parental views of in-home services: what predicts satisfaction with child welfare workers?

Parental Views of In-HomeServices: What PredictsSatisfaction with Child WelfareWorkers?

Mimi V. Chapman, Claire B. Gibbons, Richard P.Barth, Julie S. McCrae, and the NSCAW ResearchGroup

Evidence on client satisfaction deserves considerationin the design of child welfare policies, programs, andpractices. Data in this study come from the NationalSurvey of Child and Adolescent Well-Being. Clientsreceiving in-home services reported moderate levels ofsatisfaction with their child welfare workers. Caregiverreports of having less than two child welfare workers,having more recent contact, and receiving timely, re-sponsive services were associated with higher per-ceived quality of relationships with child welfare work-ers. The child welfare workers' reports ofcooperativeness by the caregiver were also associatedwith higher caregiver-reported relationship quality.

Mimi y. Chapman, PhD, MSW, is Assistant Professor; Claire B. Gibbons, MPH, andjuiie S. McCrae, MA, are doctoral students; and Richard P. Barth, PhD, MSW is theFrank Daniels Distinguished Professor at the School of Social Work, University ofNorth Carolina, Chapel Hill (UNC). The National Survey of Child and AdolescentWell-Being (NSCAW) Research Group is a collaborative effort between the ResearchTriangle Institute (RTI), UNC, and the Administration on Children, Youth, and Fami-

0009-4021/2000/050571-26 $3.00 © 2003 Child Welfare League of America 571

572 CHILD WELFARE • VoL LXXXII, #5 • September/October

The goals of in-home child welfare interventions are to pre-serve and strengthen families and to protect the childrenin the home. A child welfare worker's ability to work con-

structively with caregivers, generally birthparents, should con-tribute to these goals (DePanfilis, 2000). Yet child welfare work-ers and in-home caregivers must negotiate a relationship that isoften complicated by the competing responsibilities inherent inthe child welfare worker's role.

The child welfare worker is continually assessing whether achild's living environment is safe, whether changes can be madein the home to heighten a child's safety, or whether one or morefamily members should live elsewhere if the child is to remain inthe home. At the same time, the child welfare worker must com-municate empathy and respect toward the caregiver and moti-vate the caregiver to make changes that would benefit the child.The child welfare worker must also work with the in-home car-egiver and the court to determine how the case should proceed,how long services should last, and which services may be required(Rooney, 2000). These varying roles may conflict, making a con-structive working relationship difficult.

Little rigorous study has examined how caregivers perceivetheir relationship with child welfare workers and how they ex-perience the services they receive during chUd welfare involve-ment. Most theories of helping emphasize relationship buildingas the cornerstone of successful intervention (Kadushin, 1990;Perhnan, 1984; Shulman, 1999). Voluntary participation in a help-ing relationship is considered optimal, yet parents generally donot voluntarily seek assistance from social service or child pro-tection agencies for help with parenting (Keller & McDade, 2000).Some small studies have shown that "angry, hostile clients" evokediscomfort and worry in helping professionals about the quality

lies (ACYF), U.S. Department of Health and Human Services (DHHS). RTI is theprime contractor. NSCAW's Research Steering Committee and project managementinclude R. Barth, UNC; P. Biemer, RTI; D. Runyan, UNQM. Webb, ACYF; K. Dawd,RTI;}. S. Kinsey, RTI; and M. Weeks, RTI. NSCAW survey and analysis staff includeM. Z. Byron, RTI; G. Cam, RTI; R. Green, UNC; D. Herget, RTI; M. Langer, RTI;

M. V. Chapman / C. B. Gibbons / R. P. Barth / J. S. McCrae / NSCAW 573

of the helping relationship (Kiesler & Watkins, 1989). Theadversarial nature of the child welfare system may predisposeparents to feel angry and hostile, raising the specter of a difficultencounter. Furthermore, the typically involimtary nature of therelationship raises the question of whether a caregiver can viewa child welfare worker as an ally: someone who understands acaregiver's life circumstances and can join with them to makeneeded changes.

A small but growing body of evidence exists regarding clientperceptions of helping relationships (Ribner & Knei-Paz, 2002).Actions such as home visiting, behaving in a less formal manner,and being accessible and flexible are ways to facilitate work withmultiproblem families, many of whom are involved with the childwelfare system (Benvenisti & Yekel, 1986; Rosenfeld & Sykes, 1998;Schlosberg & Kagan, 1988).

