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Post-investigation experiences of families with complex needs at risk of maltreatment: an examination of need, matched services, and changes in need

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Post-investigation experiences of families with complex needs at risk of maltreatment: an examination of need, matched services, and changes in need

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Content i
Post-Investigation Experiences of Families with Complex Needs at Risk of Maltreatment:
An Examination of Need, Matched Services, and Changes in Need

by
James David Simon
December 2016 Conferral Date
USC Graduate School
Doctor of Philosophy (Social Work)

University of Southern California
Dissertation Guidance Committee
Devon Brooks, PhD (Chair)
Lawrence Palinkas, PhD
Thomas Lyon, PhD

ii
Dedication
This dissertation is dedicated to the numerous families involved with child protective
services (CPS) that allowed me into their homes and hearts as a CPS investigator many years
ago. You taught me many valuable lessons about engagement and understanding complex needs,
and you inspired me to embark on the difficult task of pursuing a PhD to understand how to
match needs and services. I also need to acknowledge the numerous Los Angeles County
Department of Children and Family Services children’s social workers and supervising
children’s social workers who put in long hours with me in the office and in our communities
and who continue to do so to help families in need. Thank you all for teaching me how to not let
fear drive my decision making when connecting families to needed services.
Last but not least, I need to thank my loving wife and life partner, Antonella; my son
David for always energizing me when I was drained; and my baby boy, Alessio, who waited just
few more days in his mommy’s tummy so I could submit this dissertation…well, almost.

iii
Acknowledgments
I would like to thank the following individuals who helped me along my dissertation
trajectory.
Thank you to everyone on my dissertation committee—Dr. Devon Brooks, Dr. Lawrence
Palinkas, and Dr. Thomas Lyon—for all of your assistance, patience, and feedback.
Thank you Dr. Brooks for always believing in me and the countless hours of feedback
you have provided. To Dr. Cederbaum and Dr. Traube, thank you for listening to me when I
needed encouragement and support. To the numerous professors in the Child Development and
Children’s Services cluster who provided me feedback throughout my very stages of growth.
Thank you! Although I wasn’t always ready to listen to the feedback at the time, your
constructive feedback helped me grow.
Thank you Dr. Mor Barak for always having an inspirational quote to help me through a
difficult time, and thank you Malinda for helping me put things in perspective when I needed it
most. Thank you to the USC School of Social Work for the 6 years of support to help me
complete this dissertation. In addition, I have to thank our amazing editor Eric Lindberg for
helping me polish the final version of the dissertation and for helping me improve my writing
skills tremendously.
Last but definitely not least, I have to thank everybody in my cohort, especially Dr. Hsun-
Ta Hsu, Dr. Anthony “The Wolf” Fulginiti, Dr. Hyunsung Oh, and Dr. Megan Finno-Velasquez,
all of whom helped me through my struggles with humor, support, inspiration, and the
occasional drink.

iv
Table of Contents
Post-Investigation Experiences of Families with Complex Needs at Risk of Maltreatment:
An Examination of Need, Matched Services, and Changes in Need ............................................... i
Dedication ....................................................................................................................................... ii
Acknowledgments.......................................................................................................................... iii
Table of Contents ........................................................................................................................... iv
List of Figures and Tables............................................................................................................. vii
Abstract ........................................................................................................................................ viii
Chapter One: (Overview of the Three Studies) .............................................................................. 1
Introduction and Rationale .......................................................................................................... 1
Post-Investigation Experiences of Families at Risk of Maltreatment ..................................... 1
Matching Needs and Services after a CPS Investigation ........................................................ 2
Study Goal and Structure ............................................................................................................ 3
Conceptual Model ................................................................................................................... 4
Methods....................................................................................................................................... 4
Overview ................................................................................................................................. 4
Sample..................................................................................................................................... 5
Methods................................................................................................................................... 6
Summary ..................................................................................................................................... 6
References ................................................................................................................................... 8
Chapter Two (Study 1): An Examination of Complex Needs Among Families at Risk of
Maltreatment ................................................................................................................................. 15
Complex Needs and Child Maltreatment .............................................................................. 17
Methods..................................................................................................................................... 20
Overview ............................................................................................................................... 20
Sample................................................................................................................................... 21
Measurement ......................................................................................................................... 21
Need ...................................................................................................................................... 22
Home-Based Post-Investigation Services ............................................................................. 23
Analytic Strategy .................................................................................................................. 23
Results ....................................................................................................................................... 24
Discussion and Implications ..................................................................................................... 27
Limitations ............................................................................................................................ 29
Conclusion ................................................................................................................................ 30
v
References ................................................................................................................................. 31
Chapter Three (Study 2): Matching Services for Families at Risk of Maltreatment with
Complex Needs ............................................................................................................................. 44
A Primer on Home-Based Post-Investigation Services ........................................................ 46
Matching Services to Families with Complex Needs ........................................................... 47
Matching Services and CPS Recidivism ............................................................................... 50
Methods..................................................................................................................................... 52
Sample................................................................................................................................... 52
Measurement ......................................................................................................................... 52
Need ...................................................................................................................................... 53
Home-Based, Post-Investigation Services ............................................................................ 54
Matched Services .................................................................................................................. 54
CPS Re-Referral .................................................................................................................... 55
Analytic Strategy .................................................................................................................. 55
Results ....................................................................................................................................... 55
Discussion and Implications ..................................................................................................... 59
Limitations ............................................................................................................................ 62
Conclusion ................................................................................................................................ 63
References ................................................................................................................................. 65
Chapter Four (Study 3): Matching Services to Reduce Need Among Families At Risk of
Maltreatment with Complex Needs. ............................................................................................. 78
Matched Services and a Change in Need .............................................................................. 79
Conceptual Model ................................................................................................................. 84
Methods..................................................................................................................................... 84
Sample................................................................................................................................... 84
Measurement ......................................................................................................................... 85
Need ...................................................................................................................................... 86
Reduced Need ....................................................................................................................... 86
Overall Reduced Need .......................................................................................................... 87
Home-Based, Post-Investigation Services ............................................................................ 87
Matched Services .................................................................................................................. 87
Caregiver Demographics ...................................................................................................... 88
Analytic Strategy .................................................................................................................. 88
Results ....................................................................................................................................... 88
Discussion and Implications ................................................................................................. 90
vi
Limitations ............................................................................................................................ 92
Conclusion ............................................................................................................................ 93
References ................................................................................................................................. 95
Chapter Five: Summary of Findings, Implications, and Conclusion .......................................... 102
Summary of Findings .............................................................................................................. 102
Implications for Policy and Practice ....................................................................................... 104
Conclusion .............................................................................................................................. 107
References ............................................................................................................................... 109
Appendix: Family Functioning Factors and Items (Shortened Version) .................................... 114

vii
List of Figures and Tables
Figure 1. Matching Need and Services Framework...................................................................... 14
Table 1. Caregiver Demographic Characteristics ......................................................................... 41
Table 2. Caregiver Needs and Services at Initial Assessment (N=2,008) .................................... 42
Table 3. Termination Reasons ...................................................................................................... 43
Table 4. Need, Services, and Matches of Caregivers with Complex Needs (N=836) .................. 72
Table 5. The Association between Need and HBPS by Service Type .......................................... 73
Table 6. The Impact of Need on a Service Match for Caregivers with Complex Needs .............. 74
Table 7. The Effect of Matched Services on a Re-referral to Child Protective Services ............. 75
Figure 2. Service Match Coding ................................................................................................... 76
Figure 3. Match between Need and Type of Services .................................................................. 77
Table 8. Need at Initial and Termination Assessment of Families with Complex Needs ............ 99
Table 9. The Association between Matched Services and Reduced Need ................................. 100
Table 10. The Effect of Matched Services on Overall Reduced Need between Intake and
Termination ................................................................................................................................. 101

viii
Abstract
The provision of voluntary home-based post-investigation services (HBPS) to meet the
needs of families at risk of maltreatment continues to be an important function of child protective
services (CPS) agencies in partnership with community-based agencies. One understudied area
of research involves families with complex needs that are referred to a community agency for
HBPS following a child abuse investigation. Importantly, national reports on child maltreatment
do not account for these families because they fall off the radar of CPS agencies once their
investigation is closed. Thus, little is known about the characteristics of these families and
whether they receive services matched to their needs after a child abuse investigation.
This dissertation focused on these families, giving extra attention to families with
complex needs; that is, families with needs related to domestic violence, mental health, or
substance abuse. Findings from this dissertation highlight that families with complex needs that
are referred to HBPS appear to be similar to lower-need families in terms of demographic
characteristics. However, they have different need profiles that deserve attention. Families with
complex needs differ with respect to abuse histories, needs, and the severity of their needs.
Despite the fact that they tend to receive more services, their outcomes are worse than their
lower-need counterparts, highlighting the importance of understanding whether they receive
services matched to their needs.
Importantly, many caregivers receive matched services for concrete, educational, and
clinical needs. In addition, many families with complex needs receive services they do not need.
In this study, receiving matched educational services resulted in a decreased likelihood of a
subsequent CPS re-report, although receiving matched concrete and matched clinical services did
not have a statistically significant effect on this outcome. However, receiving matched concrete,
ix
educational, or clinical services resulted in reduced need in those specific areas and overall.
These findings have important implications for CPS decision making, the provision of services to
families at risk of maltreatment, and outcomes related to matching needs and services.
1

Chapter One (Overview of the Three Studies)
Introduction and Rationale
Post-Investigation Experiences of Families at Risk of Maltreatment
Child protective services (CPS) agencies receive millions of reports annually involving
suspected child abuse or neglect (U.S. Department of Health and Human Services [USDHHS],
2016). In response to these numerous reports, CPS agencies must investigate and triage services
based on need. Families with the most needs tend to receive services when some form of child
maltreatment has occurred, often through an open case. Families whose children are at risk of
maltreatment but who can remain safely at home without CPS supervision often receive home-
based post-investigation services (HBPS), which consist of an array of services to strengthen
families by addressing their needs. These services are typically provided by a community
agency, although in some jurisdictions they might be provided by CPS agencies (see Conley,
2007; Conley & Berrick, 2010; Waldfogel, 2009).
Matching needs and services for families that receive HBPS remains difficult because
their children are safe enough to remain at home yet are still at risk of future maltreatment.
Furthermore, they typically have a multitude of complex needs that require attention. National
reports on child maltreatment do not account for families referred for HBPS through community
agencies, so little is known about their needs and the types of services they receive. Considering
that one third of all of families reported to CPS for the first time for alleged maltreatment are re-
reported within 2 years (Fluke, Shusterman, Hollinshead, & Yuan, 2008; Needell et al., 2015), it
is likely that they had needs that were not appropriately matched to services. Thus, the provision
of HBPS presents an opportunity to match family needs with services to potentially prevent
future maltreatment. Several studies have revealed that matching needs and services is associated
2

with important child welfare outcomes such as reduced substance abuse, decreased maltreatment,
and increased family reunification (Choi & Ryan, 2007; Ryan & Schuerman, 2004; B. D. Smith
& Marsh, 2002).
Matching Needs and Services after a CPS Investigation
Although many families receive services when referred for HBPS, matching services to
needs is difficult. A social worker must appropriately identify needs, find relevant services, and
overcome many obstacles to engagement such as cultural misunderstandings, stigma, coercion,
and fear of CPS (Altman, 2008; Faver, Crawford, Combs-Orme, 1999; Kemp, Marcenko,
Hoagwood, & Vesneski, 2009; King, Currie, & Petersen, 2014; Marcenko, Brown, DeVoy, &
Conway, 2010; Marcenko, Hook, Romich, & Lee, 2012). Matching needs and services appears
to be particularly challenging for families with complex needs that struggle with substance
abuse, domestic violence, and mental health problems; numerous studies have indicated that they
often do not received needed services (Bagdasaryan, 2005; Cash & Berry, 2002; Choi & Ryan,
2007; B. D. Smith & Marsh, 2002; Staudt & Cherry, 2009). This is of particular concern
considering some of the most common reasons for CPS involvement involve substance abuse,
domestic violence, and mental health problems (Barth, 2009; Child Welfare Information
Gateway, 2014; Marcenko, Lyons, & Courtney, 2011). National estimates indicate that 1 in 4
caregivers investigated for abuse have needs related to substance abuse and domestic violence
and nearly 2 in 5 have needs related to mental health (Dolan et al., 2012; NSCAW, 2007).
Furthermore, families with complex needs are more likely to experience factors that affect their
parenting (Barth, 2009; M. Smith, 2004; Wulczyn, 2009), negatively affect their emotional and
behavioral problems (Felitti et al., 1998; Wolfe, 2003), and increase the likelihood of CPS
3

recidivism (Casanueva et al., 2015; Fluke et al., 2008). Thus, it is important to understand how
the provision of matched services affects families with complex needs.
Despite the fact that thousands of families receive HBPS annually (USDHHS, 2016),
there is a dearth of empirical knowledge about how matching services affects families with
complex needs identified after a child abuse investigation. Few studies have examined the post-
investigation experiences of families with complex needs and whether providing matched
services results in decreased recidivism and changes in need. Providing matched services should
engage the family in the change process by addressing basic needs, improving client satisfaction,
and increasing parental involvement (Faver et al., 1999; Kemp et al., 2009; Marsh, Cao,
Guerrero, & Shin, 2009; B. D. Smith & Marsh, 2002). This is further supported by studies
indicating that matched services are associated with important outcomes such as decreased
substance abuse, increased program completion, and increased family reunification
(Bagdasaryan, 2005; Choi & Ryan, 2007; Marsh et al., 2009; B. D. FSmith & Marsh, 2002).
Thus, further studies exploring whether families with complex needs receive matched services
and the potential benefits of providing matched services are warranted.
Study Goal and Structure
This three-study dissertation had an overarching goal of understanding the post-
investigation experiences of families with complex needs at risk of maltreatment, with a focus on
the relationship between needs and services. Using a unique dataset consisting of families
referred for HBPS after their initial CPS investigation, this study aimed to achieve the following:
(1) To compare families with and without complex needs that are referred for HBPS.
(2) To describe the various types of matched services received and predictors of a need–
service match for families with complex needs.
4

(3) To analyze whether the provision of matched services decreases the likelihood of a re-
report to CPS.
(4) To test whether matched services results in a change in specific and overall needs.
Conceptual Model
This study was guided by three theoretical frameworks in examining whether a need–
service match results in changes in need: Maslow’s (1943) theory of human motivation,
Patterson’s (2002) risk and resilience theory, and Kemp and colleagues’ (2009) typology of
parental engagement (see Figure 1).
Maslow (1943) posited that human needs follow a hierarchical structure in which basic
safety needs have to be met to address other needs. Thus, it is presumed that matching services to
basic needs will facilitate change in other areas of need. Family risk and resilience theory posits
that risk, or need, can be moderated by strengthening family functioning (Patterson, 2002). Thus,
to mitigate risk and strengthen families, services should be matched to different areas of need
because unmet need can lead to additional problems (Patterson, 2002). Last, Kemp et al.’s (2009)
framework on parental engagement posits that preconditions, including need and cultural factors,
must be addressed by engagement strategies to facilitate change. These engagement strategies
consist of the provision of various services that address preconditions to facilitate parental
involvement, resulting in reduced need.
Methods
Overview
Data were collected as part of a longitudinal study of the Partnerships for Families (PFF),
a community-based prevention initiative offering services to address the needs of families with
children aged 5 years or younger and pregnant women at risk of child maltreatment in Los
5

