduce the administrative cost of creating adoptions through the judicious use of private contracts.

ACKNOWLEDGEMENTS Conversations with Audrey Smolkin and Jeffrey Katz improved this paper. Thanks to participants in the research seminar at the Department of Health and Human Services, Administration for Children and Families (September 20, 2007) and the Annual Adoption Conference sponsored by the Adoption Policy Institute and the New York School of Law (April 25, 2008). Raissa Adomayakpor provided research assistance.

REFERENCES Avery, R., & Mont, D. (1992). Financial support of children involved in special needs adoption: A policy evaluation. Journal of Policy Analysis and Management, 11, 419-441. Avery, G. (2000). Outsourcing public health laboratory services: A blueprint for determining whether to privatize and how. Public Administration Review, 60(4), 330-337. Barth, R. P., Lee, C.K., Wildfire, J., & Guo, S. (2006). A comparison of the governmental costs of long-term foster care and adoption. Social Service Review, 80(1), 127-158. Bernheim, B.D., & Whinston, M. (1986). Common agency. Econometrica, 54(4), 911-30. Blank, R.M. (2000). When can public policy makers rely on private markets? The effective provision of social services. The Economic Journal, 110 (462), 34–49. Blackstone, E.A., Buck, A.J., & Hakim, S. (2004). Privatizing adoption and foster care: Applying auction and market solutions. Children and Youth Services Review, 26(11), 1033-1049. Chandra, A., Abma, J., Maza, P., & Bachrach, D. (1999). Adoption, adoption seeking, and relinquishment for adoption in the United States. National Center for Health Statistics. Advance Data No. 306. Retrieved May 25, 2006, from http://www.cdc.gov/ nchs/data/ad/ad306.pdf. Clark, R.E., Dorwart, R.A., & Epstein, S.S. (1994). Managing competition in public and private mental health agencies: Implications for services and policy. The Milbank Quarterly, 72(4), 653-678. Dilger, R.J., Moffett, R.R., & Struyk, L. (1997). Privatization of municipal services in America's largest cities. Public Administration Review, 57(1), 21-26. Dixit, A. (1997). Power of incentives in public versus private organizations. American Economic Review, 87(2), 378-82. Eckholm, E. (2005). Law cutting adoption payments is faulted. New York Times, Aug. 16, A9.

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Fernandez, S., & Fabricant, R. (2000). Methodological pitfalls in privatization research: Two cases from Florida's child support enforcement program. Public Performance & Management Review, 24(2), 133-144. Florestano, P.S., & Gordon, S.B. (1980). Public vs. private: small government contracting with the private sector.” Public Administration Review, 40(1), 29-34. Hansen, M.E. (2006a). Title IV-E claims and adoption assistance payments. AFCARS Adoption Data Research Brief Number 5. Retrieved August 24, 2006, from http://www. nacac.org/pdfs/AFCARStitleivepayments.pdf. Hansen, M.E. (2006b). Age of children at adoption and time from termination of parental rights to adoption. AFCARS Adoption Data Research Brief Number 2. Retrieved August 24, 2006, from http://www.nacac.org/pdfs/AFCARSageatadoption.pdf. Hansen, M.E. (2006c). Adoptive family structure. AFCARS Adoption Data Research Brief Number 1. Retrieved August 24, 2006, from http://www.nacac.org/pdfs/AFCARS adoptivefamilystructure.pdf. Hansen, M.E. (2007). The Value of Adoption. Adoption Quarterly 10(2), 2007, pp. 65-87. Hansen, M.E., & Hansen, B.A. (2006). An economic analysis of the adoption of children from foster care. Child Welfare 85, 3(May/June 2006), 559-583. Harris Interactive, Inc. (2002). National adoption attitudes survey research report. Dave Thomas Foundation for Adoption and the Evan B. Donaldson Adoption Institute. Retrieved June 15, 2006, from http://www.adoptioninstitute.org/ survey/Adoption_ Attitudes_Survey.pdf. Hart, O., Shleifer, A., & Vishny, R.W. (1997). The proper scope of government: Theory and an application to prisons. The Quarterly Journal of Economics, 112(4), 1127-1161. Hausman, J. A.., & Taylor, W.E. (1981). Panel Data and Unobservable Individual Effects. Econometrica 49: 1377-1398. Holstrom, B., & Milgrom, P. (1991). Multitask principal-agent analysis: Incentive contracts, asset ownership and job design. Journal of Law, Economics and Organization, 7(Special Issue), 24-52. Holzer, T., Schneider, G., & Widmer, T. (2000). Discriminating decentralization: Federalism and the handling of asylum applications in Switzerland, 1988-1996. The Journal of Conflict Resolution, 44(2), 250-276. Keane, C., Marx, J., & Ricci, E. (2001). Perceived outcomes of public health privatization: A national survey of local health department directors. The Milbank Quarterly, 79(1), 115137. Kinnevy, S.C. (2002). Restructuring child welfare services: An analysis of four child welfare models in Florida. Ph.D. diss., University of Pennsylvania. Lipsky, M., & Smith, S.R. (1989). Nonprofit organizations, government, and the welfare state. Political Science Quarterly, 104(4), 624-648. Mack, K. (2006). Survey examines post adoption services among private agencies. Children's Voice, 15 (November 1). McDavid, J.C. (1985). The Canadian experience with privatizing residential solid waste collection services. Public Administration Review, 45(5), 602-608. Nightingale, D.S., & Pindus, N.M. (1997). Privatization of public social services: A background paper. Urban Institute. Retrieved April 14, 2007 from http://www.urban. org/publications/407023.html.

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North American Council on Adoptable Children [NACAC] (2003). Preserving adoption support programs: Parents can make a difference. Retrieved August 23, 20906, from http://www.nacac.org/subsidyfactsheets/difference.html. Pew Commission on Children and Foster Care (2004). Fostering the future: Safety permanence and well-being for children in foster care. Retrieved April 21, 2006, from http://pewfostercare.org/research/docs/FinalReport.pdf. Pluemper, T., & Troeger, V.E. (2007). Efficient estimation of time-invariant and rarely changing variables in finite sample panel analyses with unit fixed effects. Political Analysis. 15(1): 124-139. Poole, R.W. Jr., & Fixler, P.E. Jr. (1987). Privatization of public-sector services in practice: Experience and potential. Journal of Policy Analysis and Management, 6(4), 612-625. Rushton, A. (2004). A scoping and scanning review of research on the adoption of children placed from public care. Clinical Child Psychology and Psychiatry, 9(1), 89-106. Scarcella, C.A, Bess, R., Zielewski, E.H., Warner, L., & Geen, R. (2004). The cost of protecting vulnerable children IV (Washington, DC: Urban Institute). Schlesinger, M., Dorwart, R.A., & Pulice, R.T. (1986). Competitive bidding and states' purchase of services: The case of mental health care in Massachusetts. Journal of Policy Analysis and Management, 5(2), 245-263. Sedlack, A., & Broadhurst, D. (1993). Study of adoption assistance impact and outcomes: Final report. Submitted to the Administration for Children, Youth and Families, DHHS, Contract No. 105-89-1607. Shetterly, D.R. (2000). The influence of contract design on contractor performance: The case of residential refuse collection. Public Performance & Management Review, 24(1), 5368. Shonick, W., & Roemer, R. (1982). Private management of public hospitals: The California experience. Journal of Public Health Policy, 3(2), 182-204. Smith-McKeever, T.C., & McRoy, R.G. (2005). The role of private adoption agencies in facilitating African American adoptions. Families in Society, 86(4), 533-540. Triseliotis, J. (2002). Long-term foster care or adoption? The evidence examined. Child and Family Social Work, 7 (1), 23-33. Van Slyke, D.M. (2003). The mythology of privatization in contracting for social services. Public Administration Review, 63(3), 296-315. US DHHS (2006a). Adoption and foster care statistics. Retrieved December 10, 2006, from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm. US DHHS (2006b). Federal medical assistance percentages. Assistant Secretary for Policy and Evaluation. Retrieved September 12, 2006, from http://aspe.hhs.gov/health/ fmap.htm. Van Ijzendoorn, M.H., Juffer, F., & Poelhuis, C.W.K. (2005). Adoption and cognitive development: A meta-analytic comparison of adopted and nonadopted children’s IQ and school performance. Psychological Bulletin, 131(2), 301-316. Waldfogel, J. (2004). Welfare reform and the child welfare system. Child and Youth Services Review, 26, 919-939. Wilson, J., Katz, J., & Geen, R. (2005). Listening to parents: Overcoming barriers to the adoption of children from foster care. KSG Working Paper No. RWP05-005. Retrieved December 10, 2006, from http://ssrn.com/abstract=663944.

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Zullo, R. (2006). Is social service contracting coercive, competitive, or collaborative: Evidence from the case allocation patterns of child protection services. Administration in Social Work, 30(3), 25-42.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 8

CHILD CUSTODY PROCEEDINGS UNDER THE INDIAN CHILD WELFARE ACT: AN OVERVIEW

*

Kamilah M. Holder ABSTRACT In 1978, Congress enacted the Indian Child Welfare Act (ICWA) in response to legislative findings of harm caused to Indian children, their families, and tribes by the high separation rate of Indian children from their homes and cultural environments. Congress addressed this situation by granting Indian tribes and Indian parents an enhanced role in determining when to remove Indian children from their homes and cultural environments. Specifically, the ICWA enumerates provisions for tribal jurisdiction and tribal intervention in state court proceedings concerning the custody, adoption, foster care placement, and termination of parental rights of Indian children. No bills amending the ICWA were introduced in the 109th Congress. Still, the debate over provisions of the ICWA remains an issue of concern. This CRS report provides an overview of some of the goals and provisions of the Indian Child Welfare Act.

BACKGROUND Congress enacted the Indian Child Welfare Act (ICWA)[1] in 1978 to address the high rate of separation of Indian children from their homes and cultural environments.[2] Prior to 1978, as many as 25 to 35 percent of the Indian children in some states were removed from their homes and placed in non-Indian homes.[3] This practice of removal fragmented families and threatened the continued survival of Native American tribes. Respect for the selfdetermination of tribes required, in the view of Congress, that tribes be given a greater say in decisions affecting Indian children.[4] In evaluating the perceived biases of state agencies, the *

Excerpted from CRS Report RS22554, December 14, 2006.

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House report accompanying the legislation cited the apparent inability of social workers to accord proper recognition to factors in Indian environments that tended to mitigate the severe economic deprivations found on many reservations, deprivations that often served as a basis for state agency neglect findings.[5] The legislative history also indicated that Indian parents often lacked adequate legal representation in child custody proceedings and were frequently coerced into voluntary waivers of their parental rights.[6] As a result, addressing the situation was thought to require both procedural and substantive components to promote a policy of stability and security for Indian tribes and families while also ensuring that the foster and adoptive homes of Indian children reflected the unique values of Indian culture.[7]

COVERAGE The ICWA applies to Indian children involved in certain child custody proceedings. For purposes of the ICWA, an Indian child is an unmarried individual under age 18 who is either a member of a federally recognized Indian tribe or the biological child of a member of a tribe and eligible for membership in a tribe.[8] Membership eligibility is evaluated by tribes and the requirements vary widely by tribe.[9] Under the ICWA, Indian custodians include any Indian person with legal custody of an Indian child under tribal laws, customs, state laws or “to whom temporary physical care, custody, and control has been transferred by the parent of such child.”[10] The ICWA applies in the following child custody proceedings: • • •

•

a foster care placement;[11] any action “resulting in the termination of the parent-child relationship”;[12] a pre-adoptive placement that consists of “the temporary placement of an Indian child in a foster home or institution after the termination of parental rights but prior to or in lieu of adoptive placement;”[13] and an adoptive placement, which refers to the final placement of an Indian child for adoption including any action that results in a final decree of adoption.[14]

However, “child custody proceeding” does not include an award of custody in a divorce proceeding; nor does it include a placement based upon an action by the child that would be a crime if committed by an adult.[15]

JURISDICTION Among the most important elements of the ICWA are its jurisdictional provisions. In enacting the ICWA, Congress recognized that Indian tribes have distinct societal interests in the lives of Indian children that can be distinguished from that of the parents. In preserving these interests, the ICWA both enhances the jurisdictional reach of tribal courts and provides a right of intervention in state court proceedings that involve Indian children.[16] In part, the act delineates areas of exclusive tribal jurisdiction and those of concurrent state and tribal jurisdiction.

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Exclusive Tribal Jurisdiction Under the ICWA, an Indian tribe generally has exclusive jurisdiction over an Indian child who resides or is domiciled within the tribe’s land.[17] Indian tribes also have exclusive jurisdiction over Indian children who are wards of a tribal court that has previously exercised jurisdiction over their cases.[18] There are two exceptions to the grant of exclusive tribal jurisdiction. Tribal courts do not have jurisdiction where jurisdiction is “otherwise vested in the State by existing Federal law.”[19] The other exception is the emergency removal of a child who resides or “is domiciled on the reservation, but temporarily located off the reservation, from his parent or Indian guardian in order to prevent imminent physical harm.”[20] Under the ICWA, federal, state and tribal courts must all afford full faith and credit to the orders and judgments of a tribal court that has exercised jurisdiction in an Indian child custody proceeding.[21]

Concurrent Jurisdiction In child custody proceedings involving Indian children not residing or domiciled on the tribe’s land, the ICWA confers concurrent jurisdiction on tribal and state courts.[22] The ICWA expresses a preference for tribal jurisdiction in child custody proceedings involving Indian children. As such, state court proceedings that address foster care placement or termination of parental rights and involve Indian children residing or domiciled off the reservation may be transferred to tribal courts. This transfer shall take place upon the petition of either parent, the Indian custodian or the child’s tribe unless one of the child’s parents objects, the tribal court declines jurisdiction or good cause to deny transfer exists.[23] The first two exceptions present very little room for judicial analysis; however, the “good cause” exception is a broader area of judicial interpretation. Guidelines, issued by the Department of the Interior, state that a party opposing transfer to a tribal court bears the burden of demonstrating good cause to deny transfer.[24] The Guidelines also provide examples of what constitutes good cause.[25]

Judicial Decisions The only U.S. Supreme Court case to address the ICWA dealt with the statutory construction of the act’s domicile provision and how it was to be interpreted. In Mississippi Band of Choctaw Indians v. Holyfield, the Supreme Court determined that for purposes of the ICWA a child’s domicile at birth is that of his or her parents at the time of birth.[26] In reaching this decision, the Court reasoned that the purpose of the statute indicated congressional intent to establish uniformity in the application of the ICWA, instead of allowing varied state court definitions of a key term to dictate ICWA application. Thus, the Court held that an Indian tribe had jurisdiction over twin baby girls whose parents took care to have the children born off the reservation in order to put the children up for adoption under state law. State courts have developed different approaches to addressing general questions of ICWA applicability and such other concerns as the grounds for invoking the “good cause”