Perhaps as important as child welfare workers' actions aretheir attitudes. Recent studies suggest that when clients describesuccessful helping relationships, they focus as much on the feel-ings evoked by the worker as they do on what the worker actu-ally does. In one study, clients described their child welfare workeras "like a friend, mother, or sister." Clients also reported needinga sense of equality, accessibility, and regular contact to feel con-nected to a worker (Ribner & Knei-Paz, 2002).

The evidence specific to client-worker relationships is mixedand derived from small samples with low or indeterminate re-sponse rates, leaving many unanswered questions about the rep-resentativeness of the samples. Some studies focus on specificpopulations in the child welfare system or on extremes of experi-ence, such as highly negative caregiver experiences versus posi-tive (Akin & Gregoire, 1997; Miller, 1997; Walton & Dodini, 1999).These studies conclude that strategies aimed at increasing the

/. Ltu, RTI; T. Lytle, RTI; R. McCracken, RTI; F. Mierzwa, RTI; R. Suresh, RTI; andA. Wall, UNC. The project was funded under a contract from ACYF. Points of view oropinions in this article are those of the authors and do not necessarily represent theofficial position or policy of DHHS.

574 CHILD WELFARE • Vol. LXXXII, #5 • September/October

cultural competence of workers in child welfare are indicated andthat particular ways of acting seem to be related to client satisfac-tion with child welfare workers and services (Akin & Gregoire,1997; Miller, 1997). Additional qualitative studies and review ar-ticles support regular visits, consistent and clear messages, andfollow-through as particularly salient aspects of a successful re-lationship (Akin & Gregoire, 1997; Coleman & ColUns, 1997;Dawson & Berry, 2002).

Families have described the client-worker relationship as astrong contributor to service effectiveness (Walton & Dodini,1999). In a study of family preservation services, clients reportedthat a worker's most helpful activity was "sincerely caring andbeing a good friend" (Walton & Dodini, 1999, p. 44), and in an-other, clients reported that "listening and being heard" was themost highly valued quality in an in-home therapist (Coleman &Collins, 1997). From these investigations, the field can learn muchabout what clients value in worker behavior.

What is not known is how many clients, nationally, have posi-tive or negative relationships with child welfare workers. One ofthe few existing larger surveys on client satisfaction (n = 176) in-dicated that most clients view their workers positively (Fryer,Bross, Krugman, Denson, & Baird, 1990). Yet many parents in thisstudy also reported believing that the worker did not give theirstatements or their questions adequate attention. Existing data,although contributing to the overall sense of client satisfactionwith child welfare workers, lack information about what parent,case, child, or worker characteristics may be associated withhigher or lower levels of satisfaction with both workers and ser-vices, critical pieces of information for service improvement efforts.

Many possibilities exist as to why particular caregivers andchild welfare workers are able or unable to form productive rela-tionships. Although little evidence exists about the size of pos-sible effects on caregiver-worker relationships, demographic simi-larities between the caregiver and service provider (Everett,


Chipungu, & Leashore, 1991; Sue, 1988), cooperativeness of thecaregiver (Rooney, 2000), and the type of presenting problems ormaltreatment occurring in the home (Walton & Dodini, 1999) mayall play roles in how workers and clients view one another.

Other possible contributors to this relationship include pa-rentai dynamics that may affect the general ability to engage infunctional relationships. Examples include caregiver depression,substance abuse, domestic violence, or a lack of social support.Child characteristics may also influence satisfaction with services.Some families struggle with caring for children with clinical-levelbehavior problems, which may contribute to family conflict andtrigger the maltreatment investigation (Koyanagi, 2001;McDonald, Gregoire, Poertner, & Early, 1997).

Knowing how specific child and caregiver characteristics areassociated with positive or negative caregiver-worker relation-ships would assist child welfare workers and agencies in chang-ing practice to enhance helping relationships. In addition, socialcharacteristics, such as race and poverty level, may also irtflu-ence the helping relationship (McPhatter, 1997).

