Child protective services (CPS) investigates cases of suspected child abuse and neglect, deciding whether to remove children from their home to ensure safety or provide services to children and families in hopes of preserving the family unit. Approximately one-fifth of the 3 million children who experience a CPS investigation each year are placed in out-of-home care or “foster care” within 18 months (U. S Department of Health and Human Services, 2012). In 2019, CPS placed 423,997 children in foster care (Children’s Bureau, 2020). Once in foster care, CPS works hard to reunify children with their parents or find a safe and permanent home if reunification is impossible. However, in reality, children who enter the foster care system remain in care an average of two years (Children’s Rights, 2014), with half experiencing at least one change in placement (Connell et al., 2006). In addition to the negative impacts of child abuse and neglect, this separation from home may add more challenges or trauma for children. Children in out-of-home care are at high risk for socio-emotional, behavioral, and psychological problems (Marinkovic & Backovic, 2007). Out-of-home care also increases the likelihood of adverse outcomes, such as substance abuse (Blome et al., 2009), mental health problems (Hussey & Guo, 2003), and academic failure (Massinga & Pecora, 2004).

CPS-involved caregivers and children often have high levels of service needs (Lee & Logan-Greene, 2017). Examples of their diverse service needs include housing, substance abuse, mental illness, and domestic violence services (D’Andrade & Chambers, 2012; Jarpe-Ratner et al., 2015; Staudt & Cherry, 2009). Intending to meet the needs of caregivers and children and keep children with their families while ensuring their safety, there has been an increased focus on preventive services during the past several decades (Bezeczky et al., 2020; Gilbert et al., 2012). The assumption is, if CPS provides services that meet caregivers’ basic needs, children are less likely to be placed in foster care (Ryan & Schuerman, 2004).

The passage of the 2018 Family First Prevention Services Act (FFPSA) reflects a shift in policy focus from placing children into foster care to strengthening and supporting families. The FFPSA prioritizes in-home services with the goal of preventing children from entering out-of-care. FFPSA directs federal reimbursements to cover preventative and supportive services such as mental health counseling, substance abuse treatment, and in-home parenting training. States may decide to opt into FFPSA at different times, having the ability to delay implementing FFPSA for up to 2 years. Few states opted for early adoption. However, all states must implement FFPSA by October 1, 2021, to prevent losing federal funds for out-of-home care. Given the policy’s emphasis on supporting families through services, the current study will inform potential outcomes of FFPSA once implemented across all the U.S. states through examining the relationship between patterns of in-home service use and out-of-home care risk. By learning what types of services are most likely to prevent out-of-home care, CPS agencies can make special efforts to target families needing these services and collaborate with outside agencies providing evidence-based practice around these service needs. This study is extremely timely and highly relevant as the expiration date for states’ option to delay FFPSA implementation is nearly approaching. Thus, we are soon likely to see a significant increase in the number of states implementing FFSPA.

Risk Conditions Associated with CPS Involvement

Numerous studies have examined risk conditions associated with CPS involvement, including caregiver, family, and child characteristics. Caregiver’s demographic characteristics can be risk factors associated with child welfare involvement. For example, younger mothers are more likely to maltreat their children than older mothers (Baldwin et al., 2020; Lee & Goerge, 1999), given that young mothers may not be ready for child-rearing, which leads to more parenting stress (Easterbrooks et al., 2011). Parenting difficulties are positively associated with child maltreatment (Thomlison, 2004). Ha et al. (2015) found that compared to married mothers, the risk of child maltreatment related to child care burden is more significant for single mothers. Parent educational background is another risk factor for child welfare involvement in terms of demographic characteristics (Baldwin et al., 2020; Black et al., 2001; Thomlison, 2004). Other risk conditions include mothers’ experiences of child maltreatment, caregivers’ poor physical health and mental health, substance abuse, and involvement with the criminal justice system (Black et al., 2001; Courtney et al., 2001; Fegert et al., 2020; Fenerci & Allen, 2018; Needell et al., 1999; Shook, 1999; Thomlison, 2004).