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exception to transfer. For example, some state court judicial decisions scrutinize the level of contact between an Indian child and the Indian tribe or reservation, while other courts engage in a “best interests of the child” analysis in assessing possible reasons for transfer.[27] Other courts have dealt with the issue of applying the judicially crafted “existing Indian family exception” with varying results.[28]

Procedural Protections in State Courts In expanding the ability of tribes to strengthen and preserve Indian families, the ICWA not only enhances tribal jurisdiction but also provides comprehensive procedural protections for Indian tribes, parents and custodians throughout state court proceedings. For example, where a state court knows or has reason to know at the outset of an involuntary custody proceeding that the child at issue is an Indian child, the ICWA requires that the party seeking termination of parental rights or foster care placement notify the child’s parent or Indian custodian and tribe.[29] Notice must be given at least ten days before the advancement of the state proceedings.[30] Tribes must be notified of their unconditional right to intervene in the state court proceeding and their right to examine all relevant documents as well as their ability to obtain a delay of the proceedings.[31] These provisions are all aimed at ensuring that parents, custodians and tribes are aware of their rights under the ICWA and are given adequate time to exercise these rights. Additional provisions, applicable in both voluntary and involuntary cases, are also intended to ensure that Indian parents, custodians and tribes are not misled or coerced into losing their rights to rear Indian children. As such, cases that proceed in state courts are subject to a number of procedural protections, whether the proceeding is voluntary or involuntary. Voluntary proceedings consist of tribal member parents choosing termination of parental rights and adoption or foster care placement of their child. Involuntary proceedings involve state attempts to terminate parental rights or place Indian children in foster care. Tribes may intervene in both involuntary and voluntary proceedings. Also, an Indian child’s tribe, parent, Indian custodian or an “Indian child who is the subject of an action for foster care placement or termination of parental rights under state law” may seek to invalidate the action upon a showing that the action violated provisions of the ICWA.[32]

Voluntary Proceedings For any voluntary placement to be valid, the consent of the Indian parent must be in writing and executed before a judge of a court of appropriate jurisdiction. The judge must certify that the consequences of the action to be undertaken are explained to the parent in a language that the parent understands. The consent to the termination of parental rights cannot be executed until after the child is 10 days old.[33] Indian parents can revoke their consent at any time during their child’s foster care placement or before a decree of termination or adoption has been entered.[34] Upon revoking consent, the parent would be entitled to the immediate return of the child. However, in cases of adoption where an order accepting the voluntary termination of parental rights has been entered, then the parent may not revoke consent.

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Involuntary Proceedings First, the party seeking foster care placement or the termination of parental rights must provide notice of the proceedings to the parent or Indian custodian and the child’s tribe.[35] The ICWA gives indigent parents or Indian custodians the right to court-appointed counsel in any involuntary removal, placement or termination proceeding.[36] In involuntary proceedings, the parties also have the right to examine all reports or other documents filed with the court on which any decision may be based.[37] Furthermore, a state court cannot order an involuntary foster care placement unless it determines that the parent’s or Indian custodian’s continued custody of the child is likely to result in serious emotional or physical damage to the child.[38] The determination must also meet the clear and convincing standard and be based on evidence that includes testimony from at least one qualified expert witness.[39] In order to terminate parental rights or initiate foster care placement in regard to an Indian child, a state court must ensure that active efforts have been taken to provide remedial services and rehabilitative programs to Indian parents and custodians in order to prevent the breakup of the Indian family.[40]

Adoptive Placements The ICWA also addresses adoption. The ICWA establishes an order of preference for adoptive placement of an Indian child under state law, “in the absence of good cause to the contrary,” that looks to placing a child with extended family members, other members of the tribe or Indian families.[41] Also, the ICWA establishes a placement preference plan to be followed in foster care and preadoptive placements.[42] Tribes may establish a different order of preference by resolution, to be followed in the aforementioned placements.[43]

Proposed Legislation Although there have been attempts to amend the ICWA in earlier Congresses,[44] no legislative proposals to amend the Indian Child Welfare Act were introduced in the 109th Congress.

REFERENCES [1] [2]

[3] [4] [5] [6] [7]

P.L. 95-608, 92 Stat. 3069 (1978); codified at 25 U.S.C. §§ 1901 -1963. 25 U.S.C. § 1901(4). This embodies a congressional finding that an alarmingly high number of Indian children were being removed from their homes by nontribal public and private agencies and often placed in non-Indian institutions or homes. H.Rept. 95-1386, 95th Cong., 2d Sess. 9 (1978). Id. Id. Id. 25 U.S.C. § 1902.

132 [8]

[9] [10] [11]

[12] [13] [14] [15] [16]

[17] [18] [19]

[20] [21] [22] [23] [24] [25] [26] [27] [28]

[29] [30] [31]

Kamilah M. Holder 25 U.S.C. § 1903(4). Under 25 U.S.C. § 1903(8), “ ‘Indian tribe’ means any Indian tribe, band, nation or other organized group or community of Indians recognized as eligible for the services provided to Indians by the Secretary of the Interior because of their status as Indians, including any Alaska Native village as defined in section 1602(c) of Title 43.” Cohen’s Handbook of Federal Indian Law § 3.03[2] (Nell Jessup Newton et al. eds., 2005 ed.) [hereinafter Cohen’s Handbook]. 25 U.S.C. § 1903(6). 25 U.S.C. § 1903(1)(i). “Foster care placement” encompasses placements in which the parent or Indian custodian cannot have the child returned upon demand but the parent’s rights have not been terminated. 25 U.S.C. § 1903(1)(ii). 25 U.S.C. § 1903(1)(iii). 25 U.S.C. § 1903(1)(iv). 25 U.S.C. § 1903(1). 25 U.S.C. § 1903(12) defines tribal court as “a court with jurisdiction over child custody proceedings and which is either a Court of Indian Offenses, a court established and operated under the code or custom of an Indian tribe, or any other administrative body of a tribe which is vested with authority over child custody proceedings.” 25 U.S.C. § 1911(a). Id. 25 U.S.C. § 1911(a). This exception most often applies in states that have assumed civil jurisdiction over Indian reservations under laws such as Public Law 280 (25 U.S.C. §1321-25). (Public Law 280 is the popular name of P.L. 83-280, as amended, a law conferring jurisdiction over activities in most of the Indian country in specified states to state courts.) However, in these circumstances, 25 U.S.C. §1918 authorizes tribes to retake jurisdiction over child custody proceedings upon approval by the Secretary of the Interior. 25 U.S.C. § 1922. 25 U.S.C. § 1911(d). 25 U.S.C. § 1911(b). 25 U.S.C. § 1911(b). Guidelines for State Courts; Indian Child Custody Proceedings, 44 Fed. Reg. 67,584 (Nov. 29, 1979). See id. at 67,591 (Guideline C.3(b)(i) and (iii)). 490 U.S. 30 (1989). Cohen’s Handbook § 11.03. Compare, e.g., In re Adoption of Baby Boy L, 643 P.2d 168 (Kan. 1982) (court did not apply provisions of ICWA over the objections of a child’s Indian father and his tribe after finding that the child had no ties to his Indian father or the tribe and was not part of an existing Indian family) and In re Baby Boy C, 805 N.Y.S.2d 313, 27 A.D.3d 34 (N.Y. 2005) (court declined to adopt the “existing Indian family exception” on the grounds that it was inconsistent with the provisions of the ICWA). 25 U.S.C. § 1912(a). Id. Id.

Child Custody Proceedings under the Indian Child Welfare Act [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44]

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25 U.S.C. § 1914. 25 U.S.C. § 1913(a). 25 U.S.C. § 1913(b). 25 U.S.C. § 1912(a). 25 U.S.C. § 1912(b). 25 U.S.C. § 1912(c). 25 U.S.C. § 1912(e). 25 U.S.C. § 1912(f). 25 U.S.C. § 1912(d). 25 U.S.C. § 1915(a). 25 U.S.C. § 1915(b). 25 U.S.C. § 1915(c). Marcie Yablon, The Indian Child Welfare Act Amendments of 2003, 38 Fam. L.Q. 689 (2004-2005) (discussing proposals to, e.g, address judicial decisions that put certain children beyond the reach of the ICWA because they were not part of an “existing Indian family” ).

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 9

STATE AND FAMILY AND MEDICAL LEAVE LAWS

*

Jon O. Shimabukuro, Cassandra LaNel Foley and Tara Alexandra Rainson ABSTRACT In 1993, Congress passed the Family and Medical Leave Act (“FMLA”) to “balance the demands of the workplace with the needs of families.” When the FMLA was enacted, it supplemented approximately 30 state statutes that provided some form of family and medical leave to employees who worked in those states. Although the FMLA and state family and medical leave laws are generally similar with regard to the availability of leave, they differ both in terms of coverage and scope. This article includes summaries of the family and medical leave laws of forty-five states and the District of Columbia. Laws pertaining to family and medical leave and maternity leave were not found in the codes of all 50 states. Summaries of the relevant leave statutes and regulations are organized in alphabetical order.

In 1993, Congress passed the Family and Medical Leave Act (“FMLA”) to “balance the demands of the workplace with the needs of families.”[1] Recognizing that many employees had to choose between parenting or caregiving and job security, Congress sought to enable employees to take “reasonable leave” for medical reasons, for the birth or adoption of a child, and for the care of a child, spouse, or parent with a serious health condition.[2] When the FMLA was enacted, it supplemented approximately 30 state statutes that provided some form of family and medical leave to employees who worked in those states. Congress did not intend to preempt these laws.[3] Rather, Congress wanted to establish minimum standards for the availability of family and medical leave, particularly in states that did not have statutes extending such leave to their employees. Congress understood that more favorable leave benefits could be available under some state laws. Thus, section 401(b) of the *

Excerpted from CRS Report RL33710, dated October 26, 2006.

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FMLA indicates that nothing in the federal law “shall be construed to supersede any provision of any State or local law that provides greater family or medical leave rights than the rights established under [the FMLA].”[4] Although the FMLA and state family and medical leave laws are generally similar with regard to the availability of leave, they differ both in terms of coverage and scope. For example, under the FMLA and many of the state family and medical leave statutes and regulations, only certain employers are required to provide leave to their employees. The FMLA applies only to employers engaged in commerce or in an industry affecting commerce that have at least 50 employees who are employed for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year.[5] In contrast, the state family and medical leave laws vary with regard to the number of employees who must be employed by an employer before it becomes subject to a law.[6] The FMLA and state family and medical leave laws also differ with regard to scope. Section 102(a)(1) of the FMLA provides for a total of 12 workweeks of leave during any 12month period for one or more of the following reasons: (1) Because of the birth of a son or daughter of the employee and in order to care for such son or daughter; (2) Because of the placement of a son or daughter with the employee for adoption or foster care; (3) In order to care for the spouse, or a son, daughter, or parent, of the employee, if such spouse, son, daughter, or parent has a serious health condition; (4) Because of a serious health condition that makes the employee unable to perform the functions of the position of such employee.[7]

In contrast, some state laws permit leave for reasons other than pregnancy, adoption, or a serious health condition.[8] Forty-five states and the District of Columbia now appear to have family and medical leave laws. The following section provides citations and brief descriptions of the relevant laws. Many of the laws identified in this section govern state government employers. Title II of the FMLA amended the U. S. Code to add family and medical leave provisions to title 5 of the Code, the title that governs employees in the federal government. Under the Federal Employees Family Friendly Leave Act, federal employees are also entitled to use sick leave to care for a family member with an illness or injury, to make funeral arrangements for a family member, and to attend the funeral of a family member.[9]

STATE FAMILY AND MEDICAL LEAVE LAWS Alabama Ala. Code § 36-27-58 (2005): An Employees’ Retirement System member may purchase up to one year’s service credit in the system for any period of time while he or she was on maternity leave without pay. Ala. Code § 16-1-18.1 (2005) and Ala. Admin. Code r. 670-X-14-.01 (2006): State employees may take sick leave for personal illness, to care for a sick family member, for incapacitating personal injury, for the death of a family member, or for the death or serious illness of a non-family member with strong personal ties to the employee. Employees may

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accumulate an unlimited amount of sick leave at the rate of one day of leave per month of employment, and sick leave days may be transferred between employees. In case of serious illness, a permanent employee may be advanced an additional 24 days of sick leave.

Alaska Alaska Stat. § 39.20.305 (2006): An officer or employee of the state who is otherwise qualified to take leave of absence may take family leave because of a serious health condition for a total of 18 workweeks during any 24-month period. An otherwise qualified officer or employee may take family leave because of pregnancy and childbirth or adoption for a total of 18 workweeks within a 12-month period. An eligible employee may take family leave for the birth or adoption of a child, to care for a child, spouse or parent with a serious health condition, or because of the employee’s own health condition.

Arizona Ariz. Rev. Stat. § 41-783 (2006): Personnel rules shall provide for the transfer of accumulated annual leave (1) between state employees in the same agency, or (2) between state employees in different agencies if the employees are members of the same family. Such transfers may occur if the employee to whom the leave is transferred has a seriously incapacitating and extended illness or injury or a member of the employee’s immediate family has a seriously incapacitating and extended illness or injury and the employee has exhausted all available leave balances. Ariz. Admin. Code § 2-5-404 (2005): A state employee may take sick leave for personal illness or for the illness of the employee’s spouse, child, or parent. Sick leave may also be taken for a disability caused by pregnancy, childbirth, miscarriage, or abortion. Ariz. Admin. Code § 2-5-411 (2005): With regard to state employees, “parental leave” means any combination of annual leave, sick leave, compensatory leave, or leave without pay taken by an employee due to pregnancy, childbirth, miscarriage, abortion, or adoption of children. Parental leave shall not exceed 12 weeks. An agency shall not require an employee to exhaust all annual leave, sick leave, or compensatory leave before taking leave without pay.

Arkansas Ark. Code Ann. § 21-4-209 (2006): For public employees, maternity leave shall be treated as any other leave for sickness or disability. Accumulated sick leave and annual leave, if requested by the employee, shall be granted for maternity use, after which leave without pay may be used. Ark. Code Ann. § 21-4-210 (2006): Public employees may be granted up to six months leave without pay for maternity and sick leave. Ark. Code Ann. § 21-4-215 (2006): Public employees are entitled to up to seven days leave to serve as a bone marrow donor and up to 30 days leave to serve as an organ donor.