Angeles County (Brooks, Sessoms, et al., 2011; First 5 LA, 2014). To be eligible for PFF,
families must have had a CPS investigation that resulted in an unfounded or inconclusive
disposition and a determination of moderate to very high risk of future maltreatment based on the
Structured Decision Making tool, a standardized risk assessment tool (Brooks, Sessoms, et al.,
2011; Budde et al., 2011).
Eligible families were referred by a CPS worker to a PFF agency after the conclusion of a
child abuse investigation. An in-home outreach counselor (IHOC) then met with referred
families to offer PFF services. If the family consented, the IHOC collaborated with the family to
establish treatment goals based on an assessment of the family’s strengths and needs. The IHOC
visited the family at least twice a month and provided services until the IHOC determined that
the family had completed all of the goals agreed upon during the initial assessment. If a family
moved out of the area, declined services, or was re-reported to CPS for alleged maltreatment,
services were terminated (Budde et al., 2011). The mean length of service provision was slightly
more than 6 months (Brooks, Cohen, et al., 2011).
Sample
The initial sample consisted of 3,324 families with children aged 5 or younger that
enrolled in PFF (Brooks, Sessoms, et al., 2011; First 5 LA, 2014). Of these families, 2,929 had
data on the services they received after their initial assessment; 2,008 families had both an initial
and termination assessment. To explore the experiences of families with complex needs, this
sample was further restricted to 836 families with complex needs related to domestic violence,
mental health problems, and substance abuse. A complex need was defined as a mean score of 3
or higher for any of the following clinical needs using the Family Assessment Form: (a)
domestic violence (Factor F measuring interactions between caregivers), (b) substance abuse
6

(Item H3 measuring substance abuse), or (c) mental health (all items from Factor H except H3,
which measures substance abuse). This cutoff score was chosen because a 3 or higher in different
areas of need indicates moderate problem functioning (Brooks, Cohen, et al., 2011; Children’s
Bureau of Southern California, 2011; McCroskey & Meezan, 1997; McCroskey, Nishimoto, &
Subramanian, 1991; McCroskey, Sladen, & Meezan, 1997).
Methods
For each study, univariate descriptive statistics were used to describe the sample’s
demographic characteristics, needs, and services. Pearson chi-square analyses were used to
examine bivariate relationships between needs and matched services, and two-sample t-tests
were used to examine a change in need between the initial and termination assessments. Last,
multivariate logistic regressions were conducted to investigate the effects the various predictors
on matched services and a CPS re-report while controlling for demographic characteristics. In
addition, a multivariate logistic regression analysis was used to examine whether the provision of
matched services was associated with reduced need in different areas of need and overall.
Summary
Although some studies have examined the match between needs and services, few have
explored this issue among families that are referred to HBPS after an initial CPS investigation.
This is particularly important considering that these families are no longer followed by CPS once
their investigation is closed. Thus, it is important to understand whether families referred for
HBPS receive services matched to their needs. Of particular importance, this dissertation focused
on families with complex needs related to domestic violence, mental health, or substance abuse
because of the numerous detrimental outcomes associated with these complex needs. Findings
7

from these dissertation studies are discussed in the context of CPS decision making, the
provision of matched services to meet complex needs, and outcomes related to matched services.

8

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14

Figure 1. Matching Need and Services Framework

15

Chapter Two (Study 1)
An Examination of Complex Needs Among Families at Risk of Maltreatment
The provision of services to families at risk of maltreatment continues to be an area of
great need. One neglected area of research involves families that are referred to a community
agency for home-based post-investigation services (HBPS) following a child abuse investigation.
In 2014, child protective services (CPS) agencies received an estimated 3.6 million referrals for
suspected child abuse and neglect involving approximately 6.6 million children (U.S.
Department of Health and Human Services [USDHHS], 2016). When an investigation indicates
that maltreatment has occurred or that the family is at high risk of future maltreatment, CPS
agencies typically will open a case and provide mandated services (Waldfogel, 2009). An
alternative response may occur with families at lower risk of abuse or neglect that do not meet
the threshold required for opening a CPS case (Conley, 2007; Conley & Berrick, 2010). This
response often involves a referral of the family to a community-based agency that offers
voluntary HBPS designed to prevent future maltreatment. Additionally, this alternative response
allows CPS agencies to triage their services by targeting families at highest risk of maltreatment
for CPS involvement while referring families at lower risk to services offered by community
agencies (Conley, 2007; Conley & Berrick, 2010; Waldfogel, 2009). Although exact numbers are
hard to calculate, in part due to variation in service definitions and service provision, it is
estimated that more than 1 million families at risk of maltreatment received HBPS in 2014
(USDHHS, 2016).
Even though numerous families are referred for HBPS, little is known about the families
that receive HBPS and whether they receive services that are matched to their needs following a
CPS investigation. National reports on child maltreatment do not account for these families
16

because they are no longer followed by CPS once the investigation is closed. Presumably,
families referred out for HBPS are at lower risk of maltreatment because their CPS report did not
meet state statutes regarding requirements to open a CPS case. However, a growing body of
literature has indicated that any CPS report is an indicator of increased vulnerability and risk of
future maltreatment, particularly for young children (Dumas, Elzinga-Marshall, Monahan, van
Buren, & Will, 2015; Putnam-Hornstein, Simon, Eastman, & MacGruder, 2015). Furthermore,
prior work comparing families with substantiated and unfounded CPS reports (i.e., no evidence
of abuse or neglect after investigation by a CPS worker) indicated that families at risk of
maltreatment have a comparable need for services regardless of the decision to open a case and
provide services (Casanueva, Dolan, Smith, & Ringeisen, 2012; Drake, 1996; Drake, Jonson-
Reid, Way, & Chung, 2003; Kohl, Jonson-Reid, & Drake, 2009; Wolock, Sherman, Feldman, &
Metzger, 2001).
Despite the availability and receipt of services to prevent abuse and neglect after a child
abuse investigation, CPS agencies continue to struggle with decision making with respect to
families at risk of maltreatment. One particular challenge involves the correct identification of
families at risk of maltreatment and how best to provide services matched to their needs (López,
Fluke, Benbenishty, & Knorth, 2015). Prior studies examining the match between needs and
services have found that services may not always align with family needs, especially for families
with complex needs related to domestic violence, mental health, and substance abuse
(Bagdasaryan, 2005; Cash & Berry, 2002; Chambers & Potter, 2008; Choi & Ryan, 2007; Staudt
& Cherry, 2009). Thus, it appears that many families with complex needs that are referred for
HBPS do not receive services that address their needs. Considering that families referred for
HBPS are understudied and not followed by CPS after a child abuse investigation, more
17

information is needed about the post-investigation experiences of families with complex needs to
understand their demographic characteristics, their multiple needs, and the type of services they
receive.
Complex Needs and Child Maltreatment
The most common reasons for CPS involvement include domestic violence, mental
health, and substance abuse (Barth, 2009; Child Welfare Information Gateway [CWIG], 2014a,b;
Marcenko, Lyons, & Courtney, 2011; McCoy & Keen, 2009). Domestic violence is a risk factor
for maltreatment (Barth, 2009; Casanueva et al., 2015; Hamby, Finkelhor, Turner, & Ormrod,
2010), and several studies have found a link between domestic violence and child maltreatment
(Edleson, 1999; Hamby et al., 2010; Jouriles, McDonald, Smith Slep, Heyman, & Garrido, 2008;
Osofsky, 2003). Caregivers in relationships involving domestic violence may become violent
with their children (Jouriles et al., 2008; Taylor, Guterman, Lee, & Rathouz, 2009). Furthermore,
exposure to domestic violence is associated with emotional and behavioral problems (CWIG,
2014a,b; Felitti et al., 1998; Wolfe, 2003). National estimates indicate that nearly 30% of child
victims have been exposed to domestic violence in their home (CWIG, 2014a,b; USDHHS,
2013), and the presence of domestic violence is associated with an increased likelihood of CPS
recidivism (Casanueva, Martin, & Runyan, 2009; Casanueva et al., 2015). Thus, it is important
to provide HBPS to families that have early signs of domestic violence after a CPS investigation
(Casanueva et al., 2009; Hamby et al., 2010; Jouriles et al., 2008).
Need related to mental health is another significant reason for CPS involvement (Barth,
2009; Burns et al., 2010). Findings from a 2014 national survey indicated that an estimated 43.8
million adults, nearly 1 in 5 adults, had a mental illness during the previous year (Hedden et al.,
2015). For caregivers and parents involved with CPS, national estimates underscore a high
18

prevalence of mental health need that is worse than general population estimates (Burgess &
Borowsky, 2010; Burns et al., 2010; Chuang, Wells, & Aarons, 2014; Dolan et al., 2014). The
presence of mental health problems negatively affects parenting ability (Barth, 2009; M. Smith,
2004). For example, parents with depression may be less available to and communicative with
their children and struggle to maintain a healthy interaction (Barth, 2009; M. Smith, 2004).
Furthermore, caregivers with mental health problems have increased odds of being reported to
CPS (Casanueva et al., 2015; Dakil, Sakai, Lin, & Flores, 2011; Jonson-Reid, Emery, Drake, &
Stahlschmidt, 2010). Using national data, Casanueva and colleagues (2015) found that children
of caregivers with mental health problems were significantly more likely to be re-reported to
CPS and have substantiated re-reports.
Substance abuse is an important risk factor for child maltreatment (Barth, 2009; Brown et
al., 1998; CWIG, 2014b; Semidei, Radel, & Nolan, 2001; Traube, 2012). Estimates based on
national and local studies indicate that between one third and two thirds of families involved in
child welfare have a substance abuse problem (Semidei et al., 2001; USDHHS, 1999; Young,
Boles, & Otero, 2007). Parents dealing with substance abuse are at high risk of maltreating their
children due to numerous reasons including decreased family functioning (Wells, 2009; Wolock
& Magura, 1996), decreased parenting capabilities (Barnard & McKeganey, 2004; Barth, 2009;
Wells, 2009; Wulczyn, 2009), and financial problems (NCASA, 2001; Wulczyn, 2009).
Substance abuse is also associated with other issues such as mental health problems, domestic
violence, and housing instability that could also lead to child abuse (Barth, 2009; Semidei et al.,
2001; Wulczyn, 2009). For example, parents struggling with substance abuse may not provide
adequate supervision or medical care because of the effects of drugs (Barth, 2009; CWIG,
2014b; Wells, 2009; Wulczyn, 2009).
19

Parental substance abuse can affect child safety and well-being, and the presence of
substance abuse often results in a different levels of CPS recidivism, including a rereport
(Connell, Bergeron, Katz, Saunders, & Tebes, 2007; Dubowitz et al., 2011; Guo, Barth, &
Gibbons, 2006), a substantiated rereport (Fluke, Shusterman, Hollinshead, & Yuan, 2008;
Wolock et al., 2001), and child placement (Horwitz et al., 2011; Walsh, MacMillan, & Jamieson,
2003; Wolock & Magura, 1996). For example, Connell and colleagues (2007) found that a
family history of substance abuse was associated with a 50% increased likelihood of a re-report
to CPS. Similarly, Dubowitz and colleagues (2011) found that mothers who abused substances
were 71% more likely to be re-reported to CPS. Using national data, Fluke and colleagues (2008)
found that caregiver drug and alcohol use was associated with increased odds of re-reports and
substantiated re-reports.
Given the aforementioned issues, it is important to identify and provide appropriate
services to families with complex needs related to domestic violence, mental health, and
substance abuse as early as possible to mitigate some of these negative outcomes (Casanueva et
al., 2009; Hamby et al., 2010; Jonson-Reid et al., 2010; Jouriles et al., 2008). Prior studies have
found that the provision of matched services is associated with important child welfare outcomes
such as reduced substance abuse, decreased maltreatment, and increased family reunification
(Choi & Ryan, 2007; Marsh, Cao, Guerrero, & Shin, 2009; Ryan & Schuerman, 2004; B. D.
Smith & Marsh, 2002). In response, this study sought to understand families with complex needs
related to substance abuse, domestic violence, and mental health, with the following specific
aims.
(1) Describe the different demographic characteristics of families with and without
complex needs.
20

(2) Examine different types of need and HBPS used following an initial referral to CPS.
(3) Compare families with and without complex needs related to domestic violence,
substance abuse, and mental health.
Methods
Overview
Data were collected as part of a longitudinal study of the Partnerships for Families (PFF),
a community-based prevention initiative offering services to address the needs of families with
children aged 5 years or younger and pregnant women at risk of child maltreatment in Los
Angeles County (Brooks, Sessoms, et al., 2011; First 5 LA, 2014). To be eligible for PFF,
families must have had a CPS investigation that resulted in an unfounded or inconclusive
disposition and a determination of moderate to very high risk of future maltreatment based on the
Structured Decision Making tool, a standardized risk assessment tool (Brooks, Sessoms, et al.,
2011; Budde et al., 2011).
Eligible families were referred by a CPS worker to a PFF agency after the conclusion of a
child abuse investigation. An in-home outreach counselor (IHOC) then met with referred
families to offer PFF services. If the family consented, the IHOC collaborated with the family to
establish treatment goals based on an assessment of the family’s strengths and needs. The IHOC
visited the family at least twice a month and provided services until the IHOC determined that
the family had completed all of the goals agreed upon during the initial assessment. If a family
moved out of the area, declined services, or was re-reported to CPS for alleged maltreatment,
services were terminated (Budde et al., 2011). The mean length of service provision was slightly
more than 6 months (Brooks, Sessoms, et al., 2011).
21

Sample
The initial sample consisted of 3,324 families with children aged 5 and younger that
enrolled in PFF. Of these families, 2,929 had complete data regarding the services they received
shortly after their initial assessment. The sample was further restricted to 2,008 families with
both an initial and termination assessment. To understand the experiences of families with
complex needs, comparisons were made between families with complex needs related to
domestic violence, mental health problems, and substance abuse (n = 836) and families without
complex needs (n = 1,172). A complex need was defined as a mean score of 3 or greater on the
Family Assessment Form for any one of the following clinical needs using the Family
Assessment Form: (a) domestic violence (Factor F measuring interactions between caregivers),
(b) substance abuse (item H3 measuring substance abuse), and (c) mental health (all items from
Factor H except H3). This cutoff score was chosen because it indicates moderate problem
functioning (Brooks, Cohen, et al., 2011; Children’s Bureau of Southern California, 2011;
McCroskey & Meezan, 1997; McCroskey, Nishimoto, & Subramanian, 1991; McCroskey,
Sladen, & Meezan, 1997).
Measurement
Data were obtained from the local CPS agency and the lead agency in the PFF network of
community agencies. CPS provided demographic data on the children and caregivers in each
household. PFF lead agencies provided additional demographic data and information related to
need and services received (Children’s Bureau of Southern California, 2011). These data were
collected using a web-based version of the Family Assessment Form (FAF), a practice-based
instrument designed to help service providers standardize the assessment of service planning and
22

family functioning (Children’s Bureau of Southern California, 2011; McCroskey & Meezan,
1997; McCroskey, Nishimoto, & Subramanian, 1991).
The FAF was designed to measure family functioning using multiple items comprising
six factors (i.e., domains): (a) living conditions, (b) financial conditions, (c) caregiver support,
(d) caregiver–child interactions, (e) developmental stimulation, and (f) interactions between
caregivers (see Appendix). The FAF also measures caregiver history and personal
characteristics, FAF factors G and H, respectively. Prior research indicates that the FAF’s
subscales have interrater reliability between 75% and 80% and high interitem reliability
(Cronbach’s alpha) ranging from .68 to .93 (Children’s Bureau of Southern California, 1997,
2011; McCroskey, Sladen, & Meezan, 1997).
Need
The IHOC used the FAF to measure family functioning related to the aforementioned
FAF factors and several items in each factor (see Appendix). Need was indicated using a
continuous variable measuring the mean FAF factor score in each area of need. Each FAF factor
contained multiple items rated on a five-point Likert scale: (1) above average functioning, (2)
generally adequate functioning, (3) moderate problem functioning, (4) major problem
functioning, and (5) poor functioning. IHOCs could indicate indecision between two categories
by using a half-point such as 2.5 (McCroskey & Nelson, 1989).
Need was categorized into one of the following areas: concrete need (Factor A, B, or C),
educational and parenting need (Factor D or E), or clinical need (Factor F or Factor H, except
item H3, which measures substance abuse). Prior research indicates that item H3 does not
appropriately discriminate well the construct of personal characteristics (Franke, Christie, Ho, &
Du, 2013). It also allows for the analysis of families with substance abuse need. FAF Factor G
23

