University of Southern California Dissertations and Theses

Immigrants at a loss: the need for services that promote child well-being among Latino families with child welfare contact

(USC Thesis Other)

Immigrants at a loss: the need for services that promote child well-being among Latino families with child welfare contact

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content i Immigrants at a Loss: The Need for Services that Promote Child Well-being Among Latino Families with Child Welfare Contact by Megan Finno-Velasquez August 2015 Degree Conferral Ph.D. (SOCIAL WORK) University of Southern California Dissertation Guidance Committee Lawrence Palinkas, PhD (Co-Chair) Michael Hurlburt, PhD (Co-Chair) Nichole Esparza, PhD CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez ii Dedication This dissertation is dedicated to the hermanos y hermanas migrantes whose hearts and strength inspired me to make improving conditions for their children and communities my life’s work. I also dedicate this to the special souls who stirred and poked and prodded me to complete this, who saw in me what I didn’t, and who never lost confidence that I would make it through the struggle. I would not have gotten through this without my husband, partner, and love of my life, Joseph Paul Velasquez, and the furry family we’ve made together. To my family in Chicago, who never doubted I could do this. To the few who I keep close, who remind me that I belong somewhere when I’m lost: Alex, Nina, Eliza, and the Fab Four. To Nina and to Gene, who have supported my body and mind when I’ve most needed healing. And finally, to the “LA” friendships I’ve been blessed to make on this journey along the way. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez iii Acknowledgements I am wholeheartedly grateful for the team that has supported this effort over the past five years, and take this opportunity to say thank you: To Dr. Lawrence Palinkas, for your calm and steady support, generous sharing of your work and your brilliance, your sage perspective, and your belief in me. To Dr. Michael Hurlburt, for taking me on, for showing me the ropes, for your authentic support, and for modeling how to do this with balance and integrity. To Dr. Alan Dettlaff, Dr. Michelle Johnson-Motoyama, Dr. Jodi Berger Cardoso, Wendy Cervantes, Yali Lincroft, my compadres in this work who I am also honored to call friends, for including me in this from the beginning, and for the inspired work we will continue to do together in the future. To Dr. Ijeoma Nwazubor Ogbonnaya, Dr. Kristen Seay, future doctor Amy He, and any other future colleagues I have gained through this process. To Dr. Nicole Esparza, Dr. Jacquelyn McCroskey, Dr. Emily Putnam-Hornstein, Dr. Dorian Traube, Dr. Erick Guerrero, who have influenced my thinking and shared your time and wisdom with me over the past five years. To the USC School of Social Work doctoral program and to the friends I’ve made in the program, for your generous financial and emotional support. And finally, to USC’s Graduate School and to the Doris Duke Foundation for the Promotion of Child Well- being, for seeing something in me and for providing me with a richer and deeper learning experience than I could have imagined. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez iv Table of Contents Dedication ii Acknowledgements iii List of figures and tables vi Abstract vii Chapter One: Overview of Three Studies 1 Introduction & Rationale 1 Study Goal & Structure 10 Conceptual Model 11 Methods 12 Summary 14 References 16 Figure 24 Chapter Two (Study 1): Problematic Substance Use and Service Receipt among Latino Parents 25 Reported to Child Welfare: The Influence of Nativity and Legal Status Introduction 25 Methods 27 Results 30 Discussion 31 Conclusion 35 References 36 Tables 41 Chapter Three (Study 2): Intimate Partner Violence and Help-Seeking Services among Latino 48 Women with Child Welfare Contact: Does Immigrant Status Matter? Introduction 48 Methods 51 Results 57 Discussion 60 Conclusion 67 References 68 Tables 74 Chapter Four (Study 3): Effects of Parent Immigration on Mental Health Service Use Among 81 Latino Children Investigated by Child Welfare Introduction 81 Methods 83 Results 86 Discussion 88 Conclusions 90 References 92 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez v Tables 95 Chapter Five: Conclusions, Implications, and Future Directions 100 Introduction 100 Major Findings 101 Limitations and Future Research 105 Implications and Recommendations 109 Conclusion 112 References 113 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez vi List of Figures and Tables Figure 1.1 Andersen’s behavioral model for health services use modified for use with immigrants reported to the child welfare system Table 2.1 Substance use and service receipt among Latino biological caregivers of children remaining in the home following investigation by nativity and legal status Table 2.2 Weighted bivariate relationships between covariates and substance abuse service receipt Table 2.3 Weighted multivariate logistic regression models predicting substance abuse service receipt Table 2.4 Weighted bivariate relationships between need for services and substance abuse service receipt Table 2.5 Weighted substance abuse treatment in case plan by nativity and immigration status Table 2.6 Weighted child welfare worker perceptions of problematic substance use among caseworkers Table 3.1 Weighted patterns of physical violence and IPV service use by female Latino caregivers of children remaining at home following a child welfare investigation Table 3.2 Weighted bivariate relationships between household characteristics, caregiver functioning, child welfare contact, recent physical violence & IPV service use Table 3.3 Weighted multivariate logistic regression models predicting past year IPV Table 3.4 Weighted multivariate logistic regression models predicting IPV service use over 24 months Table 3.5 Weighted social support by nativity and immigration status Table 4.1 Weighted sample characteristics and mental health service receipt by Latino children aged 3-17 investigated by a child welfare agency Table 4.2 Weighted percentages of mental health need and service receipt for Latino school-aged children by parent nativity and citizenship/immigration status Table 4.3 Weighted logistic regression models of mental health service use by school-aged Latino children investigated by a child welfare agency (Nativity and immigration status) Table 4.4 Weighted logistic regression models of mental health service use by school-aged Latino children investigated by a child welfare agency (Time residing in U.S.) CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez vii Abstract Families who come to the attention of the child welfare system typically experience multiple stressors and face complex challenges to child well-being, some of the most common being substance abuse, partner violence, and mental health issues. A maltreatment report to a child welfare agency represents a unique chance for families’ needs to be exposed and potential negative effects on children ameliorated by connecting families with a wide range of services. A growing number of children reported to the child welfare system for abuse or neglect are of Latino ethnicity, many of who are affected by immigration issues. However, Latinos tend to underutilize health and behavioral health services throughout the U.S. Immigrants, especially, encounter many obstacles