RESEARCH REPORT — Racial Disparities in the Experiences and Outcomes of Crossover Youth by fsuchildwelfare

RESEARCH REPORT

An Examination of Racial Disparities in the Experiences and Outcomes of Crossover Youth JUNE 30, 2020 Principal Investigators: Lodi Rohrer, MSPH Roxann McNeish, Ph.D. University of South Florida

CONTENTS

Abstract................................................................................................................ 1 Project Description............................................................................................... 1 Background..................................................................................................... 1 Method.................................................................................................................. 2

Project Team: Flandra Ismajli, BA/BSW Quynh Tran, BA Andrea Combrink, BSc Jennifer Delva, MPH

Activities........................................................................................................... 2 Research Questions........................................................................................ 3 Design And Procedures................................................................................... 3 Qualitative Study........................................................................................ 3 Quantitative Study...................................................................................... 3

Funded through a contract with the Florida Institute for Child Welfare

Results.................................................................................................................. 4 Qualitative Study............................................................................................. 4 Focus Groups and Document Review........................................................ 4 Organizational and Structural Barriers............................................................ 6 Quantitative Study........................................................................................... 8 Conclusions........................................................................................................ 17 References......................................................................................................... 18

Abstract Crossover youth are a vulnerable population of minors who are involved, or are at risk of involvement, with both the child welfare and juvenile justice systems. This mixed methods study examined whether different models of treatment programs for these youth are effective in meeting the needs of minority families and producing equitable outcomes across racial and ethnic groups. The research team collaborated with two agencies that are contracted with the Florida Department of Children and Families (DCF) to offer treatment programs specifically for crossover youth and their families: National Youth Advocate Program in Jacksonville and Children’s Home Society in Tampa Bay. Data were gathered from focus groups with staff, and a review of agency documents, staff and caregiver surveys, case files, and administrative records. Results suggest that both programs have similar goals and were successful in preventing recidivism during treatment. Caregiver satisfaction and youth outcomes did not differ significantly across racial and ethnic groups. However, there were important differences between agencies in perceptions of obstacles, displays of materials promoting cultural diversity, and types of services provided. Conclusions and limitations of the analysis are discussed.

Project Description BACKGROUND

Racial and ethnic minority children, but especially Black youth, are disproportionately represented in the child welfare and juvenile justice systems,1 resulting in disparate outcomes. Disproportionality, which refers to the “underrepresentation or overrepresentation of a racial or ethnic group compared to its percentage in the total population” (p. 2),2 and disparity, which is the “unequal outcomes of one racial or ethnic group as compared to outcomes for another” (p. 2),2 are attributed to multiple causes. Minority families have elevated levels of need, often because they are subjected to higher rates of poverty.3 These families encounter racial discrimination by system professionals, largely as a result of both the child welfare and juvenile justice systems operating on the foundation of European American middle-class standards. This bias influences interactions between staff, who are more often White,2 and families, who are more often people of color.1 Researchers have found that cultural and socioeconomic differences in the use of language, use of direct or indirect communication, expression of anger, and approaches to parenting can be misinterpreted as noncompliance or hostility on the part of caregivers, leading to increasingly punitive outcomes.4 This bias also affects decision making at multiple points, such

as arrests or protective investigations.4,2 Further, Black youth in particular are “hyper-criminalized” in multiple settings, including school.5 Stressful and burdensome working conditions have also been found to cause discriminatory communication and decisionmaking as “under such conditions, workers may not provide thoughtful, reflective responses” (p. 88).4 These patterns are exaggerated for crossover youth and their families, including the extent to which minority children—but especially Black youth—are overrepresented in this population. Crossover youth is an umbrella term used to describe all minors who are involved, or at risk of involvement, with both the child welfare and juvenile justice systems.7 While exact numbers are unknown, up to 29 percent of youth in the child welfare system have engaged in delinquency and up to 50 percent of youth in juvenile court have dual system contact.6 These youth are exposed to a greater number of risk factors, are supported by fewer protective factors, and have a wider range of unmet needs than youth involved in only one system. Compared to youth in only one system, they are at higher risk of being exposed to violence, abuse, mental illness, substance abuse,7 and academic difficulties.8 They enter the juvenile justice system at a younger age and less often come from families with high levels of support and supervision.9 These youth are also increasingly represented at deeper levels of child welfare and juvenile justice involvement, such as those with probation supervision cases or those in residential treatment centers.6 The causes and extent of disproportionality and disparate outcomes of minority youth involved in one or multiple systems are well documented. Researchers have moved past studying these problems to instead studying possible solutions (Child Welfare Information Gateway, 2016).2 There is little information available about successfully treating crossover youth, but the Crossover Youth Practice Model has emerged as a prominent model, particularly for its ability to introduce greater interagency collaboration and decision-making.10, 7 There are fewer, if any, studies documenting possible solutions for crossover youth from minority backgrounds. Our research team was interested in investigated an existing evidence-informed program, the Constant and Never Ending Improvement (CANEI) program from the National Youth Advocate Program (NYAP), for its possible use in addressing disparate outcomes among racial and ethnic minority youth. The program integrates multiple evidence-based or evidenceinformed practices that have been shown to improve outcomes among families in care. These include: 1) the positive youth development approach, which “focuses on protective factors or the assets of youth … [and] embraces the concept of youth as having the capacity to thrive, defined as ‘fulfilling one’s potential and contributing positively to one’s community’” (p. 1); 2) resilience theory, which examines how people can overcome individual vulnerabilities and environmental adversities, largely “within networks of social relationships with family, friends, school, colleagues and neighbourhoods” (p. 8);13 3) Wraparound practices, which guide practitioners so that they provide families with “individualized, family-driven and youth-guided support that is community based and culturally competent” (p. 1);14 and 4) multisystemic therapy, a home-based model rooted in the understanding that individual behaviors are directly and indirectly influenced by multiple systems, that delivers “effective crisis management and high levels of direct service for each family” (p. 2), and has been shown to be effective with youth affected by “serious offending, delinquency, substance abuse, and parental physical abuse and neglect” (p. 1).15 The CANEI program also informally uses evidence-based or evidence-informed practices that have been shown to specifically address the needs of racial

and ethnic minorities, such as family group decision making.16 CANEI is currently categorized as evidence informed. We found one published case study examining the effectiveness of treatment for 16 youth enrolled in a CANEI program in 2008. At case closure, 100 percent of youth were successfully discharged, lived in a stable home environment, were enrolled in an educational program, and demonstrated increased scores on the Children’s Global Assessment Scale.11 Eighty percent did not report any new criminal activity two months before discharge.11 At three, six, and 12 months follow-up, 100 percent of youth remained in their placement, lived in a stable home environment, were employed or enrolled in a vocational training program, and did not report new criminal activity.11 With rigorous use of evidence-informed or evidence-based practices; an emphasis on individual resilience and community integration; positive results in a small case study; and application within a racially diverse setting (Jacksonville, Florida), the research team believes that CANEI offers us an important opportunity to measure how well an existing care program can alleviate racial and ethnic disparities among crossover youth, without introducing a new model or intervention.

Method

ACTIVITIES For this study, the research team collaborated with two agencies that are contracted to provide services for crossover youth and their families, the National Youth Advocate Program (NYAP) in Jacksonville and the Children’s Home Society (CHS) in Tampa Bay. In December 2017, the Florida Department of Children and Families (DCF) awarded contracts to NYAP and CHS to implement specialized treatment programs for 20 crossover youth (ages 11–17) each month. The programs are required to provide individualized treatment services to the youth and their family, including a screening and intake assessment, treatment planning, family counseling, youth group sessions, parenting skills training, therapeutic mentorship, case management, school engagement support or vocational training, independent living services, 24/7 mobile crisis support, discharge planning, and follow-up services. Youth and their families typically remain in treatment for four to six months. As of June 2020, CHS had served 83 crossover youth. Most recent reports from NYAP show that they have served 108 youth as of January 2019. Figure 1. Map of Florida’s Crossover Youth Programs in the Study Nassau Duval Clay

Pasco Hillsborough Pinellas

Children’s Home Society National Youth Advocate Program

Florida map courtesy of Free Vector Maps.com

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Each provider offers a unique set of services to meet the needs of the population. As described earlier, NYAP is implementing an evidence-informed model called Constant and Never Ending Improvement (CANEI).11 CHS treats crossover youth through its Promoting Stability for Youth program (PS4Y). Although CHS does not utilize a specific program model, they incorporate several promising practices, such as the use of standardized assessments and Wraparound principles. In spite of these different approaches, both programs have the same goals of ensuring a successful transition from juvenile justice facilities and permanency for youth and their families.

RESEARCH QUESTIONS The following research questions guide this study: 1) What are the essential components of the above programs, particularly the services that have been adapted or designed to meet the needs of crossover youth from racial and ethnic minority backgrounds? 2) a) What program components contribute to positive experiences and outcomes for minority youth and families? b) What are the perceptions of families regarding the appropriateness, effectiveness, and cultural responsiveness of treatment planning and/or service provision in the programs? 3) a) What are the similarities and differences in outcomes for minority youth based on program type? b) Specifically, do the treatment programs produce equitable outcomes in terms of recidivism, recurrence of maltreatment, treatment completion, and self-reported academic/vocational engagement?