measuring caregiver history was included as a demographic characteristic rather than an
indicator of need due to its historical nature.
Home-Based Post-Investigation Services
Families participating in PFF were offered an array of HBPS that were documented in the
FAF case notes (see First 5 LA, 2014). Following the baseline assessment and during the first
follow-up assessment, the IHOC recorded the various services that were provided. This
information was used to create dichotomous variables indicating receipt or nonreceipt of the
following services: (a) case management services, (b) concrete services, (c) educational and
parenting services, and (d) clinical services. These service receipt categories were not mutually
exclusive; that is, families often received more than one service.
Families that received case management services received in-home support and
assistance with accessing other services and navigating systems. Concrete services addressed
basic needs such as housing, food, clothing, financial assistance or income support, medical care,
and transportation. Educational and parenting services largely consisted of parenting instruction
that focused on child development and family support services. Clinical services generally
involved receipt of one or more of the following: child and family therapy, mental health
treatment, domestic violence treatment, and substance abuse treatment (First 5 LA, 2010, a,b).
Analytic Strategy
For the first aim, univariate descriptive statistics were used to describe the sample’s
demographic characteristics, needs, and services. In addition, comparisons were made between
caregivers with and without complex needs related to substance abuse, domestic violence, and
mental health using Pearson chi-square analyses. For the second aim, two-sample t-tests were
used to compare initial need between caregivers with and without complex needs. For the third
24

aim, outcomes were compared between caregivers with and without complex needs using
Pearson chi-square analyses. All statistical analyses were conducted using Stata (version 12.1).
Results
Table 1 displays the characteristics of the sample and those of families with and without
complex needs. Most caregivers were female (97%) and Hispanic (74%). Nearly half were
between the ages of 26 and 35 (48%), with the remaining quarters between 18 and 25 or 36 or
older, and the mean age was 31.1 (SD = 7.7). Nearly 70% of the caregivers earned a combined
annual income of less than $10,000 and 64% had less than a high school education. Most
households consisted of one caregiver (70%), slightly less than half of the sample had two to
three children (48%), and nearly one third (32%) had a history of childhood stability or physical,
sexual, or substance abuse, or both. It should be noted that although these caregivers had a
history of abuse as children, they did not have any prior CPS reports.
When comparing caregivers with and without complex needs, no statistically significant
differences emerged with respect to gender, ethnicity, age, level of education, income, and
number of children in the home. Only two significant differences emerged with respect to
demographic characteristics: the number of caregivers in the home and caregiver history of
abuse. More families with complex needs had two to three caregivers in the home relative to
those without complex needs (34% vs. 28%, respectively; χ
2
= 6.9, df = 1, p < .01), and
significantly more caregivers with complex needs had a history of abuse (52% vs. 17%,
respectively; χ
2
= 268.2, df = 1, p < .001).
Table 2 describes the different areas of need (as indicated by the mean FAF score at
baseline) and the various HBPS received. Average scores in the three areas of concrete need
ranged from 2.5 for living conditions to 2.8 for financial conditions. The mean score for
25

caregiver support was 2.6. With regard to educational and parenting need, the mean score for
both was 2.8. The highest areas of need were clinical need related to interactions between
caregivers, with a score of 3, followed by mental health problems, which had a mean score of
2.5. The lowest area of need was substance abuse, with a score of 1.6.
When comparing caregivers with and without complex needs, families with at least one
complex need had more needs in general. For example, 26.3% of families with complex needs
had three to five needs and nearly half (46%) had six to eight needs, compared to 9.5% and 2.8%
of families without complex needs, respectively ( χ
2
= 800.4, df = 2, p < .001). Results of two-
sample t-tests indicate that the mean level of need also differed significantly between families
with and without complex needs for each area of need. As a reminder, a score of 3 or higher
indicated moderate problem functioning (Brooks, Sessoms, et al., 2011). Furthermore, the
complex-need group consisted of caregivers with a mean score of 3 or higher for any clinical
need. Caregivers with complex needs not only had higher mean scores with regard to clinical
needs (by definition), but also had higher mean scores for concrete and educational needs. Their
mean score ranged from 2.8 to 3.0 for concrete need and was 3.1 for educational and parenting
need, whereas their counterparts without complex needs had mean scores ranging from 2.3 to 2.6
for concrete need and 2.5 for educational need. The highest areas of need were clinical need
related to interactions between caregivers (a proxy for domestic violence) with a score of 3.5,
followed by mental health problems with a mean score of 3.0, compared to 2.3 and 2.2,
respectively, for families without complex needs. The mean score for substance abuse need
among caregivers with complex needs was low (M = 1.8, SD = 0.9) but significantly higher than
families without complex needs (M = 1.4, SD = 0.5; t = 12.2, df = 1,107, p < .001).
26

Regarding service receipt, the majority of families received case management services
(78%). A little more than half of caregivers received concrete services (57%), whereas 65% of
the families received educational services and 60% received clinical services. Again, it is
important to note that services were not mutually exclusive. When examining the total number of
services received, the distribution was fairly even, with approximately 25% receiving one, two,
three, or four services.
Service receipt did not significantly differ between families with and without complex
needs in terms of case management and concrete services, with approximately 77% of both
groups receiving case management services and 57% receiving concrete services. Slightly more
caregivers with complex needs received educational and parenting services (68.7% vs. 63.1%,
respectively; χ
2
= 6.6, df = 1, p < .010) and clinical services (65.6% vs. 63.6%, respectively; χ
2
=
21.5, df = 1, p < .001) than families without complex needs. With regard to the total number of
services, fewer families with complex needs received one or two services; more of them received
three or four services ( χ
2
= 13.6, df = 3, p < .001).
Table 3 displays results regarding reasons for termination of services for the overall
sample and stratified by families with and without complex needs. Only 2% of caregivers
terminated, about 5% moved out of the service area, and 5% declined services. Forty-two percent
of families had subsequent CPS involvement and nearly 10% dropped out. Seventy-five percent
of families achieved their goals and less than 0.5% had another termination reason. When
comparing termination reason by families with and without complex needs, two significant
differences emerged. More families with complex needs had subsequent CPS involvement (47%
vs. 38%, respectively; χ
2
= 11.1, df = 2, p < .001). In addition, fewer families with complex
27

needs successfully completed the program (72% vs. 77%, respectively; χ
2
= 8.6, df = 2, p <
.010).
Discussion and Implications
This study added to the knowledge base by describing the demographic characteristics
and needs of families referred for HBPS following their initial investigation by CPS. As noted in
Table 1, our findings highlight how families with complex needs referred for HBPS appear
similar to their counterparts without complex needs with respect to most demographic
characteristics. However, our findings emphasize that families with complex needs are different
in important ways. For example, families with complex needs had more needs in multiple areas
that were greater in severity, more of them had subsequent CPS involvement, and fewer of them
successfully completed the PFF program. These findings highlight the importance of ensuring
that families with complex needs receive services to address their multiple needs, given that they
have more needs and worse outcomes. Future studies should examine whether matching services
and complex needs following a CPS investigation is associated with important outcomes such as
CPS recidivism and changes in need.
Families with complex needs were also more likely to have a history of abuse and tended
to have more than one caregiver in the home. It is no surprise that families with complex needs
were more likely to have a history of abuse considering that they all had need related to either
domestic violence, mental health, or substance abuse. Furthermore, the finding that caregivers
with complex needs were more likely to have more than one caregivers is likely because nearly
all of the families with caregivers with complex needs had need related to domestic violence,
which by definition involves more than one caregiver. Nevertheless, CPS social workers should
keep these demographic characteristics in mind because complex needs might not be readily
28

apparent or quickly disclosed, so these demographic characteristics might serve as potential
indicators to identify families with complex needs.
With respect to services, our finding that families with complex needs more often
received three or four types of services and more educational and clinical services relative to
families without complex needs is encouraging. Other studies have shown that these needs may
go unmet or unaddressed altogether, especially for families experiencing domestic violence,
mental health, or substance abuse problems (Bagdasaryan, 2005; Cash & Berry, 2002; Chambers
& Potter, 2008; Choi & Ryan, 2007). Considering that caregivers with complex needs whose
problems are more severe tend to receive an open CPS case as opposed to prevention services, it
is possible that caregivers with complex needs in our sample were more amenable to various
services because of their voluntary nature. This highlights the importance of identifying and
providing services early in the service continuum before problems become more severe (Jonson-
Reid et al., 2010; Mendoza, 2014).
Some caregivers referred for HBPS had very few needs, calling into question the
screening protocol for families referred for HBPS after a CPS investigation. Nearly all of the
caregivers without complex needs (90%) had relatively few needs (zero to two needs). Although
this need category was created to eliminate empty cells, thus enabling Pearson chi-square tests,
analyses not shown here indicated that 50% of caregivers without complex needs had no needs,
25% had one need, and 13% had two needs ( χ
2
= 986.1, df = 8, p < .001). For caregivers with
complex needs, none had zero needs, 15% had one need, and 13% had two needs. It is possible
that HBPS were provided to many families due to CPS protocols because they had a young child
in the home and some services were needed to close the investigation. Alternatively, it is
possible that caregivers did not disclose their needs during the initial assessment, thus giving the
29

impression that they had fewer needs. Nevertheless, it is important to ensure that families most in
need of prevention services are referred, families with less need could be taking service slots
from other families with complex needs. Prior studies have found that a mismatch between the
number of preventive slots relative to a community’s need can affect service provision, leading
to an insufficient number of service slots in some high-need communities (Stanley & Kovacs,
2003; Wulczyn, Feldman, Horwitz, & Alpert, 2014). Prior research has found a distinct class of
low-need families that might be better served with less-intensive services based on their need
profiles (Jarpe-Ratner, Bellamy, Yang, & Smithgall, 2015). In addition, there is evidence that
lower risk caregivers benefit from most types of service provision, whereas higher risk
caregivers benefit from more specific interventions, specifically interventions that meet their
concrete needs (Chaffin, Bonner, & Hill, 2001).
Limitations
Despite the contributions of this study, several limitations should be noted. These data
provided only a snapshot of the needs and services of caregivers participating in the PFF
initiative. Initial analyses regarding needs and services focused on data from the initial
assessment conducted by IHOCs. Importantly, this study did not include data from subsequent
assessments. Analyses not presented here indicated that some families that did not receive
services immediately following the initial assessment had received services by the time they
terminated from the PFF program. However, these data could not be used due to numerous
missing observations.
Another limitation of this study stems from missing data. As previously mentioned,
nearly one fifth of the initial sample did not have complete services data following the initial
assessment. Furthermore, another fifth of the initial sample had no termination assessment and
30

were thus excluded because the next set of analyses required a sample with both an initial and
termination assessment. A comparison of demographic characteristics between the final study
sample and caregivers who were excluded revealed only one significant difference; caregivers
with missing data were more likely to have a lower household income. Thus, it is possible that
the exclusion of these caregivers might partially explain the low rates of refusal of services and
dropout in this sample.
Last, the decision to categorize complex needs a priori is also a potential limitation.
Although the aforementioned literature review provided sufficient rationale for defining a
complex need as having a clinical need related to domestic violence, mental health, or substance
abuse, the current operationalization does not account for the severity, interaction, or the number
of complex needs.
Conclusion
CPS decision making is not easy and it important to ensure that services are provided to
families most in need of services. This study highlights that many families are referred for HBPS
following a CPS investigation despite having relatively few needs. Furthermore, among families
referred for HBPS, there is a subgroup of families with complex needs related to domestic
violence, mental health, and substance abuse that appears to be similar but has vastly different
need profiles. Findings from this study indicate that the CPS screening process needs to
accurately identify families with and without complex to ensure the appropriate service response.
Furthermore, CPS should provide families with complex needs HBPS because they have more
needs in multiple areas and worse outcomes relative to families without complex needs. Future
studies should examine whether the provision of matched services to address complex needs
following a CPS investigation improves CPS recidivism and changes in need.
31

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41

Table 1. Caregiver Demographic Characteristics
Entire Sample Families with Complex Needs
Chi-square test

n=2,008 No (n=1,172) Yes (n=836)
% % % χ
2
(df)
Gender

Female 96.9 96.8 97.0
χ
2
(1)=0.0
Male 3.1 3.2 3.0
Ethnicity

Caucasian 10.5 9.4 11.9
χ
2
(2)=3.3
African-American 45.3 15.3 15.3
Hispanic 74.3 75.3 72.8
Age

18–25 25.2 26.4 23.5
χ
2
(2)=3.0 26–35 47.6 47.6 47.7
36 and older 27.2 26.0 28.8
Education

Less than High School 64.0 62.9 65.4
χ
2
(2)=1.2
High School or GED 20.8 21.5 20.0
College Degree 15.2 15.6 14.7
Income

Less than $10,000 67.7 67.6 67.8
χ
2
(2)=0.3
$10,000 -- $20,000 20.1 19.9 20.3
More than $20,000 12.3 12.5 11.8
Number of Caregivers

1 69.6 71.8 66.4
χ
2
(1)=6.9*
2-3 30.4 28.2 33.6
Number of Children

1 27.1 27.2 26.9
χ
2
(2)=0.7
2-3 47.6 48.2 46.8
4 or more 25.3 24.7 26.3
History of Abuse
a

No 68.7 83.2 48.5
χ
2
(1)=268.2***
Yes 31.6 16.8 51.5
Note.
a
=History of abuse indicated by a mean score ≥ 3 at baseline assessment using FAF Factor G

42

Table 2. Caregiver Needs and Services at Initial Assessment (N=2,008)

Entire Sample
Families with Complex Needs

n=2,008 No (n=1,172) Yes (n=836)

M (SD) M (SD) M (SD) t(df)
Concrete Need

Living Conditions 2.54 (.70) 2.34 (.60) 2.81 (.75) -14.8 (1,541)***
Financial Conditions 2.80 (.68) 2.63 (.62) 3.03 (.70) -13.4 (1,654)***
Support to Caregivers 2.62 (.64) 2.38 (.51) 2.95 (.65) -21.4 (1,528)***

Educational/Parenting Need

Caregiver/Child Interactions 2.77 (.65) 2.52 (.56) 3.13 (.61) -22.5 (1,683)***
Developmental Stimulation 2.76 (.68) 2.50 (.56) 3.11 (.66) -21.4 (1,592)***

Clinical Need

Domestic Violence 2.96 (.80) 2.31 (.43) 3.54 (.57) -44.4 (1,263)***
Mental Health Problems
2.53 (.63)
2.20 (.41) 3.00 (.58)
-34.1 (1,391)***
Current Substance Use
1.57 (.73)
1.39 (.46) 1.82 (.92)
-12.2 (1,107)***

Services Received % % % χ2(df)
Case Management 76.9 76.7 77.3 NS
Concrete 57.4 57.7 57.1 NS
Educational 65.4 63.1 68.7 6.6 (1)**
Clinical 59.7 63.6 65.6 21.5 (1)***

Total Number of Needs % % % χ2(df)
0-2 62.8 87.7 27.8
800.4(2)** 3-5 16.5 9.5 26.3
6-8 20.8 2.8 45.9

Total Number of Services % % % χ2(df)
1 22.8 24.9 19.7
13.6 (3)**
2 23.8 24.9 22.3
3 24.7 22.5 27.6
4 28.8 27.7 30.4
Two-sample T Tests for numeric variables. Bi-variate Pearson χ2 tests for categorical variables: *p<.05.
**p<.01. ***p<.001
Satterthwaite's degrees of freedom are provided for the T Tests.