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California Cal. Gov’t Code § 12945 (2006): Public employers and private employers with five or more employees must provide reasonable accommodations for conditions related to pregnancy and must allow an employee disabled by pregnancy, childbirth or related medical conditions to take up to four months of leave and return to work. Cal. Gov’t Code § 12945.2 (2006): Public employees and private employees in organizations with five or more workers who have more than 12 months of service and with at least 1,250 hours of service during the previous 12-month period must be allowed up to a total of 12 workweeks in any 12-month period for family care and medical leave. “Family care and medical leave” means any of the following: (1) leave for the birth of a child, the placement of a child with an employee for adoption or foster care, or the serious health condition of a child of the employee; (2) leave to care for a parent or a spouse who has a serious health condition; or (3) leave because of an employee’s own serious health condition that makes the employee unable to perform the functions of the position of that employee, except for leave taken for disability on account of pregnancy, childbirth, or related medical conditions. Cal. Gov’t Code §§ 19991.6 and 19991.11 (2006): State employees are entitled to a year of leave without pay for pregnancy, 30 days leave with pay to be an organ donor, and five days leave without pay to be a bone marrow donor. Cal. Lab. Code §§ 230.7 and 230.8 (2006): No employee may be discriminated against or discharged for visiting a child’s school or day care facility. Cal. Lab. Code § 233 (2006): Any employer who provides sick leave must allow sick leave to be used to attend to the illness of a child, spouse, parent, or domestic partner of the employee.

Colorado Colo. Rev. Stat. § 19-5-211 (2005): An employer who permits paternity or maternity time off for the birth of a child must allow equal time off for the adoption of a child. If the employer has established a policy providing time off for biological parents, that period of time shall be the minimum period of leave available for adoptive parents. Any other benefits provided by the employer, such as job guarantee or pay or time off to care for a sick child, shall be available to both adoptive and biological parents on an equal basis.

Connecticut Conn. Gen. Stat. §§ 5-248a and 5-248b (2006): Each permanent state employee shall be entitled to the following: (1) a maximum of 24 weeks of family leave of absence within any two-year period upon the birth or adoption of a child of such employee, or upon the serious illness of a child, spouse or parent of such employee; and (2) a maximum of twenty-four weeks of medical leave of absence within any two-year period upon the serious illness of such employee or in order for such employee to serve as an organ or bone marrow donor. Any such leave of absence shall be without pay.

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Conn. Gen. Stat. § 31-51ll (2006): An employer of 75 or more employees must grant a total of 16 workweeks of leave during any 24-month period. Leave may be taken for the birth or adoption of a child; to care for a spouse, child or parent with a serious health condition; to serve as an organ or bone marrow donor; because of a serious health condition of the employee; or upon the placement of a child with the employee for foster care. Conn. Gen. Stat. § 46a-60 (2006): Any state employer and any employer of three or more employees must allow a pregnant employee who takes leave because of her pregnancy to be reinstated to her original job or to an equivalent position.

Delaware Del. Code Ann. tit. 29, § 5120 (2006): For child care purposes, a full-time or part-time employee of the state shall be allowed to use accumulated sick leave upon the birth of a child of the employee or the employee’s spouse, or upon the adoption by the employee of a prekindergarten age child. Del. Code. Ann. tit. 29, § 5116 (2006): An employee of the state is entitled to six weeks leave upon the adoption of a minor child.

District of Columbia D.C. Code § 1-612.32 (2006): A voluntary transfer of leave is authorized when a potential recipient state employee will suffer a prolonged absence due to the employee’s serious health condition or the employee’s responsibility to provide personal care to an immediate relative. D.C. Code §§ 32-501 and 32-502 (2006): A public or private employee is allowed 16 workweeks of family leave during any 24-month period for: (1) the birth of a child; (2) the placement of a child with the employee for adoption or foster care; (3) the placement of a child with the employee for whom the employee permanently assumes and discharges parental responsibility; or (4) the care of a family member of the employee who has a serious health condition. D.C. Code § 32-503 (2006): A public or private employee who becomes unable to perform the functions of the employee’s position because of a serious health condition shall be entitled to medical leave for as long as the employee is unable to perform the functions, except that the medical leave shall not exceed 16 workweeks during any 24-month period. The medical leave may be taken intermittently when medically necessary. D.C. Code § 32-1202 (2006): Any public or private employee who is a parent shall be entitled to a total of 24 hours leave during any 12 month period to attend or participate in a school-related event for his or her child. Each agency or independent agency shall establish a voluntary leave transfer program under which accumulated leave may be transferred on an hour-for-hour basis within the agency to the leave account of any other eligible agency employee.

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Florida Fla. Stat. § 110.221 (2006): The state shall not: (1) terminate the employment of any employee in the career service because of pregnancy or the adoption of a child; (2) refuse to grant to a career service employee parental or family medical leave without pay for a period not to exceed six months; (3) deny a career service employee the use of and payment for annual leave credits for parental or family medical leave; (4) deny a career service employee the use of and payment for accrued sick leave or family sick leave for any reason deemed necessary by a physician or as established by policy. The statute also provides that upon returning at the end of parental or family medical leave of absence, the employee shall be reinstated to the same job or to an equivalent position with equivalent pay and with seniority, retirement, fringe benefits, and other service credits accumulated prior to the leave period.

Hawaii Haw. Rev. Stat. § 398-3 (2006): Any public or private employee shall be entitled to a total of four weeks of family leave during any calendar year upon the birth or adoption of a child, or to care for the employee’s child, spouse or reciprocal beneficiary, or parent with a serious health condition.

Idaho Idaho Admin. Code § 15.04.01.242 (2005): The provisions of the federal Family and Medical Leave Act (FMLA) shall apply without regard to the exclusion for worksites employing less than fifty (50) employees in a seventy-five (75) mile area, and without the limitation on reinstatement of the highest-paid employees. Idaho Admin. Code § 15.04.01.243 (2005): Pregnancy, childbirth, and related medical conditions are considered disabilities for sick leave purposes. Maternity and paternity leave for reasons other than disability shall be leave without pay unless the employee elects to use vacation time.

Illinois 5 Ill. Comp. Stat. Ann. 400/10 (2006): Public employees may participate in a sick leave bank to be used by any participating employee who has exhausted his or her accrued vacation time, personal days, sick leave and compensatory time. An employee may only use leave from the sick leave bank for the employee’s personal catastrophic illness or injury. 5 Ill. Comp. Stat. Ann. 327/20 (2006): Public employees are entitled to up to 30 days per year to serve as organ or bone marrow donors. Leave is also available to donate blood or blood platelets.

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820 Ill. Comp. Stat. Ann. 147/10, 147/15, and 147/40 (2006): Public employers and private employers of 50 or more people must grant eight hours per year per employee of school conference and activity leave related to the employee’s child.

Indiana Ind. Admin. Code tit. 31, r. 2-11-4, 2-11-4.5, and 2-11-8 (2006): State employees accumulate paid sick and personal leave.

Iowa Iowa Code § 216.6 (2006): Public employees may take sick leave for disabilities caused by pregnancy, childbirth, miscarriage, and legal abortion. Where sufficient sick leave is not available, the employee may take up to an eight week leave of absence.

Kansas Kan. Stat. Ann. § 75-5549 (2006): State employees may donate annual and sick leave to other state employees who are suffering from, or who have a family member suffering from, an extraordinary or severe illness, injury, impairment or physical or mental condition which has caused, or is likely to cause, the employee to take leave without pay or terminate employment. “Extraordinary or severe” means serious, extreme or life threatening. Kan. Admin. Regs. §§ 1-9-5 and 1-9-6 (2006): State employees may use sick leave with pay for illness or disability, including pregnancy, childbirth, miscarriage, and abortion; the illness or disability, including pregnancy, childbirth, miscarriage, and abortion, of a family member; or for the adoption of a child or placement of a foster child. Employees may also receive up to one year of leave without pay for the same purposes.

Kentucky Ky. Rev. Stat. Ann. § 18A.197 (2006): State employees with more than 75 hours sick leave may donate sick leave to other state employees who are suffering from, or have an immediate family member suffering from, a medically certified illness, injury, impairment, or physical or mental condition which has caused, or is likely to cause, the employee to go on leave for at least 10 consecutive working days. To qualify for a donation, an employee must have exhausted his or her accumulated sick leave, annual leave, and compensatory leave balances. Ky. Rev. Stat. Ann § 337.015 (2006): Public and private employees may take up to six weeks leave for the adoption of a child under age seven.

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Louisiana La. Rev. Stat. Ann. §§ 23:341 and 23:342 (2006): Employers of 25 or more people are required to treat problems arising from pregnancy childbirth like any other temporary disability and to provide up to six weeks disability leave. Total pregnancy leave, including accrued vacation time, can be up to four months. La. Rev. Stat. Ann. § 40:1299.124 (2006): Employers of 20 or more people shall grant up to 40 hours leave for bone marrow donation.

Maine Me. Rev. Stat. Ann. tit. 26, § 636 (2005): Public employees and private employees of organizations that employ 25 or more people are entitled to 40 hours of leave in a 12 month period to care for a sick child, spouse, or parent. Me. Rev. Stat. Ann. tit. 26, § 843 (2005): Public employees and private employees of organizations that employ 15 or more people are entitled to 10 weeks “family medical leave” for a serious health condition of the employee, child, or spouse; the birth or adoption of a child; or organ donation.

Maryland Md. Code Ann., State Pers. and Pens. §§ 9-501 — 9-508 (2006): A state employee may use sick leave for personal illness, for the death or illness of an immediate family member, or for the birth or adoption of a child. Md. Code Ann., State Pers. and Pens. § 9-1001 (2006): A state employee may use other available accrued leave concurrently with family and medical leave. Md. Code Ann., State Pers. and Pens. § 9-1106 (2006): State employees are entitled to 30 days of leave to serve as an organ donor and seven days of leave to serve as a bone marrow donor. Md. Code Ann., Lab. and Empl. § 3-802 (2006): An employer who provides paid leave following the birth of a child must provide the same leave following the adoption of a child.

Massachusetts Mass Ann. Laws ch. 149, § 52D (2006): Public employers and private employers of 50 or more people must offer 24 hours of leave during any 12-month period, in addition to leave available under the federal Family and Medical Leave Act, to participate in a child’s school activities, or to accompany a child or elderly relative to routine medical or dental appointments. Mass. Ann. Laws ch. 149, § 105D (2006): State employers and private employers of six or more employees must allow eight weeks maternity leave for the birth or adoption of a

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child. Leave applies to the adoption of a child under 18 or a mentally or physically disabled child under 23.

Michigan Mich. Comp. Laws § 38.1375 (2006): Public school employee may purchase service credits for maternity or paternity leave.

Minnesota Minn. Stat. § 181.941 (2005): An employer of 21 or more employees must provide up to six weeks maternity leave following the birth or adoption of a child. Minn. Stat. § 181.9412 (2005): Any Minnesota employer must allow employees 16 hours during any 12-month period to attend school conferences or school-related activities provided the conferences or school-related activities cannot be scheduled during nonwork hours. This provision also applies to the school activities of foster children. Minn. Stat. § 181.9413 (2005): An employer of 21 or more employees must allow the use of personal sick leave to care for a sick child.

Mississippi Miss. Code Ann. § 25-3-95 (2006): Public employees may use major medical leave for the injury or illness of an immediate family member. Any employee may donate a portion of his or her earned personal leave or major medical leave to another employee who is suffering from a catastrophic injury or illness, or to another employee who has a member of his or her immediate family who is suffering from a catastrophic injury or illness.

Missouri Mo. Rev. Stat. § 105.271 (2006): Public employees may use the same leave granted to biological parents upon the birth of a child to adopt a child and may use the same leave granted to biological parents to care for a sick child to care for a sick adopted child or stepchild.

Montana Mont. Code Ann. § 2-18-606 (2005): State employees are entitled to up to 15 days of leave for the birth or adoption of a child. Mont. Code Ann. § 49-2-101(11) (2005): “Employer” means an employer of one or more persons or an agent of the employer but does not include a fraternal, charitable, or religious

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association or corporation if the association or corporation is not organized either for private profit or to provide accommodations or services that are available on a nonmembership basis. Mont. Code Ann. § 49-2-310 (2005): An employer must grant to the employee a reasonable leave of absence for pregnancy; and must allow an employee disabled as a result of pregnancy to use accrued disability or leave benefits.

Nebraska Neb. Rev. Stat. § 48-234 (2006): An employee who offers maternity leave for the birth of a child must also provide leave for the adoption of a child.

Nevada Nev. Rev. Stat. § 613.335 (2006): An employer who offers sick leave must offer leave for pregnancy, miscarriage and childbirth.

New Hampshire N.H. Rev. Stat. Ann. § 100-A:9-a (2006): Any member of the New Hampshire retirement system who is on leave under the provisions of the federal Family and Medical Leave Act of 1993 shall be considered in service for purposes of eligibility for death or disability benefits.

New Jersey N.J. Stat. Ann. § 34:11B-3 (2006): A private or public employer of 50 or more employees shall provide family leave to employees who been employed for 1,000 base hours during the immediately preceding 12-month period. N.J. Stat. Ann. § 34:11B-4 (2006): An employee shall be entitled to 12 weeks of leave in any 24-month period. Leave may be paid, unpaid or a combination of paid and unpaid. If an employer provides paid family leave for fewer than 12-workweeks, the additional weeks of leave added to attain the 12-workweek total may be unpaid.

New York N.Y. Lab. Law. § 201-c (2006): Whenever an employer or governmental agency permits leave for the birth of a child, an adoptive parent shall be entitled to the same leave. N.Y. Lab. Law. § 202-a (2006): A public or private who employs 20 or more employees must grant leave for the donation of bone marrow to an employee who works for an average of 20 or more hours per week.

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N.Y. Lab. Law. § 202-b (2006): Any state employee shall be allowed up to seven days paid leave to donate bone marrow and up to 30 days paid leave to serve as an organ donor. Such leave shall be in addition to any other sick or annual leave allowed. N.Y. Workers’ Comp. Law § 201(9) (2006): A private employers’ disability benefits shall also include pregnancy.

North Carolina N.C. Gen. Stat. § 95-28.3 (2006): An employer shall grant 4 hours of leave for the employee’s involvement in his/her child’s school. An employer is not required to pay for leave.

North Dakota N.D. Cent. Code § 54-06-14.1 (2006): State employees who suffer from or has a relative or household member suffering from an extraordinary or severe illness may use shared leave, including both annual and sick leave, that shall not exceed four months in any 12-month period. N.D. Cent. Code §54-06-14.2 (2006): State employees who suffer from an extraordinary or severe illness may use shared leave, including both annual and sick leave, that shall not exceed four months in any 12-month period. N.D. Cent. Code § 54-06-14.4 (2006): The state may grant leave of absence, not to exceed 20 workdays for the donation of an organ or bone marrow. An employee may use donated annual leave or sick leave. The state may grant a paid leave for the up to 20workdays. N.D. Cent. Code § 54-52.4-01 (2006): A state employee shall be entitled to family leave if employed for at least 12-months, and has worked at least 1,250 hours over the previous 12months. N.D. Cent. Code § 54-52.4-02 (2006): A state employer shall grant family leave for the care of a child (includes adopted or foster) within 12-months of the child’s birth or placement; the care of a child, spouse, or parent with a serious health condition; or because of the employee’s serious health condition. An employee may take leave in any 12-month period for not more than 12-workweeks. Leave is not required to be granted with pay. N.D. Cent. Code § 54-52.4-03 (2006): A state employer that provides leave for its employees for illnesses or other medical or health reasons shall grant an employee’s request to use that leave to care for the employee’s child, spouse, or parent with a serious health condition. An employee may take not more than 40 hours of leave in any 12 month period. The employer shall compensate the employee for leave.