to engaging in services and having their needs met, due to various cultural and socio-political factors dominant in U.S. society. Yet very little empirical data exists on the service experiences of some of the most vulnerable immigrant families and children, those involved with the child welfare system. This three-study dissertation aims to contribute to a greater understanding of the needs of high-risk Latino families with child welfare contact and the barriers that exist in receiving services to meet those needs. By taking advantage of a quantitative examination of the National Survey of Child and Adolescent Well-being (NSCAWII), and applying a modified version of Andersen’s behavioral model for health services use, each of the three papers attempts to explain to what extent culture and legal immigration status affect multi-dimensional needs and service receipt by Latino families reported to a child welfare agency. Chapter I presents a discussion of the immigrant experience in the U.S. that integrates the link between the three studies, briefly introducing the purpose and description of each, and providing an overview of the conceptual framework driving the three studies. Chapter II (Study 1) examines patterns of problematic substance use among immigrant and non-immigrant Latino parents reported to child welfare, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez viii as well as the relationship between immigration status and substance abuse service receipt. Chapter III (Study 2) determines the incidence of intimate partner violence in immigrant and non-immigrant Latino families reported to a child welfare agency, as well as correlates of partner violence service receipt in this population. Chapter IV (Study 3) presents findings of analyses examining the relationship between parent nativity and legal immigration status, child mental health needs, and mental health service receipt for Latino children with child welfare contact. Chapter V discusses conclusions garnered from the three studies, the broader importance of the findings, and implications of the dissertation for policy, practice, and future research. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 1 Chapter One Overview of the Three Studies Introduction and Rationale Latinos, Immigration, and Child Maltreatment in the U.S. Immigration from Latin American countries has resulted in exponential growth of the Latino population in the past several decades. Although migration from Mexico has declined in the past decade, it continues to send the largest number of immigrants to the U.S. (Passel, Cohn, & Gonzales-Barrera, 2012). Because of this trend, Latino children represent the fastest growing child population in the United States; in 2010, Latino children represented nearly one-fourth of all children in the United States (Motel, 2012). While 52% of Latino adults in the U.S. are foreign-born immigrants, only 8% of Latino children are foreign-born (Motel, 2012). As for children of immigrants, in 2011, 23.3% of children in the U.S. had an immigrant parent, 56.3% of whom were Latino (Urban Institute, 2015). The legal immigration status of immigrants to the U.S. is quite diverse. Roughly 72% of the foreign-born population consists of legal immigrants (Passel & Cohn, 2011). However, within the Latino population, the proportion of those without legal status, or those who are undocumented, is higher than in other racial and ethnic groups. Nearly 71% of foreign-born Latinos are noncitizens (including legal permanent and temporary residents), and almost half (48.3%) of noncitizens are undocumented residents (Motel, 2012). As of 2011, 4.5 million children in the U.S. had an undocumented parent, and that number is growing (Passel & Cohn, 2011). Concurrent with the growth of the Latino population in the United States, the proportion of Latino children reported to the child welfare system has rapidly increased. The proportion of children confirmed as victims of maltreatment who are Latino increased from 14.2% in 2000 to 22.4% in 2013 [U.S. Department of Health and Human Services (USDHHS), 2002, 2014]. Latinos in the U.S. also have diverse CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 2 representation from several Central and South American countries and U.S. territories that differ in important ways, and in ideal terms, should not be considered as a pan-ethnic group. Limited sources of national data estimate that children of Mexican descent represent the largest subgroup of Latinos reported to the child welfare system (60%), followed by “other” Latinos comprised of Caribbean, Central and South American origins (30%), and then Puerto Ricans (10%; Berger Cardoso et al., 2014). Given the increasing proportion of Latino children established as victims of maltreatment, heightened attention to the impact of immigration issues on Latino families, and concern that Latino children are entering the child welfare system without receiving services, national experts have identified an urgent need to more closely examine the welfare and service needs of Latino children and families, and the influence that immigration and culture have on these outcomes (Ortega, Grogan-Kaylor, Ruffolo, & Karb, 2009; Institute of Medicine [IOM], 2013) Latino and immigrant well-being. Immigration and culture are of considerable importance when studying the needs of Latinos, as immigrants differ from non-immigrants in many common indicators of well-being that affect risk for child maltreatment. A persisting pattern in research, coined the “immigrant paradox”, has demonstrated that immigrants generally fare better than non-immigrants with respect to behavioral health outcomes despite lower socioeconomic status in the U.S. (eg. Vega, Kolody, Aguilar- Gaxiola, Alderete, Catalano, Caraveo-Anduaga, 1998; Alegria Canino Shrout, Woo, Duan, Vila, & Meng, 2008). For most Latino subgroups, these initial strengths demonstrated by positive outcomes for immigrants deteriorate with acculturation and decline in subsequent generations (Vega et al., 1998; Vega, Sribney, Aguilar-Gaxiola, Kolody, 2004; Vega & Alegria, 2001). For example, several national studies have uncovered differences in substance use disorders among Latinos that can be accounted for by nativity (Vega, Kolody, Aguilar-Gaxiola, Alderete, Catalano, Caraveo-Anduaga, 1998; Grant, Stinson, Hasin, Davson, Chou, & Anderson, 2004; Alegria, Canino, Stinson, & Grant, 2006; Alegria at el., 2008; Alegria, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 3 Mulvaney-Day, Torres, Polo, Cao, & Canino, 2007). Additionally, mental health issues such as depression, anxiety, and trauma, are more commonly diagnosed in U.S. born Latinos compared to the foreign born (Alegria et al., 2007, Alegria et al., 2008). Apart from some of the outright health benefits that immigrants possess, they also face many risks to child well-being as a result of the immigration and acculturation process and the context of reception in the U.S. The immigration experience itself can be one involving exposure to danger, violence, trauma, and loss of those left behind. The stressors associated with settling in the U.S. are many, including the realization that opportunities don’t always meet expectations of the American dream, and living a reality characterized by low-wage jobs and changing gender roles and family expectations, discrimination, difficulty communicating and understanding dominant culture and systems in the U.S., and social isolation. Many