43

Table 3. Termination Reasons
Entire Sample Families with Complex Needs Chi-square test

n=2,008 No (n=1,172) Yes (n=836)

% % % χ
2
(df)
Client Terminated

No 98.5 98.3 98.6
χ
2
(1)=0.2
Yes 1.5 1.7 1.4
Client Moved Transferred

No 95.0 94.9 95.2
χ
2
(1)=0.2
Yes 5.0 5.2 4.8
Refused services, non-compliance

No 95.2 95.5 94.9
χ
2
(1)=0.4
Yes 4.8 4.5 5.1
DCFS Involvement

No 58.4 62.0 53.1
χ2(2)=11.1***
Yes 41.6 38.0 46.9
Dropped Out

No 90.4 91.3 89.1
χ
2
(1)=2.5
Yes 9.6 8.7 10.9
Family Achieved Goals

No 25.1 22.7 28.5
χ2(2)=8.6**
Yes 74.9 77.3 71.5
Other

No 99.6 99.5 99.8
χ
2
(1)=0.9
Yes 0.4 0.5 0.3
*p<.05. **p<.01. ***p<.001

44

Chapter Three (Study 2)
Matching Services for Families at Risk of Maltreatment with Complex Needs
Millions of children and their families are investigated by child protective services (CPS)
agencies annually due to a report of suspected child maltreatment (U.S. Department of Health
and Human Services [USDHHS], 2016). In response to these investigations, CPS agencies must
triage services based on families’ needs. Families with the most needs receive an array of
services, often through an open CPS case when some form of child maltreatment has occurred.
Families whose children are at risk of maltreatment but can remain safely at home without CPS
supervision receive home-based post-investigation services (HBPS). HBPS are provided to
strengthen families by addressing their needs, and the most common HBPS are concrete,
educational, and clinical services (Cash & Berry, 2002; Fraser et al., 1991; Lewis, 1991; Pecora,
Whittaker, Maluccio, & Barth, 2000). These services are typically provided by a community
agency, although in some jurisdictions they might be provided by CPS agencies (see Conley,
2007; Conley & Berrick, 2010; Waldfogel, 2009).
Families that receive HBPS pose a unique challenge for CPS agencies. On one hand, their
children are safe enough to remain at home following a CPS investigation. On the other hand, the
children are still at risk of future maltreatment because of the family’s multiple needs that require
attention. Thus, CPS agencies need to provide services matched to a family’s needs. several
studies have revealed that matching needs and services is associated with important child welfare
outcomes such as decreased substance abuse, decreased maltreatment, and increased family
reunification (Choi & Ryan, 2007; Marsh, Cao, Guerrero, & Shin, 2009; Ryan & Schuerman,
2004; B. D. Smith & Marsh, 2002). Considering that more than one third of all of families
reported to CPS for the first time for alleged maltreatment are re-reported within 2 years (Fluke,
45

Shusterman, Hollinshead, & Yuan, 2008; Needell et al., 2015), an initial CPS report presents an
opportunity to match family needs with services and potentially prevent future maltreatment.
Although many families receive services when referred for HBPS, matching services
appears to be particularly problematic for families with complex needs related to substance
abuse, domestic violence, and mental health. This is especially important because the most
common reasons for CPS involvement involve domestic violence, mental health problems, and
substance abuse (Barth, 2009; Child Welfare Information Gateway, 2014a,b; Marcenko, Lyons,
& Courtney, 2011; McCoy & Keen, 2009). Furthermore, families with complex needs often
experience negative outcomes including decreased parenting ability (Barth, 2009; M. Smith,
2004; Wulczyn, 2009), emotional and behavioral problems (Felitti et al., 1998; Wolfe, 2003),
and increased CPS recidivism (Casanueva et al., 2015; Fluke et al., 2008). Several researchers
have found that these families do not receive needed services (Cash & Berry, 2002; Chambers &
Potter, 2008; Choi & Ryan, 2007) or receive services they do not need (Bagdasaryan, 2005; B.
D. Smith & Marsh, 2002; Staudt & Cherry, 2009). Missing from the matching literature is an
examination of when workers get it right following an initial CPS investigation—that is, when
they correctly provide matched services. Prior studies have limited their analyses to service
receipt and usually include families with current or historical CPS involvement. Furthermore,
only a few studies have examined whether the provision of matched services for families with
complex needs is associated with a reduced likelihood of a CPS report. Thus, more studies
examining the match between complex needs and services after an initial CPS investigation will
help advance the existing knowledge base by zooming in on the areas of need leading to a
services match and investigating whether matched services results in decreased recidivism.
46

In response to the aforementioned gaps, this study examined the relationship between
needs and matched services for families with complex needs and at risk of maltreatment. This
study had the following specific aims:
(1) To describe how many families with complex needs receive matched services.
(2) To identify what types of needs are appropriately matched with services.
(3) To analyze what types of need predict the receipt of matched services.
(4) To examine whether the provision of matched services decreases the likelihood of a
re-report to CPS.
A Primer on Home-Based Post-Investigation Services
During the past few decades, a variety of terms have been used synonymously with
home-based post-investigation services. These include family preservation, family-based, family
support, family maintenance, and community-based services (see Pecora et al., 2000). As with
the terminology, there is considerable variation in terms of what constitutes HBPS. Generally
speaking, HBPS are home-based services designed to strengthen families to prevent
maltreatment through the provision of an array of services, including concrete, educational, and
clinical services (see Cash & Berry, 2002, 2003; Fraser et al., 1991; Lewis, 1991; Pecora et al.,
2000).
Concrete services are designed to meet the basic needs of families. These services may
include, for example, food, clothing, furniture, emergency shelter, financial assistance,
transportation, babysitting, respite care, child care, and legal aid (Cash & Berry, 2002, 2003;
Chaffin, Bonner, & Hill, 2001; Fraser et al., 1991; Pecora et al., 2000; Ryan & Schuerman,
2004). They are sometimes referred to as hard services because concrete services are provided to
meet a material need (Pecora et al., 2000).
47

Educational services, sometimes referred to as enabling services (Cash & Berry, 2002),
are designed to teach parents a particular set of skills. They often target parenting attitudes,
knowledge, and abilities and parent–child interactions (Lutzker, Gershater-Molko, & Welsh,
2003). Agencies that provide educational services may offer parenting classes and groups
addressing child development, child discipline, parent–child interaction, skill building for new
mothers, family planning, and how to obtain additional resources (Cash & Berry, 2002, 2003;
Chaffin et al., 2001).
Last, clinical services are those designed address the emotional, mental health, and
behavioral needs of caregivers and families (Cash & Berry, 2002, 2003; Fraser et al., 1991;
Pecora et al., 2000; Ryan & Schuerman, 2004). Primarily therapeutic, these services may consist
of mental health treatment to address psychological problems, maladaptive behavior, and other
family situations requiring counseling (Cash & Berry, 2002; Palusci & Ondersma, 2012; Ryan &
Schuerman, 2004). Examples of clinical services include therapy to address depression,
substance abuse, family violence, anger management, and conflict resolution (Cash & Berry,
2003; Fraser et al., 1991; Palusci & Ondersma, 2012; Ryan & Schuerman, 2004).
Matching Services to Families with Complex Needs
Despite the various studies on matching needs and services, there is no agreement on how
to conceptualize a service match. Researchers have characterized a match according to needs and
services clusters or domains (Cash & Berry, 2002; Chambers & Potter, 2008), by whether a
service was appropriately provided for an identified need (Choi & Ryan, 2007; Ryan &
Schuerman, 2004; B. D. Smith & Marsh, 2002), by recommended versus provided services
(Bagdasaryan, 2005), and by client perceptions (Kang, 2015). With respect to complex needs,
there appears to be two common findings across the service-matching literature—complex needs
48

related to domestic violence, mental health, and substance abuse are poorly matched in that only
some of them are met with needed services (Cash & Berry, 2002; Choi & Ryan, 2007; Chambers
& Potter, 2008) or mismatched in that they are provided to families that do not need them
(Bagdasaryan, 2005; B. D. Smith & Marsh, 2002; Staudt & Cherry, 2009).
Cash and Berry (2002) studied 115 families with an open family preservation case and
found that families with complex needs involving substance abuse and domestic violence
problems did not receive clinical services they needed. Needs were recorded by caseworkers
during monthly visits and were grouped into one of six areas: (a) environmental problems, (b)
parenting issues, (c) household issues, (d) relationship problems, (e) compounding issues that
included domestic violence, substance use, and mental health, and (f) other. The authors of the
study reported suspicions that the mismatch might be due to the nature of providing voluntary
services, because families are not required to participate in all of the services (Cash & Berry,
2002).
Bagdasaryan (2005) examined need–services match among families receiving family
preservation services and found a large variation between caseworker-recommended services and
service receipt. Need was determined as part of a case review at the beginning of a case and a
match occurred if the family received the service by the end of the case. Nearly one quarter of
the families in the study in need of counseling (i.e., clinical services) did not receive
recommended services. However, families that received matched counseling and housing
services were more likely to successfully complete the program, highlighting the importance of
matching services.
Choi and Ryan (2007) found an unmet service need ranging from 43% to 90% among
354 substance-abusing mothers with co-occurring problems related to housing and mental health.
49

They used the ratio of identified needs to services as provided by the caseworker to calculate a
service match and did not account for problem severity or frequency of services. Co-occurring
problems related to education, family counseling, mental health, housing, and child care were
poorly matched with services (13.2%, 18.3%, 37%, 22%, and 22%, respectively). However,
families were more likely to reunify when they received matched concrete and clinical services.
Although Bagdsaryan (2005) and Choi and Ryan (2007) examined outcomes related to a match,
they did not examine what factors predicted the receipt of matched services.
Chambers and Potter (2008) examined the match between clusters of needs and services
in a study of families with open CPS cases. Families—all of whom were referred for child
neglect (as opposed to some form of abuse)—were separated into three needs clusters: (a) low
needs; (b) substance abuse; and (c) economic, domestic violence, and mental health. They
received services in one of four clusters: (a) low services; (b) high services or economic or
domestic violence services; (c) moderate or home-based services; and (4) high services or
substance abuse or drug court services. There was a mismatch for the group with economic,
domestic violence, or mental health needs. They received high or domestic violence services
only a quarter of the time and low services half of the time (despite being a high-needs group).
Furthermore, mental health services appeared to be delivered randomly with no clear match
between needs and services (Chambers & Potter, 2008).
Findings similar to those in Chambers and Potter’s (2008) study were obtained by Staudt
and Cherry (2009), who examined 2,109 caregivers with substance abuse, mental health
problems, or both problems. Caregivers had either an open or closed child welfare case in one of
44 counties across the United States. Needs and services data was gathered from caseworker
interviews regarding caregivers’ needs and the services that were offered and provided. Many
50

caregivers with mental health problems received appropriate clinical services, compared with
caregivers with substance abuse problems who were less likely to receive clinical services.
Staudt and Cherry (2009) suggested that the mismatch between clinical need and respective
services may have been a result of inaccurate identification of problems by caseworkers.
Although the study benefited from a large sample size and the use of probability sampling
methods, statistical analyses were limited to bivariate analyses that did not take into account the
effects of other areas of need.
Matching Services and CPS Recidivism
Although some studies have considered outcomes related to a match such as family
reunification or program completion (Bagdasaryan, 2005; Choi & Ryan, 2007), few of the
aforementioned studies examining a service match have examined the impact of matching
services on child maltreatment. Studies exploring the effect of provision of matched services on
CPS recidivism have found mixed results. Some found that matched services reduce the risk of
recidivism (Ryan & Schuerman, 2004), whereas others have found that matched services
increases the likelihood of CPS recidivism (Fowler, Taylor, & Rufa, 2011).
In a study examining the provision of housing services for child-welfare-involved
families in need of housing services, Fowler and colleagues (2011) used propensity score
matching to examine the effect of housing services on out-of-home placement. They used a
national dataset comparing housing services for 183 families with children who remained at
home following a CPS investigation to 595 similar families that did not receive needed housing
services. Their findings indicated that children in families that received housing services were
more likely to be placed in out-of-home care and spend time in out-of-home care. Although their
analytic methods were strengthened by propensity score matching, their findings were limited to
51

survey data that did not account for housing availability. The authors further stated that
examining housing services is complicated because families in need of housing may face
additional scrutiny due to their lack of housing that may result in out-of-home placement for
their children (Fowler et al., 2011).
Ryan and Schuerman (2004) examined the impact of matching various problem-specific
services for families on a substantiated re-report of child abuse and placement into foster care.
The sample consisted of 292 families from three states that reported some difficulty paying bills
at intake. These families were subsequently provided matched concrete and clinical services, and
outcomes were measured until 15 months following the receipt of matched services. Findings
revealed that the provision of matched concrete services was associated with a decreased
likelihood of substantiated maltreatment and placement into foster care (Ryan & Schuerman,
2004). The authors called for more studies examining why certain services are provided and how
the provision of matched services affects future child maltreatment because of the limited
research in this area.
In summary, studies have found that complex needs related to domestic violence, mental
health, and domestic violence are poorly matched (Cash & Berry, 2002; Choi & Ryan, 2007;
Chambers & Potter, 2008) or mismatched (Bagdasaryan, 2005; B. D. Smith & Marsh, 2002;
Staudt & Cherry, 2009) with services. None of the aforementioned studies examined predictors
of a service match, instead mostly focusing on the relationship between need and service receipt.
Although important, a focus on service receipt as opposed to a match limits our understanding of
a match relative to a mismatch, a common finding among families with complex needs.
Furthermore, the evidence regarding whether matched services prevents recidivism is
understudied with the few studies that exist showing mixed results. Thus, this study added to the
52

existing knowledge base on child maltreatment prevention by exploring three areas of need—
concrete, clinical, and educational need—to understand how they are related to a need–services
match for families with complex needs and by examining whether matched services reduces CPS
recidivism.
Methods
Sample
The initial sample consisted of 3,324 families with children aged 5 or younger that
enrolled in Partnerships for Families (PFF)—a community-based prevention initiative (Brooks,
Sessoms, et al., 2011; First 5 LA, 2014). Of these families, 2,929 had data on the services they
received after their initial assessment; 2,008 families had both an initial and termination
assessment. To explore the experiences of families with complex needs, this sample was further
restricted to 836 families with complex needs related to domestic violence, mental health
problems, and substance abuse. A complex need was defined as a mean score of 3 or higher for
any of the following clinical needs using the Family Assessment Form (FAF): (a) domestic
violence (Factor F measuring interactions between caregivers), (b) substance abuse (Item H3
measuring substance abuse), or (c) mental health (all items from Factor H except H3, which
measures substance abuse). This cutoff score was chosen because it indicates moderate problem
functioning (Brooks, Cohen, et al., 2011; Children’s Bureau of Southern California, 2011;
McCroskey & Meezan, 1997; McCroskey, Nishimoto, & Subramanian, 1991; McCroskey,
Sladen, & Meezan, 1997).
Measurement
Data were obtained from the local CPS agency and the lead agency in the PFF network of
community agencies. CPS provided demographic data on the children and caregivers in each
53

household. PFF lead agencies provided additional demographic data and information related to
need and services received (Children’s Bureau of Southern California, 2011). These data were
collected using a web-based version of the FAF, a practice-based instrument designed to help
service providers standardize the assessment of service planning and family functioning
(Children’s Bureau of Southern California, 2011; McCroskey & Meezan, 1997; McCroskey,
Nishimoto, & Subramanian, 1991).
The in-home outreach counselor (IHOC) used the FAF to measure family functioning in
the aforementioned factors and on several items in each factor (see Appendix). Need was
indicated using a continuous variable measuring the mean FAF factor score in each area of need.
Each FAF factor contained multiple items rated on a five-point Likert scale: (1) above average
functioning, (2) generally adequate functioning, (3) moderate problem functioning, (4) major
problem functioning, and (5) poor functioning. IHOCs could indicate indecision between two
categories by using a half-point such as 2.5 (McCroskey & Nelson, 1989). See Appendix I for a
shortened version of the FAF.
Need
Need was categorized into one of the following areas: concrete need (Factor A, B, or C),
educational or parenting need (Factors D or E), or clinical need (Factor F and Factor H except
item H3, which measures substance abuse). This was done because prior research indicated that
item H3 does not appropriately discriminate the construct of personal characteristics (Franke,
Christie, Ho, & Du, 2013). It also allows for the analysis of families with substance abuse need.
FAF Factor G measuring caregiver history was included as a demographic characteristic rather
than an indicator of need due to its historical nature.
54