Missing in the literature are nationally representative samplesof caregivers, examinations of characteristics that may make therelationship more or less difficult, and research on the effects of apositive relationship on outcomes. This study extends the evi-dence base on client-worker relationships in two ways: (1) byproviding the views of a nationally representative sample ofcaregivers to determine their level of satisfaction with child wel-fare workers, and (2) by testing associations of characteristics thatmay influence the caregiver's perception of relationship quality.A national sample provides a means to understand the typicalexperience of clients—a view that is especially important forthinking about national policy, regulation, or training initiatives.At the same time, much child welfare policy and practice is gov-erned by local laws and conditions, and national data may notprecisely describe what occurs in any locality. Despite this limi-


tation of national data, when little is known about local condi-tions or the way case characteristics and satisfaction with ser-vices may interact in the local area, a national picture is a reason-able starting point for developing local responses.

Method

The National Survey of Child and Adolescent Well-Being(NSCAW) examined the characteristics, needs, experiences, andoutcomes for children and families involved in the child welfaresystem. The study obtained information from current caregivers,more than 80% of whom were mothers, with the remainder be-ing fathers and relatives, as well as child welfare workers, chil-dren, and teachers. The researchers collected data in 1998 and1999. Families were involved in the study because they had beenthe subject of investigations of child maltreatment. The research-ers selected children from 92 primary sampling units, typicallycounties, county-size subsets of very large counties, or combina-tions of small counties in 36 states. The sample design is a strati-fied cluster sample of all children in the target population, withoversampling of infants and children who were sexually abused.

The researchers provided caregivers with the option of partici-pating in the study and a modest honorarium, and the Office ofManagement and the Budget, Research Triangle Institute's Institu-tional Review Board (IRB), and the University of North Carolina'sIRB approved all consent procedures. Many counties and some statesalso required additional IRB review.

This analysis included caregivers, almost all of whom werebirthparents, of children remaining in the home who were re-ceiving child welfare services and who had talked with a childwelfare worker since the investigation (n = 1,872). This analysisused information collected from the current caregiver and thechild welfare worker. The study collected all information throughin-person interviews. Highly sensitive questions, such as those


regarding caregiver substance use and domestic violence, wereadministered via audio computer-assisted self-interview (ACASI).This allowed respondents' answers to remain confidential evenfrom the interviewer, because the respondents hear the questionsthrough earphones attached to a laptop computer and respondby using the keyboard. Some studies have found that ACASI hasimproved the reporting of sensitive topics (Richter & Johnson,2001).

Nearly all of the caregivers in this sample were femiale (91%).Approximately 62% were yoimger tiian 35. About 57% were white,non-Hispanic; 25% African American, non-Hispanic; 13% His-panic; and 6% other (see Table 1). Many of the families had verylow incomes—almost three-quarters earned less than $25,000 peryear, and more than half lived below 100% of the federal povertylevel. Slightly less than half of all caregivers worked either full-or part-time. Slightly more than one-third of these caregivers hadless than a high school education.

The children of these caregivers ranged in age at the time ofdata collection from less than 1 year to 11 years or older. The mostserious t5^es of maltreatment among these children were physi-cal abuse (26%), failure to supervise (33%), failure to provide(22%), sexual abuse (10%), and other abuses (9%).

Caregiver-Reported Service Characteristics and Risks

The analysis included caregiver race or ethnicity, poverty level,and maltreatment t5rpe due to plausible arguments that childvv̂ elfare services may be less responsive to poor, nonwhite, andneglecting parents (Pelton, 1989; Roberts, 2002). Consistent withthe helping literature, the analysis considered case characteris-tics that promoted relationship building, specifically, frequencyof child welfare worker visits and the number of child welfareworkers with whom the caregiver had interacted. The analysisincluded the investigation outcome due to the concem in previ-ous studies that caregivers judge their child welfare workers solely


TABLE 1

Caregiver and Child Characteristics

Characteristics

Female caregiver

Type of Maltreatment

Physical abuseSexual abuseFailure to provideFailure to superviseOther

Caregiver Age

<3535-4445-54>55

Caregiver Race

African AmericanWhiteHispanicOther

Caregiver Employmertt

Full-timePart-timeUnemployedDoes not workOther

Caregiver Education

No degreeHigh school degree/

generai equivalencyAssociate's or vocationai/

technicai degreeBacheior's degree or higherOther

Child Age

Birth to 23-56-10>11

M(SE)

36.2 (2.4)9.9(1.2)

15.6(1.6)31.1 (2.7)7.3(1.1)

33.5 (2.6)

41.4(2.6)

18.5(1.6)2.9 (0.7)3.8(1.0)

%(SE)

91.4(1.1)

25.6(2.1)10.4(1.9)22.4 (2.7)32.7 (2.4)9.0(1.4)