In terms of family risk conditions, family structure, economic hardship, and domestic violence are the main risk factors for child welfare involvement. All these risk conditions can add stress to the family, further increasing the risk of child abuse and neglect. For example, larger family size increases the likelihood of child maltreatment (Baldwin et al., 2020). Poverty, income inequality, housing issues, and unemployment were all found to be positively associated with rates of child maltreatment (Baldwin et al., 2020; Cancian et al., 2013; Eckenrode et al., 2014; Kim & Drake, 2018; Lindo et al., 2018; Lotspeich et al., 2020). Additionally, families that experience domestic violence are disproportionately involved with CPS (Casanueva et al., 2014; Victor et al., 2018) and may be at greater risk for having a substantiated child welfare referral (Victor et al., 2019).

Children involved with the child welfare system are usually exposed to multiple risk conditions related to the abuse and neglect, such as younger age, more siblings, and physical and mental health problems (Black et al., 2001; Courtney et al., 2001; Shook, 1999; Thomlison, 2004). Researchers have found that children with different racial/ethnic backgrounds are subject to child maltreatment at different rates (Putnam-Hornstein et al., 2013). Black children are over-represented in the child welfare system, while White and Latino children are typically underrepresented (Shaw et al., 2008). Children involved with the child welfare system are particularly vulnerable to emotional, mental, and behavioral problems (Gyamfi et al., 2012). Compared to children in the general population, children assessed for maltreatment showed a higher risk of mental health issues such as depression, anxiety, and disassociation (Leslie et al., 2005; Moylan et al., 2010). Maltreatment experiences were significantly associated with children’s internalizing and externalizing behavioral problems (English et al., 2005). Therefore, children involved with the child welfare system are an at-risk population.

Factors Related to the Decision of Out-of-home Care

Researchers have examined factors related to CPS caseworkers’ decisions to place children in out-of-home care. They found that these decisions are primarily influenced by child characteristics, maltreatment characteristics, parent and family perspectives, and caseworker or organizational factors (Grumi et al., 2017). Many studies have found that young children and infants were more likely to be placed in out-of-home care than older children (e.g., Andersen, 2010; Bhatti-Sinclair & Sutcliffe, 2012; Damashek & Bonner, 2010; Glisson & Green, 2006; Rivaux et al., 2008). Further, children of color are more likely to be placed in out-of-home care (Lorthridge et al., 2012). For example, African American children were more likely to be removed from the home for child abuse/neglect than White children (Knott & Donovan, 2010; Sminth & Devore, 2004). Child disability, externalizing behavior problems, and mental health problems are also risk factors associated with out-of-home care (Glisson et al., 2000; Slayter & Springer, 2011; Yampolskaya & Chuang, 2012). In terms of maltreatment characteristics, Zuravin and DePanfilis (1997) found that if families had a recurrence of maltreatment, or more than one type of maltreatment existed in the family, children in these families were more likely to be removed than those in other families. Regarding child maltreatment types, sexual abuse reduced the probability of out-of-home care compared to physical abuse (Bhatti-Sinclair & Sutcliffe., 2012).

Risk factors of the decision making related to parents and family include parent’s poverty, substance abuse, mental health problems, the experience of domestic violence, and parents’ prior child welfare history (Hollinshead et al., 2017; Horwitz et al., 2011; Ogbonnaya & Guo, 2013; Rivaux et al., 2008; Roscoe et al., 2018; Zuravin & DePanfilis, 1997). Some studies found that many children placed in out-of-home care were from single-parent household and they focused on studying mothers, who showed that the above risk factors associated with out-of-home care (e.g. Ahmadabadi et al., 2018; Andrews et al., 2018; Horwitz et al., 2011; Kohl et al., 2011; Wall-Wieler et al., 2018; Zuravin & DePanifills, 1997). Perlman and Fantuzzo (2013) found that use of emergency housing is also predictive of out-of-home care. In addition, referral policy, caseworker’s placement preferences and resources were associated with the placement decision (Grogan-Kaylor, 2000; Huenfner et al., 2010; Jedwab et al., 2020). Among all the factors examined in their study, Bhatti-Sinclair and Sutcliffe (2012) found that child characteristics were more important than the nature of maltreatment and the situation of the household.