Home-Based, Post-Investigation Services
Families participating in PFF were offered an array of HBPS that were documented in the
FAF case notes (see First 5 LA, 2014). Following the baseline assessment and during the first
follow-up assessment, the IHOC recorded the various services that were provided. This
information was used to create dichotomous variables indicating receipt or nonreceipt of the
following services: (a) concrete services, (b) educational or parenting services, and (c) clinical
services. It is important to note that the service receipt categories were not mutually exclusive;
that is, families often received more than one service.
Concrete services addressed basic needs such as housing, food, clothing, financial
assistance or income support, medical care, and transportation. Educational or parenting services
consisted largely of parenting instruction that focused on child development and family support
services. Clinical services generally involved receipt of one or more of the following: child and
family therapy, mental health treatment, domestic violence treatment, and substance abuse
treatment (First 5 LA, a,b).
Matched Services
Figure 2 below displays the service match coding. A dichotomous variable was coded as
a match if a caregiver had any of the eight types of need and received a matched service (need =
yes, service = yes). If a caregiver had a need but did not receive a service, this was coded as a
mismatch (need = yes, service = no). If a caregiver had no need but received a service, this was
also coded as a mismatch (need = no, service = yes). If a caregiver had no need and did not
receive the service, this was coded as no match (need = no, service = no). This coding was used
to create a series of match covariates for each type of need—three for concrete need and concrete
55

services, two for educational need and educational services, and three for clinical need and
clinical services.
As outlined in Figure 3, a match was considered appropriate if it met its respective need,
i.e., concrete services for a concrete need, educational services for an educational need, and
clinical services for a clinical need.
CPS Re-Referral
Re-referral data was provided by the Los Angeles County Department of Children and
Family Services and matched to data provided by the community-based agency that served the
family. A variable was created to indicate whether a CPS re-referral was received at any time
during the study period, between July 2006 and April 2011 (1 = re-referral, 0 = no re-referral).
Analytic Strategy
To address the first aim, univariate descriptive statistics were provided to describe needs,
services, and matches. For the second aim, bivariate Pearson chi-square analyses were used to
examine the relationship between needs and services. For the third aim, a multivariate logistic
regression analysis was used to determine the impact of different areas of need on a services
match while controlling for demographic characteristics. Last, a final multivariate logistic
regression analysis was conducted to analyze the effect of matched services on a CPS re-referral
while controlling for demographic characteristics. All statistical analyses were conducted using
Stata version 12.
Results
Table 4 displays the different caregiver needs, services, and service matches. Roughly
half of the caregivers had need in at least one of the three areas of concrete need, with 45% of
caregivers having a concrete need related to living conditions, 55% related to financial
56

conditions, and 51% related to caregiver support. More than half of the caregivers had one of the
two educational needs: 61% for caregiver child interactions and 64% for developmental
stimulation. All of the caregivers had a clinical need because caregivers had to have had at least
one of these complex needs to be included in this study. Nearly all of the caregivers (92%) had a
clinical need related to domestic violence, 56% had a clinical need related to mental health, and
19% had a clinical need related to substance abuse. With respect to the total number of needs,
need was almost evenly distributed across the eight areas of need (12% to 15% each). The
exception was caregivers with eight needs; only 7% of caregivers had every type of need.
When examining any service receipt, 57% of caregivers received concrete services, 69%
received educational services, and 66% received clinical services. With regard to service
matches, 41% had a concrete match, 49% had an educational match, and 66% of caregivers had
at least one clinical match. The total number of matches by category ranged from 0 to 3.
Seventeen percent of caregivers had no match, 32% had at least one match, 33% had two
matches, and almost 20% had three matches.
Table 5 presents the bivariate associations between the different areas of need and the
receipt of either concrete, educational, and clinical services. This analysis examined how well
needs and services were matched. As a reminder, a match was considered appropriate if it met its
respective need, i.e., a concrete service for a concrete need, an educational service for an
educational need, and a clinical service for a clinical need.
A few general patterns emerged, although interpretations should be made cautiously
because there was significant overlap among the areas of need. First, services were often
provided even if they were not needed. Second, concrete need was significantly associated with
57

each service type. Third, nearly every area of need was significantly associated with the receipt
of concrete services. The remaining results are presented below by service type.
For concrete services, more caregivers with concrete need received concrete services
relative to caregivers without this need. For example, more caregivers with concrete need related
to financial conditions received concrete services (62% vs. 51%, respectively; χ
2
= 9.0, df = 1, p
< .01). Furthermore, more caregivers with educational need related to developmental stimulation
received concrete services (61% vs. 52%; χ
2
= 6.3, df = 1, p < .05), and more caregivers
experiencing clinical need related to mental health (61% vs. 51%; χ
2
= 8.6, df = 1, p < .01) and
substance abuse (66% vs. 54%; χ
2
= 7.2, df = 1, p < .01) received concrete services. In contrast,
although clinical need related to domestic violence was significantly associated with concrete
services, fewer caregivers experiencing domestic violence received concrete services (55% vs.
70%; χ
2
= 6.3, df = 1, p < .001).
For educational services, only concrete need related to living conditions was significantly
associated with service receipt. Specifically, fewer caregivers with this need received educational
services relative to caregivers without this need (65% vs. 72%, respectively; χ
2
= 5.9, df = 1, p <
.05). No additional areas in either educational need or clinical need were associated with the
receipt of educational services. With respect to matching educational need and educational
services, caregivers were almost equally likely to receive educational services regardless of need.
For clinical services, only concrete need was associated with service receipt. Specifically,
fewer caregivers with either concrete need related to living conditions (58% vs. 72%; χ
2
= 18.6,
df = 1, p < .001) or financial conditions (60% vs. 73%; χ
2
= 18.6, df = 1, p < .001) received
concrete services relative to caregivers without these concrete needs. No other areas in either
educational need or clinical need were associated with the receipt of clinical services, although
58

two approached statistically significance. Specifically, slightly more caregivers with educational
need related to developmental stimulation and clinical need related to mental health received
clinical services.
Table 6 examines the impact of different areas of need on a services match based on a
multivariate logistic regression while controlling for demographic characteristics. Results are
discussed by matched service type.
For a concrete match and an educational match, both models were significant and
appeared to indicate an appropriate services match by area of need. For example, concrete need
related to financial conditions was associated with increased odds of receiving a concrete
services match (OR = 1.63; 95% CI = 1.05, 2.52). Educational need related to caregiver–child
interactions (OR = 4.28; 95% CI = 2.55, 7.19) and developmental stimulation (OR = 13.8; 95%
CI = 7.64, 24.8) were associated with increased odds of receiving an educational services match.
Regarding a clinical match, caregivers with concrete need related to living conditions had
reduced odds of receiving matched clinical services (OR = 0.46; 95% CI = 0.28, 0.75).
Educational need was not associated with a clinical services match. Caregivers with clinical need
related to mental health had increased odds of receiving a clinical services match (OR = 1.81;
95% CI = 1.06, 3.10). Clinical need related to domestic violence or substance abuse was not
associated with a clinical services match.
Table 7 examines the effect of matched services on a re-referral to CPS while controlling
for demographic characteristics. Neither matched concrete services nor matched clinical services
was associated with a re-referral to CPS. In contrast, caregivers who received matched
educational services were 40% less likely to be re-reported to CPS relative to caregivers who did
not received matched educational services (OR = 0.60; 95% CI = 0.42, 0.85).
59

Discussion and Implications
The primary purpose of this study was to understand whether caregivers with complex
needs receive matched services. One of the most striking findings is that social workers did get it
right from a matching standpoint. Families with complex needs received services matched to
their needs. For example, families with concrete need related to living and financial conditions
were more likely to receive matched concrete services, as prior studies have found (Cash &
Berry, 2002; Fernandez, 2007; Ryan & Schuerman, 2004). Similar to other studies, this was also
evident for educational need related to developmental stimulation (an indicator of parenting
need); caregivers with this particular type of need were more likely to receive matched
educational services (Cash & Berry, 2002). For matched clinical services, this relationship was
only present for clinical need related to mental health. Caregivers were more likely to receive
clinical services if they presented with a mental health problem. This conflicts with prior studies
that found caregivers with mental health problems do not received needed clinical services
(Bagdasaryan, 2005; Chambers & Potter, 2008; Choi & Ryan, 2007). Findings in prior studies
that some clinical needs are met suggest that caseworkers might not be accurately identifying
needs or only accurately identifying some needs (Cash & Berry, 2002; Staudt & Cherry, 2009).
IHOCs involved in the PFF program were trained to engage families in services by conducting
joint case planning in which they engaged in the families in services to address the needs that
they felt were a priority (Brooks, Sessoms, et al., 2011; First 5 LA, 2014). This might have
resulted in a higher identification of complex needs as IHOCs are not considered to be agents of
CPS. In contrast, this relationship did not hold for caregivers presenting need related to domestic
violence or substance abuse, which is similar to other studies indicating that families with
complex needs do not receive matched clinical services (Cash & Berry, 2002; Choi & Ryan,
60

2007; Chambers & Potter, 2008). This might be explained by the stigma attached to certain
needs which might affect a caregiver’s willingness to open up about complex needs (Faver,
Crawford, Combs-Orme, 1999; Kemp, Marcenko, Hoagwood, & Vesneski, 2009; King, Currie,
& Petersen, 2014).
Findings also indicate that many families with complex needs receive numerous services
even if they did not need them. From a resource allocation perspective, the provision of services
should be based on need. However, it is possible that the provision of multiple services (even
when they are not needed) may have resulted in increased parental engagement in PFF. This
would be consistent with the notion that bridging services—that is, services that engage parents
because they are not only helpful but because they also facilitate parental involvement—are
instrumental in engaging families in prevention services (Kemp, Marcenko, Hoagwood, &
Vesneski, 2009). Bridging services are believed to enhance trust and the therapeutic alliance
between service providers and clients by helping families meet basic needs, improving client
satisfaction, and increasing parental involvement (Faver, Crawford, & Combs-Orme, 1999;
Kemp et al., 2009; Marsh et al., 2009; B. D. Smith & Marsh, 2002; Stevens et al., 2005). Future
studies should examine whether the provision of bridging services is associated with increased
engagement in additional voluntary prevention services.
Caregivers with concrete need related to living conditions, an indicator of poverty, were
less likely to receive matched clinical services than caregivers without need related to their living
conditions. Perhaps concrete need related to living conditions may affect basic safety needs,
which if unaddressed can affect a family’s ability to receive services to address other higher-
order needs as posited by Maslow (1943). Considering that nearly all of the caregivers in this
sample had need related to domestic violence, it is possible that this finding might partially
61

reflect difficulty accessing services for some families experiencing domestic violence. This
would be especially problematic for caregivers in domestic violence situations where having a
safe place to stay would take precedence over receiving clinical services to address issues related
to domestic violence.
This study also expanded on prior studies by predicting a service match as opposed to
service receipt. This definition of a match, or “getting it right,” is important for several reasons.
From a resource allocation standpoint, families at risk of maltreatment should only receive
needed services and not be given services they do not need. Although two prior studies examined
a similar match concept (Bagdasaryan, 2005; Kang, 2015), these studies did not involve families
with an initial report to CPS and did not examine whether needs predicted the receipt of matched
services, instead focusing on outcomes. Although other studies found a mismatch among
families with complex needs and services (Cash & Berry, 2002; Chambers & Potter, 2008; Choi
& Ryan, 2007), their definitions of a match varied and they often included families with open
CPS cases (Bagdasaryan, 2005; Cash & Berry, 2002; Chambers & Potter, 2008; Ryan &
Schuerman, 2004; Staudt & Cherry, 2009). These are typically the highest-risk families, often
with current or historical child welfare involvement. However, the families that are the focus of
this study, namely families without an open CPS case, are typically high-risk families with no
histories of child welfare involvement. Thus, the match found in this study might apply to
families with complex needs early in the services continuum before services are mandated;
families with severe complex needs are not usually offered voluntary services because they tend
to receive open CPS cases.
The last aim of this study was to examine whether matched services reduce the likelihood
of a CPS re-report following a CPS investigation. Only matched educational services were
62

associated with a lower likelihood of a subsequent CPS re-report. Prior studies have found mixed
results regarding whether the provision of matched concrete services and clinical services results
in increased recidivism, so future studies should continue to examine multiple CPS outcomes to
broaden the evidence base related to matched services. Although it is unclear why only one of
the three matched services had an impact on CPS recidivism, it is important to understand how
matched educational services reduces CPS recidivism. Some researchers have argued that the
provision of parenting services (educational services in this study) can reduce the impact of risk
factors such as mental health and substance abuse (Barth, 2009). Thus, it is possible that matched
educational services could also reduce recidivism by mitigating such risk factors. Future studies
should examine how different types of matched services affect different indicators of CPS
recidivism and whether this is affected by the provision of matched educational services that
utilize and evidence-based parenting curriculum. Furthermore, proximal outcomes should be
examined, such as whether the provision of matched services is associated with a change in need.
Limitations
Despite the contributions made by this study, some limitations should be noted. These
data provide only a snapshot of matched services obtained by families participating in PFF.
These analyses focused on services data from the initial assessment conducted by IHOCs.
Importantly, they did not include services data from subsequent assessments. Thus, results
represent the match between need and early service receipt. It is possible that the observed match
might have differed had this study included data from subsequent assessments. Although
services data from subsequent assessments were available, these data could not be used because
many IHOCs did not indicate during the termination assessment whether additional services had
been received.
63

Another limitation of this study stems from missing data. As previously mentioned,
several caregivers had missing data from initial and subsequent assessments. Upon comparison
of demographics and needs of the study sample to the caregivers who were included, significant
differences emerged with respect to income. Caregivers with missing data had lower household
income. Thus, findings might have been different had these individuals been included in this
study. Furthermore, the sample size for the logistic regression models was reduced due to
listwise deletion. Despite this limitation, comparisons were made between models with and
without covariates that reduced sample size. Findings from these analyses were similar in
magnitude and direction for the covariates.
Last, it should be noted that there was a moderate correlation among the need variables,
which might have affected results of logistic regression models. A variance inflation factor test
was conducted for all of the multivariate models and the mean value was less than 3 for all
models, which is well under the score of 10 that indicates a problem with multicollinearity
(UCLA Statistical Consulting Group, n.d.). Therefore, findings from this study should not have
been greatly affected by this correlation, although it is important to acknowledge as a potential
limitation. In addition, multiple comparisons were made while conducting bivariate and
multivariate analyses to answer the specific aims of this study. Thus, findings might have been
affected by these multiple comparisons, which may have resulted in differences that were not
truly statistically significant.
Conclusion
Matching services for families with complex needs is difficult. Findings from this study
indicate that families with complex needs receive multiple services following a CPS
investigation. It is promising that many families received matched services to address their
64

multiple needs. Furthermore, receiving matched educational services resulted in a decreased
likelihood of a subsequent CPS re-report, highlighting the benefit of some matched services.
However, families with complex needs continue to receive services they do not need. Although
this may not necessarily be a bad thing because it might serve as an engagement strategy (Kemp
et al., 2009), future researchers should continue to examine whether bridging services are in fact
resulting in increased engagement and better outcomes.