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Ohio Ohio Rev. Code Ann. § 124.136 (2006): State permanent full-time and part-time employees who work 30 or more hours per week may be eligible for parental leave and benefits upon the birth or adoption of a child. Employees may elect to receive $2,000 for adoption expenses in lieu of receiving the paid leave benefit. Parental leave shall not exceed 6 continuous weeks. Use of parental leave does not prohibit taking leave under the “Family and Medical Leave Act of 1993.”

Oklahoma Okla. Stat. tit. 74, § 840-2.23 (2005): An eligible state employee who is suffering from an extraordinary illness or condition, has experienced the death of a relative or household member, or is affected by a presidentially declared national disaster may participate in the state leave sharing program. An employee may use up to 261 days of donated leave during total state employment. An employee suffering from a terminal illness may receive up to 365 days of donated leave during total state employment.

Oregon Or. Rev. Stat. § 659A.153 (2006): A public or private employer of 25 or more persons during each of 20 or more calendar workweeks is required to grant family leave to eligible employees. Or. Rev. Stat. § 659A.156 (2006): An employee shall have worked 180 days or 25 hours per week during the 180 days immediately before the date on which the family leave would commence. Or. Rev. Stat. § 659A.159 (2006): Leave taken for the care of an infant/newly adopted child/newly placed foster child/adopted or foster child more than 18 years old must be completed within 12 months after birth or placement of child. Or. Rev. Stat. § 659A.162 (2006): An eligible employee is entitled to up to 12 weeks of family leave within any one-year period. In addition, a female employee may take a total of 12 weeks within any one-year period for an illness, injury or condition related to pregnancy or childbirth. An employee may take an additional 12 weeks of leave within one year to care for a sick child. Or. Rev. Stat. § 659A.312 (2006): An employer shall grant already accrued paid leave to an employee for the donation of bone marrow. The leave shall not exceed accrued paid leave or 40 work hours, whichever is less. An employee shall have worked an average of 20 or more hours per week.

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Rhode Island R.I. Gen. Laws § 28-48-1 (2006): A private employer of 50 or more employees and a public employer of 30 or more employees are required to grant parental and family leave. R.I. Gen. Laws § 28-48-2 (2006): An employee who has been employed for 12 consecutive months shall be entitled to 13 weeks of parental or family leave in any 2 calendar years. Leave may consist of paid and unpaid leave. R.I. Gen. Laws § 28-48-11 (2006): An employer who allows sick time or sick leave to be utilized after the birth of a child shall allow the same time for the adoption placement of a child 16 years of age or less. R.I. Gen. Laws § 28-48-13 (2006): An employee shall be entitled to 10 hours during 12 months to attend school conferences or other school-related activities for a child. The employee is not entitled to paid leave; except accrued paid leave.

South Carolina S.C. Code Ann. § 8-11-40 (2005): Eligible full-time state employees are entitled to 15 days’ sick leave a year with pay. Eligible part-time state employees are entitled to sick leave prorated on the basis of 15 days a year. Employees may use no more than 10 days of sick leave annually to care for ill members of their immediate families. S.C. Code Ann. § 8-11-65 (2005): A public employee who wishes to be an organ donor and who accrues annual or sick leave is entitled to leave of up to 30 days in a fiscal year. S.C. Code Ann. § 8-11-155 (2005): A state adoptive parent may use up to six weeks of accrued sick leave to care for a child after placement. S.C. Code Ann. §§ 8-11-700 and 8-11-710 (2005): State employees may request leave from the pool leave account for a personal emergency. S.C. Code Ann. § 44-43-80 (2005): A private or public employer of 20 or more employees may grant paid leave for the donation of bone marrow. An employee who works an average of 20 or more hours a week may request paid leave not to exceed 40 work hours.

South Dakota S.D. Codified Laws § 3-6-7 (2006): An eligible state employee may use up to five days for sick leave for personal emergency. Adoption of a child is treated as natural childbirth for leave purposes. S.D. Codified Laws § 3-6-8 (2006): Sick leave, not exceeding 28 days, may be advanced to an employee who has used up all of his accumulated and earned leave. S.D. Codified Laws § 3-6-10 (2006): Employees may take leave without pay.

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Tennessee Tenn. Code Ann. § 4-21-408 (2005): Full time employees of private and public employers with 100 full-time employees may be absent for up to four months for adoption, pregnancy, childbirth and nursing an infant. Leave may be with or without pay. Tenn. Code Ann. § 8-50-802 (2005): Sick leave may be granted to a state officer or employee who is scheduled to work 1,600 hours or more in a fiscal year. Sick leave for maternity or paternity shall not exceed the accumulated sick leave balance or 30 working days, whichever is less. Tenn. Code Ann. § 8-50-806 (2005): Adoptive parents are granted a special 30-day leave. An employee may use sick leave for all or a portion of that 30 days, not to exceed the employee’s leave balance if the child is one year old or less. Tenn. Code Ann. § 8-50-905 (2005): An eligible state employee may participate in the sick leave bank. Tenn. Code Ann. § 8-50-907 (2005): Participants in the sick leave bank may be granted up to 90 days of leave.

Texas Texas Gov’t Code Ann. § 661.004 (2006): An eligible state employee may use time in the sick leave pool for a catastrophic illness/injury. Texas Gov’t Code Ann. § 661.006 (2006): An employee may also withdraw time in the case of catastrophic illness or injury of an immediate family member. Time withdrawn shall not exceed the lesser of 1/3 of the total time in the pool or 90 days. Texas Gov’t Code Ann. § 661.206 (2006): A state employee may use up to 8 hours of sick leave to attend parent-teacher conferences. Texas Gov’t Code Ann. § 661.902 (2006): A state employee is entitled to emergency leave without a deduction in salary because of death in the family. Texas Gov’t Code Ann. § 661.906 (2006): A state employee is entitled to leave without a deduction in salary for attending meetings regarding a foster child. Texas Gov’t Code Ann. § 661.909 (2006): A state employer may grant leave without pay. Leave may not exceed 12-months. Texas Gov’t Code Ann. § 661.910 (2006): A disabled state employee is entitled to leave without deduction in salary for attending a dog training program. The leave may not exceed 10 working days in a fiscal year. Texas Gov’t Code Ann. § 661.912 (2006): A state employee with 12 months of service and 1,250 work hours is entitled to leave under the Family and Medical Leave Act of 1993. Texas Gov’t Code Ann. § 661.913 (2006): A state employee who has been employed for fewer than 12 months or who worked fewer than 1,250 hours during the 12-month period preceding the beginning of leave is eligible to take parental leave of absence not to exceed 12 weeks for the birth of a natural child or adoption or foster care placement of a child younger than three years of age. The employee must first use all available and applicable vacation and sick leave while taking the leave, and the remainder of the leave is unpaid.

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Vermont Vt. Stat. Ann. tit. 21, § 471 (2006): Parental leave requirements apply to a private and public employer of 10 or more individuals who are employed for an average of 30 hours per week during a year. Family leave requirements apply to private and public employers of 15 or more individuals who are employed for an average of 30 hours per week during a year. Vt. Stat. Ann. tit. 21, § 472 (2006): An employee, during any 12-month period, shall be entitled to take unpaid leave not to exceed 12 weeks for parental or family leave. The employee may use accrued sick, vacation, or other accrued paid leave, not to exceed six weeks. Vt. Stat. Ann. tit. 21, § 472a (2006): In addition, an employee shall be entitled to take unpaid leave not to exceed 4 hours in any 30-day period and not to exceed 24 hours in any 12-month period to attend a child’s school activities; family member’s medical/dental or professional services appointments; and to respond to a child’s medical emergency.

Virginia Va. Code Ann. § 51.1-1107 (2006): Eligible state employees shall receive a calculated amount of family and personal leave based on the number of months of state service. Va. Code Ann. § 51.1-1108 (2006): Eligible state employees can take family and personal leave for short-term incident, illness or death of a family member, or other personal need. Employers shall compensate employees 100% for each hour taken, not to exceed the employee’s family and personal leave balance. Va. Code Ann. § 51.1-1110 (2006): Short-term disability benefits shall be payable only during periods of total disability, partial disability, maternity leave, or periodic absences due to a major chronic condition.

Washington Wash. Rev. Code § 41.04.665 (2006): A state employee shall not receive more than 260 days leave from the leave sharing program. Wash. Rev. Code § 49.78 (2006): An employee is entitled to 12 workweeks of leave during any 12-month period. Leave granted may consist of unpaid leave. Leave may consist of paid and unpaid leave. In addition the employee is entitled to leave for sickness or temporary disability because of pregnancy or childbirth. Wash. Rev. Code § 49.78.020 (2006): A private or public employer of 50 or more employees is required to provide medical and family leave.

West Virginia W. Va. Code § 21-5D-3 (2006): A state employer is not prohibited from providing employees with rights to family leave which are more generous.

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W. Va. Code § 21-5D-4 (2006): An employee shall be entitled to 12 weeks of unpaid family leave, following the exhaustion of all annual and personal leave, during any 12-month period. W. Va. Code § 29-6-28 (2006): A full-time state employee shall receive up to 120 hours of paid leave for donation of a liver or kidney. A full-time state employee shall receive up to 56 hours of paid leave for the donation of bone marrow.

Wisconsin Wis. Stat. § 103.10 (2006): Family leave applies to private employers of 50 or more individuals on a permanent basis and to a state employer. The employee shall have been employed for at least 1,000 hours during the preceding 52-week period. In a 12-month period, an employee may take six weeks for the birth or adoption placement of a child; two weeks to care for a family member; or eight weeks for any combination of reasons. No employee may take more than two weeks of medical leave during a 12-month period. An employee may use paid or unpaid leave. Wis. Stat. § 230.35 (2006): A state employer shall grant 5 workdays of leave to a bone marrow donor. A state employer shall grant 30 workdays of leave to a human organ donor. An employee shall receive his or her base state pay without interruption during the leave of absence.

REFERENCES [45] [46] [47] [48] [49]

[50]

[51] [52]

[53]

29 U.S.C. § 2601 et seq. See 29 U.S.C. § 2601(b)(2). See S.Rept. 103-3, at 38 (1993). 29 U.S.C. § 2651(b). 29 U.S.C. § 2611(4)(I). See also 29 U.S.C. § 2611(2)(B)(ii) (Employers who employ 50 or more employees within a 75-mile radius of an employee’s worksite are subject to the FMLA even if they may have fewer than 50 employees at a single worksite.). For example, in Montana, an employer of just one individual is subject to the relevant state law. Alternately, the Oregon family and medical leave statute applies to an employer of 25 or more employees during each of 20 or more calendar workweeks. 29 U.S.C. § 2612(a)(1). For example, under Rhode Island law, an employee is entitled to 10 hours of unpaid leave during a 12-month period to attend a child’s school conferences or other schoolrelated activities. Similarly, under Louisiana law, employers of 20 or more individuals shall grant up to 40 hours of leave for bone marrow donation. See 5 U.S.C. § 6307.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Short Communication

PSYCHOPATHIC PERSONALITY FEATURES AND THE CHILD WELFARE SYSTEM: IMPLICATIONS FOR PREVENTION OF PROBLEMS OVER THE LIFE-COURSE Michael G. Vaughn, School of Social Work and Departments of Epidemiology and Public Policy Saint Louis University, USA

Matt DeLisi, Coordinator, Criminal Justice Studies, Iowa State University, USA

Kevin M. Beaver, College of Criminology and Criminal Justice, Florida State University, USa

John Paul Wright Division of Criminal Justice, University of Cincinnati, USA

INTRODUCTION The past ten years have witnessed a remarkable surge of research on psychopathy (i.e., psychopathic personality) in children and adolescents. Although possessing a long history in the psychological and psychiatric sciences (Vaughn & Howard, 2005), the downward extension of psychopathy to youth is fraught with numerous problems and prospects. One benefit may be the potential ability to identify and intervene with children who manifest behaviors and thoughts characteristic of psychopathy such as lack of empathy for others, a diminished capacity for self-control, and manipulative behavior. This is important given the robust criminological literature based on birth-cohort and longitudinal investigations that has established that approximately 5 to 10% of persons account for the majority of offending (DeLisi, 2005). Individuals with psychopathic personality features are responsible for a large share of not only crime but also drug abuse, family burden, and medical and judicial costs associated with this deleterious mix of personality traits. Thus, forestalling these life-course

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problems are of tremendous benefit to society at large, as well as to the children afflicted with these traits. This commentary will focus on the available research on psychopathic personality traits and children in the child welfare system. Salient issues and several new avenues for future research and early intervention are proffered.

THEORETICAL AND EMPIRICAL BACKGROUND What is psychopathy? Despite numerous definitions, psychopathy can be considered a syndrome of traits comprised of self-centeredness, callousness and guiltlessness, poor impulse control, conning, sensation-seeking, interpersonal exploitation, deception, relative fearlessness, an a inability to learn socially approved ways of satisfying immediate wants and needs (Cleckley, 1976; Hare, 1996; Lynam, 2002; McCord & McCord, 1964). Recent research is showing that their may be two major types of psychopathy—primary and secondary. Primary psychopathy is perhaps the prototypical psychopath that is devoid of feelings toward others and suffers little comorbid psychological distress. This form of psychopathy is likely to possess a strong genetic component (Viding, 2005) and is theorized as being less amenable to treatment. In popular culture, the notion of a cold-blooded psychopath who feels nothing for his victims is consistent with the psychological profile of primary psychopathy. In contrast, secondary psychopathy is characterized by greater comorbidity with anxiety and depressive disorders and presents with less of the coldheartedness associated with primary psychopathy. Factor analyses derived from multiple measures of psychopathy indicate that there is a behavioral component characterized by impulsivity, fearlessness, and antisocial acts, an interpersonal domain comprised of narcissism and manipulation, and an affective domain characterized by callousness and carefree unemotionality (Cooke & Michie, 2001; Lee, Vincent, Hart, & Corrado, 2003; Skeem & Cauffman, 2003; Farrington, 2005). Among adolescents, several studies have found that psychopathic personality features are predictive of recidivism (Corrado, Vincent, Hart, & Cohen, 2004), institutional violence (Murrie, Cornell, Kaplan, McConville, & Levy-Elkon, 2004), and career criminality (Vaughn & DeLisi, 2008). Employing a 10-year follow-up period, Gretton and associates (2004) found that high psychopathy scores increased risk for violence even after controlling for the relevant covariates of conduct disorder, violence history, and criminal onset. The eminent psychological criminologist David Farrington (2006) using data from the Cambridge Study of Delinquent Development, a 40-year prospective longitudinal survey of the criminal careers and social histories of 411 London males found that high psychopathy scores were retrospectively associated successful adulthood adaptation. Although there is progress with regard to psychopathy research in juveniles, investigations have largely relied on correctional samples thus reducing the generalizability of findings (cf., Frick & Marsee, 2006). Given the risk for legal involvement among foster youth (Vaughn, Shook, & McMillen, 2008) and general life problems faced by youth in the child welfare system, an understanding of the role of psychopathic personality feature are potentially quite important.