immigrants exhibit great resilience through this experience, but some struggle more than others, placing themselves and their children at risk for a range of negative outcomes. For example, the relationship between immigration and intimate partner violence among Latinos is tenuous at best (Klevens, 2007). Limited empirical studies have found that immigrant and nonimmigrant women experience similar rates of intimate partner violence (Hazen & Soriano, 2007; Kaufman Kantor, Jasinski, & Aldarondo, 1994; Sorenson & Telles, 1991), but others have concluded that immigrants are more at risk than non-immigrants (Biafor & Warheit, 2007) for reasons including greater adherence to culturally traditional male dominant gender roles and tolerance of abuse, and increased social isolation and economic insecurity (Raj & Silverman, 2002). Immigrant women also encounter more social, legal, and financial challenges that may act as barriers to leaving violent relationships, such as an undocumented legal status and fear of deportation, especially when they are unaware or untrusting of protections available to them under the Violence Against Women Act (Menjívar & Salcido, 2002 Amanor-Boadu,Messing, Stith, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 4 Anderson, O’Sullivan, & Campbell, 2012; Hass, Dutton, and Orloff, 2000; Raj & Silverman, 2002; Ingram, McClelland, Martin, Cabellero, Mayorga, & Gellespie, 2010; Kelly, 2009). Challenges to receiving services. An additional challenge is that immigrant families tend to underutilize services designed to support children and families, including a wide range of safety net services, as well as health and mental health services (Johnson-Motoyama, 2013; Finno-Velasquez, 2013; Fix, Capps, & Kaushal, 2009; Fix & Passel, 2002; Alegria et al., 2007), many times for reasons related to culture barriers. In regards to intimate partner violence services, for example, cultural norms that may inhibit engagement in services include rigid patriarchal ideology, prioritizing family over self, and acceptance of spousal abuse (Erez, 2000). In addition, many immigrant communities have traditionally preferred to keep interpersonal conflict private, making it difficult for immigrants to seek help for family violence (Erez, 2000; Earner, 2010). However, surprisingly little research has been conducted on substance abuse service receipt by Latinos. Of studies that do exist, immigrant status has not been a factor predicted to influence receipt of services (Alvarez, Olson, Jason, Davis, & Ferrari, 2004; Alvarez, Jason, Olson, Ferrari, & Davis, 2007; Guerrero, Cepeda, Duan, & Kim, 2012; Guerrero, Marsh, Duan, Oh, Perron, & Lee, 2013; Guerrero, Marsh, Cao, Shin, & Andrews, 2014). As for child mental health services, reduced service receipt among those in immigrant families has been linked to stronger adherence to cultural beliefs concerning mental illness and stigma associated with treatment, as well as less familiarity with social problems affecting youth in the U.S. (Roberts, Alegría, Roberts, & Chen, 2005; Ho, Yeh, McCabe, & Hough, 2007; Gudiño, Lau, & Hough, 2008), and a lack of culturally appropriate services available (Gudiño et al., 2008; Lopez, Bergren, & Painter, 2008). Inhibitors to receiving help among Latinos may also be related to immigrants’ marginalized socio- economic and socio-political status. Immigrants have reported barriers to the receipt of intimate partner violence services to include a lack of financial means; fear of deportation and of losing custody of their CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 5 children, or of their situation worsening; beliefs that abuse must be tolerated, or that authorities are oblivious to violence or will discriminate against them; being unaware of available services; language difficulties; and lack of transportation (Acevedo, 2000; Bauer et al., 2000; Dutton, Orlaff & Hass, 2000). Some research has also suggested that undocumented immigrants with intimate partner violence issues do not seek help because they feel available services are not adequate to help them (Amanor-Boadu et al., 2012). Additionally, many studies have linked unmet child mental health needs to immigrant parents' limited English proficiency, lower levels of formal education, lack of insurance coverage, and restricted access to regular health care providers (eg. Fiscella, Franks, Doescher, & Saver, 2002; Solis, Marks, Garcia, & Shelton, 1990). A parent’s undocumented legal status may further impede families from seeking out services due to fear of exposure to government authorities (Fix, Capps, & Kaushal, 2009). Despite the fact the most children of immigrants are U.S. born and thus eligible for services themselves, children often take on the status of the immigrant parent by default, limiting their access to benefits (Fix & Passel, 2009; Fix & Passel, 1999). Latinos and child welfare system involvement. Latinos have historically been underrepresented in the child welfare system (USDHHS, 2014), although that trend may be changing. In 2013, Latinos in California became slightly overrepresented in the California child welfare system (Needell, Webster, Armijo, Lee, Dawson, Magruder, et al., 2013). Immigrant families may have less involvement in the child welfare system than other Latinos (Putnam-Hornstein, Needell, King, & Johnson-Motoyama, 2013), although national data do not exist to test this supposition. Two main theories for immigrant underrepresentation in child welfare reporting are often cited: 1) that protective factors present in traditional immigrant culture reduce their risk for child maltreatment, and 2) that immigrants underutilize preventative services and are thus underexposed to mandated reporters and other child protecting CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 6 professionals and agencies that would identify potential maltreatment (Dettlaff & Finno-Velasquez, 2013; Johnson-Motoyama et al., 2014). Nevertheless, a meaningful number of immigrant families face challenges that bring them into contact with the child welfare system. It is estimated that among Latino children reported to a child welfare agency, over a third have a primary caregiver who is an immigrant (Dettlaff, Earner and Phillips, 2009). Approximately 19% live with at least one parent who is undocumented and an additional 11% live with a parent who is a non-citizen legal resident (Berger-Cardoso, Dettlaff, Finno-Velasquez, Scott, & Faulkner, 2014). Latino Child Welfare and Service Needs. Families who come to the attention of the child welfare system typically experience multiple stressors and have diverse needs. Although an investigation by a child welfare agency often does not lead to further involvement with the system, the initial child welfare report serves as an important signal for complex family needs, some of the most pervasive being substance abuse, intimate partner violence, and mental health issues (Hazen, Connelly, Kelleher, Landsverk, & Barth, 2004; McCue Horwitz, Hurlburt, Heneghan, Zhang, Rolls-Reutz, Fisher…& Stein; 2012; Young, Boles, & Otero, 2007). Any contact with child welfare, whether or not maltreatment is substantiated, has been associated with long-term risks to child well-being (Kohl, Jonson-Reid, & Drake, 2009). For high-risk families with multi-dimensional stressors, and for immigrants especially, a child welfare report provides a unique opportunity for connection to services of all kinds that they might not otherwise access, with the