DESIGN AND PROCEDURES The study utilizes a mixed methods approach. Primary data were collected via focus groups with administrators and staff as well as surveys that were distributed to administrators, staff, and caregivers. Secondary data were collected from program policy document reviews, case file reviews, and by accessing records and databases maintained by each agency. Qualitative Study To examine RQs 1 and 2, the team conducted a review of documents that outline each program’s structure, design, goals, and intended outcomes. In addition, team members facilitated semi-structured focus groups with supervisors, case managers, and therapists within each treatment program. Staff discussed topics relevant to service delivery for racial and ethnic minorities in the treatment program. Questions addressed perceived challenges and opportunities when providing services to these families; personal barriers when interacting with different types of families; agency policies and programs that support or impede the provision of culturally responsive services; techniques used to address risks and incorporate relevant supports into treatment; and the extent to which each model was being carried out as intended. Focus group sessions were professionally transcribed and subsequently coded. Three members of the research team conducted an analysis of the transcripts to increase inter-rater reliability. Grounded, thematic coding was utilized to identify findings that emerged from the focus group data, including comparing responses across programs.

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Quantitative Study To examine RQ 1, the research team administered a checklist to supervisors, case managers, and therapists within each treatment program. The self-assessment checklist, called Promoting Cultural Diversity and Cultural Competency (PCDCC), was originally developed by the National Center for Cultural Competence as a self-assessment checklist for personnel who provide behavioral health services and supports to children and their families (a copy of the PCDCC is provided in Appendix G).18 The PCDCC contains three domains and asks participants to rate their agency’s efforts to enhance cultural competency. Domains include: 1) physical environment, materials, and resources; 2) communication styles; and 3) values and attitudes. Each item is rated from A to C, where A (or 1) = things I do frequently, or statement applies to me to a great degree; B (or 2) = things I do occasionally, or statement applies to me a moderate degree; and C (or 3) = things I do rarely or never, or statement applies to me to a minimal degree or not at all. Thus, lower scores indicate a greater degree of cultural competency within the organization. Statistical analysis of responses was conducted using SPSS Statistics 26. To examine RQ 3, and to provide additional information to examine RQ 2, the research team created an electronic survey using Qualtrics to assess the experiences of families as minorities in treatment (see Appendix H). Caregivers were asked to complete a modified version of the Quality of Care (QOC) survey.19 Some items, such as those related to cultural background or crossover youth status, were added, while other items, such as those related to pediatric symptoms or medication, were removed. The finalized survey contained 86 questions and sub-questions, including those used to collect demographic information. The modified QOC provided a more in-depth assessment of families’ perceptions of care, including program accessibility, appropriateness, effectiveness, and cultural responsiveness. Upon completion of the survey, caregivers were given the option of providing their contact information so that they could be mailed a $10 gift card. We asked staff to provide recruitment flyers (see Appendix B) to caregivers as they neared the end of treatment to advertise the study. Families could then use one of three methods listed on the recruitment flyer to complete the survey—to use the Qualtrics link and complete the survey online individually; call or email the research team and complete the survey by phone or email; or give permission to the research team to call the caregiver and complete the survey by phone. The research team asked CHS to begin flyer distribution on September 25, 2019; and NYAP to begin on November 18, 2019. Both agencies also included the survey in their post-care assessments. To examine RQ 3, the research team requested administrative data from NYAP and CHS so that we could assess whether outcomes varied for minority youth and families by treatment program. We requested data on all youth admitted to the program as of January 1, 2019. The administrative data we received included information about race/ethnicity, gender, age, length of treatment, and discharge status. Only CHS provided the results of assessments that are administered at multiple time points to measure progress. The research team compared discharge and post-discharge outcomes across racial groups both within and between treatment programs, such as whether the youth remained in the home. The analytic approach consisted of one sample or independent samples t-tests for continuous outcomes and chi-square tests of independence for categorical outcomes. For assessments that were administered at multiple time points at CHS, difference scores served as the outcome variable. The primary predictor variables of interest were race and ethnicity, and

t-tests were used to determine if specific groups had a significant improvement in scores from admission to discharge. To further examine RQ 2, as well as RQ 3, the research team conducted a comprehensive on-site review of 15 case files of discharged youth from each program. The research team developed a case file review protocol focused on gathering information related to case completion and service provision (see Appendix C). The protocol included examining the reason for referral and discharge, placement at referral and discharge, recommended services, challenges to completing services, concerns raised by minority families, how concerns were addressed, and relevant discharge and post-discharge outcomes, such as changes in functioning and academic reengagement. Comparisons were made across programs as well as categories of race/ethnicity.

Results

QUALITATIVE STUDY Focus Groups and Document Review Using data drawn from focus group analysis and document review, the research team was able to learn more about the nature of each agency’s crossover youth program. The research team requested documents that guided agency practice. CHS returned a blank monthly data report log, a blank quarterly outcome measures template, the CHS Team Member Training Plan guide, and the Organizational Wraparound Readiness Assessment Protocol guide. NYAP returned a CANEI program flyer, a list of mandatory trainings, and, as requested by the research team, brief descriptions on six trainings. These documents helped describe crossover youth program guidelines and operations, from training to care provision to outcome measurement. The research team also conducted three focus groups in total, all audio recorded with permission from agency staff. The first was conducted with NYAP in November 2019. A total of ten employees participated, including case managers, therapists, and supervisors. The team then conducted a focus group with CHS in January 2020. Seven case managers, therapists, and supervisors participated. Following the first focus group with NYAP, researchers modified some of the focus group questions to include more to include more questions related to care provided to minority families at the individual, organizational, and community level. The research team found considerably more success in gathering relevant data during the CHS focus group with this revised version of the focus group guide. We asked NYAP to schedule a second focus group, which they agreed to do in May 2020. We used the revised focus group guide during this session and added a few questions about how services were being completed during the COVID-19 virus pandemic. Seven of the original 10 participants took part in this second focus group. Our analysis is drawn from the only focus group session with CHS and the second focus group session with NYAP. After sending the audio files of these sessions to an external agency for transcription, three members of the research team conducted theme analysis. Each member read the two focus group transcripts. They then created their own codes largely driven by the topics framed within each question as well as the concepts that emerged from both dialogues. The team met again to discuss their findings and finalize the list of codes, which was used to finalize how each quote was coded. The list totaled 28 codes, which relate to program functioning, relationships among staff, organizational support, identity, and other topics. From these

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codes, the team found three emerging themes: program structure and implementation, micro and macro level barriers to effective care provision, and the needs of minority families and staff. Program Structure and Implementation Focus group participants offered information about the nature of their agency’s crossover youth program, which included the purpose of their program, staff roles and responsibilities, caseload and frequency of contact with families, characteristics of their client base, among other details. Case and Treatment Planning Both agencies collaborated with families to complete assessments and create treatment plans. Staff used assessments to guide conversations with their families about their history, needs, strengths, and goals. CHS used multiple assessments formatted in their agency’s unique template; this included biopsychosocial assessments and Wraparound notes. Staff provided multiple instances of how needs, strengths, and goals were implemented into treatment plans so that care was tailored to each family. In one case, treatment was scheduled so that services were completed before Ramadan, so as not to interfere with observation of the Muslim holiday. In another, the team “incorporated [the client’s] quirky nature” into the treatment plan. After learning about the youth’s interest in gaming, staff assigned the client with the task of inventing a game, one which reflected his progression with services. Staff had the client “create this ideal game because he was a gamer… he's got to be at a game in order to move up or move out. And then how that evolves and, and what the goal of the game is going to be. So, it's written in a way so that it becomes part of the game.” NYAP also used assessment tools to guide conversations with families. NYAP used multiple standardized instruments, such as the Adult-Adolescent Parenting Inventory or the Structured Assessment of Violence Risk in Youth, as well as self-assessments. Treatment plans were individualized and updated at least monthly; “we're going to develop this document but it's not a dead document.” Neither agency had difficulty identifying what a family needed because families were upfront with their concerns and requests. CHS did not have a time limit for cases. NYAP did not specify an exact time limit but noted that most cases ended at eight to nine months. Required Training Both agencies required their workers to complete an extensive number of trainings. CHS required staff to complete nearly 50 trainings within their first 180 days, depending on their position. Some, like safety trainings, were repeated annually. The trainings relevant to working with vulnerable and minority populations include: Introduction to LGBTQ Cultural Competency, Diversity and Cultural Competence, Introduction to Domestic Violence, Human Trafficking 101, Advanced Co-Occurring Disorder, Introduction to Trauma Informed Care, Civil Rights: Title IV and ADA, Children and Meth, and Children and Trauma. These trainings were all completed by staff one time. Promoting Stability for Youth staff also completed a training for Wraparound, an evidence-based model for service delivery in child welfare that emphasizes providing culturally competent care, embedded within a family’s natural supports, that views a family as partners in decision-making (National Wraparound Initiative, 2020).20 NYAP staff completed 50 to 70 trainings within their first 180 days, depending on their position. The trainings relevant to working with vulnerable and minority populations include: Diversity and