65

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72

Table 4. Need, Services, and Matches of
Caregivers with Complex Needs (N=836)
n Valid %
Concrete Need
a

Living Conditions 377 45.3
Financial Conditions 462 55.3
Support to Caregivers 425 50.9
Educational Need

Caregiver/Child Interactions 503 60.9
Developmental Stimulation 521 63.6
Clinical Need

Domestic Violence 630 91.8
Mental Health 465 56.2
Substance Abuse 151 18.5
Total Number of Needs
1 127 15.2
2 105 12.6
3 105 12.6
4 115 13.8
5 101 12.1
6 119 14.2
7 109 13.0
8 55 6.6
Any Service Received

Concrete 477 57.1
Educational 574 68.7
Clinical 549 65.6
Matches

Concrete Match 346 41.4
Educational Match 406 48.6
Clinical Match 549 65.7
Number of Matches
0 135 16.5
1 265 31.7
2 272 32.5
3 164 19.6
Note.
a
=Need indicated by a mean score ≥ 3 at
baseline assessment using the FAF
DV=Domestic Violence, MH=Mental Health,
SA=Substance Abuse

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Table 5. The Association between Need and HBPS by Service Type

Home-Based, Post-Investigation Services (HBPS)

Concrete Educational Clinical
Areas of Need (Yes)
a

No
(%)
Yes
(%)
a

χ
2

No
(%)
Yes
(%)
χ
2

No
(%)
Yes
(%)
χ
2

Concrete Need

Living Conditions

No 44.2 55.8
0.8
27.7 72.3
5.9*
27.9 72.1
18.6***
Yes 41.1 58.9 35.5 64.5 42.2 57.8
Financial Conditions

No 48.7 51.3
9.0**
30.8 69.3
0.1
27.0 73.0
16.1***
Yes 38.3 61.7 31.8 68.2 40.3 59.7
Support to Caregivers

No 43.4 56.6
0.1
29.5 70.5
1.3
33.4 66.6
0.3
Yes 42.6 57.4 33.2 66.8 35.3 64.7

Educational Need

Caregiver/Child Interactions

No 41.5 58.5
0.7
28.8 71.2
1.8
36.2 63.8
0.8
Yes 44.3 55.7 33.2 66.8 33.2 66.8
Developmental Stimulation

No 48.0 52.0
6.3*
31.9 68.1
0.1
38.3 61.7
2.6
Yes 39.0 61.0 30.7 69.3 32.6 67.4

Clinical Need

Domestic Violence

No 30.4 69.6
4.4*
21.4 78.6
2.0
30.4 69.6
0.4
Yes 44.9 55.1 30.3 69.7 34.4 65.6
Mental Health

No 48.9 51.1
8.6**
31.5 68.5
0.0
37.9 62.2
3.3
Yes 38.7 61.3 31.4 68.6 31.8 68.2
Substance Abuse

No 45.8 54.2
7.2**
31.3 68.7
0.5
33.0 67.0
0.7
Yes 33.8 66.2 28.5 71.5 36.4 63.6
Note.
a
=Need indicated by a mean score ≥ 3 at baseline assessment.
* = p < .05; ** = p < .01; *** = p < .001. One degree of freedom for all χ2 statistics.

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Table 6. The Impact of Need on a Service Match for Caregivers with Complex Needs

Concrete Match Educational Match Clinical Match

(n=625) (n=625) (n=625)
Areas of Need (Yes)
a
OR 95% CI OR 95% CI OR 95% CI
Concrete Need

Living Conditions 1.57 [1.00, 2.48] 0.68 [0.41, 1.14] 0.46** [0.28, 0.75]
Financial Conditions 4.53*** [2.85, 7.21] 0.77 [0.46, 1.29] 0.73 [0.45, 1.20]
Support to Caregivers 1.59 [1.00, 2.54] 0.74 [0.44, 1.26] 1.28 [0.76, 2.12]
Educational Need

Caregiver/Child Interactions 0.44** [0.25, 0.76] 4.28*** [2.55,7.19] 0.87 [0.51, 1.47]
Developmental Stimulation 2.83*** [1.61, 4.98] 13.8*** [7.64, 24.8] 1.83 [1.04, 3.24]
Clinical Need

Domestic Violence 0.56 [0.28, 1.12] 0.83 [0.38, 1.80] 0.95 [0.42, 2.16]
Mental Health 1.34 [0.82, 2.20] 0.87 [0.52, 1.46] 1.81* [1.06, 3.10]
Substance Abuse 1.28 [0.76, 2.15] 0.71 [0.41, 1.24] 1.35 [0.75, 2.46]
Model χ
2
= 200.8*** 238.6*** 171.7***
Pseudo R
2
= 0.24 0.33 0.22
Note.
a
=Need indicated by a mean score ≥ 3 at baseline assessment

* = p < .05; ** = p < .01; *** = p < .001.

OR=Odds ratios adjusted for demographic characteristics; CI=95% Confidence Intervals.

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Table 7. The Effect of Matched Services on a Re-referral to Child Protective Services

CPS Re-Referral (n=746)
Matched Services by Area of Need OR 95% CI

Matched Concrete Services 1.19 [0.84, 1.69]
Matched Educational Services 0.60 [0.42, 0.85]
Matched Clinical Services for Clinical Need 1.01 [0.70, 1.48]
Model χ
2
55.3***
Pseudo R
2
0.06
Note. Adjustments were made for the following caregiver demographic characteristics:
ethnicity, age, number of caregivers, number of children, income, & history of abuse.
* = p < .05; ** = p < .01; *** = p < .001.

76

Figure 2. Service Match Coding

Service

No Yes
Need
No No Match = 0 Mismatch = 0
Yes Mismatch = 0 Match = 1

77

Figure 3. Match between Need and Type of Services

78

Chapter Four (Study 3)
Matching Services to Reduce Need Among Families At Risk of Maltreatment with Complex
Needs.
Despite the fact that numerous families receive home-based post-investigation services
(HBPS) following a child protective services (CPS) investigation, matching services to meet
their specific needs is difficult. A social worker must first appropriately identify these needs and
then find relevant services. Matching is further complicated because many families may not
engage in services because they feel misunderstood, stigmatized, coerced, fearful of CPS, or
unready to address identified needs (Altman, 2008; Faver, Crawford, & Combs-Orme, 1999;
Kemp, Marcenko, Hoagwood, & Vesneski, 2009; King, Currie, & Petersen, 2014; Marcenko,
Brown, DeVoy, & Conway, 2010; Marcenko, Hook, Rimich, & Lee, 2012). CPS agencies should
provide services matched to a family’s needs because several studies have revealed that
matching needs and services is associated with important child welfare outcomes such as
decreased substance abuse, lowered rates of maltreatment, and increased family reunification
(Choi & Ryan, 2007; Kang, 2015; Marsh, Cao, Guerrero, & Shin, 2009; Ryan & Schuerman,
2004; Smith & Marsh, 2002).
Although thousands of families receive HBPS annually (U.S. Department of Health &
Human Services, 2015), there exists a dearth of empirical knowledge about how matching
services affects families with complex needs identified after a child abuse investigation. Few
studies have directly examined whether providing various matched services results in a change in
need among families struggling with complex needs involving mental health, substance abuse,
and domestic violence. Providing matched services should facilitate change by addressing basic
needs, improving client satisfaction, and increasing parental involvement (Faver et al., 1999;
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Kemp et al., 2009; Marsh et al., 2009; Smith & Marsh, 2002). Even though several studies have
examined important outcomes associated with the provision of matched services (Bagdasaryan,
2005; Choi & Ryan, 2007; Marsh et al., 2009; Smith & Marsh, 2002), few of these studies have
examined different areas of need and whether matched services results in change in those areas
of need. Thus, further studies exploring whether providing matched services facilitates changes
in different areas of need are warranted.
In response to the aforementioned gaps, this study examined the change in need among
families with complex needs that received matched services following a CPS investigation. This
study had the following specific aims:
(1) To describe the level of need among families with complex needs at initial and
termination assessments.
(2) To compare the change in need associated with matched services.
(3) To examine whether the provision of matched services is associated with an overall
reduction in need.
Matched Services and a Change in Need
There exists a dearth of studies on the change in need among families referred for HBPS
after a CPS investigation. The few studies that exist have indicated that the participation in
home-based services is associated with a change in need (Brooks, Sessoms, et al., 2011; Reuter,
Melchior, & Brink, 2016). For example, Brooks, Sessoms, and colleagues (2011) examined
3,423 families with caregivers at risk of maltreatment that participated in a community-based
prevention initiative (the source of data for the present analysis). Caregivers who participated in
prevention initiative showed mean improvements in all areas of family functioning as measured
by the Family Assessment Form (FAF; Brooks, Sessoms, et al., 2011). Furthermore, families
80

experienced significant reductions in need as they became more engaged in services (Brooks,
Sessoms, et al., 2011). Although this study highlighted the importance of engaging clients in
services to reduce levels of need, it did not determine what services resulted in the observed
change in need among participating caregivers.
Reuter and colleagues (2016) examined 306 caregivers who participated in the same
community-based prevention initiative. The caregivers were eligible because they were either
pregnant mothers at risk of maltreatment (n = 183) or referred by CPS (n = 123). The caregivers
experienced significant reductions in all areas of need. In the subset of CPS-referred caregivers,
this study found that clinical need related to mental health and interactions between caregivers,
an indicator of domestic violence, improved with participation in services; however, CPS-
referred families with substance use issues did not experience a significant change in need
(Reuter, Melchior, & Brink, 2016). This study advanced knowledge of how participation in
services guided by a mental health services model can result in a change in need. However, it did
not examine what services resulted in this change in need.
Fernandez (2007) used the North Carolina Family Assessment Scale to examine change
in need in five domains related to environment, parental capabilities, family interactions, family
safety, and child well-being. Families were either self-referred or referred by CPS (56% of the
sample) to a community-based center to receive an array of home-based services to prevent child
maltreatment. Fernandez (2007) found that the families experienced reduced need in each
domain. Furthermore, receiving concrete services related to housing resulted in improvements
between intake and termination in the parenting, family safety, and family interaction domains.
Although this was one of the few studies to examine what services led to a change in need, it was
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limited (particularly with respect to understanding at-risk families in the United States) by its
relatively small sample of 51 families referred to a family support program in Australia.
A similar study examined whether the provision of services affected need in domains
related to environmental problems, household issues, relationship issues, domestic violence,
substance abuse, and mental health among 104 families with an open family-preservation case
(Cash & Berry, 2003). Although the results indicated that the provision of clinical services was
associated with successful program completion and a reduction in need among children, no
specific types of services were associated with a reduction in need among caregivers (Cash &
Berry, 2003). This study’s small sample size may have affected its results, because the authors
used more than the recommended number of independent variables in logistic regression models
(Cash & Berry, 2003). Thus, they might not have been able to detect any change in need among
caregivers.
Apart from the aforementioned findings, other relevant studies have not considered
whether matched services resulted in a change in need (Chambers & Potter, 2008; Staudt &
Cherry, 2009), although some researchers explored different outcomes related to matched
services (Bagdasaryan, 2005; Choi & Ryan, 2007). Bagdasaryan (2005) examined need–services
match among families receiving family preservation services and found large variation between
services recommended by caseworkers and service receipt. Nearly one quarter of the families in
the study in need of parenting (i.e., educational) and counseling (i.e., clinical) services did not
receive recommended services, resulting in a mismatch. However, families that received
matched counseling and housing services were more likely to have successfully completed the
program.
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In a study examining the match between need and services among 354 substance-abusing
mothers with co-occurring problems related to housing and mental health problems, Choi and
Ryan (2007) found rates of unmet service need ranging from 43% to 90%. The lowest rates for
service matches occurred for education, family counseling, mental health, housing, and child
care services (13.2%, 18.3%, 37%, 22%, and 22%, respectively). Despite these low rates,
families were more likely to reunify when they received matched concrete and clinical services.
A study of open CPS cases conducted by Chambers and Potter (2008) examined the
match between different domains of needs and services. Families referred for child neglect (as
opposed to some form of abuse) were separated into three needs domains, referred to as clusters:
(a) low needs; (b) substance abuse; and (c) economic, domestic violence, and mental health.
They were also classified by four services clusters: (a) low-intensity services; (b) high-intensity
services for economic, and domestic violence need; (c) moderate-intensity home-based services,
and (d) high-intensity substance abuse and drug court services. A mismatch occurred in the
economic, domestic violence, and mental health needs group. They received high-intensity
domestic violence services only a quarter of the time and low-intensity services half of the time
(despite being a high-needs group). Furthermore, mental health services appeared to be delivered
randomly, with no clear match between needs and services (Chambers & Potter, 2008). Although
this study was strengthened by the statistical methods used to develop its clusters to examine
need–services match, it was limited by the small sample of 160 high-risk families that were
solely reported for neglect (all other types of substantiated abuse were excluded) and did not
examine whether the provision of specific services resulted in a change in need.
Staudt and Cherry (2009) reached similar findings regarding mismatched needs and
services after examining 2,109 families with child welfare cases from counties in 50 states across
83

the United States. Many caregivers with mental health problems received appropriate clinical
services, yet caregivers with substance abuse problems were less likely to receive clinical
services. Staudt and Cherry (2009) posited that the mismatch among educational and clinical
need may have been a result of inaccurate identification of problems by caseworkers. Although
the study benefited from a large sample size and the use of probability sampling methods,
statistical analyses were limited to bivariate analyses and the authors did not examine whether
the provision of services led to a change in need.
In summary, the aforementioned studies did not advance understanding of need and
matched services in that they examined a change in need without specifying the service that led
to the observed change (Brooks, Sessoms, et al., 2011; Fernandez, 2007; Reuter, Melchior, &
Brink, 2016); considered other outcomes related to matched services but not change in need
(Bagdasaryan, 2005; Choi & Ryan, 2007); or explored the match between need and services but
not any accompanying change in need (Chambers & Potter, 2008; Staudt & Cherry, 2009). Two
studies that examined the type of services that led to a change in need were limited by their
relatively small sample sizes, affecting their generalizability (Cash & Berry, 2002; Fernandez,
2007). Especially problematic was the inclusion of families with open CPS cases (Bagdasaryan,
2005; Cash & Berry, 2003; Chambers & Potter, 2008; Ryan & Schuerman, 2004; Staudt &
Cherry, 2009). These are typically high- or very high-risk families, often with current or
historical child welfare involvement. However, the families that are the focus of the current
study, namely families without an open CPS case, are typically high-risk families with no
histories of child welfare involvement. This study sought to expand the existing knowledge base
on matching needs and services by exploring the provision of matched services in three specific
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areas of need—concrete, clinical, and educational—to examine whether matched services result
in change among families with complex needs with no prior history of CPS involvement.
Conceptual Model
As noted in Figure 1, this study was guided by three theoretical frameworks in examining
the match between needs and services among families with complex needs and resulting changes
in need: Maslow’s (1943) theory of human motivation, Patterson’s (2002) risk and resiliency
theory, and Kemp and colleagues’ (2009) typology of parental engagement.
Maslow (1943) posited that human needs follow a hierarchical structure in which basic
safety needs have to be met to address other needs. Thus, it is presumed that matching services to
basic needs will facilitate change in other areas of need. Family risk and resilience theory posits
that risk, or need, can be moderated by strengthening family functioning (Patterson, 2002). Thus,
to mitigate risk and strengthen families, services should be matched to different areas of need
because unmet need can lead to additional problems (Patterson, 2002). Last, Kemp et al.’s (2009)
framework on parental engagement posits that preconditions, including need and cultural factors,
must be addressed by engagement strategies to facilitate change. These engagement strategies
consist of the provision of various services that address preconditions to facilitate parental
involvement, resulting in reduced need.
Methods
Sample
The initial sample consisted of 3,324 families with children aged 5 or younger that
enrolled in Partnerships for Families (PFF)—a community-based prevention initiative (Brooks,
Sessoms, et al., 2011; First 5 LA, 2014). Of these families, 2,929 had data on the services they
received after their initial assessment; 2,008 families had both an initial and termination
85

assessment. To explore the experiences of families with complex needs, this sample was further
restricted to 836 families with complex needs related to domestic violence, mental health
problems, and substance abuse. A complex need was defined as a mean score of 3 or higher for
any of the following clinical needs using the Family Assessment Form (FAF): (a) domestic
violence (Factor F measuring interactions between caregivers), (b) substance abuse (Item H3
measuring substance abuse), or (c) mental health (all items from Factor H except H3, which
measures substance abuse). This cutoff score was chosen because it indicates moderate problem
functioning (Brooks, Cohen, et al., 2011; Children’s Bureau of Southern California, 2011;
McCroskey & Meezan, 1997; McCroskey, Nishimoto, & Subramanian, 1991; McCroskey,
Sladen, & Meezan, 1997).
Measurement
Data were obtained from the local CPS agency and the lead agency in the PFF network of
community agencies. CPS provided demographic data on the children and caregivers in each
household. PFF lead agencies provided additional demographic data and information related to
need and services received (Children’s Bureau of Southern California, 2011). These data were
collected using a web-based version of the FAF, a practice-based instrument designed to help
service providers standardize the assessment of service planning and family functioning
(Children’s Bureau of Southern California, 2011; McCroskey & Meezan, 1997; McCroskey,
Nishimoto, & Subramanian, 1991).
The FAF was designed to measure family functioning using multiple items comprising
six factors (i.e., domains): (a) living conditions, (b) financial conditions, (c) caregiver support,
(d) caregiver–child interactions, (e) developmental stimulation, and (f) interactions between
caregivers (see Appendix). The FAF also measures caregiver history and personal characteristics
86