Needs and Access to the Services

Children and families involved with the child welfare system have many needs, given their risk conditions. Using administrative data, Chambers and Potter (2008) examined the match between needs and services for high-risk neglecting families. They used cluster analysis and found three clusters: low needs, substance abuse, and economic/domestic violence/mental health. Jarpe-Ratner et al. (2015) used Latent Class Analysis (LCA) to examine the following service needs among child welfare-involved families: mental health, partner violence, post-traumatic stress, resources/residential instability, and substance abuse. They identified four categories: low need, substance abuse, mental health, and high need. Lee and Logan-Greene (2017) also conducted LCA to explore the patterns of service needs for child welfare involved families. They identified four classes: low needs, medical needs, poverty support, and high needs. They found that higher service needs were associated with diminished caregiver-child relationship.

To meet the needs of children and families, after receiving and assessing a child maltreatment report, CPS provides in-home services if the caseworker believes that the child and families can benefit from the services delivered in the home. The primary goal of providing in-home services is to strengthen families so that parents can obtain the resources needed to address the issues that led to, or could lead to, child maltreatment, and children can remain near their support system (Child welfare information gateway, 2014). Because of the negative perspectives of removing children from home (e.g., trauma, instability, and poor well-being outcomes; DeGarmo et al., 2009; Doyle, 2007; Kolko et al., 2010; Testa et al., 2015; Waid et al., 2016), providing in-home services to children and families is important to keep children in the family, and to promote their safety and well-being. Research showed that in-home services provided to families involved with the child welfare system helped improve parents’ disciplinary practices and reduce mental health and substance-related problems, child abuse and neglect, and domestic violence (Parra et al., 2016). For example, an increase in caregiver’s education was associated with the reduced risk of maltreatment and the decreased adolescent risk behaviors (Ben-David et al., 2015). Whitaker et al. (2020) found that behavioral parenting training programs improved outcomes for families at risk of maltreatment and recidivism with child welfare services.

Although services are provided to children and families, the needs of children and caregivers are often unmet (Burns et al., 2004). Unmet needs for mental health are common among children and caregivers involved with the child welfare system (Bunger et al., 2012; Palusci et al., 2010). Burns et al. (2004) analyzed the National Survey of Child and Adolescent Well-Being (NSCAW) data. They found that only about one-fourth of the children with emotional and behavioral problems received services. Burns et al. (2010) tracked 2959 depressed maternal caregivers whose children remained in the home for three years after the first investigation and found that only one-third of caregivers received mental health services. Other researchers have found that economically disconnected caregivers who lack access to financial assistance reported higher unmet needs for basic services, including medical care and housing services (Marcenko et al., 2012). Common factors associated with low service use and unmet needs included child behavior problems, caregiver mental health status, health insurance, transportation, resource and social support, caregiver perceived needs, characteristics of caseworkers and organizations, etc. (Anderson, 2008; Bunger et al., 2012; Coleman & Wu, 2016; Rosen et al., 2004). Therefore, to address risk conditions and prevent out-of-home care, child welfare services should aim to help children and families gain access to the services they need.

The Current Study

Given that the FFPSA policy emphasizes strengthening and supporting families by providing in-home services and many states will soon be implementing FFPSA, it is crucial to explore how child welfare service use patterns influence child out-of-home care risk. Previous child welfare studies have found that in-home services were associated with better child and caregiver well-being and lower rates of out-of-home care (Parra et al., 2016; Ryan & Schuerman, 2004). However, to our knowledge, none of these studies examined the relationship between service use patterns and child out-of-home care. Thus, we used LCA to analyze two waves of NSCAW data and classify individuals receiving in-home services into homogenous subpopulations, examining whether certain patterns of service use are associated with child out-of-home care risk. Study objectives were: (1) To derive service use patterns at wave 1 among children using LCA; (2) To investigate associations between class membership of service use at wave 1 and out-of-home care at wave 2.