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PSYCHOPATHIC YOUTH AND THE CHILD WELFARE SYSTEM There has been one study that has examined the construct of psychopathy in a community sample of 404 foster care youth transitioning out of care (Vaughn, Litschge, DeLisi, Beaver, & McMillen, 2008). Multivariate statistical models showed that psychopathic personality traits measured by the Psychopathic Personality Inventory – Short Form (PPI-SF) and its subfactors PPI-SF Narcissism, PPI-SF Extraversion, PPI-SF Unemotionality, and PPI-SF Fearless-Nonconformity were significant yet inconsistent predictors for diverse forms of criminal behavior and subsequent involvement with the criminal justice system. Table 1 provides a summary of the significant predictors and the effect sizes. Non-significant predictors: Age, race, ADHD, unemployed, family support, DSM substance abuse disorder, childhood trauma Negative binomial models predicting number of arrests showed that PPI-SF Narcissism (z = 2.58, p = .01) and PPI-SF Unemotionality (z = 5.43, p<.001) were significant predictors while controlling for demographics, neighborhood disorder, deviant peer affiliations, prior abuse and trauma, family support, and ADHD. Additional models revealed that PPI Fearless non-conformity was predictive of illegally making money (z = 3.79, p < .001) and drug selling (z = 3.07, p = .002) over and above previously mentioned control variables. Moreover, all three PPI-SF factors were significant predictors of assault with a weapon. Table 1. Significant Predictors and Effect Sizes in Relation to Problem Behaviors among Foster Youth (N=404) Problem behavior Number of arrests PPI-SF Unemotionality Gender (Male) Deviant peers Neighborhood disorder PPI-SF Narcissism Illegally making money PPI-SF Fearless nonconformity 3.79 Neighborhood disorder Gender (Male) Drug selling PPI-SF Fearless nonconformity 3.07 Neighborhood disorder Deviant peers Assault with a weapon Deviant peers PPI-SF Narcissism PPI-SF Extraversion PPI-SF Fearless nonconformity

Effect size 5.43 4.80 2.85 2.66 2.58

3.05 2.50

2.88 2.18 3.02 2.87 2.84 2.07

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Overall, this study provides evidence that foster care youths who score high on psychopathy may be at considerable risk for poor successful transitions out of care. Increased knowledge about these traits may provide enhanced prevention and intervention efforts for these youth while in care. Although there has been federal legislation that has provided resources to states to expand services to foster youth leaving the system, youth aging out of the child welfare system face substantial challenges in making these transitions (Courtney & Heuring, 2005). For a subset of foster youth with psychopathic personality traits, the successful transition to successful adulthood will be compromised. Unfortunately, preliminary findings portend a transition to local jails and prison. A number of policy and practice relevant implications surfaced from this study. In terms of policy, extensions of services are warranted for youth who possess psychopathic features. This may help to prevent future harm to others. Because criminal involvement tends to decrease rapidly in the adult years—although perhaps not for psychopathic persons—and because recent neuroscience research shows that the adolescent brain is not fully formed until approximately age 25, the bulk of prevention resources should be targeted for these youths. Practitioners who work with individual foster youth may need to realize that not all of them are alike. For some, behavioral problems are not merely a result of a broken home environment or hailing from a disadvantaged neighborhood. Psychopathic personality traits exist among children and youth and practitioners in the child welfare system. This must be recognized in order to find innovative ways to treat youth who demonstrate pronounced psychopathic features in order to blunt or redirect harmful post-care trajectories. Because experimental studies provide the strongest evidence for treatment effects, increasing the number of controlled studies which test various interventions is an important avenue in which practitioners can contribute to finding a way to help psychopathic youth and reducing the destruction they cause. Recent research has cast doubt on the historical skepticism regarding treatment success. For instance, Salekin (2002) found that intensive treatment did produce modest reductions in psychopathic features and recidivism outcomes. In addition, a recent study by Caldwell and colleagues (2006) involving 141 juvenile offenders found that intensive treatment reduced recidivism among high scoring youth on the Psychopathy Checklist – Youth Version (PCLYV). Although several limitations exist with respect to these studies, they do provide a ray of optimism for a devastating disorder with apparently strong biological roots that was formerly dismissed as impervious to intervention.

REFERENCES Caldwell, M., Skeem, J., Salekin, R., & Van Rybroek, G., (2006). Treatment response of adolescent offenders with psychopathy features: A two-year follow-up. Criminal Justice and Behavior, 33, 571-596. Cleckley, H. (1976). The mask of sanity (5th ed.), St. Louis, MO: Mosby. Cooke, D.J., & Michie, C. (2001). Refining the construct of psychopathy: Towards a hierarchical model. Psychological Assessment, 13, 171-188.

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Corrado, R. R., Vincent, G. M., Hart, S. D., & Cohen, I. M. (2004). Predictive validity of the psychopathy checklist: youth version for general and violent recidivism. Behavioral Sciences and the Law, 22, 5-22. Courtney, M.E., & Heuring, D.H. (2005). The transition to adulthood for youth “aging out” of the foster care system. In D. W. Osgood, E. M. Foster, C. Flanagan, & G. R. Ruth (Eds.), On your own without a new: The transition to adulthood for vulnerable populations (pp. 27-67). Chicago: University of Chicago Press. DeLisi, M. (2005). Career criminals in society. Thousand Oaks, CA: Sage. DeLisi, M., & Vaughn, M. G. (2008). Still psychopathic after all these years. In M. DeLisi & P. J. Conis (Eds.), Violent offenders: Theory, research, public policy, and practice. Sudbury, MA: Jones & Bartlett. Farrington, D. P. (2005). The importance of child and adolescent psychopathy. Journal of Abnormal Child Psychology, 33, 489-497. Farrington, D. P. (2006). Family background and psychopathy. In C. J. Patrick (Ed.), Handbook of psychopathy (pp. 229-250). New York: The Guilford Press. Farrington, D. P., & Coid, J.W. (2003). (Eds.). Early prevention of adult antisocial behaviour. Cambridge: Cambridge University Press. Gretton, H. M., Hare, R. D., & Catchpole, R. E. H. (2004). Psychopathy and offending from adolescence to adulthood: A 10-year follow-up. Journal of Consulting and Clinical Psychology, 72, 636-645. Hare, R.D. (1996). Psychopathy: A clinical construct whose time has come. Criminal Justice and Behavior, 23, 25-54. Lee, Z., Vincent, G. M., Hart, S. D., & Corrado, R. R. (2003). The validity of the antisocial screening device as a self-report measure of psychopathy in adolescent offenders. Behavioral Sciences and the Law, 21, 771-786. Lynam, D.R. (2002). Fledgling psychopathy: A view from personality theory. Law and Human Behavior, 26, 255-259. McCord, W., & McCord, J. (1964). The psychopath: An essay on the criminal mind. Princeton, NJ: Van Nostrand. Murrie, D. C., & Cornell, D. G., Kaplan, S., McConville, D., & Levy-Elkon, A. (2004). Psychopathy scores and violence among juvenile offenders: A multi-measure study. Behavioral Sciences and the Law, 22, 49-67. Salekin, R. T. (2002). Psychopathy and therapeutic pessimism: Clinical lore or clinical reality. Clinical Psychology Review, 22, 79-112. Skeem, J. L., & Cauffman, E. (2003). Views of the downward extension: Comparing the youth version of the Psychopathy Checklist with the Youth Psychopathic traits Inventory. Behavioral Sciences and the Law, 21, 737-770. Vaughn, M. G., & DeLisi, M. (2008). Were Wolfgang’s chronic offenders psychopaths? On the convergent validity between psychopathy and career criminality. Journal of Criminal Justice, 36, 33-42. Vaughn, M.G., & Howard, M.O. (2005). The construct of psychopathy and its role in contributing to the study of serious, violent, and chronic youth offending. Youth Violence and Juvenile Justice, 3, 235-252. Vaughn, M. G., Litschge, C., DeLisi, M., Beaver, K. M., & McMillen, C. J. (2008). Psychopathic personality features and risks for criminal justice system involvement among emancipating foster youth. Children and Youth Services Review, in press.

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Vaughn, M. G., Shook, J. E., & McMillen, C. J. (2008). Aging out of foster care and legal involvement: Toward a typology of risk. Social Service Review, in press. Viding, E., Blair, J. R., Moffitt, T. E., & Plomin, R. (2005). Evidence for substantial genetic risk for psychopathy in 7-year-olds. Journal of Child Psychology and Psychiatry, 46, 592-597.

INDEX A abortion, 139, 143 absorption, 95 academic, 37, 77 access, viii, 1, 11, 12, 13, 14, 27, 54, 94, 95, 101 accounting, 106, 110 accuracy, 83 achievement, 77 acute, 88 adaptation, 41, 154 addiction, 77 ADHD, 155 adjustment, 6, 7, 41 administration, 47, 62, 117, 118, 121, 123 administrative, 83, 120, 122, 125, 134 administrators, 23, 117, 119, 120, 121 adolescence, 57, 58, 59, 60, 74, 75, 76, 77, 157 adolescent drinking, 74 adolescent problem behavior, 60, 75 adolescent psychopathy, 157 adolescents, vii, viii, x, 35, 36, 37, 39, 41, 46, 53, 55, 57, 58, 59, 60, 61, 70, 72, 73, 74, 75, 76, 77, 78, 153, 154 adult, 4, 11, 43, 46, 50, 58, 88, 97, 111, 130, 156, 157 adulthood, 9, 74, 76, 154, 156, 157 adults, 2, 49, 50, 52, 61, 76, 77, 88, 116 advocacy, 56 Afghanistan, 84, 88 Africa, 25, 84, 85, 86, 90, 92, 94, 95, 97 African American, viii, 6, 10, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 34, 76, 117, 127 African American women, 23 African Americans, 21, 24, 27, 29 African continent, 90 age, ix, 14, 22, 28, 32, 57, 62, 63, 64, 71, 72, 82, 87, 93, 109, 110, 111, 130, 141, 143, 149, 150, 156

agent, 58, 118, 119, 126, 145 agents, 118 aggression, 62, 69, 70, 71 aging, 156, 157 agricultural, 87, 94 agriculture, 79 aid, 3, 34, 42 Alabama, 9, 138 Alaska, 21, 30, 32, 134, 139 Alaska Natives, 30, 32 Alaskan Native, 20, 30 Albania, 84 alcohol, ix, 45, 50, 57, 59, 60, 62, 63, 64, 65, 66, 67, 71, 72, 73, 74, 75, 76, 77, 78 alcohol consumption, 73 alcohol use, ix, 57, 59, 62, 63, 64, 65, 66, 67, 71, 72, 75, 76 Algeria, 84 alternative, 44, 104, 115 alternatives, 122 Amazon, 97 American Community Survey, 17 American culture, 27 American Indian, 20, 30, 31, 32, 34 American Psychiatric Association (APA), viii, 35, 40, 41, 42, 44, 45, 49, 50, 51, 53 American Psychological Association, viii, 35, 40, 41, 43, 45, 50, 53, 54, 55 amphetamines, 63 Amsterdam, 97, 113 androgyny, 74 Angola, 84 anthropological, 106, 108 anthropometry, 107, 113 antisocial acts, 36, 154 ants, 118 anxiety, 6, 154 application, 120, 123, 126, 131

158

Index

applied research, 101 Arizona, 10, 139 Arkansas, 9, 139 Armenia, 84 ash, 59 Asia, 83, 84, 85, 86, 88, 92, 94, 95, 103, 104 Asian, 20, 33, 34, 90, 103 assault, 31, 36, 155 assessment, 30, 36, 40, 42, 43, 44, 50, 52, 53 assumptions, 101 asylum, 118, 126 athletes, 108 attachment, 6, 16, 60, 73, 77 attachment theory, 60 attitudes, 59, 77, 126 Australia, 55, 84, 88 authoritarianism, 75 Authoritative, 72 authority, 14, 134 autonomy, 58, 73 availability, x, 60, 86, 88, 108, 137, 138 Azerbaijan, 84

B Bangladesh, 84, 103, 104, 105 barrier, 11, 58 barriers, vii, viii, 2, 9, 11, 12, 13, 14, 29, 45, 127 barter, 103 behavior, x, 6, 40, 42, 44, 59, 60, 61, 72, 73, 74, 76, 77, 153, 155 behavioral aspects, 41 behavioral problems, 156 Beijing, 104 beliefs, 47, 58, 77 belongingness, 101, 102 benchmarks, 103 benefits, 7, 8, 34, 46, 49, 50, 52, 95, 103, 124, 137, 140, 142, 146, 147, 148, 151 bias, 20, 23, 24, 43, 81, 90, 94, 112, 121, 122, 123 bilingual, 12, 14 biological parents, 2, 3, 5, 6, 8, 12, 22, 25, 27, 36, 38, 39, 42, 51, 55, 140, 145 biometric, 108 birth, x, 2, 5, 8, 25, 29, 49, 104, 111, 131, 137, 138, 139, 140, 141, 142, 144, 145, 146, 147, 148, 149, 150, 152, 153 births, 104 blood, 2, 142 body dissatisfaction, 60 body temperature, 101 Bolivia, 84, 95, 97 bonding, 58

bonds, 6, 51 bone marrow, 139, 140, 141, 142, 144, 146, 147, 148, 149, 151, 152 bonus, 118 Bosnia, 84, 88 Boston, 54 Botswana, 84 boys, ix, 36, 54, 60, 61, 64, 65, 71, 80, 99, 109, 110, 111 brain, 88, 156 brain development, 88 Brazil, 84, 95 breastfeeding, 93 buffer, 61 Burkina Faso, 84 Burundi, 84

C California, 140 calorie, 87 Cambodia, 84 Cameroon, 84 capacity, x, 11, 153 capitalism, 61 care model, 37 caregiver, 8, 12, 13, 36 caregivers, 3, 4, 5, 6, 7, 8, 10, 12, 13, 14, 15, 22, 29, 30, 50, 78 caregiving, 137 caretaker, 51 Caribbean, 80, 84, 85, 86, 95, 96 case study, 36, 119 cast, 104, 105, 156 casting, 111 catalysis, 58 Caucasian, 10, 22, 30 causality, 93, 95, 112 Census, 5, 9, 13, 16, 17, 30, 32 Census Bureau, 5, 13, 17, 30, 32 Central America, 84, 85 certificate, 8, 25 Chad, 84 child abuse, 38, 47, 58, 61, 118 child labor, 108 child maltreatment, 20, 21, 23, 26, 30, 34, 38, 74 child protection, 11, 15, 25, 30, 36, 37, 38, 41, 42, 43, 44, 51, 53, 58, 127 child protective services, 10, 21, 22, 23, 25, 31, 32, 37 child rearing, 24 child welfare, vii, viii, ix, x, 1, 2, 3, 4, 5, 6, 8, 9, 12, 13, 14, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29,