Inclusion, Introduction to Cultural Competency, Indian Child Welfare Act of 1978, Trauma Informed Care, and Foster Care’s Invisible Youth: LGBTQ+ Training. Overall the two agencies had a similar number of required trainings as well as variety of trainings related to servicing minorities. Characteristics of Families Served The Children’s Home Society served families from a variety of backgrounds across Pinellas, Pasco, and Hillsborough Counties. These families were predominately Black, White, Hispanic/Latino, or multiracial. A few families required interpretation and translation services. CHS had one staff member who spoke both English and Spanish, so the program was able to provide services to Spanishspeaking families without issue. Participants noted that the gap between the number of male and female cases was narrowing but did not specify a ratio. When asked to describe types of families served, participants explained that they often provided services to youth being raised by single parents or grandparents. Working with grandparents posed a significant challenge. As one participant said: “That’s a particularly difficult population because you're dealing with traditional values that are sort of clash even with today's world.... their own guilt about their children's choices and that they as a grandparent may not have done what was right. And trying to work and balance this out with, with the family is I think probably one of the hardest challenges that we've really faced.” Among the most commonly cited needs that families often dealt with were multigenerational trauma, mental illness, substance abuse, physical or sexual abuse, and a lack of basic resources. The National Youth Advocate Program provided approximate figures for its client base in 2019: youth were 80 percent Black, 19 percent White, and 1 percent Hispanic/Latino. The focus group reflected on the fact that these numbers were not representative of the county population as a whole: “there's a huge Croatian population here. We’ve not seen any kids from that background. We don’t see a lot from Hispanic [backgrounds] and there’s a very big Hispanic population here. It’s very rare.” The CANEI program did not have multilingual staff; however, staff did not face issues as they received few, if any, referrals for families with limited English proficiency. Three in four cases involved male clients; one in four involved female clients. Staff often provided services to youth being raised by single parents, foster parents, grandparents, and friends of the family. Families dealt with multigenerational trauma, abandonment, mental illness, substance abuse, and poverty. They also dealt with environmental issues, such as a lack of social support or community resources. Progress and Outcome Measurement Both agencies provided information about outcome measurement, either in their focus group or document submission. CHS measured outcomes using a monthly and quarterly log. Items included the number of referrals received; number of face to face contacts; entry and discharge of cases; discharge to a higher, lower, or identical level of care at three; six and 12 months follow up; juvenile justice violations or criminal charges at three, six, and 12 months follow up; and enrollment in a school or vocational

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program at three, six, and 12 months follow up. In their focus group, CHS staff shared that they had a 98 percent success rate in preventing recidivism in the child welfare and juvenile justice systems but did not specify a timeframe. NYAP did not provide a template to illuminate what data they track during their document review. However, the research team did find a follow up form, used at three, six, and 12 months, that asked about level of care, juvenile justice violations or criminal charges, and enrollment in school or vocational programs, as well as needs and supports. NYAP offered the following statistics in their program flyer: “93% of youth are in the same placement they were at discharge; 93% of youth are free of new juvenile justice involvement; 91% of youth continue to be enrolled in an educational or vocational training program or are employed.” The timeframe was not specified. Barriers to Service Provision Individual and Family Barriers Participants spent a large portion of their respective focus group sessions discussing engagement barriers and strategies. Barriers were found at all levels; however, the research team noticed a difference in the way these were discussed by both agencies. CHS listed a variety of both micro- and macro-level barriers, heavily focusing on macro-level barriers such as funding sources, lack of organizational networking, and political climate. NYAP listed a variety of micro- and macro-level barriers but named fewer macro-level barriers overall. We discussed barriers and strategies from the individual and family level to the organizational and cultural level. Families were said to be hesitant or resistant to enrollment and completion of services for multiple reasons. One of the most common reasons was that families were exhausted by previous involvement with child welfare, juvenile justice, or other systems. They reported feeling ignored, frustrated, or misunderstood as a result of past interactions with case managers, counselors, or other professionals. This manifested in a variety of ways, including delaying care, such as when children refused to speak during counseling sessions; “A lot of times these kids have already had counseling and it's like, ‘You’re just one more counselor. You're just going to leave just like the rest of them.’ … It's like they don't want to open up for three, four months, which is hard when we are on a deadline.” While all families were said to have dealt with “systemic abuses,” both agencies acknowledged that minority families were left feeling particularly helpless as a result of racial discrimination. One participant brought up an example of such discrimination by reflecting on a glaring discrepancy in treatment between Black and White youth: But our Black males that are in the DJJ system, by and far, they go to detention centers. They get held to a much higher standard as far as how their crimes are looked at as opposed to a White male. White males in the program that have had 10 auto theft charges and they just keep halving their charge… then we’ll have a Black male that will steal one car and they are pushing the sentence to a detention center. So I think we see that with primarily every case that we get that’s a DJJ or a crossover case. Both groups added that the accumulation of such experiences caused varying degrees of distance or distrust between clients and practitioners of different racial or ethnic backgrounds.

In severe cases, a client would refuse to work with a practitioner altogether: We’ve got four therapists. One is a Black male, one is a Black female, and two White females. And by far the White females have had a harder time… being able to make true connections with Black males… I think it’s a cultural stigma obviously… I also think part of it comes in from, what we see with a lot of our Black males is they just don’t trust women. So, they have a hard time relating to a White female. Downright, ‘I’m not working with you. You’re White.’ Staff used many strategies to overcome feelings of exhaustion or alienation among families. In some cases, clients were intentionally paired with a practitioner from a similar background. “Even on my team, which is a White female and a Black male, who don’t connect [with] me normally connect with her. So, you got to balance it.” Nearly all focus group participants from minority backgrounds shared that their identities and experiences helped them gain a family’s trust, often in a fairly short amount of time. One participant strongly advocated for racial and ethnic matching of clients and practitioners for this reason: “Being an African American woman, my interaction[s] with African American families are completely different. Immediately as soon as they see me and I’m going to be honest, a sigh of relief crosses their face… they’re like, ‘Oh my God, finally.’” Participants added that connecting with families was not limited to similarities in racial and ethnic background. In some cases, intersecting identities like gender, age, religion, or socioeconomic status played an important role. Some participants found that intersecting identities could facilitate engagement, such as one who explained, “I’m an older Black male… I’m older than the parents…I find with my identity it’s easier to communicate with the families.” Others found that it could inhibit engagement. In a debate about the necessity of racial matching among clients, one participant shared an example of a time when class became a divisive issue between her and her clients, despite a similar racial background: One of the things when I first started working with domestic violence victims was a lot of the Black women wouldn’t work with me. They hated me… [My mentor] explained socioeconomics. I pulled up in three different cars every other day… that’s who they thought I was. I didn’t realize that unintentionally they thought, ‘Well, you think you're better than us.’… I did not know that in their eyes, it was just like, ‘You don’t understand anything about me. You are a Black woman. Yeah sure you are. You ain’t Black enough.’ Just being a Black woman with natural hair does not make me the authority. The group overall found that while racial matching was effective, it was not a necessity, and in many ways an impracticality considering the demographic differences between staff and families. When staff could not connect with families on the basis of background—or when connecting by background provided to be insufficient—they shared their own experiences with illness, violence, poverty, and trauma to connect with clients. Sometimes families were surprised to learn about the presence of hardship in their practitioner’s lives. These hardships often gave practitioners more credibility in their efforts to help. As one focus group participant said, “All of my girls have been raped or sexually abused. And that’s one of the questions that they always ask, ‘Well, how could you understand if you haven’t been? And so you can’t help me because you haven’t been.’ And I have been, so I’m able to just say, ‘I know where you’re coming from.’”