Method

NSCAW II Sample Design

Our data comes from the second cohort of the National Survey of Child and Adolescent Well Being (NSCAW II). The NSCAW II is a national study of U.S. children and families investigated by CPS for alleged child abuse and/or neglect between February 2008 and April 2009. Data were drawn from parents/caregivers, child welfare caseworkers, and child interviews. NSCAW II interviewed participants at three time points, including baseline (beginning March 2008 and completed September 2009), 18-month follow-up, and 36-month follow-up. The current study uses baseline (Wave 1) and 18-month follow-up (Wave 2) data.

NSCAW II used a two-stage cluster sampling design. The first stage entailed primary sampling units (PSUs) consisting of 81 counties that were randomly selected across 30 states. The second stage involved randomly selecting one child from each PSU. The entire NSCAW II sample consisted of 5872 children and adolescents aged 0 to 17.5 years. To participate, during the time of study enrollment, participants had to (a) be no greater than 17.5 years old, (b) have no sibling involved in the study, (c) not be a perpetrator in the child abuse investigation, and (d) have no more than one investigation open.

NSCAW II oversampled participants who were living in out-of-home care and infants. These high-risk subgroups were oversampled to ensure there was a large enough sample to produce reliable estimates. Additionally, weights were created to account for this oversampling, the study’s stratified design, and participants’ nonresponse. Statistical weights also allowed study analyses to produce nationally representative findings of the U.S. child welfare population. For additional information about NSCAW II study procedures and weights, see Dowd et al. (2012).

Analyzed Sample

To understand how preventive services implemented as part of the FFPSA of 2018 may impact risk of out-of-home care, we limited the current study’s sample to children and adolescents who remained in the home following the CPS investigation and were provided with formal services following the investigation (n = 2325). Given their involvement with child welfare, we considered these children at risk of out-of-home care.

Measures

Service Receipt

Service receipt was measured during the baseline study period with data from the child welfare worker instrument. This instrument captured a wealth of caregiver, child, and family-level services data. We included measures on the following service types: (a) employment assistance, (b) parent mental health, (c) child mental health, (d) family mental health, (e) caregiver substance abuse treatment, (f) domestic violence, (g) legal assistance, (h) housing assistance, and (i) parenting support. Regarding these service types, caseworkers were asked: Regardless of the outcome of the investigation, have any services been provided to the family? An affirmative response to the provision of each of the service types indicated that the parent/caregiver, child, or family had at least some service contact.

Out-of-Home Care at 18-Month Follow-Up

Out-of-home care was measured using caseworkers’ 18-month follow-up report regarding whether a child was placed in out-of-home care (yes/no).

Demographic and Case Characteristics

Demographic control variables were measured during baseline and included child’s race/ethnicity, child’s age, child’s gender, and primary abuse type. Abuse type was measured using the child welfare caseworker reports on child’s primary maltreatment type in case files. Caseworkers used the Modified Maltreatment Classification System (MMCS; English & the LONGSCAN Investigators, 1997) to identify primary abuse types. For each child, caseworkers reported on all types of maltreatment included in the case report. After listing all types of maltreatment, caseworkers used the MMCS to identify the most significant maltreatment type. Abuse type was coded into one of the following mutually exclusive child maltreatment categories: physical maltreatment, neglect-failure to provide, neglect-lack of supervision, domestic violence exposure, sexual maltreatment, emotional maltreatment, substance-abusing parent, and other (e.g., abandonment and educational maltreatment).

Data Analysis

A regression auxiliary model using the BCH method was used to examine the distinct patterns of various service usage among children who remained in-home following the maltreatment investigation at Wave 1, their contributing factors, as well as how service patterns predict child’s likelihood in future out-of-home care. The BCH method has multiple advantages. It avoids shifts in latent class in the final stage that the 3-step method is susceptible to and performs well when the variance of the auxiliary variable varies substantially across classes (Asparouhov & Muthen, 2014). We first classified the patterns of service use among children at risk of child out-of-home care and saved the BCH weights. Then a general auxiliary model was run conditional on the latent class variable using the BCH weights. The auxiliary model examined the association of factors with service use patterns and the prediction of such patterns on child’s subsequent out-of-home care at Wave 2.