Index 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 57, 58, 73, 99, 100, 110, 116, 117, 118, 119, 121, 124, 126, 127, 154, 156 childbirth, 139, 140, 142, 143, 144, 146, 148, 149, 151 childcare, 96 childhood, 38, 58, 88, 97, 155 China, ix, 79, 80, 84, 90, 95, 96, 97, 98, 103, 104, 105, 109 Chi-square, 63, 64, 65, 66, 67, 68, 70, 71 cigarette smoking, 59 cigarettes, 62, 63, 64, 65, 70 Cincinnati, 153 citizens, 11, 13 citizenship, 8, 9, 11, 13 civil law, 40 civil liberties, 105 civil rights, 105 civil war, 96 class period, 62 classes, 37, 38 classification, 83, 86 clients, 27, 40, 41, 47, 48 clinical psychology, 44 clinical trial, 44, 46 clinical trials, 46 clinician, 42 Clinton administration, 116 close relationships, 58 Co, 96, 117 codes, viii, x, 35, 37, 40, 41, 42, 44, 45, 49, 53, 137 cognitive, 45, 88, 127 cognitive behavioral therapy, 45 cognitive development, 127 cohesion, 9 cohort, x, 153 collaboration, 55 Colorado, 140 Columbia, x, 8, 53, 84, 115, 121, 137, 138, 141 Columbia University, 53 commerce, 138 communication, 12, 14, 15, 39, 45, 59, 60, 72 communism, 100, 103, 104 communist countries, 104, 105 communities, 2, 5, 21, 23, 24, 25, 27, 28, 29, 34, 37 community, vii, 1, 11, 12, 20, 24, 25, 26, 32, 34, 39, 45, 49, 54, 111, 134, 155 community service, 39 comorbidity, 154 compensation, 29 competence, 40, 43, 44, 47, 76 competition, 125

159

compliance, 31, 39, 50, 119 components, 102, 105, 108, 130 compounds, 29 concentration, viii, 2 concordance, 72 concrete, 8 conduct disorder, 154 conduct problems, 6 confidentiality, 40, 42, 43, 44, 45, 51, 53 conflict, 42, 57, 75 conformity, 155 Congress, iv, x, 26, 31, 116, 118, 129, 130, 133, 137 Connecticut, 31, 140 consent, 29, 36, 43, 44, 46, 48, 49, 53, 54, 62, 132 constraints, 101 construction, 131 consultants, 37 consumer goods, 108 consumers, 40, 106 consumption, 71, 73, 86, 87, 91, 102, 111, 113 consumption patterns, 111 contingency, 45 continuity, 29 contracts, vii, x, 115, 117, 119, 120, 121, 122, 123, 125, 126 control, 2, 44, 45, 59, 60, 61, 73, 80, 87, 91, 93, 94, 121, 130, 154, 155 control group, 44 controlled studies, 156 convergence, 74 coordination, 33 Coping, 69, 70, 71 coping strategies, 69, 71 correlation, 95, 111, 120, 122 correlations, 120 cost saving, 117 Costa Rica, 84, 88 costs, x, 11, 46, 88, 103, 118, 122, 124, 125, 153 counsel, 133 counseling, 120 country of origin, 9 courts, viii, 3, 13, 25, 31, 33, 35, 36, 42, 44, 51, 124, 130, 131, 132, 134 coverage, x, 8, 84, 137, 138 CPS, 21, 23, 30 credentials, 11 credit, 131, 138 crime, x, 130, 153 criminal behavior, 155 criminal justice, 155, 157 criminal justice system, 155, 157 criminality, 154, 157 criminals, 157

160

Index

critical period, 58 criticism, 103 cross-country, 84 cross-cultural, 72 cross-sectional, 73, 81, 87, 103 cross-sectional study, 73, 81, 87 CRS, x, 129, 137 cultural heritage, 25 cultural influence, 61 cultural values, vii, 1, 11, 52 culture, vii, 1, 9, 11, 12, 47, 61, 73, 94, 96, 97, 130, 154 currency, 90

D daily care, 25 danger, 42 data availability, 106 data collection, 11, 33, 62, 119 data gathering, 43 database, 80, 81, 82, 83, 87, 88 death, 138, 144, 146, 148, 150, 151 deaths, 104 decentralization, 126 decision makers, 20, 24, 93 decision making, 26, 52 decisions, 21, 25, 31, 39, 42, 43, 45, 46, 48, 49, 51, 52, 61, 73, 116, 125, 130, 132, 135 decomposition, 121, 122, 123 deduction, 150 deficit, 7 deficits, 73, 87 definition, 2, 3, 108 delinquency, 75, 77 delivery, vii, viii, x, 2, 39, 50, 115, 116, 117, 119 demand, 5, 42, 134 democracy, 87, 105, 109 democratization, 93, 96, 105 demographic data, 33 demographics, 155 denial, 25 Department of Health and Human Services, vii, 1, 10, 11, 13, 17, 20, 21, 22, 23, 24, 28, 32, 118, 125 Department of the Interior, 131 dependent variable, 92 depreciation, 90 depression, 60 depressive disorder, 154 depressive symptomatology, 58 depressive symptoms, 77 deprivation, 25, 29, 31, 111 desire, 30, 59

destruction, 156 developed countries, 84, 88, 104 developed nations, 111 developing countries, 80, 95, 96, 103, 104, 107, 111, 113 development policy, 100 diarrhea, 87 dietary, 73 dietary habits, 73 dignity, 41, 45, 47 disability, 41, 139, 140, 142, 143, 144, 146, 147, 151 disabled, 140, 145, 146, 150 disaster, 148 discharges, 141 discipline, 25, 45, 52 discomfort, 41 discrimination, 24, 25 discriminatory, 44 diseases, 91, 93 disorder, 46, 155, 156 displacement, vii disseminate, 41 distortions, ix, 82, 99, 112 distribution, 103 District of Columbia, x, 8, 115, 121, 137, 138, 141 division, 38 divorce, 50, 61, 130 domestic violence, 34, 51, 54 Dominican Republic, 84 donor, 139, 140, 141, 144, 147, 149, 152 donors, 142 drinking, 59, 63, 65, 68, 69, 71, 74, 77 drinking pattern, 71 drinking patterns, 71 drug abuse, x, 36, 60, 153 drug abusers, 36 drug addict, 54 drug addiction, 54 drug treatment, 38 drug use, ix, 23, 57, 59, 62, 63, 64, 66, 67, 68, 69, 70, 74, 76 drug-related, 59 drugs, 45, 60 DSM, 155 due process, 38, 48 durability, 87, 93, 94, 96 duration, 72

E earth, 100 Eastern Europe, 86 economic activity, 103

Index economic development, 80, 113 economic disadvantage, 29 economic growth, 90 economic hardships, 6 economic incentives, 105 economic indicator, ix, 99, 105, 106 economic performance, 103, 104 economic transformation, 111 economically disadvantaged, 74 economics, 100, 104, 107, 108, 113 Ecuador, 84, 95 Education, 22, 34, 76, 77, 109 Egypt, 85 El Salvador, 85 elderly, 144 election, 93 elementary school, 75 eligibility criteria, 13 emotional, 5, 7, 29, 36, 39, 40, 41, 43, 54, 55, 60, 61, 73, 74, 76, 101, 102, 133 emotional abuse, 43 emotional disorder, 36, 39 emotional health, 60, 74 empathy, x, 153 employees, x, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 151, 152 employers, 138, 140, 143, 144, 147, 149, 150, 152 employment, 32, 93, 115, 139, 142, 143, 148 empowered, 34 energy, 86, 87, 91, 93, 95, 107, 108, 112 energy consumption, 86, 87, 91 England, 37 environment, ix, 5, 11, 12, 38, 51, 58, 60, 76, 79, 80, 86, 93, 96, 108, 111, 112, 156 environmental impact, 111 Eritrea, 85 estimating, 108, 122 estimator, 121, 122 ethical issues, 37, 49 ethical principles, 37, 47, 48, 50 ethical standards, 41, 47, 48 ethics, viii, 35, 37, 40, 41, 44, 47, 49, 53, 54, 56 ethnic background, 10 ethnic groups, 6, 23, 34, 82, 108 ethnic minority, viii, 19, 23, 26, 34 ethnicity, 20, 22, 23, 30, 96 Europe, 83, 84, 85, 86, 88, 92, 94, 95, 111, 118 evidence, 133 evolution, 28 examinations, 108 exclusion, 27, 29, 142 excuse, 27 exercise, 4, 48, 73, 132

161

expenditures, 121, 123, 124 expert, iv, 41, 42, 43, 45, 133 expertise, 47 exploitation, 40, 49, 154 externalizing, 74, 75 externalizing behavior, 74, 75

F failure, 12, 55 fairness, 41 faith, 131 familial, ix, 57, 58, 60, 61, 62, 73 family, vii, ix, x, 1, 2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 22, 23, 25, 26, 29, 32, 34, 36, 38, 42, 44, 47, 49, 50, 51, 52, 54, 57, 58, 59, 60, 61, 62, 66, 69, 70, 71, 72, 74, 75, 76, 115, 116, 126, 132, 133, 134, 135, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 150, 151, 152, 153, 155 Family and Medical Leave Act (FMLA), x, 137, 138, 142, 144, 146, 148, 150, 152 family environment, 52 family life, 47, 74 family members, 3, 4, 5, 8, 9, 11, 12, 29, 42, 63, 69, 70, 71, 133 family relationships, 9 family structure, ix, 34, 57, 59, 60, 62, 66, 72, 74, 76, 126 family support, 11, 22, 60, 155 family system, 8 famine, 80, 96, 97 FAO, 87 farmers, 90 fear, 93 federal funds, 12 federal government, 4, 20, 25, 27, 28, 29, 31, 33, 34, 37, 38, 124, 125, 138 federal law, 27, 31, 37, 138 feeding, 97 feelings, 36, 52, 154 felony, 40 females, 87, 93, 95 fertility, 87, 94, 95 fertility rate, 87, 94 financial problems, 7 financial support, 3, 11, 14, 116 financing, 7 fluctuations, 87 fluid, 25 FMAP, 123 food, 12, 86, 88, 94, 96, 101, 102, 103, 105, 107, 108, 111, 112 food aid, 107

162

Index

food intake, 107 food production, 94 foreigners, 104 forensic, 54, 106, 108 forensic psychology, 54 fractures, 23 freedom, 48, 105, 109 frequency distribution, ix, 57 fringe benefits, 142 funding, 4, 8, 13, 14, 38 funds, 3, 8, 27, 29, 30, 31, 116, 119 futures, 26

G Gabon, 85 garbage, 117 Gaza, 84, 86, 88 GDP per capita, ix, 87, 92, 94, 99, 104, 106, 109, 111, 112, 113 gender, 22, 64, 71, 75, 76, 77, 80 gender differences, 80 General Accounting Office (GAO), 4, 5, 17, 22, 30 general education, 104 generalizability, 73, 154 generation, 9 genes, 111 Geneva, 96, 98, 113, 114 genotype, 111 genotypes, 111 Georgia, 85 Ger, 109 Germany, 103, 104 girls, 54, 60, 61, 64, 65, 71, 80, 132 goals, x, 27, 31, 32, 39, 50, 129 gold, 44 gold standard, 44 goods and services, 103 government, 4, 14, 20, 25, 27, 28, 29, 31, 33, 34, 37, 38, 83, 93, 103, 110, 117, 124, 125, 126, 138 grades, 62 grandparents, 2, 5, 6, 61 grants, 3, 8 gross domestic product (GDP), ix, 87, 92, 94, 99, 103, 104, 106, 109, 111, 112, 113 gross national product (GNP), 103, 104 groups, 6, 7, 23, 26, 28, 34, 82, 101, 106, 108, 118 growth, 5, 15, 74, 80, 82, 83, 86, 88, 90, 95, 97, 107, 108, 111, 112, 113 growth spurt, 111 guardian, 36, 42, 44, 52, 131 Guatemala, 85 guidance, 6, 49, 60

guidelines, viii, 4, 8, 35, 37, 40, 41, 42, 43, 44, 46, 47, 48, 49, 50, 53 guiding principles, 49 Guinea, 85 Guyana, 85

H Haiti, 85 handling, 126 harm, x, 6, 38, 40, 129, 131, 156 Harvard, 97, 114 Hawaii, 142 health, viii, 8, 22, 30, 35, 39, 43, 50, 51, 54, 58, 59, 61, 73, 74, 75, 76, 77, 78, 80, 81, 83, 87, 93, 94, 95, 96, 100, 101, 102, 103, 104, 105, 106, 107, 108, 112, 115, 126, 127, 137, 138, 139, 140, 141, 142, 144, 147 Health and Human Services (HHS), vii, 1, 10, 11, 13, 17, 20, 21, 22, 23, 24, 28, 30, 32, 118, 125 health care, 54, 103, 127 health problems, 58 health services, 22, 24, 39, 50, 54, 55 health status, 75, 80, 81, 107 hearing, 36, 38, 39, 42, 45 heart, 27, 29 heavy smoking, 73 height, ix, 80, 87, 93, 99, 100, 104, 106, 107, 108, 109, 110, 111, 112 heterogeneous, 59 hierarchy of needs, 101, 102, 105 high school, ix, 6, 57, 58, 62, 63, 78 high-risk, 26, 72, 77, 78 high-tech, 83 Hispanic, v, vii, viii, 1, 9, 10, 11, 12, 13, 14, 20, 22, 23, 32, 33 Hispanic population, viii, 1, 10, 12 Hispanics, 9, 33 homelessness, 20 homogenous, 111 Honduras, 85 Hops, 61, 76 hospital, 45 hospitals, 23, 83, 117, 127 hostile environment, 112 House, 105, 109, 130 household, 8, 10, 11, 83, 93, 94, 104, 108, 147, 148 household income, 83 households, 9, 90, 94 housing, 90 human, vii, ix, 40, 41, 47, 96, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 110, 111, 112, 113, 124, 152

Index human actions, 40 human development, ix, 99, 102, 103, 104, 105, 106, 112 human development index, ix, 99, 112 human motivation, 113 human rights, 41, 100 human values, 101, 106 human welfare, vii, ix, 99, 100, 101, 102, 103, 104, 105, 106, 107, 110, 111, 112 humanistic perspective, 13 humanitarian, 100, 105 humans, 101 Hungarian, 70, 72, 76, 77 Hungary, 57, 77, 78 hypothesis, 93, 112