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Participants used other techniques, many of which centered on showing empathy or providing goods. Staff reassured families that services were meant for whole families, not just youth. “They’re happy that we work with them. They’re like, ‘So you’re going to talk to me too?’” They avoided bringing paperwork to introductory meetings, used humor to lighten the mood, encouraged families to ask questions and share concerns, and avoided formal speech or jargon to use familiar speech instead— “If they’re dropping F-bombs, I will make them feel at home.” They emphasized choice and individualization in treatment planning, which was important for crafting culturally sensitive plans, such as those that scheduled around holidays and followed gender norms. One family, for example, required a driver of the same sex during transportation due to gender norms within their religion. Both agencies believed bonding around food was important, as were culturally sensitive rejections of food. Consistency in service and communication was one of the most important ways to ensure families stayed in services, especially to combat weariness from past involvement. We asked NYAP to explain how stay-at-home orders during the Covid-19 pandemic were affecting services. Staff were considered essential workers, so they continued providing services, but almost all faced increased difficulty trying to engage youth and caregivers. Many families were fearful of exposure to the virus and were facing employment loss. One participant added that virtual formats overall made disengagement easier. “I think it’s more that they feel like they can just avoid having to participate sometimes… It’s harder to do when you’re actually there, they have to see us.” Staff tried re-engaging families through constant texts and calls, which was most helpful for youth. ORGANIZATIONAL AND STRUCTURAL BARRIERS CHS and NYAP shared similar engagement barriers and strategies. They also held a similar understanding of the importance of identity and experience. The two, however, differed from one another when discussing issues of organizational and structural barriers. CHS believed that their efforts to provide adequate services to families, minority or not, were greatly suppressed by issues related to funding, deadlines, training, education, and networking. These views were expressed as critiques of the entire fields of child welfare and juvenile justice, not as critiques of their agency exclusively. Child welfare and juvenile justice professionals were limited by issues of poor funding, stressful workloads, and frequent driving. The agency, for example, employs a small group, but provides services across an expansive area. “We cover Pinellas, Pasco and Hillsborough. At one point they wanted us to cover all the Suncoast region. It’s like ‘Whoa, three people.’” The agency’s current funding source holds strict deadlines, many of which are left unmet. Staff felt that these deadlines were inconsiderate to families’ needs. One explained, “with families who are dealing with such trauma, it takes weeks, sometimes months to get the child to even say hello… [but] I have that clock that says the bio[psychosocial] has to be done by day three.” They also felt that forcing families to fill out paperwork during introductions, a time when staff would rather build rapport, made engagement more difficult. A few participants were dissatisfied with the way funding was structured, believing it could be better invested in much needed services like interpretation. Staff found that while they had considerable support from their team and supervisor, they were isolated from upper management, partially because of the size of the entire organization. One participant believed opportunities to network within the organization would benefit everyone and help them become educated about trends in the communities they serve.

On the topic of training and education, nearly all participants at CHS felt that their training and education was burdensome and inadequate. Staff took it upon themselves to research how best to provide services to minority families, but were frustrated by taking on this extra task, especially when it required sorting through many sources. “Tell me where it is so I can go get it... that’s my headache.” Required trainings, which were done by computers in isolated settings, were rushed and did not provide opportunities for discussion or exploration; “I can’t even remember the details of the cultural competency training.” Staff also felt that human services education did not prepare students for the realities of the job, often reducing the complexities of realworld cases in classroom settings. One participant described having conversations with a friend to help them understand what working with families really looks like; “It’s helped out and she’s working in a school system now and she has a better grip of how to approach different situations than what the textbooks gave.” Participants felt that discussions with other professionals helped them work through topics like treating complex needs or providing culturally competent care. They suggested that organizations mandate dialogue-based trainings and open avenues to direct contact with upper management. Staff also felt that policymakers were passing legislation that ultimately ignored the expertise of child welfare professionals. In the CHS focus group, participants discussed recently passed legislation that called for group home closure in fall 2020. Participants were shocked and confused by this change, expressing that it was made by those who have minimal (if any) involvement in the child welfare system. One participant was outraged. Another expressed sadness for the disruption these children would experience: “The reality is, it’s the kids who they pour the salt in the wound and rip the Band-Aid off. Because now they moved to a whole other system. They didn’t even understand the first system. Now they’re in adoptions… We wonder why kids are anxious. Well, guess what? We just did it.” NYAP did not express the same complaints, believing that they had strong agency support and organizational support. Within the agency, staff drew support from one another, especially when youth were difficult to engage. Within upper management, one participant cited involvement by the organization’s CEO in the well-being of both staff and families as evidence of a supportive system: Our CEO is a social worker at heart and she’s amazing throughout this process. I mean, we have ten different [locations]. And on a fairly regular basis she’s texted me and said, ‘Hey, is your staff doing okay? Do you guys need anything?’ We have almost 2,000 employees... She actually remembered that [client name] and [client name] are both single moms. ‘Are their day cares closed? Is there anything we can do to help them? If they need to bring the kids into work, they can.’… Those little touches are really what makes our company different. Participants also described a positive relationship with a community partner that enables better service provision: As far as processes go, I don’t think we’ve had any issues. I mean, our court’s super supportive here. We actually have a crossover court here in Jacksonville… If a child is both in foster care and the dependency system, to alleviate the amount of time the foster parents or kinship caregivers are having to bring that child to court, they move everything in one court setting. Our court system’s super supportive. Our lead agency is amazing. So, I don't think we've had any other external challenges.

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NYAP staff added further that they believe their trainings were “adequate” and provided core skills needed for service. Needs of Minority Families and Staff Staff from both agencies reported specific needs among minority families based on cultural and religious values. Most comments were made by African American staff about their work with African American families. First, minority families broached stigmatized topics differently than majority families. Families held a wide variety of attitudes about mental illness or developmental disability, from denying a diagnosis to seeking a diagnosis for disability support. Families that denied illness usually framed problems as moral or behavioral. As one participant pointed out, “My families aren’t using that language. They’re not using terms like bipolar and ADHD. They’re bad. These kids are spoiled. And again, that’s cultural.” These families suggested solutions to their child’s troubles through physical or social activity, like ‘playing basketball.’ By understanding language and attitudes around stigma, staff were able to point out when families needed a culturally sensitive and oftentimes trauma-informed approach to psychoeducation. For example, reframing behavioral issues as having neurological roots greatly helped families understand their diagnoses. Second, families expressed great fear within their environments. One participant discussed partnering with leaders in minority communities to facilitate community activism, such as using churches to provide services. Others quickly pointed out, however, that many families were burdened by daily obligations and growing fears, making the prospect of grassroots activism unlikely. One participant alluded to the impact that the current political climate has had on minority families: My families are afraid. They trust no one right now. They’re not doing anything outside of work, church and home. They’re afraid to shop. They’re afraid to drive. They’re afraid.… I’m talking about people who are actually gearing up, where we are in January [2020], who are actually gearing up for the hell that’s coming to us at election time. That’s what I’m dealing with in my families. I don’t say these things to frighten you… The fear is this nation right now, especially amongst people of color is unreal. They want to do nothing except get home alive… ‘Maybe I should volunteer?’ [then] like ‘Nope I’m going home; all my children home by eight o’clock. I trust no one, I want to go home.’ CHS staff pointed out that they were not equipped with the language tools needed to provide services to families who did not speak a common minority language, such as Spanish. One participant brought up how they had to reject a referral for a family that spoke a Micronesian language because they could not find an interpreter. They suggested using a program that could connect workers to interpreters instantly, which a few team members had used before in other agencies. Minority staff listed one primary need, which was the need to receive support from others, especially when dealing with harassment and discrimination on the job. Both agencies reported that their coworkers and supervisors offered strong support on this issue. One participant described a situation in which a Black practitioner was harassed by a White client. The team intervened: “She did have early-on issues with a White family being very racist with her. And we all had a big basically coming-to-Jesus talk of, “This is not okay. You can’t treat people like this.’… And it really turned around for them.” Another thanked their supervisor

for listening and taking action when she reported concerns, such as fears of traveling through a neighborhood with Confederate flags. In general, staff members explained that they relied on one another for support and information, citing it as a strength in the program. Whether it was to learn about a culture, increase engagement, or vent about work frustrations, both agencies expressed gratitude for the camaraderie among staff. Several participants believed that their interactions with staff, but especially minority staff, helped them learn about their families more so than their education and training did. QUANTITATIVE STUDY This section describes results of the quantitative components of the study, including the staff and administrator survey, caregiver survey, case file reviews, and administrative data. Each component is analyzed with a special focus on differences between agencies and categories of race/ethnicity. Staff and Administrator Survey Results of the Promoting Cultural Diversity and Cultural Competency survey (PCDCC) are shown in Table 1. Eight employees from NYAP and seven employees from CHS completed the paper-pencil survey in person prior to participating in their respective focus group session. Data were entered into SPSS Statistics 26 for analysis. For the majority of the items, mean scores obtained from employees were not statistically different across programs based on independent samples t-tests. However, there were significant differences on items 1â&#x20AC;&#x201C;4, with NYAP respondents indicating that they frequently enhance their physical environment with materials and resources to promote cultural diversity and cultural competency. In addition, even on the items for which no statistically significant difference was found, NYAP consistently had lower (i.e., better) scores on the measures. Table 1. Scores by Agency on the Promoting Cultural Diversity and Cultural Competency Survey NYAP

CHS

n=8

n=7

Item

I display pictures, posters and other materials that reflect the cultures and ethnic backgrounds of children, youth, and families served by my program or agency.

1.63

.916

2.71

.756

2.49

.027

I ensure that magazines, brochures, and other printed materials in reception areas are of interest to and reflect the different cultures of children, youth, and families served by my program or agency.

2.00

.926

3.00

.000

3.06

.018

When using videos, films, CDs, DVDS, or oth-er media resources for mental health prevention, treatment or other interventions, I ensure that they reflect the cultures of children, youth, and families served by my program or agen-cy.

1.13

.354

2.71

.756

5.34

.000

When using food during an assessment, I en-sure that meals provided include foods that are unique to the cultural and ethnic back-grounds of children, youth, and families served by my program or agency.

1.75

.707

3.00

.000

5.00

.002

I ensure that toys and other play accessories in reception areas and those which are used during assessment are representative of the various cultural and ethnic groups within the local community and the society in general.

2.13

.991

2.71

.488

1.49

.166

For children and youth who speak languages or dialects other than English, I attempt to learn and use key words in their language so that I am better able to communicate with them during assessment, treatment, or other interventions.