61.6(2.5)30.9 (2.7)5.7 (0.8)1.8 (0.5)

24.8 (3.3)57.0 (3.8)12.6(2.6)5.6(1.0)

20.7(1.9)22.2(1.8)31.2(2.2)25.9(2.1)


Characteristics M (SE) % (SE)

Income

<S10,000 31.8(2.6)10,000-14,999 18.1 (1.9)15,000-24,999 23.9 (2.0)25,000-34,999 11.1(1.3)35,000-49,999 9.0 (1.3)>50,000 6.1 (1.0)

based on the outcome of the case (English, Marshall, Coghlan,Brummel, & Orme, 2002). The analysis tested the contribution ofprimary abuse t)^e and other case variables, such as depression,substance abuse, and social support, due to the possibility thatchild welfare workers might feel better able to intervene in sometypes of situations than others. Likewise, child welfare workersmight view some types of maltreatment as more or less amenableto in-home intervention (Unrau, 1997). Table 2 provides descrip-tive statistics of these case characteristics.

The Child Behavior Checklist (CBCL) was "designed to pro-vide standardized descriptions of behavior" (Achenbach, 1991, p.iii). Items are on a three-point, Likert-type scale (0 = not true, 1 =somewhat or sometimes true, and 2 = very true or often true). Thisanalysis uses the Total Problem Score, the internal consistency ofwhich is excellent (alpha = .96; Achenbach, 1991). These analysescode scores of 60 or above as borderline or clinical scores.

The study measured major depression among caregivers us-ing the major depressive episode section of the Composite Inter-national Diagnostic Interview-Short Form (CIDI-SF). CIDI-SF isa highly standardized interview that screens for mental healthand substance use disorders using the criteria established in theDiagnostic and Statistical Manual of Mental Disorders (4th ed.; Ameri-can Psychiatric Association, 1994). CIDI-SF correctly classified89.6% of the cases identified by CIDI, which is considered to be agold standard (Kessler, Andrews, Mroczek, Ustun, & Wittchen,1998).

Researchers in this study scored CIDI-SF according to WorldHealth Organization instructions (see http://www.who.int/msa/


TABLE 2Service Characteristics and

Characteristics

Risics

%(SE)

Number of Child Welfare Workers

1-23 or more

Last Verbal Contaot

Within tine last weei<2-4 weeks ago2-3 months ago4-6 months ago>6 months ago

Investigation Outcome

Substantiated/high risi<Indicated/medium risi<Neither/iow risi<

Poverty

Below poverty iineAbove poverty iine

Family Risks

Domestic vioienceLow social supportMajor depressionAicohol or drug problemChild behavior probiems

73.3 (2.6)26.8 (2.6)

34.7 (2.4)31,9 (2.5)20.3 (2.2)11.5(1.7)1.7 (0.4)

72.6 (2.9)19.9(2.7)7.5(1.5)

58.3 (2.5)41.7 (2.5)

Reasonable ievel of caregiver cooperation

CaregiverReport%(SE)

32.4 (2.0)83.2 (1.4)39.4 (3.2)31.3(2.2)35.1 (2.0)

—

Ctiiid WeifareWorker Report

%(SE)

37.2(2.1)45.5 (2.3)22.9 (2.5)22.8(2.1)29.6 (2.6)91.4(1.0)

cidi/cidisf.htm). Researchers coded individuals with a score ofthree or more as having a major depressive episode in the past 12months. The researchers scripted questions to ask about the pre-vious 12-month period (Nelson, Kessler, & Mroczek, 1998); in-person interviewers administered the section on depression.

The analysis measured social support using seven items thatasked respondents to state the number of people available to pro-vide following types of help: household tasks, child care, caringfor them when they are sick, helping with transportation, finan-

M V. Chapman / C. B. Gibbons / R. P. Barth / J. S. McCrae / NSCAW 581

cial advice, general advice, or inviting them out for an evening.To compare respondents' levels of support, the researchers di-vided responses for each question into quartiles. They then cre-ated a composite variable by summing the quartile scores on theseven items and dividing by the number of questions each indi-vidual answered. Scores ranged from one to four, with one indi-cating the lowest level of social support and four indicating ahigher level of social support (alpha = .74).