In the classification step, Mplus Version 7.4 (Muthen & Muthen, 1998–2020) evaluated the fit of a two-class solution followed by a three-class solution, and so on, until the ten-class solution. The Bayesian Information Criteria (BIC), Consistent Akaike’s Information Criterion (CAIC), Approximate Weight of Evidence Criterion (AWE), and the adjusted LR chi-square test of exact fit reported overall model fit. The Lo-Mendell-Rubin Adjusted LRT Test (Adj LMR-LRT) compared the fit of the K-class solution with a model with one less class. Non-significant results suggest that a more parsimonious class solution is accurate enough to reflect the data. Relative entropy was used to test the overall precision of classification across all the latent classes. A value ≥ 0.7 indicated an overall good separation of the latent classes (Masyn, 2013). This study employed Full Information Maximum Likelihood (FIML) to address missing data for the analyses (e.g., Enders & Bandalos, 2001).

Results

As shown in Table 1, approximately 30% of children were either White, African American/Black, or Hispanic/Latinx. The average child age was 4 years old. The most reported primary child maltreatment type was other (22%), followed by neglect-lack of supervision (19%), physical abuse (17%), domestic violence (13%), parent substance abuse (11%), and so on.

Table 1 Sample characteristics (N = 2325)
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Model fit results indicated that the six-class model performed the best compared to other classification solutions (see Table 2). However, its relative entropy was lower than 0.7, indicative of poor separation of the class memberships. We excluded it and sought the second-best solution. Three solutions (i.e., the four-class, five-class, and seven class solutions) performed the second best, but the four-class solution was the most parsimonious and its entropy was the only one larger than 0.7. Therefore, we concluded that the four-class solution was the most parsimonious to accurately capture the homogeneity of class membership of service usage among families at risk of child out-of-home care (see Table 3). In this solution, Class 1 (N = 128) was specified by a relatively high probability of receiving housing services. Class 2 (N = 286) was characterized by extremely high probabilities of receiving mental health services for parents, children, and families, which were referred as family-focused services. Class 3 (N = 314) was typified by a majority of parents receiving mental health services and a moderately high probability of families receiving parenting support services, which were referred as parent-focused services. Class 4 (N = 1597), the most prevalent class, was characterized by receiving no services.

Table 2 Fit of competing models
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Table 3 Model responsibilities in latent classes for human services
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After the four-class model was retained, its BCH weight, parents and children’s demographic characteristics and child’s subsequent out-of-home care at Wave 2 were added to the final model, which examined the factors that contributed to patterns of service use and the effect of service patterns on child’s subsequent out-of-home care. Results of the final model suggested that families who experienced domestic violence were more likely to enter Class 1, the housing service only group (OR = 4.53, p = 0.029). Families with older children were more likely to be in Class 2, the family-focused service group (OR = 1.26, p < 0.001). Compared to their White counterparts, Hispanic/Latinx families (OR = 3.16, p = 0.009) were more likely to enter Class 3, the parent-focused service group. Moreover, experiencing domestic violence (OR = 5.46, p = 0.001) and child emotional abuse (OR = 7.37, p = 0.005) were both associated with the likelihood in Class 3 (the parent-focused service group). Finally, Classes 1 (housing service group) and 2 (family-focused service group) did not differ from Class 4 (the no service group) in experiencing subsequently out-of-home place at Wave 2. However, compared to Class 4 (no service group), Class 3 (parent-focused service group), the group of having adult mental health services and partially parenting services, tended to experience a slightly higher risk of experiencing out-of-home care during the 18-month follow-up period (OR = 1.13, p = 0.05). More details are presented in Table 4.

Table 4 Results of demographics predicting latent class membership and latent classes predicting subsequent out-of-home care
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Discussion

The 2018 FFPSA policy aims to strengthen family services and supports, in hopes of preventing children from entering out-of-home care. Early on, many states opted to delay adopting FFSPA. However, states will be required to begin implementing FFPSA by October 1, 2021. If not, they risk losing their FFPSA funding. Thus, knowing that many more states will soon be implementing FFPSA, our study, which examined the relationship between patterns of in-home service use and subsequent child out-of-home care, provides a meaningful policy response. Findings from this study suggest that the parent-service group (Class 3) was at greater risk of out-of-home care than children in families requiring no child welfare services (Class 4). We found no significant association between out-of-home care and any other Class, including Class 2, the family-focused service group. These findings may be explained by the unique demographic and child welfare characteristics associated with each Class. Participants categorized as Class 3 (parent-focused service group) and Class 1 (housing service group) were more likely to have a report of domestic violence as the primary child maltreatment type than physical abuse. Class 3 (parent-focused service group) was also associated with having an increased likelihood of emotional abuse as a primary maltreatment type and being Hispanic/Latinx versus white.