(Factors G and H, respectively). Prior research indicated that the FAF’s subscales have interrater
reliability between 75% and 80% and high interitem reliability (Cronbach’s alpha) ranging from
.68 to .93 (Children’s Bureau of Southern California, 1997, 2011; McCroskey, Sladen, &
Meezan, 1997).
Need
An in-home outreach counselor (IHOC) used the FAF to measure family functioning
related to the aforementioned FAF factors and several items in each factor (see Appendix). Need
was indicated using a continuous variable measuring the mean FAF factor score in each area of
need. Each FAF factor contained multiple items rated on a five-point Likert scale: (1) above
average functioning, (2) generally adequate functioning, (3) moderate problem functioning, (4)
major problem functioning, and (5) poor functioning. IHOCs could indicate indecision between
two categories by using a half-point such as 2.5 (McCroskey & Nelson, 1989).
Need was categorized using the following domains: concrete need (Factor A, B, or C),
educational and parenting need (Factor D or E), or clinical need (Factor F or Factor H, except
item H3, which measures substance abuse). Prior research indicated that item H3 does not
appropriately discriminate the construct of personal characteristics (Franke, Christie, Ho, & Du,
2013). It also allows for the analysis of families with substance abuse need. FAF Factor G
measuring caregiver history was included as a demographic characteristic rather than an
indicator of need due to its historical nature.
Reduced Need
For the present analysis, reduced need was indicated by a change from a mean score of 3
or greater (problematic functioning) to a score of less than 3 in any area of need (adequate
functioning). As previously noted, a cutoff score of 3 was chosen because it indicates moderate
87

problem functioning (Brooks, Cohen, et al., 2011). Change scores were calculated for each area
of need to create a series of dichotomous variables (1 = reduction in need, 0 = no reduction in
need).
Overall Reduced Need
To capture overall reduced need, a mean score was calculated across all areas of need to
create an overall need score ranging from 12 to 36. The overall mean score was then divided by
the eight types of need to return to the original 5-point scale. This new score was coded as 1
(reduction in need) or 0 (no reduction in need), similar to the reduced need variable.
Home-Based, Post-Investigation Services
Families participating in PFF were offered an array of HBPS that were documented in the
FAF case notes (see First 5 LA, 2014). Following the baseline assessment and during the first
follow-up assessment, the IHOC recorded the various services that were provided. This
information was used to create dichotomous variables indicating receipt or nonreceipt of the
following service types: (a) concrete, (b) educational, (c), and clinical. Service receipt categories
were not mutually exclusive; that is, families often received more than one service.
Matched Services
Figure 2 outlines the need–service match coding scheme. A dichotomous variable was
coded as a match if a caregiver had any of the eight types of need and received a corresponding
service. A mismatch was indicated if a caregiver had a need but did not receive a service or had
no need but received a service. If a caregiver had no need and did not receive the service, this
was coded as no match. This coding was used to create match covariates for each type of need—
three for concrete need and concrete services, two for educational need and educational services,
and three for clinical need and clinical services.
88

Caregiver Demographics
This study controlled for the following caregiver demographics with indicated reference
categories obtained from the FAF: (a) ethnicity (African American, Asian, and Hispanic vs.
Caucasian); (b) primary caregiver’s age (26–35 and 36 or older vs. 18–25); (c) number of
caregivers in the household (two or three caregivers vs. one caregiver); (d) number of children
(two or three children and four or more children vs. one child); (e) household income ($10,000–
$20,000 and more than $20,000 vs. less than $10,000); and (f) history of abuse (history of abuse
vs. no history of abuse).
Analytic Strategy
For the first aim, paired sample t-tests were used to compare need between the initial and
termination assessment. For the second aim, Pearson chi-square analyses were used to examine
the bivariate association between matched services by area of need and reduced need. For the
third aim, multivariate logistic regressions were conducted to determine the impact of matched
services per area of need on overall reduced need while controlling for demographic
characteristics. All statistical analyses were conducted using Stata (version 12.1).
Results
Table 8 presents the level of need at the initial and termination assessments in the
different areas of need (as indicated by the mean FAF score) and the mean change for each type
of need. Caregivers experienced significant reductions in their level of need in each area, as
indicated by paired t-tests. Regarding concrete need, caregivers experienced a 0.55 mean
reduction in financial-related need. For the two types of educational need related to parenting,
the mean level of need decreased by roughly 0.62 for both caregiver–child interactions and
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developmental stimulation. Regarding clinical need, the mean reduction was 0.69 for domestic
violence, 0.50 for mental health, and 0.21 for substance use.
Table 9 displays the bivariate association between matched services by area of need on
reduced need (as indicated by a change in need from a score of 3 or higher to 3 or lower between
intake and termination). For caregivers with concrete need, each type of need was significantly
associated with reduced need in that respective area. For example, 56% of caregivers who
received matched concrete services experienced a reduction in need related to financial
conditions, relative to 16% of caregivers who receive matched concrete services but didn’t need
them ( χ
2
= 144.1, df = 1, p < .001). Similar reductions in need were observed for matched
services for living conditions and support to caregivers.
A similar pattern emerged for educational need, whereby more caregivers who received
matched educational services experienced a reduction in need relative to caregivers who received
matched educational services they did not need—namely, 58% versus 21% for caregiver–child
interactions ( χ
2
= 119.8, df = 1, p < .001) and 46% versus 216 for development stimulation ( χ
2
=
88.4, df = 1, p < .001).
For clinical need, a slightly different pattern emerged. Receiving matched clinical
services for domestic violence was not significantly associated with reduced need, compared to
receiving matched services that were not needed (42% vs. 40%, respectively). However, more
caregivers who received matched clinical services for mental health and substance abuse
experienced reduced need between intake and termination assessments. For example, 56% of
caregivers who received matched clinical services for mental health experienced a reduction in
mental health need, relative to 16% of caregivers who received matched services they did not
need ( χ
2
= 142.0, df = 1, p < .01). Likewise, 24% of caregivers who received matched clinical
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services for substance abuse experienced a reduced need for substance abuse, relative to 3% of
caregivers who did not receive matched services ( χ
2
= 4.1, df = 1, p < .05).
Table 10 highlights the effect of matched services by area of need on overall reduced
need between intake and termination while controlling for demographic characteristics. Odds
ratios greater than 1 indicate a reduction in overall need, whereas odds ratios less than 1 indicate
no change or an increase in overall need. For caregivers with concrete need related to living
conditions, receiving matched concrete services was associated with an increased likelihood of
overall reduced need (OR = 3.46; 95% CI = 1.84, 6.51). This pattern was similar for educational
need related to caregiver–child interactions (OR = 2.16; 95% CI = 1.15, 4.04). For clinical need,
receiving matched clinical services for mental health (OR = 4.11; 95% CI = 2.31, 7.09) was
associated with an overall reduction in need. Regarding clinical need related to domestic
violence and substance abuse, the provision of matched clinical services was not associated with
an overall reduction in need.
Discussion and Implications
This study expanded on prior studies by not only examining the level of need and change
in need among families at risk of maltreatment but also specifying what types of matched
services resulted in the observed change. The findings indicate that the provision of matched
services is associated with a reduction in need for families with complex needs that are at risk of
maltreatment. This reduction in need was observed in different areas of need and across need
overall. Thus, matched services appear to reduce need in targeted areas and overall.
At the bivariate level, matched services reduced need among caregivers in nearly every
area of need with one exception (clinical need related to domestic violence). For example,
caregivers who received matched concrete services for financial conditions, an indicator of
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having trouble paying bills, experienced a reduction in need; their average level of need
decreased from a score of 3 or higher to less than 3. This reduction in need was also observed for
matched services targeting educational need, an indicator of parenting need, and matched
services targeting clinical need involving mental health and substance abuse. That is, more
caregivers receiving matched services in those areas had a reduction in need in those same areas.
This is promising evidence that matched services can reduce need in targeted areas and
complements prior studies in this population (Brooks, Sessoms, et al., 2011; Reuter et al., 2016).
At the multivariate level, findings indicate that matched services in each area of need can
reduce overall need. This was evident for caregivers receiving matched services targeting
concrete need related to living conditions, an indicator of poverty, which is similar to findings by
Fernandez (2007). Although that study did not determine whether need–service match affected
overall need, it supported the notion that targeted services have the potential to not only change
need in one area (as found in the current study) but also change overall need. This provides
evidences supporting the importance of addressing basic safety needs as a starting point for
change (Kemp et al., 2009; Maslow, 1943; Patterson, 2002). Similar changes in overall reduced
need were observed for matched services for educational need related to caregiver–child
interactions and clinical need related to domestic violence and mental health. This makes sense
from a family systems change perspective, in that need can be changed by strengthening
different areas of family functioning (Patterson, 2002). This is also encouraging and in alignment
with various change frameworks in that targeted services in one area of need can result in change
in other areas of need (Kemp et al., 2009; Maslow, 1943; Patterson, 2002).
Despite the aforementioned findings, matched services for substance abuse did not reduce
overall need, although they did reduce clinical need. Although contrary to previous research
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(Reuter et al., 2016), this result might have been affected by the fact that families with clinical
need related to substance abuse are typically not referred for voluntary HBPS. Thus, very few
caregivers with clinical need related to substance abuse were referred to the PFF prevention
initiative, and only caregivers were lower levels of clinical need for substance abuse were
offered voluntary prevention services through PFF.
Limitations
Despite the contributions of this study, some limitations should be noted. Although this
study examined a reduction in need from intake to termination, these data provide only a
snapshot of matched services obtained by families participating in PFF at the intake assessment.
Thus, results represent the match between need and early service receipt. It is possible that the
observed change in need might have been different had this study included services data from
subsequent assessments. Although these data were available, they could not be used because
many IHOCs did not record additional services received during the termination assessment.
Another limitation of this study stems from missing data. As previously mentioned,
nearly one fifth of the initial sample did not have complete services data following the initial
assessment. Furthermore, another fifth of the initial sample had no termination assessment and
was thus excluded because the next set of analyses required data from both initial and
termination assessments. A comparison of demographic characteristics between the final study
sample and caregivers who were excluded revealed only one significant difference; caregivers
with missing data were more likely to have a lower household income. Thus, it is possible that
the exclusion of these caregivers might partially explain the low rates of refusal of services and
dropout in this sample. Furthermore, the sample size for the logistic regression models was
reduced due to listwise deletion. However, comparisons were made between models with and
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without covariates that reduced sample size. Findings from these analyses were similar in
magnitude and direction regarding the demographic characteristics and covariates.
It should be noted that some of the findings might have been affected by the lack of
specificity regarding types of services. For example, clinical services could have included
therapy to address domestic violence, mental health, or substance abuse, but information on the
specific type of service was not available. This might explain why some matched services were
significant at the bivariate level but not at the multivariate level. It could also have been affected
by multiple comparisons, which might have resulted in differences that were not truly
statistically significant.
Last, it is important to note that the same IHOC rated the caregivers during the initial and
termination assessments. Thus, it is possible that IHOCs may have been inclined to rate the
caregivers as having lower scores (indicating improvement) during the termination assessment.
Despite this potential limitation, the FAF subscales have been found to have high interrater
reliability, between 75% and 80%, and high interitem reliability (Cronbach’s alpha), ranging
from .68 to .93 (Children’s Bureau of Southern California, 1997, 2011; McCroskey, Sladen, &
Meezan, 1997). Furthermore, IHOCs were encouraged to consult the FAF definitions prior to
scoring and if deciding between two scores.
Conclusion
Matching services to need remains an important function of CPS agencies in conjunction
with community-based agencies, and findings from this study highlight that matching services
can reduce individual areas of need and overall need for families with children at risk of
maltreatment. Matched services resulted in reduced need for nearly every area of need at the
bivariate level. At the multivariate level, matched services in several areas of need resulted in
94

reduced overall need. For example, caregivers who received matched concrete services for living
conditions experienced a significant reduction in overall need, supporting the notion that
addressing basic safety needs can result in change in other areas of need (Kemp et al., 2009;
Maslow, 1943; Patterson, 2002). Similarly, reductions in overall need were observed for matched
services for educational need and clinical need related to domestic violence and mental health.
These findings highlight the importance of reducing need by strengthening different areas of
family functioning (Patterson, 2002) and how providing matched services can serve as a catalyst
for change in other areas of need (Kemp et al., 2009; Maslow, 1943; Patterson, 2002).

95

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Table 8. Need at Initial and Termination Assessment of Families with Complex Needs
Families with Complex Needs (n=836)

Mean Initial
Assessment (SD)
Mean Termination
Assessment (SD)
Mean
Change
t(df)
Concrete Need
Living Conditions 2.81 (.75) 2.36 (.67) -.45*** 20.0 (822)
Financial Conditions 3.03 (.70) 2.48 (.63) -.55***
22.6 (827)
Support to Caregivers 2.96 (.65) 2.41 (.62) -.54*** 25.2 (825)

Educational Need
Caregiver/Child Interactions 3.13 (.61) 2.49 (.64) -.63*** 26.7 (823)
Developmental Stimulation 3.10 (.65) 2.50 (.66) -.61*** 25.7 (806)

Clinical Need
Domestic Violence 3.53 (.55) 2.83 (.73) -.69*** 22.2 (593)
Mental Health 3.00 (.58) 2.50 (.61) -.50***
22.3 (820)
Current Substance Use 1.82 (.93) 1.61 (.73) -.21***
7.90 (803)
Note. Paired Sample T-Tests for numeric variables. *p<.05. **p<.01. ***p<.001
A score of 3 or higher indicated need.