The study assessed domestic violence risk using questionsfrom the Conflict Tactics Scale (CTS) (Straus, Hamby, Boney-McCoy, & Sugarman, 1996), which assesses ways family mem-bers respond to conflicts. Cronbach's alpha for the CTS rangesbetween .79 and .95 (Straus et al., 1996). The eight items from thephysical violence scale assess caregivers' experiences with inti-mate partner violence. The items ask about a variety of violentbehaviors the respondent may have experienced in the last year.If a caregiver reported that any of these types of behaviors werepresent, the researcher coded the risk as present.

The study assessed substance abuse risk using CIDI-SF screen-iiTg questions asked of ali in-home caregivers. These questionsasked whether a caregiver had had four or more drinks on oneday during the past year or had abused legal or illegal drugsduring the past year. If caregivers responded positively to any ofthese screening questions, they were considered at risk for sub-stance abuse.

Child Welfare Worker-Reported Measures

At the time of the investigation, the researchers asked child wel-fare workers about the presence or recent history of risk factorsm caregivers' lives. For this analysis, the study measured the fol-lowing risks using five questions that most closely matched thecontent of the caregiver self-report measures:

• Social support: "Was there low social support?"« Recent domestic violence: "Was there a history of domes-

tic violence against the caregiver?"


• Substance abuse: "Was there active alcohol abuse or drugabuse by the primary caregiver?"

• Emotional or mental health problems: "Did the primarycaregiver have any serious mental health or emotionalproblems?"

• Child behavioral difficulties: "Did the child have major spe-cial needs or behavior problems?"

All were dummy coded, with the lower score representingthe presence of the risk.

The study asked about service responsiveness, the degree towhich caregivers agreed that their child welfare worker gave themenough time to make changes, offered services in a timely fash-ion, offered helpful services, and offered enough services. Theresearchers selected these items to represent the timeliness, ap-propriateness, and adequacy of services. These five-point re-sponse scales for each item were recoded to range from one{strongly agree) to five {strongly disagree). The study included theseas single items in the analysis. See Table 3 for the distribution ofthese items.

The study measured relationship quality using six questionsasked of caregivers about their perception of the relationship withtheir child welfare worker. Caregivers answered how often theirchild welfare worker listened to their concems, understood theirsituation, treated them with respect and fairness, explained treat-ment and service options to them, and met with them to developan action plan to address their needs and concems. These itemswere coded as zero or one and summed. The scale showed highintemal consistency (alpha = .89) and ranged from one to six,with higher scores indicating higher relationship satisfaction.

Although individual child welfare worker characteristicscould, in theory, help explain client satisfaction, the researchersdid not enter these, because the worker who was interviewed,usually the investigation worker, was typically not the client'scurrent child welfare worker. Information about the specificworker with whom clients were engaged was not available.

IV. V. Chapman / C. B. Gibbons / R. P. Barth / J. S. McCrae / NSCAW 583

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Results

These analyses weighted the data back to a national probabilitysample and corrected the variance estimates through the use ofSUDAAN®. SUDAAN® supports analysis of data from complexsample surveys. Specifically, it computes correct standard errorsby taking into account the survey design (Shah, Bamwell, & Bieler,1997). In addition to descriptive statistics, the analysis fit a mul-tiple linear regression equation for the dependent measure.

Very little information is available regarding what factors con-tribute to the relationship between caregivers and child welfareworkers. Some variables included in the model have been foundto influence the quality of the relationship between caregiversand child welfare workers. Others were considered to be relatedto the quality of the relationship, although researchers had notpreviously studied them.

Caregiver characteristics included in the model were race orethnicity, poverty, type of maltreatment, and the outcome of theinvestigation. The researchers also h5^othesi2ed that the num-ber of different workers a caregiver came into contact with, andwhen the caregiver last had verbal contact with the child welfareworker, would affect the quality of the relationship. Caregiverand child welfare worker reports of family risks modeled includeddomestic violence, low social support, major depression, alcohol ordrug risk, and child behavior problems. Finally, the study includedfour items that measured the caregiver's satisfaction with ttie childwelfare worker.

The researchers asked caregivers of children remaining in thehome and receiving in-home services when they last spoke with achild welfare worker. More than one-quarter (28%) reported thatthey had not spoken with a child welfare worker since the investiga-tion. Of these cases, 89% involved caregivers receiving contractedchQd welfare services or cases identified as abandonment. Caregivers

hfi. V. Chapman / C. B. Gibbons / R. P Barth / J. S. McCrae / NSCAW 585

who had no contact with a child welfare worker since the investiga-tion did not com.plete items about their satisfaction with the childwelfare worker, and this article does not include them.