goal of mitigating the damaging effects of maltreatment and family dysfunction on children. Very little is known about the needs of Latino families who are reported to child welfare, and whether culture and immigration status serve as a barriers to receiving needed services. By the very fact that these families are selected into the child welfare system representing a limited subgroup of the Latino population, it cannot be assumed that their service needs reflect what is known about the general CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 7 population. Initial studies are inconclusive. Some suggest that immigrant families differ from non- immigrant families in patterns of risk and maltreatment, depending on both nativity and legal immigration status, although these patterns differ from study to study (Dettlaff, Earner & Phillips, 2009; Dettlaff & Johnson, 2011; Johnson-Motoyama, Dettlaff, & Finno, 2012; Cardoso, Dettlaff, Finno-Velasquez, Scott, & Faulkner, 2014). Other studies suggest that legal immigration status and cultural concerns may indeed act as barriers to immigrant families involved with child welfare receiving needed services (Finno-Velasquez, 2013; Dettlaff & Cardoso, 2010; Rajendran & Chemtob; Ayon, 2009). Therefore, the overall focus of this dissertation lies in whether and how nativity and immigration status influence the needs of Latino families reported for maltreatment, as well as their receipt of needed services. Substance abuse service needs. Patterns of substance use and service needs have been largely under explored within the child welfare population, in great part because there has been minimal monitoring of overlap between the child welfare and substance abuse treatment systems (Young, Boles, & Otero, 2007). This is problematic, given that as many as 40% to 80% of families involved with child welfare systems are estimated to have substance abuse problems (Osterling & Austin, 2008; Young, Boles, & Otero, 2007; Young, Gardner, & Dennis, 1998; Semidei, Radel, & Nolan, 2001). Nevertheless, ongoing challenges exist to coordinating substance abuse services for child-welfare involved parents (Young, Boles & Otero, 2007). Substance abuse tends to be lower in families whose children remain in the home as opposed to entering foster care (Semidei, Feig-Radel, & Nolan, 2001; Young et al., 2007), but no discernable differences exist in problematic substance use by ethnicity (Libby, Orton, Barth, Lead, Burns, Wood, & Spicer, 2006). Similar to the general population, limited descriptive analyses of the National Survey of Child and Adolescent Well-being (NSCAWI & NSCAWII) revealed that child welfare workers perceive alcohol and drug abuse to be lower for immigrants than non-immigrant Latino caregivers (Berger-Cardoso CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 8 et al., 2014; Dettlaff, Earner, & Phillips, 2009). However, it is well documented that child welfare workers under-identify substance abuse issues in parents (Berger, Slack, Waldfogel, & Bruch, 2010). Studies identifying predictors of substance abuse service receipt in the child welfare population are virtually non- existent. Because there are notable differences in patterns of substance use between immigrants and non- immigrants in the general population (Alegria, et al., 2008; Alegria, et al., 2007; Grant, et al., 2004; Vega, et al., 2004; Alvarez, 2007; Vega, et al., 1998), examining problematic substance abuse among Latino parents reported to child welfare, and the relationship of immigration to service receipt within the Latino population, is well-warranted. Intimate partner violence service needs. Intimate partner violence, as it relates to immigration and culture, is a topic that remains mostly unexamined within the child welfare population. In a study of risks for maltreatment among Latinos using the National Survey of Child and Adolescent Well-being I (NSCAWI), child welfare workers identified domestic violence as a risk for maltreatment at higher rates for U.S. born Latino children compared to children born outside the U.S. (Dettlaff & Johnson, 2011). However, other studies using the NSCAWI and NSCAWII have not shown bivariate differences in rates of intimate partner violence between Latino immigrants and non-immigrants (Dettlaff, Earner & Phillips, 2009; Berger-Cardoso, Dettlaff, Finno-Velasquez, Scott, & Faulkner, 2014). In all of these studies, intimate partner violence was based solely on caseworker report, a limitation given that child welfare caseworkers are likely to under-report partner violence relative to caregivers (Kohl, Barth, Hazen, Landsverk, 2005). In a recent analysis of the NSCAWII, undocumented immigrant caregivers reported similar rates of domestic violence as U.S. citizens, but were more likely to have child maltreatment allegations involving domestic violence (Ogbonnaya, Finno-Velasquez, & Kohl, 2015). These families were not, however, more likely to have substantiated allegations of maltreatment, suggesting that partner violence among undocumented parents may be of concern but difficult to substantiate (Ogbonnaya, Finno-Velasquez, & CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 9 Kohl, 2015). Such evidence points to a need for ongoing study of partner violence issues in high-risk immigrant families. Finally, although there are national estimates of partner violence service receipt among families reported to child welfare, research on partner violence services within the Latino population does not exist. In one national study, over half of caregivers with active partner violence received services in the 18 months following an investigation (Kohl, Barth, Hazen, and Landsverk, 2005). In that study, no differences were reported between Latinos and non-Latinos. However, examining the influence of immigration on partner violence service use is a critical piece of the larger picture of Latino family needs, especially given other research that has suggested that low acculturation characteristic of newer immigrants is associated with reduced service use for Latinas (West et al., 1998). Child mental service needs. Much attention has been paid to the mental health needs of children involved with child welfare and access to mental health services to address such needs (Burn, Phillips, Wagner, Barth, Kolko, Campbell, & Landsverk., 2004; Hurlburt, Leslie, Landsverk, Barth, Burns, & Gibbons, 2004; Horwitz, Hurlburt, & Zhang, 2009). Although the majority of such research has focused on children in non-relative foster care, several studies have found that children who are reported to child welfare but remain in their homes experience serious emotional disturbances at a rate similar to youth in foster care (Farmer, Burns, Chapman, Phillips, Angold, & Costello, 2001; Kolko, Seleyo, & Brown, 1999; Stahmer, Leslie, Hurlburt, Barth, Webb & Landsverk, 2005). The mental health needs of Latino children, however, have not been the focus of the majority of this research, and results are inconclusive. One nationally representative study estimated that older Latino children involved with the child welfare system were more likely to experience depression than younger Latinos, and that rates of change in depressive symptoms over time differed by country of origin (Ayon & Marcenko, 2008). Another descriptive study examining need for mental health services among Latino children showed that need was higher for young CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 10 children of