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Table 9. The Association between Matched Services and Reduced Need

Reduced Need
b

Matched Service by Areas of Need
a

No
(%)
Yes (%) χ
2

Matched Concrete Services for Concrete Need

Living Conditions

No 89.5 10.5
150.5***
Yes 50.2 49.8
Financial Conditions

No 84.1 15.9
144.1**
Yes 43.9 56.1
Support to Caregivers

No 84.8 15.2
154.0***
Yes 42.3 57.7

Matched Educational Services for Educational Need

Caregiver/Child Interactions

No 79.6 20.5
119.8***
Yes 42.4 57.6
Developmental Stimulation

No 84.1 15.9
88.4***
Yes 53.8 46.2

Matched Clinical Services for Clinical Need

Domestic Violence

No 60.4 39.6
0.47
Yes 57.6 42.4
Mental Health

No 83.6 16.4
142.0***
Yes 43.8 56.2
Substance Abuse

No 97.2 2.82
74.6***
Yes 76.0 24.0
Note.
a
=Matched services examined by area of need.
b
=Reduced Need measured as > 3 at intake to < 3 at termination.

* = p < .05; ** = p < .01; *** = p < .001. One degree of freedom for all χ2 statistics.

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Table 10. The Effect of Matched Services on Overall Reduced Need between Intake and
Termination

Overall Reduced Need
Matched Services by Area of Need (n=625) OR 95% CI

Matched Concrete Services for Concrete Need

Living Conditions 3.46*** [1.84, 6.51]
Financial Conditions 1.29 [0.69, 2.42]
Support to Caregivers 1.90 [1.01, 3.57]

Matched Educational Services for Educational Need

Caregiver/Child Interactions 2.16* [1.15, 4.04]
Developmental Stimulation 0.71 [0.36, 1.38]

Matched Clinical Services for Clinical Need

Domestic Violence 1.04 [0.59, 1.81]
Mental Health 4.11*** [2.34, 7.09]
Substance Abuse 1.28 [0.66, 2.46]

Model χ
2
223.5***
Pseudo R
2
0.30
Note. Adjustments were made for the following caregiver demographic characteristics:
ethnicity, age, number of caregivers, number of children, income, & history of abuse.
* = p < .05; ** = p < .01; *** = p < .001.
Odds ratios greater than 1 indicate a reduction in overall need.

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Chapter Five
Summary of Findings, Implications, and Conclusion
The specific goals of this dissertation study were fourfold: (a) to describe the
demographic characteristics and need profiles of families with complex needs following an
initial CPS investigation, (b) to examine whether families with complex needs receive matched
services, (c) to investigate whether the receipt of matched services results in decreased
recidivism, and (d) to test whether receiving matched services is associated with reduced need.
Considering that child protective services (CPS) agencies play an important role in assessing and
addressing families’ needs with relevant services, it is important for CPS agencies to understand
families with complex needs during their initial contact with CPS and respond appropriately. The
major findings are summarized along with implications and concluding thoughts.
Summary of Findings
The first study highlighted how families with complex needs that are referred for home-
based post-investigation (HBPS) appear to be the same as their lower-need counterparts with
respect to demographic characteristics. However, a closer examination of their needs indicated
that they are different in important ways. First, although families referred to HBPS may appear
to be a homogenous group, families with complex needs have different need profiles that deserve
attention. Families with complex needs, defined as families with clinical needs related to
domestic violence, mental health, and substance abuse, differed with respect to their abuse
histories, the number of caregivers in the home, and their multiple needs. Despite the fact that
they received more services, their outcomes were worse than their lower-need counterparts,
highlighting the importance of understanding whether they receive services matched to their
needs.
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The second study expanded on the first study by examining the match between needs and
services and the predictors of a need–service match, as opposed to service receipt. Furthermore,
the study examined whether the provision of various matched services resulted in decreased
recidivism. Findings from the second study were encouraging in that social workers providing
services to families with complex needs were getting it right and appropriately providing
matched services, i.e., concrete, educational, and clinical services when families had concrete,
educational, or clinical needs, respectively. Furthermore, receiving matched educational services
was associated with a decreased likelihood of a subsequent CPS report, highlighting the
importance of providing matched educational services to prevent future maltreatment. Providing
matched services is important not only from an ethical standpoint, because services should be
provided to address needs, but also from a resource allocation perspective considering that CPS
spends so much money on providing services to families at risk of maltreatment.
The third study complemented the first two studies by examining whether the provision
of matched services resulted in a change in need. Based on the results, providing matched
concrete, educational, and clinical services not only reduced respective areas of need (with the
exception of domestic violence) but also reduced overall need. Of particular note, receiving
matched services for concrete need related to living conditions, educational need related to
caregiver-child interactions, or clinical need related to mental health was associated with reduced
overall need. These findings provide evidence supporting the importance of matched services in
reducing need in targeted areas. Furthermore, they highlight the importance of addressing basic
safety needs as a potential starting point for change and indicate that addressing need in one area
could potentially act as a catalyst for change in other areas of need (Kemp, Marcenko,
Hoagwood, & Vesneski, 2009; Maslow, 1943; Patterson, 2002).
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Implications for Policy and Practice
Keeping in mind the limitations detailed in previous chapters, findings from this
dissertation have important implications with respect to the identification of families with
complex needs, considering the vast literature indicating that these families have detrimental
outcomes related to parenting ability (Barth, 2009; Smith, 2004; Wulczyn, 2009), emotional and
behavioral problems (Felitti et al., 1998; Wolfe, Crooks, Lee, McIntyre-Smith, & Jaffe, 2003),
and CPS recidivism (Casanueva et al., 2015; Fluke, Shusterman, Hollinshead, & Yuan, 2008).
Having just one complex need should be an indicator that a family is likely to have multiple
needs, as highlighted in the first study. CPS social workers should spend extra time to ensure that
families with relatively few needs are referred to lower-risk prevention programs because there is
evidence that lower-risk families will benefit from most types of services, whereas caregivers
with complex needs would benefit from more tailored interventions (Chaffin, Bonner, & Hill,
2001). Furthermore, CPS social workers should thoroughly assess families with caregivers who
present with histories of child maltreatment and or multiple caregivers because these are
potential indicators that a family has complex needs.
Another important implication involves the screening and triage process following a child
abuse investigation. First, it is important to put Partnerships for Families (PFF) in the context of
the literature involving differential response, also known as alternative response. California’s
differential response model consists of a three-track system in which services are assigned to one
of the following responses: (a) a community response, (b) a community and child welfare
response, or (c) a child welfare response (Conley & Berrick, 2010). Although Los Angeles
County does not officially have a differential response system in place, PFF closely resembles
Track 2 in that eligible families receive services from community-based agencies following an
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investigation by CPS. Although it is difficult to directly compare the Los Angeles County service
response model to models in other states that provide a differential response in place of a
traditional investigation (see Casey Family Programs, 2012; Merkel-Holguín, Kaplan, & Kwak,
2006), findings from these dissertation studies highlight that some lower-risk families, i.e.,
families that could be served by a non-investigation model or programs targeting lower-risk
families, are being referred alongside higher-risk families, most often for domestic violence.
Furthermore, during the PFF prevention initiative, Los Angeles County’s service response model
also allowed for lower-risk families to be referred for alternative response services or the
Prevention Initiative Demonstration Project (Department of Children and Family Services
[DCFS], 2015; McCroskey et al., 2009). This is important because lower-risk families could be
taking slots from other higher-risk families. Researchers have found that a mismatch between the
number of preventive slots and a community’s need can result in an insufficient number of
service slots in some high-need communities (Stanley & Kovacs, 2003; Wulczyn, Feldman,
Horwitz, & Alpert, 2014).
It is promising that Los Angeles County DCFS is moving toward a more comprehensive
prevention approach akin to a Track 1 differential response (Conley & Berrick, 2010) during
screening of CPS referrals. Although this initially began during a trial period, it has now been
fully implemented using a prevention and aftercare services approach (DCFS, 2013, 2016). Thus,
it is important for CPS social workers to understand the child welfare services continuum to
determine the best service response depending on a family’s presenting problems. Part of this
decision-making process should involve an evaluation based on not only a family’s level of risk
but also a continuum of need. CPS social workers investigating families that present with one or
more complex needs should conduct a thorough assessment of complex needs considering the
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vast literature in child welfare indicating that multiple negative outcomes are associated with the
presence of complex needs. Furthermore, social workers should take the extra time to engage
their clients in prevention services, which can be difficult at times considering the sometimes
adversarial approach of conducting a child abuse investigation by children’s social workers with
large caseloads. CPS agencies should provide training to CPS social workers that addresses how
their values and attitudes can affect client engagement and clinical assessment (Palmer, Maiter,
& Manji, 2006; Schreiber, Fuller, & Paceley, 2013; Tracy & Farkas, 1994). Furthermore, CPS
agencies could address barriers related to service engagement by reducing caseloads to provide
social workers with more time to engage clients in clinical services (Staudt, 2007).
This dissertation also highlights the importance of using a strengths-based approach to
engaging high-risk families in HBPS. PFF was a well-funded prevention initiative that
emphasized client engagement, a commonly identified factor that supports working with families
experiencing complex needs (Altman, 2008; Dawson & Berry, 2001; Kemp et al., 2009; King,
Currie, & Petersen, 2014). Furthermore, one of the key ingredients of PFF was that its services
were guided by the strengthening protective factors framework, which recommends
strengthening families by targeting five protective factors to prevent child maltreatment: parental
resilience, social connections, knowledge of parenting and child development, concrete support
in times of need, and children’s social and emotional competence (First 5 LA, 2010a; Harper
Browne, 2014; Horton, 2003). Considering that PFF was an expensive program costing $50
million over 5 years, it is important to understand the benefits from an investment perspective.
Several reports highlighted the benefits of PFF program participation, especially for families
who were fully engaged in services (Brooks, et al., 2011; First 5 L.A., 2010b). It is less clear
how costly programs such as PFF fare in comparison to other less expensive programs. Future
107

studies should conduct cost analyses that examine programs such as PFF and other similar
prevention programs relative to client needs to compare outcomes across different risk levels and
examine service dosage.
Last, it is important to consider the CPS response to maltreatment from an evidence-
based perspective. As the evidence grows for the types of prevention services that are most
effective to target the needs of different populations (see Hawkins et al., 2015), it is crucial that
CPS agencies thrive to fully implement evidence-based services and practices to prevent child
maltreatment. This is critical not only for families with complex needs that have not experienced
maltreatment but also for families that have already experienced child maltreatment. Social
workers should consider the guidelines set forth by the American Professional Society on the
Abuse of Children that prioritize the use of evidence-based interventions to target the most
critical needs of families with the fewest services possible (Berliner et al., 2015). A summarized
version of these recommendations is available at
http://www.apsac.org/assets/documents/apsac%20alert%20summer%202015.pdf.
Conclusion
The overarching aim of this dissertation was to understand families at risk of
maltreatment with complex needs with respect to their need profiles, the matched services they
receive, and the resulting change in need. Findings from this dissertation indicate that families
with complex needs appear similar to their lower-need counterparts with respect to demographic
characteristics but differ significantly with respect to their multiple needs. Furthermore, their
outcomes are worse despite the fact that they receive more services. These findings highlight the
importance of correctly identifying needs to determine the appropriate service response
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following a CPS investigation considering that CPS social workers often serve as gatekeepers to
services.
Regarding matched services, families with complex needs received multiple services that
were often matched to their needs. Importantly, families that received matched educational
services experienced reduced recidivism and were more likely to experience a reduction in need
in both specific areas and overall. Furthermore, providing matched services was found to reduce
individual areas of need and overall need. Thus, findings from these studies indicated that
although not all matched services resulted in decreased recidivism, they did result in reducing
need for families with complex needs that were at risk of maltreatment. This is especially
important for families with complex needs because of the many obstacles they face and the vast
literature indicating that they will likely experience more detrimental outcomes.

109

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114

Appendix: Family Functioning Factors and Items (Shortened Version)
i

Section A: Living Condition
A1 Cleanliness/Orderliness — Outside Environmental Conditions
A2 Cleanliness/Orderliness — Outside Home Maintenance
A3 Cleanliness/Orderliness — Inside Home Maintenance
A4 Safety — Outside Environmental Conditions
A5 Safety — Outside Home Maintenance
A6 Safety — Inside Home Maintenance

Section B: Financial Conditions
B1 Financial Stress
B2 Financial Management
B3 Financial Problem Due to Welfare System/Child Support
B4 Adequate Furniture
B5 Availability of Transportation

Section C: Support to Caregivers
C1 Support from Friends and Neighbors and Community Involvement
C2 Available Child Care
C3 Chooses Appropriate Substitute Caregivers
C4 Available Health Care
C5 Provides for Basic Medical/Physical Care
C6 Ability to Maintain Long-Term Relationship

Section D: Caregiver/Child Interactions
D1 Understands Child Development
D2 Daily Routine for Child(ren)
D3 Use of Physical Discipline
D4 Appropriateness of Disciplinary Methods
D5 Consistency of Discipline
D6 Bonding Style with Child(ren)
D7 Attitude Expressed About Child(ren)/Caregiver Role
D8 Takes Appropriate Authority Role
D9 Quality And Effectiveness of Communication (Caregiver to Child[ren])
D10 Quality And Effectiveness of Communication (Child[ren] to Caregiver)
D11 Cooperation/Follows Rules and Directions
D12 Bonding to Caregiver

Section E: Developmental Stimulation
E1 Appropriate Play Area/Things — Inside Home
E2 Provides Enriching/Learning Experiences for Child(ren)
E3 Ability and Time for Child(ren)’s Play
E4 Deals with Sibling Interactions

Section F: Interactions between Caregivers
115

F1 Conjoint Problem Solving Ability
F2 Manner of Dealing with Conflicts/Stress
F3 Balance of Power
F4 Supportive
F5 Caregivers’ Attitude toward Each Other
F6 Ability to Communicate (Verbal and Nonverbal)

Section G: Caregiver History
G1 Stability/Adequacy of Caregiver’s Childhood
G2 Childhood History of Physical Abuse/Corporal Punishment
G3 Childhood History of Sexual Abuse
G4 History of Substance Abuse
G5 History of Aggressive Act as an Adult
G6 History of Being an Adult Victim
G7 Occupational History
G8 Extended Family Support

Section H: Caregiver Personal Characteristics
H1 Learning Ability/Style
H2 Ability to Trust
H3 Current Substance Use
H4 Passivity/Helplessness/Dependence
H5 Impulse Control
H6 Cooperation
H7 Emotional Stability (Mood Swings)
H8 Depression
H9 Aggression/Anger
H10 Practical Judgment/Problem-Solving and Coping Skills
H11 Meets Emotional Needs of Self/Child
H12 Self-Esteem

i
Please refer to http://www.familyassessmentform.com for more information about the FAF.

Abstract (if available)

Abstract The provision of voluntary home-based post-investigation services (HBPS) to meet the needs of families at risk of maltreatment continues to be an important function of child protective services (CPS) agencies in partnership with community-based agencies. One understudied area of research involves families with complex needs that are referred to a community agency for HBPS following a child abuse investigation. Importantly, national reports on child maltreatment do not account for these families because they fall off the radar of CPS agencies once their investigation is closed. Thus, little is known about the characteristics of these families and whether they receive services matched to their needs after a child abuse investigation. ❧ This dissertation focused on these families, giving extra attention to families with complex needs

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Asset Metadata

Creator Simon, James David (author)

Core Title Post-investigation experiences of families with complex needs at risk of maltreatment: an examination of need, matched services, and changes in need

School School of Social Work

Degree Doctor of Philosophy

Degree Program Social Work

Publication Date 09/26/2016

Defense Date 06/08/2016

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag change in need,child abuse investigation,child abuse prevention,child maltreatment prevention,child protective services,Child welfare,child welfare services,complex needs,CPS decision making,family assessment,family functioning,home-based,matched services,matching needs and services,OAI-PMH Harvest,post-investigation services

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Language English

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Advisor Brooks, Devon (committee chair), Lyon, Thomas (committee member), Palinkas, Lawrence (committee member)

Creator Email eops_james@yahoo.com,Jamesdsi@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c40-307274

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