Among the caregivers who had spoken with a child welfareworker since the investigation, 66% reported speaking with a childwelfare worker within the past month (see Table 2). A fifth of thecaregivers had last spoken with a child welfare worker two tothree months ago, and 13% had last spoken with a worker fouror more months ago. Most caregivers (73%) interacted with twoor fewer child welfare workers. Most investigations in this samplewere substantiated or high risk (73%).

Relationship Quality with the Child Welfare Worker

The mean score for relationship quality was 4.6, indicating amoderate level of perceived relationship quality. Table 4 presentsresults of a regression model to explain satisfaction with the childwelfare worker. The model includes demographic, case charac-teristic, caregiver, and case dynamics; the match betweencaregivers' and child welfare workers' perceptions of case dy-namics; and questions about service provision. The researchersdeveloped the model by selecting variables with a theoretical rela-tionship to the outcome and entering those variables simultaneously.They retained variables in the model regardless of their actual con-tribution. The overall model explained 38% of the variance in per-ceived relationship quality with the child welfare worker.

A number of significant negative relationships are presentbetween case and service characteristics reported by the caregjver:two or more child welfare workers {p < .001), longer length oftime between visits (p < .01), not being offered the kind of helpneeded {p < .001), that more services should have been offered {p< .001), and the perceived relationship quality with the childwelfare worker (p < .01). In addition, the child welfare worker'sassessment of a "reasonable level of cooperativeness" is predic-tive of higher perceived relationship quaiity (p < .05).


TABLE 4Regression Explaining Quality of Reiationsiiip

Beta Coefficients (SE) F p

Intercept 4.56 ( .48)"

Caregiver Race/Ethrticity 1.94 <.13

White ReferenceAfrican American .40 (.20)*Hispanic .00 (.24)Other -.14 (.32)

Number of DifferentChild Welfare Workers 28.66 <.OOO1

1 or 2 Reference3 or more -.62 (.13)**

Last Verbal Contact with Worker 4.37 <.003

2-4 weei<s agoWithin the last week2-3 months ago4-6 months ago>6 months ago

Investigation Outcome

Indicated/medium riskSubstantiated/high riskNeither/iow risk

PovertyAbove poverty lineBeiow poverty line

Type of Maltreatment

Physicai abuseSexual abuseFailure to provideFailure to superviseOther

Reference.14 (.24)

-.17 (.24)-.94 (.38)**.87 (.04)*

Reference.30 (.20).37 (.36)

Reference.26 (.19)

Reference-.26 (.24)-.05 (.25)-.08 (.21).10 (.29)

1.26 <.29

1.93 <.17

.47 <.76

Caregiver Report of Family Risks

Domestic vioience .11 (.16) .46 <.5OLow social support -.07 (.16) .17 <.68Major depression -.10 (.18) .33 <.57Alcohol or drug risk .11 (.20) .30 <.58Child behavior problem .27 (.15) 3.39 <.O7

M. V. Chapman / C. B. Gibbons / R. P Barth / J. S. McCrae / NSCAW 587

Beta Coefficients (SE)

Worksr Report of Family Risks

Caregiver cooperationDomestic vioienceLOW sociai supportStienta! health problemAlcohol or drug riskChild behavior problems

Should Have Been GivenMore Time to Make Changes

Strongly disagreeStrongiy agreeAgreeNeither agree nor disagreeDisagree

Services Should Have BeenMade Available Sooner

Strongly disagreeStrongly agreeAgreeNeither agree nor disagreeDisagree

Services Should Have BeenMore Helpful

Strongiy disagreeStrongly agreeAgreeNeither agree nor disagreeDisagree

Should Have Been OfferedMore Services

Strongiy disagreeStrongly agreeAgreeNeither agree nor disagreeDIsagrse

.52 (.22)*

.20 (.17)-.29 (.16)-.10 (.19)-.03 (.17)-.32 (.17)

Reference-.75 (.49)-.57 (.45)-.44 (.45)-.72 (.42)

Reference.42 (.49).74 (.51).27 (.45).83 (.51)

Reference-1.24 (.32)**-.91 (.34)**-.32 (.34)- 22 (.27)

Reference-.81 (.35)*

05 (.35)-.06 (.38).36 (.31)

Note: This anaiysis used 653 observations. R^coefficient is 0.*p< .05 **p < .01.