I id, 31, 38, 63, 80, 134, 137 Idaho, 142 identification, 102, 107, 108 identity, 31, 58, 107 ideology, 117 Illinois, 29, 37, 38, 54, 117, 142 immigrants, vii, viii, 1, 9, 11, 12, 13, 14 immigration, 12 immunization, 87, 91, 93, 94, 96 implementation, vii, viii, 2, 4, 14, 119 impulsivity, 154 in situ, 8, 42 in transition, 84 incentive, 36, 118, 119 incentives, 27, 28, 103, 116, 119, 125 incidence, 26 inclusion, 29, 81, 122 income, 3, 4, 7, 8, 23, 26, 74, 83, 88, 94, 95, 101, 102, 103, 104, 105, 111, 112 income distribution, 103 incomes, 6, 21 independence, 37 independent variable, 94, 122 India, 83, 85, 96, 103, 104, 105, 109 Indian, v, x, 4, 20, 30, 31, 129, 130, 131, 132, 133, 134, 135 Indian Child Welfare Act (ICWA), ICWA, x, 4, 31, 32, 129, 130, 131, 132, 133, 134, 135 Indiana, 143 Indians, 131, 134 indicators, vii, viii, ix, 23, 57, 81, 83, 87, 88, 95, 99, 100, 101, 102, 103, 104, 105, 106, 109, 111, 112, 114 indices, 105 indoctrination, 104, 105

163

Indonesia, 85 industrial, 97, 111, 113 industrial revolution, 113 industrialization, 111 industry, 47, 138 inequality, 80, 94, 97 infant mortality, ix, 87, 93, 94, 95, 96, 99, 104, 105, 112 infant mortality rate, 94, 104 infants, 17, 31, 88, 93 infection, 87 inflation, 90, 124 information systems, 83 informed consent, 36, 43, 44, 48, 50, 53 infrastructure, 90, 95, 96 initiation, ix, 57, 58, 74, 75, 76, 77 injury, iv, 23, 138, 139, 142, 143, 145, 148, 150 injustice, 47 insight, 58 inspection, 88 institutions, 3, 31, 37, 109, 133 integrity, 40, 47 intensity, 101 intentions, 58, 60, 77 interaction, 5, 77, 86, 93, 96 interactions, 47 interdisciplinary, 100 internalizing, 75 interpretation, 93, 131 intervention, x, 44, 45, 88, 129, 131, 154, 156 interview, 112 invasive, 45 investigative, 16 investment, x, 115 IQ, 127 Iran, 85 Iraq, 85 Islamic, 85 isolation, 34

J jails, 156 JAMA, 55 January, 22, 29, 32 Japan, 83, 103, 109 Jefferson, 29 Jordan, 85 judge, 132 judges, 11, 12, 14 jurisdiction, x, 14, 129, 131, 132, 134 jurisdictions, 32, 117, 118 justice, 25, 30, 41, 47, 54

164

Index

juvenile justice, 25, 54 juveniles, 154

K Kazakhstan, 85 Keeping Children and Families Safe Act, 11 Kentucky, 143 Kenya, 85 kidney, 151 kindergarten, 141 King, 22, 34 kinship network, 25 Korea, ix, 79, 85, 99, 100, 102, 103, 104, 105, 106, 110, 112, 113 Korean, ix, 80, 97, 99, 100, 103, 104, 110, 111, 112, 113, 114

L L2, 33 labor, 87, 91, 93, 94, 103, 104, 107, 108 labor force, 87, 91, 93, 94 labor-intensive, 104 LAC, 80, 84, 85, 86, 89, 92, 94, 95 land, 95, 131 language, 12, 13, 30, 32, 100, 132 later life, 88 Latin America, 9, 11, 12, 14, 80, 86, 88, 95, 96, 97 Latin American countries, 12, 14, 88 Latino, viii, 12, 13, 17, 19, 20, 22, 23, 28, 32, 33, 34 Latinos, 20, 33 law, 4, 23, 24, 26, 27, 31, 38, 40, 115, 131, 132, 133, 134, 138, 152 law enforcement, 23 laws, x, 13, 27, 31, 37, 38, 40, 46, 130, 134, 137, 138 lead, 61, 102, 112 legality, 37 legislation, 11, 33, 34, 37, 130, 156 legislative, x, 129, 130, 133 legislative proposals, 133 Liberia, 85 liberty, 80, 105 Libya, 85 licensing, 3, 4, 7, 8, 11 life expectancy, ix, 99, 104, 105, 112 life span, 41 lifecycle, 58 lifestyle, 61, 73, 74 lifestyle theory, 73, 74 lifestyles, 74, 76 lifetime, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72

likelihood, 14, 44, 51, 60 limitation, 142 limitations, 31, 73, 103, 105, 156 linguistically, 100 links, 105 literacy, ix, 99, 104, 105, 109, 112 literacy rates, ix, 99, 104, 112 litigation, 117 liver, 151 living conditions, 76 living standard, ix, 79, 80, 93, 100, 106, 110 living standards, ix, 79, 80, 93, 110 London, 54, 154 long period, 116 longitudinal study, 60, 73 long-term, 22, 36, 51, 87, 115, 116, 125 Louisiana, 144, 152 love, 101, 102 low-income, 23, 74 loyalty, 48 Luxembourg, 83

M Macedonia, 85 macroeconomic, 102, 103, 105 magnetic, iv Maine, 9, 144 mainstream, 38 maintenance, 86, 102, 108, 112 Malaysia, 85 males, 154 malnutrition, vii, ix, 79, 80, 81, 82, 84, 86, 87, 88, 89, 90, 91, 92, 93, 95, 96, 97, 104, 107, 108, 109, 113 maltreatment, 20, 21, 23, 24, 26, 34, 38, 48 management, 45, 59, 60, 61, 127 mandates, 5, 34 manipulation, 102, 154 manslaughter, 27 marijuana, 63, 72, 75 market, ix, 46, 61, 99, 103, 112, 117, 125 market economy, 61 market value, 103 markets, 125 marriage, 2 marrow, 139, 140, 141, 142, 144, 146, 147, 148, 149, 151, 152 Marx, 126 Maryland, 144 mask, 156 Massachusetts, 10, 44, 51, 115, 127, 144 maternal, 6

Index matrix, 94 Mauritania, 85 measles, 87 measurement, ix, 74, 81, 82, 99, 106, 112, 114 measures, 62, 103, 154 media, 24, 30, 38, 46 mediation, 47 mediators, 74 Medicaid, 11 medication, 45, 46, 53 medications, 45, 46, 56 medicine, 46, 77, 95, 100 membership, 31, 40, 110, 130 men, 111 mental health, viii, 22, 24, 30, 35, 37, 39, 40, 44, 50, 51, 53, 54, 55, 117, 125, 127 mental health professionals, viii, 35, 37, 39, 41, 44, 51 mental illness, 46 mentor, 61 metabolic, 107, 108 metric, 107 metropolitan area, 83 Mexican, viii, 2, 9, 13, 16, 17 Mexico, 9, 11, 12, 13, 14, 15, 33, 85, 95, 97 migration, 90 military, 108 Minnesota, 30, 145 minorities, 20, 30 minority, viii, 8, 13, 19, 23, 26, 29, 34 miscarriage, 139, 143, 146 Mississippi, 9, 131, 145 Missouri, 145 models, 39, 95, 126, 155 moderators, 74, 75 modern society, 58 modernization, 111 money, 8, 155 Mongolia, 85 monozygotic twins, 111 Montana, 145, 152 Monte Carlo, 122 Montenegro, 86 morality, 40 morals, 40 Morocco, 85 mortality, ix, 87, 92, 93, 94, 95, 96, 99, 104, 105, 109, 111, 112, 113, 114 mortality rate, 104 mortality risk, 113 mothers, 68, 69, 72, 93, 96 motivation, 45, 113 movement, 39, 51

165

Mozambique, 85 multidimensional, 59, 76 multidisciplinary, 42 murder, 27 Myanmar, 85

N Namibia, 85 narcissism, 154 Nash, 59, 76 nation, ix, 2, 33, 99, 103, 108, 110, 111, 112, 134 national, vii, 1, 9, 10, 11, 12, 13, 15, 20, 21, 22, 23, 26, 28, 30, 32, 33, 37, 38, 40, 54, 70, 72, 76, 81, 83, 90, 95, 103, 110, 119, 126, 148 national income, 103 National Indian Child Welfare Association, 30 national origin, 26 Native American, viii, 4, 19, 20, 21, 22, 30, 33, 34, 129 Native Americans, 21, 34 natural, 27, 28, 61, 149, 150 Nebraska, 146 negative consequences, 52 negative peer influences, 60 negative selection, 123 neglect, 21, 22, 23, 24, 31, 38, 43, 47, 96, 118, 130 Nepal, 85 Netherlands, 54, 78 network, 25, 58 neuroscience, 156 Nevada, 146 New England, 97 New Jersey, 114, 146 New Mexico, 33 New York, iii, iv, 7, 9, 10, 22, 23, 24, 26, 32, 33, 53, 54, 55, 114, 125, 146, 157 New York Times, 125 New Zealand, 84 Newton, 22, 23, 134 NGOs, 81 Nicaragua, 85 Niger, 85 Nigeria, 85 NIS, 21 non-citizen, 12, 13 non-uniform, 38 normal, 77 norms, 59 North America, 124, 126 North Carolina, 147 North Korea, v, vii, ix, 80, 97, 99, 100, 102, 103, 104, 105, 106, 109, 110, 111, 112, 113

166

Index

nuclear, 9 nursing, 149 nurturance, 25 nutrition, 80, 86, 91, 95, 106, 107, 108, 113

O obedience, 73 obligation, 44, 52 obligations, 9, 48, 51 observations, 123 occasional drinkers, 63, 65 Oceania, 84, 92, 94 OECD, 104, 110 offenders, 36, 156, 157 Office of Juvenile Justice and Delinquency Prevention (OJJDP), 32 Ohio, 9, 147 Oklahoma, 148 online, 54, 55 oppression, 24 optimism, 156 Oregon, 125, 148, 152 organ, 139, 140, 141, 142, 144, 147, 149, 152 organism, 101 organization, vii, x, 37, 40, 115, 116 organizations, viii, 12, 35, 37, 50, 53, 119, 125, 126, 140, 144 orientation, x, 115, 120, 122, 123 outliers, 88, 95 out-of-pocket, 11 overnutrition, 84, 111 oversight, 23, 32 ownership, 126 oxygen, 101

P Pacific, 20 Pacific Islander, 20 Pakistan, 85 paper, x, 80, 81, 83, 84, 88, 93, 95, 96, 97, 98, 104, 115, 116, 123, 125, 126, 127 parent child relationship, 27 parental attitudes, 59 parental consent, 44 parental control, 59, 60, 73 parental influence, 61, 73 parental smoking, 59 parent-child, vii, viii, 57, 58, 59, 60, 61, 70, 72, 73, 77, 130 parenthood, 27

parenting, vii, ix, 7, 24, 38, 48, 52, 57, 59, 70, 72, 73, 74, 75, 76, 77, 137 parenting styles, vii, 74 parents, viii, x, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 22, 25, 26, 27, 28, 29, 33, 36, 38, 39, 42, 44, 45, 46, 47, 48, 50, 51, 52, 55, 56, 57, 58, 59, 60, 61, 62, 66, 68, 70, 72, 74, 76, 77, 78, 83, 115, 116, 118, 120, 124, 127, 129, 130, 131, 132, 133, 140, 145, 150 passports, 108 paternalism, 48 paternity, 140, 142, 145, 149 pathways, 22, 32 patients, 106, 108 PCL-YV, 156 pediatric, 23, 55 peer, 58, 59, 60, 74, 76, 77, 78, 155 peer group, 58 peer influence, 59, 74, 76, 78 peers, 58, 59, 74, 75, 76, 77, 110, 155 penalties, 116 Pennsylvania, 126 per capita, ix, 87, 91, 92, 94, 99, 103, 104, 106, 109, 111, 112, 113 per capita GNP, 103, 104 perception, 59 perceptions, 73 performance, ix, 88, 99, 102, 103, 104, 105, 106, 108, 127 performance indicator, ix, 99, 106 periodic, 151 permit, 138 personal, 41, 45, 59, 101, 105, 138, 139, 141, 142, 143, 144, 145, 149, 151 personality, x, 36, 77, 153, 154, 155, 156, 157 personality traits, x, 77, 153, 155, 156 Peru, 80, 86, 95 pessimism, 157 Philadelphia, 30 philosophical, 100, 101 philosophy, 40 physical abuse, 21, 23, 38 physical activity, 107 physical aggression, 70, 73 physicians, 38, 46, 61 physiological, ix, 99, 101, 102, 103, 104, 105, 106, 110, 111, 112 planning, 24, 27, 38, 51, 54 platelets, 142 play, ix, 37, 38, 49, 58, 99, 101, 102, 103, 105, 106, 110, 112 police, 47 policy making, 87

Index policymakers, 39 political stability, ix, 79, 87, 96 politics, 93 poor, 7, 58, 62, 66, 67, 72, 79, 80, 90, 96, 111, 154, 156 population, viii, ix, 2, 13, 14, 20, 21, 24, 30, 32, 33, 35, 36, 37, 39, 40, 41, 45, 46, 48, 49, 50, 52, 53, 61, 70, 80, 81, 82, 84, 87, 88, 90, 92, 94, 99, 103, 106, 107, 108, 111, 112, 113 population size, 103 positive reinforcement, 51 post-socialist transition, 77 poverty, 6, 8, 9, 13, 14, 20, 23, 24, 31, 34, 87, 90, 95, 114 poverty rate, 9, 31 power, 93, 96, 101, 103, 123 PPI, 155 PPP, 109 predictors, 75, 155 pre-existing, 2 preference, 2, 4, 101, 131, 133 pregnancy, 93, 138, 139, 140, 141, 142, 143, 144, 146, 147, 148, 149, 151 pregnant, 141 preschoolers, 56 pressure, 32 prevention, 61, 76, 156, 157 preventive, 76 prices, 96 prisoners, 107 prisons, 126 privacy, 40 private, vii, x, 2, 5, 7, 23, 25, 47, 102, 115, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 133, 140, 141, 142, 143, 144, 146, 147, 148, 149, 150, 151, 152 private benefits, 124 private sector, 126 privatization, 117, 125, 126, 127 problem behavior, 58, 60, 61, 74, 78 problem behaviors, 78 problem solving, 60 professions, viii, 35, 40, 49, 50 profit, 146 program, 3, 14, 42, 45, 63, 119, 125, 141, 148, 150, 151 promote, 26, 27, 38, 40, 41, 130 property, iv, 101, 102 protection, 11, 15, 25, 27, 30, 36, 37, 38, 41, 42, 43, 44, 48, 49, 51, 53, 58, 59, 60, 72, 77, 127 protective factors, 59, 61, 74, 75, 76, 77, 78 protein, 87 proteins, 92, 94, 95