immigrants, and lower for older children of immigrants, compared to children of U.S. born parents (Dettlaff & Berger Cardoso, 2010). In regards to service receipt, Latino children reported to child welfare may be less likely to receive mental health services than White children (Horwitz, et al., 2012; Horwitz et al., 2009). These studies have shown overall patterns of high need among all children, but a gap in mental health service use (Burns et al., 2004), with service receipt increasing over time and involvement with the child welfare system (Horwitz et al., 2009). However, the influence of parent nativity or immigration status has not been examined as a potential explanation for underutilization of mental health services by Latino children involved with the child welfare system. Descriptive analyses of the NSCAWI showed that younger children of Latino immigrants received mental health services at higher rates than non-immigrants, and authors called for further investigation of the issue (Dettlaff & Berger-Cardoso, 2010). Deeper exploration of patterns of mental health service use and needs of children of immigrants is warranted, as this group may be particularly vulnerable due to the residual stress and pressure experienced by immigrant families as a result of immigration and acculturation (Finno, Vidal de Haymes, & Mindell, 2006; Segal & Mayadas, 2005). Study Goal & Structure This three-study dissertation has an overarching goal of contributing to a greater understanding of the service needs of Latino parents and children involved with the child welfare system and barriers to service receipt to meet those needs. Applying a modified version of Andersen’s behavioral model for health services use, each of the three papers identifies to what extent culture and immigration status explain the patterns of utilization of services by Latino children and parents at risk for child maltreatment. An empirical examination of the National Survey of Child and Adolescent Well-being II (NSCAWII) provides a ripe opportunity to identify relationships between the receipt of services and predisposing factors, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 11 enabling conditions, and family needs relevant to immigrant families among Latinos reported to child welfare. The specific questions addressed in each study are as follows: Study 1: Do Latino caregivers reported to child welfare differ from non-immigrant caregivers in patterns of problematic substance use? Do parent nativity and legal immigration status serve as barriers to receiving substance abuse services? Study 2: Do Latino immigrant families reported to child welfare differ from non-immigrant families in need for intimate partner violence services and connection to partner violence services? Is parent undocumented legal status a barrier to connection to partner violence services? Study 3: Do Latino children of immigrants reported to child welfare differ from children of non- immigrants in need of and connection to child mental health services? Do children of undocumented parents receive mental health services at lower rates than children of parents with legal residency or U.S. citizenship? Conceptual model A modified version of Andersen’s behavioral model of health service utilization (Andersen 1995; Aday &Andersen, 1974 ) serves as the overall framework for the three studies in this dissertation (see Appendix 1, Figure 1). This model is grounded in an ecological perspective that considers both individual and societal determinants of service use (Urdang, 2008). It conceptualizes service use as a function of (1) predisposition to use services, (2) enabling conditions for securing services, and (3) needs for such services (Andersen 1995). Predisposing factors refer to the propensity of different individuals to use more or fewer services based on characteristics that are static, such as gender, age, and education. In this context, parent nativity is conceptualized to be a predisposing factor for service receipt. Enabling factors are conditions that make service resources available to individuals (e.g., income, insurance status, language, etc). In this CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 12 context, legal immigration status is perceived to be an enabling condition that can influence access to services. Need factors include the individual’s perceived and evaluated need for services. Contextual factors are environmental factors specific to a situation that may influence service receipt. In this study, the fact that needs occur and decisions are made within the context of a child welfare investigation influences the mechanism behind which families are connected to services. Thus, various aspects of the child welfare case are taken into account. The behavioral model’s focus on individual-level variables may be limited in its ability to explain such complex processes by not fully incorporating the impact of important cultural factors on help-seeking behavior (Kleinman 1978 ; Lewis-Fernandez and Diaz 2002 ). However, the original model has been adapted for use in a variety of service settings and has been applied to study the correlates of service use in child welfare settings (Zima, Bussing, Yang, & Belin, 2000), and service use among Latino immigrants (Portes, Kyle, & Eaton, 1992; Choi 2006 ; Gonzalez et al. 2009 ; Lee and Choi 2009 ; Vera et al. 1998; Lee & Matejkowski, 2012). With immigrants, an expanded theoretical framework integrates both general factors, which can be used to explain service use in any population regardless of its immigrant status, and specific factors (i.e., nativity, legal immigration status, preferred language) relevant to the immigrant population (Lee & Matejkowski, 2012). Methods Data for this dissertation are drawn from the National Survey of Child and Adolescent Well-Being-II (NSCAW II). The NSCAW II is the second national longitudinal study of children and families involved in the child welfare system. The sample of the NSCAW II study consists of 5,873 children, birth to 17.5 years of age, who came to the attention of the child welfare system due to a report of maltreatment. Children and families in the NSCAW II study were sampled from child abuse and neglect investigations that were completed between February 2008 and April 2009. The baseline Wave 1 data were collected CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 13 between March 2008 and September 2009, roughly four months after the index child protective services investigation was completed (Dowd, Dolan, Wallin, Miller, Biemer, Aragon-Logan, & Smith, 2012). Key respondents included caregivers, children (if they were 11 years of age and older), caseworkers, teachers and agency directors. Of the 5,873 children included in the sample, all of them had accompanying caregiver interviews, but 782 were missing caseworker interviews, in most cases due to unavailability of the caseworker in the allotted timeframe for data collection (Dowd et al., 2012). Wave 2 interviews were collected approximately 18 months after the close of the investigation, or 12-14 months after baseline interviews, between October 2009 and January 2011 (Dowd, et al., 2012). The overall weighted response rate in Wave 2 was 82.8% (Dowd, et al., 2012). In Wave 2, services caseworkers were interviewed only if caregivers identified a need for services in Wave 1. The NSCAW II sample was collected using a two-stage stratified sample design. The United States was divided into nine strata. The