5.811.323.50

.26

.033.4

1.13

2.18

5.85

6.0

= .36. The reference group

<.O2<.25<.O6<.61<.86<.O7

<.35

<.O8

<.0003

<.00003


A few case domains tended toward significance in predictingcaregivers' perceptions of their child welfare worker. Bothcaregivers' and children's descriptions of problem behavior inthe child appear related to a more positive view of the child wel-fare worker (p < .07). The child welfare worker's perception thata caregiver has low social support appears to predict a less favor-able view of the relationship. Race did not have a significant over-all relationship to client satisfaction with the relationship to thechild welfare worker (p < .13), although African American clientshad a significantly more positive relationship than white clients.

Several key reported variables were not significantly relatedto caregivers' perceptions of their relationship with the childwelfare worker, including type of maltreatment, investigationoutcome, major parental depression reported by the caregiver,mental health problems reported by the child welfare worker,substance abuse risk defined by either caregiver or child welfareworker, and low social support reported by the caregiver. Thus,caregivers with the most serious problems were not more likelyto report poor relationship quality with their child welfare worker.

Discussion

The results inform the evidence base on child welfare worker-caregiver relationship building in several ways. First, the descrip-tive statistics demonstrate that caregivers receiving in-home ser-vices have muitipie physical and emotional needs. Manycaregivers live in or near extreme poverty, experience major de-pression, and have high levels of interpersonal violence. Althoughmost caregivers had contact with their child welfare workerswithin the last month, many clients have no or infrequent con-tact with their child welfare workers following the investigation.This finding is troubling because, at the very least, child welfareworkers are expected to monitor the safety of children remainingat home when a case is open. That a large number of respondentsreport little or no regular contact indicates that basic monitoringmay not be taking place for vulnerable children.


Although explanations may account for some of these no-con-tact cases—for example, that having an open child protective ser-vices case is needed to obtain resources like day care and that noother supervision is needed—the authors argue that an optimalpublic heaith-oriented system of care would include hard ser-vices and enough continued contact to ensure that these serviceswere continued and that additional safety concems had not arisen.

Similarly, most caregivers report involvement with no morethan two child welfare workers since the investigation, althoughmore than one-quarter had already interacted with two or morechild welfare workers in the roughly four months since the in-vestigation (on average). That more recent verbal contact with achild welfare worker and a lower number of workers is associ-ated with higher satisfaction with child welfare services is in ac-cord with the helping literature, which suggests that the incre-mental value of services develops with more time and regularcontact (see, for example, Foster, 2000).

The child welfare worker's view of the caregiver as reason-ably cooperative is predictive of a positive caregiver view of therelationship. In some ways, this finding appears ridiculously ob-vious, however, the notion of cooperativeness, sometimes termedcompliance, is complicated. Certainly, a cooperative caregivermakes a worker's job easier. These caregivers are probably morelikely to follow through on case plans, appear committed tochange, and are relatively welcoming to the child welfare worker.Yet the descriptive section of this article demonstrates that work-ers classify more than 90% of caregivers as reasonably coopera-tive. This relatively low variation may indicate that only the fewcaregivers identified as noncooperative are driving this finding.For the vast majority of cooperative caregivers, other factors areplaying a larger role in how a relationship progresses.

The trend toward significance of the role of child behaviorproblems merits comment. The finding that caregiver and childwelfare worker assessment of behavior problems is related tomore positive views of the relationship raises the possibility that

590 CHILD WELFARE • VoL LXXXII, #5 • September/October

some families are coming into contact with child welfare becauseof overwhelming behavioral needs that are not met elsewhere.This is a longstanding (Bernstein, Snider, & Meezan, 1975) butoften overlooked function of child welfare services. The findingis consistent with NSCAW data showing that nearly half of chil-dren entering out-of-home care have a CBCL in the borderline orclinical range, and one in five children entering out-of-home carehas a primary caregiver whom the child welfare worker does notview as having substance abuse issues, parental mental illness,problems paying for basic necessities, or active domestic violence(Barth, Wildfire, & Green, 2003). More recognition needs to begiven to the child welfare role of working with families in which theproblems are not solely or primarily parents' behavioral problems.

Caregivers may find the presence of a child welfare workerparticularly helpful if they have been unable to successfully ac-cess services for their child in other ways. Child welfare workersare apparently responsive to the difficulty of parenting childrenwith significant behavior problems.