167

provider networks, 46 proxy, 50, 87, 96, 100, 103, 104, 105, 106, 107, 110, 112 psychiatric disorder, 54 psychiatric disorders, 54 psychiatrist, 45, 46 psychiatrists, viii, 35, 37, 40, 45, 46 psychological assessments, 41 psychological distress, 154 psychological problems, 6, 7 psychologist, 36, 40, 41, 42, 43, 44, 52, 54 psychology, 37, 42 psychopath, 154, 157 psychopathic, x, 153, 154, 155, 156, 157 psychopathology, 49, 52 psychopaths, 157 psychopathy, x, 153, 154, 155, 156, 157, 158 psychopharmacology, 55 psychosomatic, 58 psychotherapy, 40 psychotropic drug, 45 psychotropic drugs, 45 psychotropic medications, 45, 46, 56 public, 2, 23, 24, 25, 27, 40, 46, 47, 54, 55, 95, 117, 119, 124, 125, 126, 127, 133, 139, 141, 142, 146, 148, 149, 150, 151, 157 public goods, 95 public health, 117, 125, 126 Public Health Service, 54 public policy, 125, 157 public service, 117 purchasing power, 103 purchasing power parity, 103 Pyongyang, 100, 102, 105

Q quality control, 81 quality of life, 79, 83, 88, 100, 103, 106, 112 quality of service, 117 questionnaire, 62 questionnaires, 62

R race, 21, 22, 26, 30, 118, 155 racism, 25 radical, 61 radius, 152 random, 121 range, 21, 38, 60, 62, 118 real wage, 113

168

Index

reality, 61, 157 recidivism, 154, 156, 157 recognition, 48, 130 reconcile, 49 recreation, 107 recruiting, 52, 120, 122, 123 reduction, 38, 59, 83, 88, 96, 107 regional, 80, 81, 83, 89, 94, 95 regression, 81, 91, 93, 94, 95, 121, 122 regression analysis, 94 regressions, 90, 91, 93, 94 regular, 63, 65, 100 regulation, 50 regulations, x, 137, 138 rehabilitation, 39, 54 rehabilitation program, 39 reimbursement, 4, 28, 29 reinforcement, 51 relationship, ix, 6, 8, 9, 13, 14, 27, 40, 41, 42, 48, 51, 57, 58, 59, 60, 62, 63, 66, 67, 72, 73, 74, 75, 77, 113, 130 relationships, 2, 6, 9, 12, 42, 43, 44, 47, 48, 58, 60, 61, 66, 72, 74 relative prices, 111 relatives, 2, 3, 4, 5, 6, 8, 11, 28, 29, 61 relaxation, 45 relevance, 41, 100 reliability, 40 religion, 94 reporters, 21, 23 research, viii, x, 1, 5, 6, 9, 12, 14, 19, 22, 23, 24, 30, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 44, 45, 46, 49, 50, 52, 54, 57, 58, 59, 60, 70, 73, 80, 87, 88, 90, 96, 100, 101, 106, 107, 108, 110, 111, 125, 126, 127, 153, 154, 156, 157 researchers, 14, 22, 33, 34, 37, 39, 49, 106, 107, 108, 122 reservation, 26, 32, 131, 132 reserves, 107 residential, vii, 1, 9, 10, 25, 36, 39, 42, 126, 127 residuals, 121 resilience, 78 resolution, 133 resources, 7, 8, 15, 27, 29, 61, 121, 156 responsibilities, 31, 45, 47, 53, 118 restructuring, 45, 58 retardation, 97 retirement, 142, 146 returns, 38 reunification, 2, 3, 21, 27, 33, 34, 36, 38, 51 rewards, 119 Rhode Island, 148, 152

risk, vii, viii, ix, 2, 14, 20, 22, 23, 24, 26, 27, 31, 32, 34, 38, 46, 57, 58, 59, 60, 61, 66, 72, 74, 75, 76, 77, 78, 116, 154, 156, 158 risk assessment, 58 risk behaviors, 59, 60, 75, 76 risk factors, ix, 20, 24, 26, 34, 57, 75, 76 risks, 49, 50, 51, 52, 74, 157 roadblocks, 42 Romania, v, viii, 57, 61, 62, 70, 71, 75, 86 rural, vii, ix, 32, 79, 80, 81, 83, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96 rural areas, 32, 79, 80, 83, 89, 90, 93, 94, 95, 96 rural people, 90 rural population, 87, 90, 94 rural women, 93 Russian, 74 Rwanda, 86

S safeguards, 50, 52 safety, 2, 3, 14, 27, 45, 46, 51, 101, 102, 103, 105 salary, 150 sample, viii, 30, 33, 57, 59, 60, 62, 64, 65, 70, 72, 73, 75, 81, 82, 83, 106, 107, 122, 127, 155 sampling, 81, 83 sanctions, 100 satisfaction, 102 savings, 124 schema, 60 school, ix, 3, 5, 6, 8, 36, 44, 52, 56, 57, 58, 59, 62, 63, 74, 75, 78, 83, 93, 105, 108, 110, 127, 140, 141, 143, 144, 145, 147, 149, 151, 152 school activities, 144, 145, 151 school enrollment, 105 school performance, 127 schooling, 52 scientific knowledge, 43, 46 scientists, 101 scores, 88, 105, 154, 157 seals, 100 seasonality, 88 Seattle, 16, 32 second generation, 9 secular, 111 secular trend, 111 security, 11, 60, 101, 102, 130, 137 Self, 77 self-actualization, 101, 102 self-control, x, 153 self-esteem, 6, 60 self-report, 73, 157 self-reports, 73

Index Senate, 31 Senegal, 86 sensation, 154 separation, x, 6, 51, 108, 129 Serbia, 86 series, vii, x, 96, 113, 115, 121, 122 service provider, 12 services, iv, vii, x, 3, 7, 8, 10, 11, 12, 13, 20, 21, 22, 23, 24, 25, 27, 29, 30, 31, 32, 33, 34, 37, 38, 39, 44, 47, 48, 50, 51, 54, 101, 103, 115, 116, 117, 118, 119, 120, 125, 126, 127, 133, 134, 146, 151, 156 SES, 77 sexual abuse, 21, 27, 52 sexual activity, 102 sexual behavior, 75 sexually abused, 36 sharing, 148, 151 shelter, 102 short period, 87 short run, 93 shortage, 5, 14, 116 short-term, 88, 110, 151 sibling, 6, 7, 28 siblings, 6, 36, 58 signals, 105 significance level, 63 signs, 123 simulations, 122 singular, 27 sites, 37 skills, 51, 61 slavery, 24 smoke, 63, 70 smokers, 63, 70 smoking, ix, 57, 58, 59, 60, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 73, 74, 75, 76, 77, 78 social benefits, 7 social change, 61 social construct, 24 social costs, 88 social factors, 49, 59 social influence, 58 social influences, 58 social injustices, 47 social isolation, 34 social justice, 30, 47 social learning, 60 social network, 6, 58 social problems, 47, 61 social relations, 101, 102 social resources, 61 social security, 3, 11

169

social services, vii, x, 37, 40, 115, 116, 125, 126, 127 social skills, 61 social support, 60, 77 social work, viii, 35, 36, 37, 40, 47, 48, 49, 52, 54, 118, 130 social workers, viii, 35, 37, 40, 47, 48, 49, 118, 130 socialism, 61 socialist, 73, 74, 77 socialization, 58, 61, 73 socioeconomic, ix, 41, 61, 99, 100, 107, 108, 110, 112 socioeconomic conditions, 108, 112 solid waste, 126 solutions, 125 Somalia, 86 South Africa, 86 South America, 9, 84, 85, 86, 95 South Carolina, 9, 149 South Dakota, 149 South Korea, ix, 83, 99, 103, 104, 106, 109, 110, 111, 114 Southampton, 79 sovereignty, 31 Soviet Union, 75 special education, 36 spectrum, 41 speculation, 45 spheres, 100 spouse, 137, 138, 139, 140, 141, 142, 144, 147 SPSS, 63 Sri Lanka, 86 St. Louis, 156 stability, vii, ix, 1, 5, 29, 79, 87, 93, 96, 130 stabilization, 93 staffing, 16 stages, 30, 32 stakeholders, 53, 117 standard error, 124 standard of living, ix, 79, 83, 89, 97, 100, 103, 105, 107, 108, 110, 112, 113, 114 standardization, 81, 82 standards, 3, 4, 8, 11, 31, 40, 41, 42, 47, 48, 49, 55, 80, 93, 97, 137 state laws, 46, 130, 137, 138 state office, 149 statistics, vii, viii, 1, 9, 11, 12, 19, 20, 81, 100, 127 status of children, 54, 80, 81, 86, 107 statutes, x, 40, 137, 138 statutory, 131 steroids, 63 stigma, 36 stimulus, 45 strain, 14

170

Index

strains, 58 strategic, 23 strategies, 45, 54, 69, 70, 71, 117 stress, 12, 50, 60, 86, 88, 112, 124 stress factors, 86 stressful events, 61 stressors, 20, 24 structural characteristics, 94 students, ix, 54, 57, 62, 63, 66, 71, 72 subsidies, 8, 28, 30, 38, 116, 121, 123 subsidy, 116, 119, 121, 122 subsistence, 96 substance abuse, vii, 22, 30, 33, 34, 45, 76, 77, 155 substance use, ix, 39, 50, 53, 57, 58, 59, 60, 61, 62, 63, 64, 66, 67, 68, 70, 72, 73, 74, 76, 77 substances, 60 substitutes, 118, 119 Sudan, 86 suffering, 46, 88, 90, 96, 143, 145, 147, 148 suicide, 60 suicide attempts, 60 summaries, x, 137 supervision, 7, 45, 72 supervisor, 14, 118 supervisors, 23 supply, 95 support services, 7, 22, 33 Supreme Court, 131 surveillance, 23, 25, 81, 107, 108 survival, 129 Switzerland, 78, 126 symptoms, 45, 75, 77 syndrome, 55, 154 systems, vii, ix, 2, 12, 13, 20, 23, 24, 79, 83, 87, 93, 96, 114, 119

T TANF, 3, 8, 28, 29, 32, 34 Tanzania, 86 tar, 22, 32 tax credit, 28 tax credits, 28 taxation, 90 teachers, 61 teaching, 41 teens, 60, 72 temperature, 101 Tennessee, 9, 149 terminal illness, 148 testimony, 43, 133 Texas, vii, viii, 1, 2, 9, 10, 11, 13, 14, 15, 17, 46, 150 textile, 106, 108

theft, 36 theoretical assumptions, ix, 99, 106 theory, 26, 41, 113, 157 Theory of Planned Behavior, 76 therapists, 41 therapy, 36, 44, 45 Thomson, 7 threat, 46 threatened, 31, 129 threatening, 143 time, vii, x, 4, 7, 8, 10, 12, 13, 15, 21, 26, 30, 32, 33, 37, 39, 46, 47, 59, 61, 63, 72, 81, 87, 93, 95, 104, 111, 113, 115, 116, 121, 122, 126, 127, 131, 132, 138, 140, 141, 142, 144, 147, 149, 150, 151, 157 time frame, 4 time series, 113, 122 title, 138 tobacco, 59, 73, 76 toddlers, 82 Togo, 86 torture, 27 totalitarian, ix, 93, 99, 100, 105, 110, 112 toys, 7 trade, 101 tradition, vii, 1, 2, 11, 24, 27, 100 training, 44, 55, 120, 122, 123, 150 training programs, 44 traits, x, 154, 156, 157 trans, 100 transfer, 31, 131, 132, 139, 141 transformation, 111 transformations, 73 transition, viii, 37, 57, 156, 157 transition period, viii, 57 transition to adulthood, 157 transitions, 156 transparent, 118 transportation, 7 transracial, 26 Transylvania, v, 57, 62, 70 trauma, 6, 45, 155 trend, 32, 111 trial, 44 tribal, x, 31, 32, 119, 129, 130, 131, 132, 134 tribes, x, 31, 129, 130, 131, 132, 134 trust, 60 Tunisia, 86 Turkey, 86 Turkmenistan, 86 twins, 111 typology, 158

Index

U Uganda, 86 Ukraine, 86 underlying mechanisms, 108 undernutrition, 84, 88, 111 UNDP, 109, 114 unemployment, 34, 58, 101, 102, 103 unemployment rate, 103 UNICEF, 88, 98, 109, 114 uniform, 38 United Kingdom, 55, 79 United Nations (UN), ix, 81, 84, 86, 99, 105, 107, 112 United States, 2, 3, 4, 5, 6, 8, 9, 10, 11, 12, 13, 14, 15, 17, 19, 26, 28, 30, 32, 34, 37, 38, 39, 40, 46, 55, 75, 78, 98, 115, 125 universities, 50 urban areas, 25, 80, 89, 90, 93, 95, 96 urban population, 80 urbanization, 87, 94 Uzbekistan, 80, 86

V vacation, 142, 144, 150, 151 validity, 40, 112, 157 values, vii, 1, 11, 42, 47, 52, 77, 88, 101, 102, 106, 118, 130 variable(s), ix, 62, 73, 80, 86, 87, 92, 93, 94, 99, 100, 106, 107, 120, 121, 122, 123, 127, 155 variance, 95, 111 variation, 49, 74, 80, 103, 113, 120, 122 vector, 121, 122, 123 vein, 88, 95, 104, 105, 107, 111 Vermont, 9, 150 victims, 22, 38, 154 Victoria, 97 Vietnam, 86 vignette, 36, 44, 52 village, 79, 83, 134 violence, 51, 101, 102, 154, 157 violent, 157 violent recidivism, 157 Virginia, 151 voice, 79 voids, 44 vulnerability, 49

wants and needs, 154 war, 25, 49, 131 wastes, 107 water, 101, 102, 105 wealth, 101, 102, 108, 112 weight control, 60 welfare, vii, viii, ix, x, 1, 2, 3, 4, 5, 6, 8, 9, 11, 12, 13, 14, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 57, 58, 73, 81, 99, 100, 101, 102, 103, 104, 109, 110, 111, 112, 116, 117, 118, 119, 121, 124, 126, 127, 154, 156 welfare economics, 103 welfare law, 24, 37 welfare reform, 34 welfare state, ix, 99, 112, 126 welfare system, vii, viii, x, 1, 2, 5, 8, 19, 20, 21, 22, 23, 24, 25, 27, 28, 30, 32, 33, 34, 35, 36, 37, 38, 39, 41, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 127, 154, 156 well-being, 3, 27, 36, 43, 51, 77, 80, 100, 101, 102, 103, 105, 107, 127 West Africa, 25 West Bank, 86 white women, 23 Wisconsin, 9, 152 witnesses, 31, 41 women, 23, 33, 81, 93 workers, 7, 14, 23, 24, 27, 31, 34, 47, 48, 49, 118, 119, 130, 140 working women, 96 workplace, x, 137 World Bank, 87, 95, 97, 98, 109, 114 World Health Organization (WHO), 60, 78, 81, 82, 83, 87, 88, 96, 98, 109 writing, 47, 132

Y Yemen, 86 yes/no, 63 yield, 104 young adults, 76, 77 youth transition, 155

Z Zimbabwe, 86

W wage rate, 122

171