1.75

.886

2.14

.900

0.85

.410

I attempt to determine any familial colloquialisms used by children, youth, and families that may impact assessment, treatment, or other interventions.

1.50

.756

1.86

.900

0.84

.418

I use visual aids, gestures, and physical prompts in my interactions with children and youth who have limited English proficiency.

1.88

.835

2.29

.951

0.89

.389

I use bilingual or multilingual staff or trained/certified interpreters for assessment, treatment, and other interventions with children and youth who have limited English proficiency.

2.25

.886

2.71

.756

1.08

.299

I use bilingual staff or multilingual trained/certified interpreters during assessments, treatment sessions, meetings, and for other events for families who would require this level of assistance.

2.38

.744

2.71

.756

0.88

.398

11a

When interacting with parents who have limited English proficiency, I always keep in mind that limitations in English proficiency are in no way a reflection of their level of intellectual functioning.

1.25

.707

1.86

1.069

1.28

.230

11b

When interacting with parents who have limited English proficiency, I always keep in mind that their limited ability to speak the language of the dominant culture has no bearing on their ability to communicate effectively in their language of origin.

1.25

.707

1.86

1.069

1.28

.230

Table continued on page 9

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Table 1. Scores by Agency on the Promoting Cultural Diversity and Cultural Competency Survey (continued) NYAP

CHS

n=8

n=7

11c

When interacting with parents who have lim-ited English proficiency, I always keep in mind that they may or may not be literate in their language of origin or English

1.25

.707

2.00

1.000

1.70

.114

When possible, I ensure that all notices and communiquĂŠs to parents, families, and caregivers are written in their language of origin.

1.50

.926

1.33

.816

0.35

.732

I understand that it may be necessary to use alternatives to written communications for some families, as word of mouth may be a preferred method of receiving information.

1.13

.354

1.14

.378

0.10

.926

14a

I understand the principles and practices of linguistic competency.

1.25

.463

1.33

.816

0.24

.812

14b

I understand the principles and practices of linguistic competency and apply them within my program or agency.

1.38

.744

1.67

1.033

0.62

.549

14c

I understand the principles and practices of linguistic competency and advocate for them within my program or agency.

1.38

.744

1.67

1.033

0.62

.549

I understand the implications of health/mental health literacy within the context of my roles and responsibilities.

1.00

.000

1.00

.000

I use alternative formats and varied approaches to communicate and share information with children, youth, and/or their family members who experience disability.

1.13

.354

1.00

.000

0.62

.549

I avoid imposing values that may conflict or be inconsistent with those of cultures or ethnic groups other than my own.

1.00

.000

1.00

.000

In group therapy or treatment situations, I discourage children and youth from using racial and ethnic slurs by helping them understand that certain words can hurt others.

1.00

.000

1.67

1.033

1.00

.351

I screen books, movies, and other media re-sources for negative cultural, ethnic, or racial stereotypes before sharing them with children, youth, and their parents served by my program or agency.

1.13

.354

1.43

.787

1.58

.175

I intervene in an appropriate manner when I observe other staff or parents within my program or agency engaging in behaviors that show cultural insensitivity, bias, or prejudice.

1.13

.354

1.57

.976

0.94

.374

I understand and accept that family is defined differently by different cultures (e.g. extended family members, fictive kin, godparents).

1.00

.000

1.00

.000

I recognize and accept that individuals from culturally diverse backgrounds may desire varying degrees of acculturation into the dom-inant or mainstream culture.

1.00

.000

1.00

.000

I accept and respect that male-female roles in families may vary significantly among different cultures (e.g. who makes major decisions for the family, play and social interactions expected of male and female children).

1.00

.000

1.00

.000

I understand that age and life cycle factors must be considered in interactions with individuals and families (e.g. high value placed on the decisions of elders or the role of the eldest male in families).

1.00

.000

1.00

.000

Even though my professional or moral viewpoints may differ, I accept the family/parents as the ultimate decision makers for services and supports for their children.

1.00

.000

1.00

.000

I recognize that the meaning or value of be-havioral health prevention, intervention, and treatment may vary greatly among cultures.

1.00

.000

1.00

.000

I recognize and understand that beliefs and concepts of emotional well-being vary significantly from culture to culture.

1.00

.000

1.00

.000

I understand that beliefs about mental illness and emotional disability are culturally based. I accept that responses to these conditions and related treatment/interventions are heavily influenced by culture.

1.13

.354

1.00

.000

1.15

.288

I understand the impact of stigma associated with mental illness and behavioral health services within culturally diverse communities.

1.00

.000

1.00

.000

I accept that religion, spirituality, and other be-liefs may influence how families respond to mental or physical illnesses, disease, disability, and death.

1.00

.000

1.00

.000

I recognize and accept that folk and religious beliefs may influence a family's reaction and approach to a child born with a disability or later diagnosed with a physical/emotional disability or special health care needs.

1.13

.354

1.00

.000

1.00

.351

I understand that traditional approaches to disciplining children are influenced by culture.

1.13

.354

1.00

.000

1.00

.351

Item

Table continued on page 10

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Table 1. Scores by Agency on the Promoting Cultural Diversity and Cultural Competency Survey (continued) NYAP

CHS

n=8

n=7

Item

I understand that families from different cultures will have different expectations of their children for acquiring self-help, social, emo-tional, cognitive, and communication skills.

1.00

.000

1.00

.000

SD *

t *

I accept and respect that customs and beliefs about food, its value, preparation, and use are different from culture to culture.

1.00

.000

1.00

.000

Before visiting or providing services in the home setting, I seek information on acceptable behaviors, courtesies, customs, and expectations that are unique to families of specific cultures and ethnic groups served by my program or agency.

1.13

.354

1.29

.488

1.00

.351

I seek information from family members or other key community informants that will assist in service adaptation to respond to the needs and preferences of culturally and ethnically diverse children, youth, and families served by my program or agency.

1.25

.463

1.00

.000

0.74

.474

I advocate for the review of my program’s or agency’s mission statement, goals, policies, and procedures to ensure that they incorporate principles and practices that promote cultural diversity and cultural and linguistic competence.

1.25

.463

1.14

.378

1.53

.170

I keep abreast of new developments in pharmacology, particularly as they relate to racially and ethnically diverse groups.

1.75

.463

2.14

1.069

0.49

.630

I either contribute to and/or examine current research related to ethnic and racial disparities in mental health, health care, and quality improvement.

1.63

.744

2.33

.816

0.90

.394

I accept that many evidence-based prevention and intervention approaches will require adaptation to be effective with children, youth, and their families from culturally and linguistically diverse groups.

1.00

.000

1.00

.000

1.69

.116

Note. *Cannot be computed because the SDs of both groups are zero.

Caregiver Survey Results of the caregiver survey are shown in Tables 2 and 3 as well as Figures 2 and 3. The research team received a total of 23 completed electronic surveys in Qualtrics, and the data were exported to SPSS 26 for analysis. Nineteen of the responding families were served by CHS and four were served by NYAP. Due to the small sample size, analyses were restricted to comparisons of responses based on the child’s race/ethnicity, and results of Fisher’s exact test are reported rather than the chi-square statistic. The race/ethnicity of the youth who were being cared for by the respondents included Non-Hispanic White (n = 8), NonHispanic Black (n = 5), Hispanic (n = 5), multiracial (n = 4), and other (n = 1). Due to the small numbers in each subgroup, youth were grouped into two categories for the analysis (i.e., White/nonwhite). A majority of the caregivers had a male child receiving services (over 60%) across both race categories. Chi-square tests revealed no statistically significant differences in the likelihood of White and nonwhite youth to receive specific mental health diagnoses (see Figure 2). However, a greater proportion of White youth were diagnosed with depressive disorders, and a greater proportion of nonwhite youth were diagnosed with oppositional defiant disorder. These findings should be interpreted cautiously due to the small sample which may not be representative of all families in treatment. With regard to services received (see Figure 3), there was a trend for nonwhite youth to be more likely to receive mentoring

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than White youth (Fisher’s exact = .077). There were no other significant differences in services by race category. There was no statistically significant difference by race in whether or not youth had been involved with the juvenile justice system. However, there was a significant difference by race in whether or not the youth had been involved with the child welfare system. Nonwhite youth were significantly more likely to have a history of child welfare involvement than White youth (Fisher’s exact = .039). There were no statistically significant differences between race groups in their quality of experiences with the child welfare or juvenile justice systems as determined by a one-way ANOVA. Caregivers were given the opportunity to report what they liked about the program in an open-ended response. The majority indicated that individual counseling and one-on-one visits were the most helpful. One respondent stated the following that highlights the benefits of culturally competent services: [Case manager’s name] contacted me before my son was discharged from SIPP- services [were] put in place before he came home for us- [case manager’s name] understood our culture, struggles, and spoke with us in our native language. He helped me understand my son- his healthcare needs, medications, and helped me utilize all the supports we needed- including my family. Reduced my stress and brought us together as a family.