Finally, aU individual items about specific services providedapproached or achieved significance in predicting the quality ofthe relationship to child welfare services, which illustrates theimportance of providing caregivers with services but also mak-ing sure those services are relevant to their needs and wishes, aredelivered as quickly as possible, and are delivered in a manner inwhich the caregiver feels comfortable being a part of those ser-vices. "Needing more time to make changes" is not predictive ofrelationship quality, suggesting that in-home service recipients,at least, are not experiencing the limited duration of in-home ser-vices as being so stressful as to contaminate their view about thechild welfare worker. This seems less important than other char-acteristics of the services.

These findings support the field's general concem with con-tinuity of care (Cohen, 2002) and prior studies in health servicesresearch (e.g., Bacchus, Mezey, & Bewley, 2003; Schers et al., 2002)


that have described the importance of access and consistency inhelping relationships, especially when the problems to be solvedare serious and require considerable knowledge of a complexproblem. This work extends these studies by adding specific in-formafion about what aspects of service delivery may be associ-ated with positive and negafive relationship quality. These find-ings may mean that time constraints imposed by courts, orlegislation that child welfare workers have to impose, may notbe inherent barriers to successful relationships. Rather, these jfind-ings suggest that if appropriate and relevant services can bequickly put in place, child welfare workers are seen as respon-sive to caregivers' needs.

On balance, these findings suggest that relationships betweenchild welfare workers and in-home caregivers are generally per-ceived as helpful, despite the pervasive problems of large case-loads and the demanding situafions of clients. More important,these findings show that successful relationships are not deter-mined by unchangeable aspects of the case, such as client race,type of abuse that prompted the investigation, investigation out-come, and even particular dimensions of risk. Rather, a positiverelationship is within the grasp of most child welfare worker-caregiver pairs. Positive relafionships appear to be created byactions that are within the child welfare agency and worker'scontrol. Specifically, maintaining frequent contact, emphasizingcontinuity of worker service provision to caregivers, offering andputting relevant services into place quickly, and ensuring, to theextent possible, that the services will be helpful are most predic-tive of a successful relationship.

Som.e researchers have argued that a trusting and productiverelationship between the client and child welfare agency is be-yond the control of child welfare agencies because of the struc-tural nature of child welfare agencies being involved in both in-vestigation and service provision (e.g., Pelton, 1997). Thesefindings, however, do not lend support to inherent confounding


of investigation and services. To the contrary, the investigafionoutcome was not related to client safisfaction with the child wel-fare worker.

Certainly, a limitation of these findings is that they do notapply to all child welfare clients—they apply only to that pro-porfion with an open case who have had contact with child wel-fare workers since the investigafion. According to NSCAW esfi-mates, about 18% of the cases that are invesfigated nafionaiiyresult in open, in-home cases in which continued contact existsbetween child welfare workers and caregivers since the invesfi-gafion. Although about four times as many cases are closed fol-lowing the investigation without the provision of any child wel-fare services, only 10% of invesfigafions result in placement ofchildren in out-of-home care. Nonetheless, this analysis is relevantto a substantial proporfion of the more than 1.6 million childrenwho are subjects of invesfigafions each year (U.S. Department ofHealth and Human Services, 2000).

Children and families who remain at home following childabuse reports and invesfigations have been relafively overlookedby researchers, despite the substanfial amount of child welfareacfivity and cost involved in invesfigation (Courtney, 1998). Thismay partly explain why, unfil relafively recently (see Waldfogel,1998), program designers and polic5nTiakers have given little at-tenfion to the quality of services to these families.

These analyses are based on a fragment of the vast evidencethat NSCAW makes available to researchers to leam about theoperation of child welfare services from the perspective ofcaregivers, children (Chapman, Wall, Barth, & the NSCAW Re-search Group, 2002), foster parents (Barth et al., 2003), child wel-fare workers, and independent assessors of children's safety andwell-being. Addifional analyses of this evidence base should bepart of a concerted national effort to extend the state-led effortsto redesign the process by which workers assess families and thechild welfare system engages them, so that the system is more

M. V. Chapman / C. B. Gibbons / R. R Barth / J. S. McCrae / NSCAW 593

responsive to their varying needs and capacifies. Drawing on thelongitudinal nature of NSCAW, which will eventually follow fami-lies for three years, such analyses would seek to better imder-stand the types of families that come into child welfare, usingtj^ologies that include parent and child characterisfics and howwell different types of services benefit these children and fami-lies over

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