Our finding indicating no relationship between Class 2 (family-focused service group) and out-of-home care, yet a significant relationship between Class 3 (parent-service group) and out-of-home care suggests that mental health services may be most effective at preventing out-of-home care when provided across all domains-parent, child, and family domains. This is likely because parenting practices, parent mental health, and child mental health are interrelated. For example, maternal depression is related to a higher risk of harmful parenting (Chaffin et al., 1996; Lyons-Ruth et al., 2002; Rinehart et al., 2005). Harmful parenting, in turn, is related to youth internalizing and externalizing problems (Bender et al., 2007).

Interestingly, although domestic violence was a primary maltreatment type associated with both Class 1 (housing service group) and Class 3 (parent-focused service group), out-of-home care was only associated with Class 3. Out-of-home care decisions involving domestic violence likely vary depending on the type of domestic violence service need. Examples of common types of domestic violence services include crisis services, legal advocacy services, support group services, individual counseling services and shelter/housing services (Macy et al., 2009). Participants in Class 1 were categorized as needing housing services whereas Class 3 participants were categorized as needing mental health and parenting services. Further, Class 3 differed from Class 1 in that this Class was more likely to include Hispanic/Latinx children and cases of emotional abuse.

Domestic violence may be categorized as emotional maltreatment versus a child maltreatment type in and of itself, and emotional abuse is often reported as a subtype of domestic violence (Black et al., 2020). Whether domestic violence is defined as a maltreatment type may depend on such factors as state/jurisdiction policy or whether a child is directly (e.g., hearing or witnessing, physically intervening in) or indirectly (e.g., experiencing the aftermath of an IPV event) exposed to domestic violence (Child Welfare Information Gateway, 2003). Thus, it is not surprising that, in addition to domestic violence, emotional abuse was a primary maltreatment type associated with Class 3 (parent-focused service group).

Domestic violence negatively impacts families in many ways including increased risk of child maltreatment, substance use, depression, poor parenting, child behavior problems, and homelessness (Lawson, 2019; Ogbonnaya et al., 2019; Victor et al., 2019). In light of the current study’s findings, it seems plausible that the more domestic violence-related service needs families have the more at risk they are for out-of-home care, especially if needing parenting and parent mental health services. Risk for poor parenting behaviors, including the use of physically aggressive discipline, increases when domestic violence is presence in child welfare cases. This risk becomes even greater when the parent is dealing with domestic violence and depression (Ogbonnaya et al., 2019). Thus, the parent-focused services received by participants in Class 3 are likely an indicator of greater child maltreatment risk and could be the reason for their greater out-of-home care risk. Additional research is needed to understand how service needs among families experiencing domestic violence influence child welfare workers’ out-of-home care decisions.

It is also possible that the mental health and parenting services received were not enough to improve parental functioning. For instance, despite having domestic violence as an associated maltreatment type, neither Class 1 nor Class 3 were categorized as having a high probability of receiving domestic violence services. Consideration of such specialized services is essential, as parental risk conditions present barriers to a parent’s capacity to engage fully in services. For instance, although home visiting programs are commonly used in child welfare, maternal depression and domestic violence influence the delivery and outcomes of home visiting services and therefore lessen their effectiveness (Stevens et al., 2002). Additionally, although there is strong empirical support for parenting interventions, parent mental illness and “marital conflict”—factors highly relevant to the child welfare population—serve as barriers to positive outcomes (Kazdin, 2005; Kazdin & Wassell, 1999).