Table 2. Demographic and Background Information as Reported by Caregivers White

Nonwhite

n=8

Total

n = 15

N = 23

n or M

% or SD

n or M

% or SD

N or M

% or SD

14.8

1.9

14.6

1.5

14.6

1.6

Male

62.5

66.7

65.22

Female

37.5

33.3

34.78

Yes

62.5

66.6

65.2

37.5

33.3

34.8

Negative or very negative

25.0

33.4

36.9

Neutral

37.5

40.0

47.4

Positive or very positive

12.5

13.4

15.8

Yes

25.0

73.4

56.5

75.0

26.7

43.5

Negative or very negative

0.0

40.0

46.2

Neutral

25.0

13.3

30.8

Positive or very positive

0.0

20.0

23.1

8th grade or less

0.0

Some high school, but did not graduate

0.0

13.3

8.7

High school graduate or GED

25.0

13.3

17.4

Some college or 2-year degree

62.5

60.0

60.9

4-year college degree

12.5

13.3

13.0

More than 4-year college degree

0.0

Full-time

62.5

73.3

69.6

Part-time

0.0

6.7

4.3

Not employed

25.0

13.3

17.4

Other

12.5

6.7

8.7

Father

12.5

6.7

9.1

Mother

50.0

66.7

63.6

Foster parent

0.0

13.3

9.1

Grandparent

37.5

6.7

18.2

Childâ&#x20AC;&#x2122;s age Childâ&#x20AC;&#x2122;s gender

Did your child have any contact with the juvenile justice system (arrested, in detention center, etc.) before or after beginning this treatment program?

If yes, how would you describe your experiences with the juvenile justice system overall?

Did your child have any contact with the child welfare system before or after beginning this treatment program?

If yes, how would you describe your experiences with the child welfare system overall?

What is the highest grade or level of education you have completed?

What is your current employment status?

What is your relationship to the child receiving services?

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Figure 2. Mental Health Diagnoses of Youth as Reported by Caregivers

Table 3. Services and Outcomes Information as Reported by Caregivers White

Nonwhite

n=8

n = 15

My child's needs were identified 4.88 by program staff.

.354

4.33

1.447

Program staff talk to me using words I understand.

4.88

.354

4.67

1.047

Program staff speak to me in my preferred language.

4.88

.354

4.73

1.033

Program staff display signs written in a language I understand.

4.75

.463

4.73

1.033

Program staff incorporated my religious preferences into care.

4.75

.463

4.73

1.033

Program staff respect me and my child.

4.88

.354

4.73

1.033

Program staff took my opinions and feelings into account when working with my family.

4.88

.354

4.73

1.033

The location of the treatment program was convenient to get to.

4.88

.354

4.73

1.033

The office hours of program staff were adequate.

4.88

.354

4.73

1.033

I was able to talk to program staff when I called.

4.88

.354

4.60

1.121

4.75 If my child needed an appointment with program staff right away, he/she could usually be seen right away.

.463

4.80

.775

I had to pay for medicine or services with my own money.*

1.75

1.488

1.47

1.125

It seems like program staff talked to each other about my child's treatment.

4.63

5.18

4.87

.352

Program staff helped me deal with all of the people and systems I need to work with to help my child.

4.75

.707

4.80

.561

Program staff asked me about my family customs and traditions that may affect treatment.

4.75

.463

4.80

.561

Program staff respected my beliefs about forms of treatment that are important to me and my family.

4.75

.463

4.93

.258

Program staff had difficulty understanding my racial or ethnic background.*

2.13

1.808

1.87

1.642

Transportation to get services for my child was not a problem.

4.75

.463

4.47

1.246

Item

SERVICES

Figure 3. Services Received by Youth as Reported by Caregivers

The majority of items contained in the caregiver survey pertained to the quality of services received by the youth and their family as well as perceived outcomes of treatment. Quality of service items (#1â&#x20AC;&#x201C;48) were rated on a 5-point scale where 1 = strongly agree and 5 = strongly disagree. For this domain, results of independent samples t-tests indicated that responses did not differ significantly between White and nonwhite families. Results also indicated that families viewed services very positively. Across both groups, the lowest scoring item was #20, with respondents agreeing that it could be problematic to secure childcare in order for the target youth to receive services. Outcomes of treatment items (#49â&#x20AC;&#x201C;55) were also rated on a 5-point scale where 1 = very dissatisfied and 5 = very satisfied. Results indicate that respondents were very satisfied with treatment and, again, there were no statistically significant differences between White and nonwhite families based on t-tests. However, some notable trends emerged. For example, as compared to nonwhite families, White families had a tendency to indicate that services did not necessarily result in increased interest in school or work for the youth. Both groups were tentative in their agreement about the youth being able to make new friends over the past 6 months (#48) or having a renewed interested in a sport or hobby (#46).

Table continued on page 13

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Table 3. Services and Outcomes Information as Reported by Caregivers (continued)

Item

White

Nonwhite

White

Nonwhite

n=8

n = 15

n=8

n = 15

SERVICES (continued)

Item

SERVICES (continued)

I often missed time from work or other activities to get my child services.*

1.75

1.642

1.87

1.389

The treatment my child received included services that were based on his/her needs.

4.75

.463

4.93

.258

Getting childcare so my child can receive services was not a problem.

4.25

1.389

4.40

1.404

I think my child received all the services that he/she needed.

4.63

.744

4.67

.816

.744

4.73

.799

Program staff talked to me about different treatment options for my child.

4.50

.756

5.00

.000

My child received treatment that was right for him/her.

4.63

.744

4.80

.775

I had a choice of different treatments for my child (for example, medication, counseling, etc.).

4.50

Program staff were good at taking care of my child's emotional/ behavioral problems.

.756

4.47

1.246

OUTCOMES Within the last six monthsâ&#x20AC;Ś .756

3.80

1.207

my child has been in less trouble at school or work.

4.38

.518

4.00

1.512

Program staff asked my opinion about my child's treatment.

4.75

.463

4.93

.258

my child has been more interested in school or work.

3.50

1.604

4.07

1.486

Program staff asked about my child's strengths, what he/she is good at.

4.75

.463

4.93

.258

my child's school grades (or work performance) have improved.

3.75

1.282

4.27

1.438

My opinions and input were included in planning my child's treatment.

4.75

.463

4.93

.258

my child's attendance at school or work has been better.

4.25

1.165

4.27

1.438

.744

4.60

.828

Program staff gave me information about my child's condition and/or treatment.

4.63

.518

4.93

.258

my family members have gotten along better.

4.38

3.75

1.282

3.80

1.424

My child was not receiving the services I wanted (for example, he/she was put on medication instead of oth-er services you may have preferred).*

1.75

my child had a new or renewed interested in a hobby, sport, or other activity.

overall, things have been good for my child.

4.25

1.035

4.13

1.506

3.63

1.061

3.87

1.125

The people who provided my child's services respect-ed my family's right to privacy.

4.88

.354

4.93

.258

my child has been making new friends.

I had concerns that information about my child would be shared with others without my permission.*

1.50

1.609

1.27

.594

My child had a treatment plan for emotional/behavioral problems that was created just for him/her.

4.63

My child's strengths were included in the treatment plan.

4.75

.463

4.87

.352

My child's treatment plan was changed and updated regularly or when needed.

4.75

.463

4.87

.516

I signed my child's treatment plan.

4.75

.463

4.93

.258

I was given or offered a copy of my child's treatment plan.

4.75

.463

4.80

.775

1.389

.518

2.00

4.87

.000

4.00

4.75

5.00

my child has been getting along better with his or her peers.

Program staff talked to me about ways to manage my child's behavior, stress, or other issues.

.463

1.648

How satisfied are you withâ&#x20AC;Ś 49

your ability to get services for your child?

4.75

.707

4.67

.900

your involvement in planning for your child's services?

4.75

.707

4.73

.704

how your beliefs were respected during services?

4.88

.354

4.93

.258

the services your child received?

4.75

.707

4.93

.258

the people who provided your child's services?

4.88

.354

4.93

.258

the quality of the services your child received?

4.75

.707

4.87

.516

how your child is doing as a result of the services he/she received?

4.38

1.061

4.40

1.298

.516

* Reverse-scored item.

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Case File Reviews The research team reviewed 15 case files from NYAP and 15 case files from CHS using the protocol shown in Appendix C. The information was collected using pencil and paper and later entered into SPSS Statistics 26 for analysis. The following subsections present results obtained from the files, including demographic characteristics of the youth, and information about assessments, treatment planning, services, and changes in placement. Demographic Characteristics Of all files reviewed, 43.3 percent of the youth were Black or African American, 30 percent were White Non-Hispanic, 13.3 percent were Hispanic, 10 percent were mixed race, and 3.3 percent were classified as other. The majority of files reviewed were for males (73.3%). The average age of adults in the household was 41 years of age. The average age of focal children was 16 years of age. Most of the youth resided at home (73.3%), 20 percent lived with a relative or non-relative, and 3.3 percent had been placed in a licensed foster home or detention facility. Service Timeline Although nearly half of the families were not contacted within 24 hours of referral (46.7%), the vast majority received an assessment within 30 days (93.3%). Most families completed intake within 15 days of the initial assessment (80%). During the first two months of treatment, three weekly contacts was infrequent and only occurred in about 10 percent of cases. However, the location of the meetings was convenient for the families involved (86.7%). A series of chi-square tests of independence indicated that the differences between agencies on these indicators was not statistically significant. Speed of referral and assessment were also compared across races. No significant differences were found for any of abovementioned categories between African Americans, Hispanics, those who identified as mixed race or other categories. Assessments A series of chi-square tests with Fisher’s exact test were performed to determine whether there were differences between agencies on the indicators specified in Table 4. Most indicators showed no statistically significant differences by agency. However, the files from CHS were more likely to indicate that the special needs of the child and family were identified, and CHS was more likely to report on the youth’s perspective of his/her strengths. None of the indicators showed statistically significant differences by race of the youth.