first eight strata corresponded to the states with the highest child welfare caseloads, while the ninth stratum consisted of the remaining states and the District of Columbia. Within each stratum, cases were randomly sampled from within primary sampling units, usually counties. Using this approach, the final sample was comprised of children from 83 counties in 30 states (Dowd et al., 2012). Certain sub-populations of interest, including infants, children receiving services, and children in out-of-home placement were oversampled to enable analyses of these groups (Dowd et al., 2012). For each of the three studies in this dissertation, a subset of Latino children was selected for purposes of analysis. All analyses applied weights provided by NSCAW survey developers in order to create estimates representative of the national population of Latino children reported to a child welfare agency. Descriptive analyses in the three studies examined bivariate associations between parent nativity and immigration status, need, and the service outcome of interest. Weighted Pearson’s chi square analyses and weighted ANOVA analyses were employed to conduct bivariate analyses. Weighted multivariate CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 14 logistic regression analyses were utilized to identify predictors of service receipt in each of the three papers, as well as the influence of parent nativity and legal immigration status on the odds of service receipt adjusting for other covariates. Summary Numerous studies have examined substance use, intimate partner violence and child mental health services needs among high-risk families reported to a child welfare agency for maltreatment. However, very few have surveyed the Latino population in regards to immigration and cultural issues that may shed light on explanations for service underutilization in this rapidly growing population. The three individual studies independently contribute to determining the effects of parent nativity and legal immigration status on the receipt of critical services to improve child well-being. Results of these dissertation studies contribute to a portfolio of work surveying the needs of Latino immigrant families reported to the child welfare system that examines relationships between citizenship and maltreatment types/risks (Berger- Cardoso, Dettlaff, Finno-Velasquez, Scott, & Faulkner, 2014), substantiation patterns (Johnson, Dettlaff, & Finno, 2012), concrete service needs (Finno-Velasquez, 2013), and evidence of intimate partner violence (Ogbonnaya, Finno-Velasquez, & Kohl, 2015). The answers to the questions posed are critical to advancing a broader understanding of the needs and barriers to service receipt for vulnerable Latino families reported to child welfare, and inform where the child welfare system and broader social welfare system can better intervene to capture the needs of such families. Findings offer implications for where reforms may be made to better engage Latino families in services to improve child well-being, and provide direction for future research identifying how such services can be made more accessible and relevant for immigrant families. Because the majority of Latino children reported to a child welfare agency are themselves U.S. citizens, placing focal attention on the relationship between factors such as immigration status, culture, and access to resources, aptly addresses CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 15 concerns for the future of our children and strengthening long-term well-being and productivity of U.S. society. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 16 References Acevedo, M. J. (2000). Battered immigrant Mexican women’s perspectives regarding abuse and helpseeking. Journal of Multicultural Social Work, 8, 243-282. Achenbach, R. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry. Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9, 208–220. Alegría, M., Canino, G., Shrout, P., Woo, M., Duan, N., Vila, D., ... & Meng, X. L. (2008). Prevalence of mental illness in immigrant and non-immigrant US Latino groups. American Journal of Psychiatry, 165(3), 359-369. Alegría, M., Mulvaney-Day, N., Woo, M., Torres, M., Gao, S., & Oddo, V. (2007). Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study. American Journal of Public Health, 97(1), 76-83. Alvarez, J., Jason, L. A., Olson, B. D., Ferrari, J. R., & Davis, M. I. (2007). Substance abuse prevalence and treatment among Latinos and Latinas. Journal of ethnicity in substance abuse, 6(2), 115-141. Alvarez, J., Olson, B. D., Jason, L. A., Davis, M. I., & Ferrari, J. R. (2004). Heterogeneity among Latinas and Latinos entering substance abuse treatment: findings from a national database. Journal of Substance Abuse Treatment, 26(4), 277-284. Amanor-Boadu, Y.,Messing, J. T., Stith, S. M., Anderson, J. R., O'Sullivan, C. S., & Campbell, J. C. (2012). Immigrant and nonimmigrant women: Factors that predict leaving an abusive relationship. Violence Against Women, 18, 611–633. Andersen, R.M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1–10. Ayón, C. (2009). Shorter time-lines, yet higher hurdles: Mexican families' access to child welfare mandated services. Children and Youth Services Review, 31, 609–616. Ayón, C., & Marcenko, M. O. (2008). Depression among Latino children in the public child welfare system. Children and Youth Services Review, 30, 1366−1375. Bauer, H. M., Rodriguez, M. A., Quiroga, S. S., & Flores-Ortiz,Y. G. (2000). Barriers to health care for abused Latina and Asian immigrant women. Journal of Health Care for the Poor & Underserved, 11, 33-44. Berger, L. M., Slack, K. S., Waldfogel, J., & Bruch, S. K. (2010). Caseworker-perceived caregiver substance abuse and child protective services outcomes. Child Maltreatment, 15(3), 199-210. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 17 Biafora, F., & Warheit, G. (2007). Self-reported violent victimization among young adults in Miami, Florida: Immigration, Race/Ethnic and gender contrasts. International Review of Victimology, 14(1), 29-55. Burnette, D., & Mui, A. (1999). Physician utilization by Hispanic elderly persons. Medical Care, 37, 362– 374. Burns, B. J., Angold, A., Magruder-Habib, K., Costello, E., & Patrick, M. (1996). The Child and Adolescent Services Assessment (CASA). Durham, NC: Duke University School of Medicine. Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 960-970. Caetano, R., Schafer, J., Clark, C. L., Cunradi, C. B., & Raspberry, K. (2000). Intimate partner violence, acculturation, and alcohol consumption among Hispanic couples in the United States. Journal of Interpersonal Violence, 15(1), 30-45. Cardoso, J. B., Dettlaff, A. J., Finno-Velasquez, M., Scott, J., & Faulkner, M. (2014). Nativity and immigration status among Latino families involved in the child welfare system: Characteristics, risk, and maltreatment. Children and Youth Services Review, 44, 189-200. Choi, S. (2006). Insurance status and health service utilization among newly-arrived older immigrants. Journal of Immigrants and Minority Health, 8(2), 149–161. Dettlaff, A. J., & Berger Cardoso, J. (2010). Mental health need and service use among Latino children of immigrants in the child welfare system. Children and Youth Services Review, 32, 1373–1379. Dettlaff, A. J., Earner, I., & Phillips, S. D. (2009). Latino children of immigrants in the child welfare system: Prevalence, characteristics, and risk. Children and Youth Services Review, 31, 775–783. Dettlaff, A. & Finno-Velasquez, M. (2013). Child Maltreatment and Immigration Enforcement: Considerations for Child Welfare and Legal Systems Working with Immigrant Families. Loyola University Chicago Law Journal, 33(1), 37-63. Dettlaff, A. J., & Johnson, M. A. (2011). Child maltreatment dynamics among immigrant and US born Latino children: Findings from the National Survey of Child and Adolescent Well-being (NSCAW). Children and Youth Services Review, 33(6), 936-944. Dowd, K., Dolan, M., Wallin, J., Miller, K., Biemer, J., Aragon-Logan, E., & Smith, K. (2012). National survey of child and adolescent well-being (NSACW): NSCAW II Combined waves 1-2 data file user’s manual, restricted release version. Ithaca, NY: National Data Archive on Child Abuse and Neglect, Cornell University. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 18 Dutton, M. A., Orloff, L. E., & Hass, G. A. (2000). Characteristics of help-seeking behaviors, resources and service needs of battered immigrant Latinas: Legal and policy implications. Georgetown Journal on Poverty Law & Policy, 7, 245-305. Earner, I. (2010). Double risk: Immigrant mothers, domestic violence and public child welfare services in New York City. Evaluation and Program Planning, 33(3), 288-293. Erez, E. (2000). Immigration, culture conflict and domestic violence/woman battering. Crime Prevention and Community Safety: An International Journal, 2(1), 27-36. Farmer, E., Burns, B. J., Chapman, M. V., Phillips, S. D., Angold, A., & Costello, E. J. (2001). Use of mental health services by youth who come in contact with social services. Social Service Review, 75, 605−624. Finno, M., Vidal de Haymes, M., & Mindell, R. (2006). Risk of affective disorders in the migration and acculturation experience of Mexican Americans. Protecting Children, 21(2), 22−35. Finno-Velasquez, M. (2013). The relationship between parent immigration status and concrete support service use among Latinos in child welfare: Findings using the National Survey of Child and Adolescent Well-being (NSCAWII). Children and Youth Services Review, 35(12), 2118-2127. Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparities in health care by race, ethnicity, and language among the insured. Medical Care, 40, 52−59. Fix, M. E., Capps, R., & Kaushal, N. (2009). Immigrants and welfare: Overview. In M. E. Fix(Ed.), Immigrants and welfare: The impact of welfare reform on America's newcomers (pp. 1–36). New York, NY: Russell Sage Foundation. Fix, M. E., & Passel, J. S. (2002). The scope and impact of welfare reform's immigrant provisions. Washington, DC: Urban Institute. Fix,M., & Passel, J. (1999). Trends in noncitizens’ and citizens’ use of public benefits following welfare reform: 1994–1997. Washington, D.C.: The Urban Institute. Golding, J. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14, 99-132. Gonzalez, H. M., Vega, W. A., Rodriguez, M. A., Tarraf, W., & Sribney, W. M. (2009). Diabetes awareness and knowledge among Latinos: Does a usual source of healthcare matter? Journal of General Internal Medicine, 24(Suppl 3), 528–533. Grant, B.F., Stinson, F.S., Hasin, D..S, Dawson, D.A., Chou, P., Anderson, K. (2004). Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the United States. Arch Gen Psychiatry, 61,1226-1233. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 19 Gudiño, O. G., Lau, A. S., & Hough, R. L. (2008). Immigrant status, mental health need, and mental health service utilization among high-risk Hispanic and Asian Pacific Islander youth. Child & Youth Care Forum, 37, 139−153. Guerrero, E. G., Marsh, J. C., Cao, D., Shin, H. C., & Andrews, C. (2014). Gender disparities in utilization and outcome of comprehensive substance abuse treatment among racial/ethnic groups. Journal of Substance Abuse Treatment, 46(5), 584-591. Guerrero, E. G., Marsh, J. C., Duan, L., Oh, C., Perron, B., & Lee, B. (2013). Disparities in completion of substance abuse treatment between and within racial and ethnic groups. Health Services Research, 48(4), 1450-1467. Guerrero, E. G., Cepeda, A., Duan, L., & Kim, T. (2012). Disparities in completion of substance abuse treatment among Latino subgroups in Los Angeles County, CA. Addictive Behaviors, 37(10), 1162- 1166. Harris, R. J., Firestone, J. M., & Vega, W. A. (2005). The interaction of country of origin, acculturation, and gender role ideology on wife abuse. Social Science Quarterly, 86(2), 463-483. Hazen, A. L., Connelly, C. D., Kelleher, K., Landsverk, J. & Barth, R. (2004). Intimate partner violence among female caregivers of children reported for child maltreatment. Child Abuse and Neglect, 28, 310-319. Hazen, A. L., & Soriano, F. I. (2007). Experiences with intimate partner violence among Latina women. Violence Against Women, 13(6), 562-582. Herrenkohl, T. I., Sousa, C., Tajima, E. A., Herrenkohl, R. C., & Moylan, C. A. (2008). Intersection of child abuse and children’s exposure to domestic violence. Trauma, Violence, & Abuse, 9, 84–89. Ho, J., Yeh, M., McCabe, K., & Hough, R. L. (2007). Parental cultural affiliation and youth mental health service use. Journal of Youth and Adolescence, 36, 529−542. Horwitz, S., Hurlburt, M. S., Heneghan, A., Zhang, J., Rolls-Reutz, J., Fisher, E., ... & Stein, R. E. (2012). Mental health problems in young children investigated by US child welfare agencies. Journal of the American Academy of Child & Adolescent Psychiatry, 51(6), 572-581. Horwitz, S.M., Hurlburt, M.S., & Zhang, J. (2009). Patterns and predictors of mental health services use by children in contact with the child welfare system. In: Webb, M.B., Dowd, K., Harden, B.J., Landsverk, J., Testa, M., eds. Child Welfare and Child Well-Being: New Perspectives from the National Survey of Child and Adolescent Well-Being (279-329). New York, NY: Oxford University Press. Hurlburt, M. S., Leslie, L. K., Landsverk, J., Barth, R. P., Burns, B. J., Gibbons, R. D., et al. (2004). Contextual predictors of mental health service use among children open to child welfare. Archives of General Psychiatry, 61, 1217−1224. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 20 Ingram, M., McClelland, D. J., Martin, J., Caballero, M. F., Mayorga, M. T., & Gillespie, K. (2010). Experiences of immigrant women who self-petition under the violence against women act. Violence Against Women, 16(8), 858-880. Institute of Medicine (2013). Report Brief: New Directions in Child Abuse and Neglect Research. Washington, D.C.: National Academies of Sciences. Johnson-Motoyama, M. (2014). Does a paradox exist in child well-being risks among foreign-born Latinos, US-born Latinos, and Whites? Findings from 50 California cities. Child Abuse & Neglect, 38(6), 1061-1072. Johnson-Motoyama, M., Dettlaff, A., & Finno, M. (2012). Parental nativity and the decision to substantiate: Findings from a study of Latino children in the second National Survey of Child and Adolescent Well-being (NSCAW II). Children and Youth Services Review, 34 (11), 2229–2239. Johnson-Motoyama, M., Putnam-Hornstein, E., Dettlaff, A. J., Zhao, K., Finno-Velasquez, M., & Needell, B. (2014). Disparities in Reported and Substantiated Infant Maltreatment by Maternal Hispanic Origin and Nativity: A Birth Cohort Study. Maternal and Child Health journal, 1-11. Kauffman Kantor, G. K., Jasinski, J. L., & Aldarondo, E. (1994). Sociocultural status and incidence of marital violence in Hispanic families. Violence and Victims, 9(3), 207-222. Kelleher, K. J., Hazen, A. L., Coben, J. H., Wang, Y., McGeehan, J., Kohl, P. L., & Gardner, W. P. (2008). Self-reported