The FFPSA of 2018 allows child welfare agencies to claim Title IV-E reimbursement for prevention services, providing the opportunity for child welfare agencies to consider the specific needs of the populations they serve. To qualify for FFPSA funding, services must be evidence-based or agencies can choose to utilize funds to evaluate programs that are not currently evidence-based (Center for the Study of Social Policy, 2018). Based on our overall study findings, child welfare agencies may consider investing FFPSA funding towards evidence-based domestic violence and mental health services that target the entire family unit (parent, child, and family). Additionally, CPS agencies should provide domestic violence training and institutional guidance and support for domestic violence screening and intervention, recognizing that many domestic violence-affected families have numerous and severe problems, including mental illness. Child welfare and domestic violence services must be integrated to effectively serve parents and children (Holmes et al., 2019).

Our findings showing that Class 3 was at greater risk of out-of-home care and more likely to experience domestic violence and be Hispanic/Latinx, suggests evidence-based services should be developed and provided more for Hispanic/Latinx families experiencing domestic violence and involved with child welfare. Hispanic/Latinx child welfare-involved families tend to have several factors that protect them from child welfare involvement relative to families from other racial/ethnic backgrounds (Drake et al., 2011). However, their child welfare outcomes vary depending on cultural and legal factors such as immigrant status, nativity, and acculturation level (Ciro & Ogbonnaya, 2019; Dettlaff & Berger Cardoso, 2010; Finno-Velasquez, 2013; Finno-Velasquez et al., 2015, 2016). For instance, domestic violence survivors who are Hispanic/Latinx immigrants have reported obstacles to seeking services including language barriers, social isolation, language barriers, and poor awareness of legal rights, law enforcement structures, and social services (Bauer et al., 2000). Thus, it is important that child welfare agencies provide this population culturally appropriate services, taking into consideration these barriers. We recommend further research to understand the role of culture and immigrant status on likelihood of out-of-home care among Hispanic/Latinx children with parents receiving mental health and parenting services, similar to those categorized as Class 3 in the current study.

Limitations

We acknowledge study limitations. Because our study was restricted to NSCAW II data, we were unable to gather additional information regarding services. For examples, services received likely varied based on length, frequency, and intensity. Also, service receipt was measured based on caseworker reports. Thus, it is possible that some reports may be inaccurate. Additional research is needed to understand whether risk of out-of-home care may vary depending on these service characteristics. This research should collect data using multiple informants, including self-reports from parents/caregivers and youth.

Future analyses should also control for factors related to possible associations with decisions of out-of-home care not included in this study (e.g., child disability, externalizing behavior problems, and mental health problems). Due to the complicatedness of the model, we were unable to control for such factors. Although we assumed that services received were based on service needs, including measures specifically designed to assess for such needs could provide a clearer understand of the role of service receipt on out-of-home care. Future studies could explore how patterns of service use buffer the adverse effect of risk factors on placing children in out-of-home care.

The data used in this study were slightly more than ten years old. Notwithstanding, families involved with child welfare have similar service needs (US Department of Health and Human Services, 2020). Thus, findings from this study are likely still relevant. Nonetheless, we recommend similar research using data collected more recently. These data should examine out-of-home care risk comparing outcomes before versus after FFPSA implementation.

Finally, the findings presented in this study only assume an association between service use patterns studied and child out-of-home care risk. In no way do findings prove that the services received (or lack of services) are what caused out-of-care placement.

Conclusions

This study provides valuable information about the combination of services received by child welfare-involved children and families following the maltreatment investigation, and how these services influenced child’s risk of future out-of-home care. We found that, when services were only focused on parents, particularly mental health and parenting services, children were more at risk of out-of-home care than when there were no services received. However, there was no difference in out-of-home care risk comparing the group categorized as receiving combined mental health services for parent, child, and family and the group categorized as receiving no services. These finding suggest that it is not enough to only address parents’ service needs. If wanting to prevent risk of children being placed in out-of-home care, the service needs of children and other family members must also be addressed. Parenting practices and mental health pose a high risk to child well-being, and may present barriers to a parent’s capacity to engage fully in services. Additionally, mental health and parenting services received by parents might not be adequate or timely to improve parental functioning. The FFPSA presents an opportunity to meet the needs of children and families involved with child welfare, allowing greater opportunities to preserve the family unit.