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Table 4. Assessment Components The assessment considered the following:

Yes (n)

Yes (%)

Significant Difference by Agency?

Significant Difference by Race?

Caregivers’ capacity to protect the child and manage his/her behavior.

96.7

Observations of interactions between the child and household members.

Whether the child can live safely in the current home or placement.

93.3

An assessment of the caregivers’ strengths and resources.

76.7

An assessment of the caregivers’ needs that hinder providing a safe and stable home.

96.7

An assessment of the youth’s strengths and resources.

93.3

An assessment of the youth’s needs and risk of dual system involvement.

93.3

Yes χ (1, 30) = 16.133, p = 0.001. CHS performed this assessment more often. 2

Identification of special needs of the child and family.

50.0

The caregivers’ perspective of their strengths and needs.

53.3

Yes The youth’s perspective of his/her strengths and needs.

90.0

χ2 (1, 30) = 8.511, p = .003. CHS performed this assessment more often.

Treatment Planning A series of chi-square tests (with Fisher’s exact test for small cell sizes) were performed to determine whether there were differences between agencies and race categories on the indicators specified in Table 5. Some of the indicators showed a statistically significant difference by agency. For example, information from the selected files indicated that CHS was more likely than NYAP to offer family counseling, whereas NYAP was more likely to offer parental skill building and independent living training. None of the indicators showed statistically significant differences by race of the youth. Table 5. Treatment Plan Components The treatment plan included:

Yes (n)

Yes (%)

Significant Difference by Agency?

Significant Difference by Race?

Yes Family counseling

66.7

Weekly youth group sessions

50.0

χ2 (1, 30) = 5.40, p = 0.02. CHS treatment plans included this more often. Yes, but CHS did not offer weekly youth sessions.

Yes χ2 (1, 30) = 6.14, Fisher’s exact = .035. NYAP treatment plans included this more often.

Parental skill building

73.3

A therapeutic mentor for t he youth

40.0

Case management

96.7

School or vocational engagement

100.0

Yes

Skill building for transition to adulthood or independent living

60.0

Availability of 24/7 crisis support

3.3

χ2 (1, 30) = 20.0, p < .0001. NYAP treatment plans included this more often. No

Of the 30 files reviewed, most youth did not experience a change in placement after intake (56.7% no). If a change in placement occurred, the most likely transition was to living at home (10%), living with a relative/non-relative (10%), or living in a foster home (6.7%) or detention facility (6.7%). There was no statistically

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significant different between agencies as far as the likelihood of a new placement after intake or at discharge. Moreover, there were no differences between races on either of these indicators. Administrative Data Tables 6 and 7 compare results obtained from an analysis of administrative data submitted to the research team by the two agencies. The data file from CHS contained 61 cases with admission dates ranging from January 2019 to May 2020. The data file from NYAP contained 58 cases with admission dates ranging from February 2018 to May 2020. In order to ensure the samples covered the same time period, the research team limited both files to cases with admission dates between January 2019 and May 2020. This reduced the sample size to 35 youth for NYAP. The administrative data submitted by CHS contained preadmission and post-discharge total scores for youth on the Child Behavior Checklist (CBCL).21 The CBCL measures constructs such as social withdrawal, somatic complaints, anxiety/depression, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior. The instrument contains 113 items that are rated on a three-point scale: 0 (“not true”), 1 (“sometimes true”), and 2 (“very true or often true”). Scores on the individual items are summed to produce a raw Total Problems score. Total scores below 67 are considered in the normal range, scores ranging from 67–70 are considered to be borderline clinical, and scores above 70 are in the clinical range. Of the 57 discharged cases, 32 (56%) had a valid postdischarge CBCL score. A one-sample t-test indicated that all racial/ethnic groups had a statistically significant improvement in their scores. A descriptive analysis of scores indicated that both Black youth and non-Black youth had a nearly 10-point improvement in scores. The difference between these groups was not statistically significant as indicated by an independent samples t-test. CHS also included pre-admission and post-discharge scores on the Parenting Stress Index (PSI). The PSI identifies issues that may lead to problems in the child’s or parent’s behavior and focuses on three major domains of stress: child characteristics, parent characteristics and situational/demographic life stress. For the PSI, 15–80 is considered typical, 81–89 is considered high stress, and 90–100 is considered clinically significant stress. Of the 57 discharged cases, 32 (56%) had a valid post-discharge PSI score. A one-sample t-test indicated that all groups had a statistically significant improvement in their PSI scores. Non-Black families (n = 25) had an average improvement of 12.0 points whereas Black families (n = 7) had an average improvement of 11.6 points. This difference was not statistically significant. For each youth in the CHS program, the length of treatment in months was calculated. Overall, the average number of months in treatment was 5.07 (SD = 4.80) and ranged from 0 to 20. The length of treatment was longer for Black youth (6.0 months) as compared non-Black youth (4.8 months), but this difference was not statistically significant. When comparing nonwhite and White youth, the average length of treatment for nonwhite youth was 4.0 months (SD = 3.12) and 6.82 months for White youth (SD = 6.52). This difference also was not statistically significant.

Table 6. Administrative Data from CHS Black

White

Hispanic

Other

Total

n or M

% or SD

n or M

% or SD

n or M

% or SD

n or M

% or SD

N or M

% or SD

Male

71.4

90.9

30.0

80.0

73.8

Female

28.6

9.1

70.0

20.0

26.2

14.4

2.3

13.4

2.0

14.0

2.4

13.9

2.2

13.9

2.2

DCF*

35.7

10.0

20.0

13.3

21.3

DJJ

14.3

27.3

20.0

21.3

Other

50.0

54.5

60.0

66.7

57.4

6.00

3.85

6.82

6.52

5.00

1.00

2.33

2.18

5.07

4.80

Age Referral source

Average length of treatment (in months) Mean CBCL total score at admission

78.0

6.35

76.73

7.92

78.00

7.54

78.67

7.78

77.70

7.35

Mean CBCL total score at discharge

69.14

5.52

71.00

7.24

64.60

2.97

70.22

6.04

69.38

6.18

Mean PSI score at admission

62.0

10.74

63.36

9.95

65.80

8.95

65.00

11.41

63.85

10.2

Mean PSI score at discharge

52.14

9.17

52.64

11.39

52.40

8.23

54.89

10.22

53.13

9.75

100.0

95.24

100.0

98.25

Successful completion (among closed cases only)

*Includes dependency case management and partner agencies.

Although the research team did not receive outcome measures from NYAP, we made comparisons between average length of treatment and successful completion for White and Black youth (one youth was classified as Hispanic and was excluded from these analyses.) White and Black youth had similar average lengths of treatment, with White youth averaging 4.62 months (SD = 2.40) and Black youth averaging 4.70 months (SD = 3.25). This difference was not statistically significant. A higher proportion of Black youth successfully completed treatment (63.16%) as compared to White youth (53.85%) but again, this difference was not statistically significant.

Table 7. Administrative Data from NYAP Black n or M

White % or SD

Total

n or M

% or SD

N or M

% or SD

Male

81.0

53.8

70.59

Female

19.0

46.2

29.41

15.38

1.90

15.25

1.17

15.33

1.64

DCF*

42.9

64.3

51.4

DJJ

47.6

28.6

40.0

Community

9.5

7.1

8.6

5.26

2.10

4.62

2.40

5.00

2.21

63.16

53.85

55.88

Mean Age Referral source

Average Length of Treatment (in months) Successful Completion**

*Includes partner agencies. ** Youth who do not successfully complete are not necessarily unsuccessful.

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Conclusions Overall, results suggest the CHS program (Promoting Stability for Youth) and the NYAP program (Constant and Never Ending Improvement) are very similar. Both programs are comprised of case managers, therapists, and supervisors, and staff members described the purpose of their program as being able to intervene during a crisis and prevent further involvement with the child welfare and juvenile justice systems. Both agencies spent adequate time providing a variety of services to youth and their families, including individualized treatment plans, individual counseling, family counseling, parenting courses, and case management, among other services. The agencies accepted referrals of youth aged 11 to 17 years from DCF, DJJ, and community organizations. The agencies required their staff members to complete a number of trainings (e.g., cultural competency, LGBTQ+ training, and domestic violence awareness) that typically ranged between 50 and 70 hours. As families typically dealt with adverse child and community experiences (e.g., sexual and physical abuse, lack of social support, fear of discrimination in their environment, etc.), families involved with both agencies were said to be engaged in services due to feeling ignored or misunderstood from past interactions with other professionals, particularly among clients and practitioners of different racial or ethnic backgrounds. Staff from both agencies used many strategies to overcome these challenges including racial matching, sharing personal experiences, showing empathy, creating a welcoming environment, and being sensitive to cultural norms. Overall, these agencies showed great success. CHS staff shared that they had a 98 percent success rate in preventing recidivism in the child welfare and juvenile justice systems while NYAP noted 93 percent of youth were free of new juvenile justice involvement. However, there are key differences within each agency regarding the presence of a guiding model, use of multilingual staff, and organizational barriers. CHS stated that they did not have a centralized model to guide its service provision while NYAP utilized an evidence informed, strengths-based treatment model (i.e., CANEI program). As few CHS families required interpretation and translation services, CHS had one staff member who spoke both English and Spanish. Mainly due to the lack of necessity, NYAP did not have multilingual staff. Instead, they offered referrals for families with limited English proficiency. Most importantly, CHS shared many macro-level barriers not expressed by NYAP. CHS faced obstacles related to funding, deadlines, burdensome and inadequate training, education, and feeling isolated from upper management. Conversely, NYAP did not express the same sentiments, believing that they had strong agency support and organizational support, even from upper management. NYAP trainings were well-received and staff felt that they acquired vital skills needed for service.

With regard to racial differences, there were no statistically significant differences in the likelihood of White and nonwhite youth to receive specific mental health diagnoses or be involved with the juvenile justice system. However, nonwhite youth were more likely to be involved with the child welfare system and receive mentoring services than White youth. The implementation of mentoring services is important because research has shown that this service has the potential to benefit Black youth in academic performance, social-emotional well-being, and behavioral health. Notably, caregivers indicated that individual counseling and one-on-one visits were helpful and there were no significant differences between White and nonwhite families in their level of satisfaction with services. In both agencies, irrespective of race, youth had similar average lengths of treatment. Results from this evaluation should be interpreted with caution. Researchers intended to analyze qualitative data through extensive document reviews. However, CHS returned a blank monthly data report log and quarterly outcome measures template resulting in only a handful of items to review. Researchers also conducted a second focus group with NYAP with a revised focus group guide. The impacts of being interviewed twice, holding an interview during a global pandemic, and receiving fewer participants may have implications for the quality of the data. In addition, the relatively small number of youths served by the programs prevented us from using a quasi-experimental approach to investigate variability in outcomes for minority youth and families. As such, we could not create a matched comparison group or conduct a multivariate analysis. Moreover, due to small sample sizes of racial subgroups, youth had to be classified into two categories (i.e., White/nonwhite) for some of the analyses. Unfortunately, this categorization does not account for racial and cultural differences among youth in the nonwhite category. Although we cannot conclude that the implementation of an evidence-informed model, such as CANEI, yields higher quality services or better outcomes, results from this evaluation provide greater insight into the outcomes of implementing these models with minority youth and their families.

With respect to similarities and differences between the two agencies, there were several significant differences noted in the staff and administrator survey, caregiver survey, case file reviews, and administrative data. NYAP staff and administrators were more likely to enhance their physical environment with materials and resources to promote cultural diversity and cultural competency (e.g., displaying representative materials and providing culturally sensitive meals during assessments). CHS was more likely to identify the special needs of the child and family as well as the youthâ&#x20AC;&#x2122;s perspective of his/her strengths. Results also indicated that CHS was more likely than NYAP to offer family counseling whereas NYAP was more likely to offer parental skill building and independent living training. There was no statistically significant difference between agencies as far as the likelihood of a new placement (i.e., living at home, living with a relative/non-relative, foster care, or detention facility) after intake or at discharge.

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References 1

Ganasarajah, S., Siegel, G., & Sickmund, M. (2017). Disproportionality rates for children of color in foster care. National Council of Juvenile and Family Court Judges Juvenile Law Program. Retrieved from https://www.ncjfcj.org/wp-content/uploads/2017/09/NCJFCJ-Disproportionality-TAB-2015_0.pdf Child Welfare Information Gateway. (2016). Racial disproportionality and disparity in child welfare. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved from https://www.childwelfare.gov/pubPDFs/racial_disproportionality.pdf American Psychological Association. (2017). Ethnic and racial minorities & socioeconomic status. Washington, DC: Author. https://www.apa.org/pi/ses/resources/publications/minorities Marshall, J. M., & Haight, W. L. (2014). Understanding racial disproportionality affecting African American youth who cross over from the child welfare to the juvenile justice system: Communication, power, race and social class. Children and Youth Services Review, 42, 82-90. https://doi.org/10.1016/j.childyouth.2014.03.017 Kim, M., Garcia, A. R., Jung, N., & Barnhart, S. (2020). Rates and predictors of mental health service use among dual system youth. Children and Youth Services Review, 114, 105024. doi:10.1016/j.childyouth.2020.105024 Kolivoski, K. M., Goodkind, S., & Shook, J. J. (2017). Social justice for crossover youth: The intersection of the child welfare and juvenile justice systems. Social Work, 62(4), 313-321. https://doi.org/10.1093/sw/swx034 Wright, E. M., Spohn, R., Chenane, J., & Juliano, N. (2017). The importance of interagency collaboration for crossover youth. Youth Violence & Juvenile Justice, 15(4), 481-491. https://doi.org/10.1177/1541204016686663 Hwang, S., Griffis, H., Song, L., & Rubin, D. (2014). Supporting the needs of students involved with the child welfare and juvenile justice system in the School District of Philadelphia. Retrieved from http://policylab.chop.edu/sites/default/files/pdf/publications/PolicyLab_Report_Supporting_ Students_Involved_with_Child_Welfare_June_2014.pdf Ryan, J., Williams, A., & Courtney, M. (2013). Adolescent neglect, juvenile delinquency and the risk of recidivism. Journal of Youth & Adolescence, 42(3), 454–465. https://doi.org/10.1007/s10964-013-9906-8 Herez, D., Lee, P., Lutz, L., Stewart, M., Tuell, J., Wig, J…& Kelley, E. (2012). Addressing the needs of multi-system youth: Strengthening the connection between child welfare and juvenile justice. Retrieved from http://cjjr.georgetown.edu/wp-content/uploads/2015/03/MultiSystemYouth_March2012.pdf National Youth Advocate Program. (2008). Constant and Never Ending Improvement (Case Study). Retrieved from the Council on Accreditation website: http://coanet.org/about/innovative-practices-award/awardwinners/national-youth-advocate-program/ Development Services Group, Inc. (2014). Positive youth development: Literature review. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention. https://www.ojjdp.gov/mpg/litreviews/PositiveYouthDevelopment.pdf van Breda, A.D. (2018). A critical review of resilience theory and its relevance for social work. Social Work, 54(1), 1-18. doi: http://dx.doi.org/10.15270/54-1-611 Bruns, E. (2008). The evidence base and wraparound. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to wraparound. Portland, OR: National Wraparound Initiative, Research and Training Center for Family Support and Children’s Mental Health. Retrieved from https://nwi.pdx.edu/NWI-book/Chapters/Bruns-3.2-(research-base).pdf Zajac, K., Randall, J., & Swenson, C. C. (2015). Multisystemic Therapy for Externalizing Youth. Child and Adolescent Psychiatric Clinics of North America, 24(3), 601–616. doi:10.1016/j.chc.2015.02.007 California Department of Social Services. (2019). Topic: Reducing racial disparity and disproportionality in child welfare: Programs [Website]. Retrieved from http://www.cebc4cw.org/topic/reducing-racial-disparity-and-disproportionality-in-child-welfare/ Children's Home Society. (2020). Promoting stability. Retrieved from https://www.chsfl.org/services/for-teens/promoting-stability/ Goode, T. D. (2009). Promoting cultural diversity and cultural competency self-assessment checklist for personnel providing behavioral health services and supports to children, youth and their families. National Center for Cultural Competence, Georgetown University Center for Child & Human Development. Retrieved from https://nccc.georgetown.edu/documents/ChecklistBehavioralHealth.pdf Vargo, A. C., Sharrock, P. J., Johnson, M. H., & Armstrong, M. I. (2013). The use of a participatory approach to develop a framework for assessing quality of care in children’s mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 40, 286299. https://doi.org/10.1007/s10488-012-0419-7 Hill, R. (2020). Wraparound: A key component of school-wide culture competence to support academics and socio-emotional well-being. Peabody Journal of Education, 95(1), 66-72, https://doi.org/10.1080/0161956X.2019.1702424

Achenbach, T. M. (1991). Manual for child behavior checklist/ 4–18 and 1991 profile. Burlington: University of Vermont, Department of Psychiatry.

Abidin, R. R. (2012). Parenting stress index (4th ed.). Lutz, FL: PAR.

Sanchez, B. (2016). Mentoring for black male youth. Chicago, IL: DePaul University and National Mentoring Resource Center. Retrieved from http://nationalmentoringresourcecenter.org/images/PDF/BlackMales_Population_Review.pdf

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