disciplinary practices among women in the child welfare system: Association with domestic violence victimization. Child Abuse & Neglect, 32, 811–818. Kelly, U. A. (2009). "I'm a mother first": The influence of mothering in the decision-making processes of battered immigrant Latino women. Research in Nursing & Health, 32(3), 286-297. Kitzmann, K. M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003). Child witnesses to domestic violence: a meta-analytic review. Journal of consulting and clinical psychology, 71(2), 339. Kleinman, A. (1978). Concepts and a model for the comparison of medical systems as cultural systems. Social Science and Medicine, 12, 85–93. Klevens, J. (2007). An overview of intimate partner violence among Latinos. Violence Against Women, 13(2), 111-122. Kohl, P. L., Barth, R. P., Hazen, A. L., & Landsverk, J. A. (2005). Child welfare as a gateway to domestic violence services. Children and Youth Services Review, 27(11), 1203-1221. Kohl, P. L., Jonson-Reid, M., & Drake, B. (2009). Time to leave substantiation behind: Findings from a national probability study. Child Maltreatment, 14(1), 17-26. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 21 Kolko, D. J., Seleyo, J., & Brown, E. J. (1999). The treatment histories and service involvement of physically and sexually abusive families: Description, correspondence, and clinical correlates. Child Abuse & Neglect, 23, 459−476. Lee, S., & Choi, S. (2009). Disparities in access to health care among non-citizens in the United States. Health Sociology Review, 18, 307–320. Lee, S., & Matejkowski, J. (2012). mental health service utilization among noncitizens in the United States: findings from the National Latino and Asian American Study. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 406-418. Lewis-Fernandez, R., & Diaz, N. (2002). The cultural formulation: A method for assessing cultural factors affecting the clinical encounter. Psychiatric Quarterly, 73(4), 271–295. Lopez, C., Bergren, M. D., & Painter, S. G. (2008). Latino disparities in child mental health services. Journal of Child and Adolescent Psychiatric Nursing, 21, 137−145. Menjívar, C., & Salcido, O. (2002). Immigrant women and domestic violence: Common experiences in different countries. Gender & Society, 16, 898–920. Motel, S. (2012). Statistical portrait of Hispanics in the United States: 2010. Washington, DC: Pew Hispanic Center. Needell, B., Webster, D., Armijo, M., Lee, S., Dawson, W., Magruder, J., Exel, M., Cuccaro-Alamin, S., Putnam-Hornstein, E., Williams, D., Yee, H., Hightower, L., Mason, F., Lou, C., Peng, C., King, B., Henry, C.,& Lawson, J. (2013). Child Welfare Services Reports for California. University of California at Berkeley Center for Social Services Research website. URL: <http://cssr.berkeley.edu/ucb_childwelfare Ogbonnaya, I. N., Finno-Velasquez, M., & Kohl, P. L. (2015). Domestic violence and immigration status among Latina mothers in the child welfare system: findings from the National Survey of Child and Adolescent Well-being II (NSCAW II). Child Abuse & Neglect, 39, 197-206. Ortega, R. M., Grogan-Kaylor, A., Ruffolo, J. C., & Karb, R. (2009). Racial and ethnic diversity in the initial child welfare experience: Exploring Areas of Convergence and Divergence. Child Welfare and Child Well-Being: New Perspectives from the National Survey of Child and Adolescent Well- Being (236-278). New York, NY: Oxford University Press. Passel, J., & Cohn, D. (2011). Unauthorized Immigrant Population: National and State Trends, 2010. Washington, DC: Pew Hispanic Center. Passel, J., Cohn, D., Gonzalez-Barrera, A. (2012). Net migration from Mexico falls to zero-and perhaps less. Washington, DC: Pew Hispanic Center. Perilla, J. L., Bakeman, R., & Norris, F. H. (1994). Culture and domestic violence: The ecology of abused Latinas. Violence and Victims, 9, 325-339. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 22 Portes, A., Kyle, D., & Eaton, W. W. (1992). Mental illness and help-seeking behavior among Mariel Cuban and Haitian refugees in South Florida. Journal of Health and Social Behavior, 33, 283–298. Putnam-Hornstein, E., Needell, B., King, B., & Johnson-Motoyama, M. (2013). Racial and ethnic disparities: A population-based examination of risk factors for involvement with child protective services. Child Abuse & Neglect, 37(1), 33-46. Raj, A., & Silverman, J. (2002). Violence against immigrant women: The roles of culture, context, and legal immigrant status on intimate partner violence. Violence Against Women, 8, 367–398. Rajendran, K., & Chemtob, C.M. (2010). Factors associated with service use among immigrants in the child welfare system. Evaluation and Program Planning, 33, 317–323 Roberts, R. E., Alegría, M., Roberts, C. R., & Chen, I. G. (2005). Mental health problems of adolescents as reported by their caregivers. The Journal of Behavioral Health Services & Research, 32(1), 1-13. Schroeder, J., Lemieux, C., & Pogue, R. (2008). The collision of the Adoption and Safe Families Act and substance abuse: Research-based education and training priorities for child welfare professionals. Journal of Teaching in Social Work, 28, 227–246. Segal, U., & Mayadas, N. (2005). Assessment of issues facing immigrant and refugee families. Child Welfare, 84, 563−583. Semidei, J., Feig-Radel, L., & Nolan, C. (2001). Substance abuse and child welfare: Clear linkages and promising responses. Child Welfare, 8, 109–128. Solis, J. M., Marks, G., Garcia, M., & Shelton, D. (1990). Acculturation, access to care, and the use of preventative services by Hispanics. American Journal of Public Health, 80, 11−19. Sorenson, S. B. & Telles, C. A. (1991). Self-reports of spousal violence in a Mexican-American and non- Hispanic white population. Violence and Victims, 6, 3-15. Stahmer, A. C., Leslie, L. K., Hurlburt, M., Barth, R. P., Webb, M. B., Landsverk, J., et al.(2005). Developmental and behavioral needs and service use for young children in child welfare. Pediatrics, 116, 891−900. Straus, M. (1990). Measuring physical and psychological maltreatment of children with the conflict tactics scales. Durham, NH: University of New Hampshire Family Research Laboratory. Torres, S. (1991). A comparison of wife abuse between two cultures: Perceptions, attitudes, nature, and extent. Issues in Mental Health Nursing, 12, 113-131. Urban Institute (2015). Children of Immigrants Data Tool. Retrieved from http://datatool.urban.org/charts/datatool/pages.cfm CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 23 Urdang, E. (2008). Human behavior in the social environment: Interweaving the inner and outer worlds. New York, NY: Routledge. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2002). Child maltreatment 2000. Retrieved from http://www.acf.hhs.gov/programs/cb/pubs/cm00/cm2000.pdf U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2014). Child Maltreatment 2013. Available from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can. Vega, W. A., & Alegría, M. (2001). Latino mental health and treatment in the United States. Health issues in the Latino community, 8, 179. Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55(9), 771. Vega, W. A., Sribney, W. M., Aguilar-Gaxiola, S., & Kolody, B. (2004). 12-month prevalence of DSM-III- R psychiatric disorders among Mexican Americans: nativity, social assimilation, and age determinants. The Journal of Nervous and Mental Disease, 192(8), 532-541. Vera, M., Alegria, M., Freeman, D., Robles, R., Pescosolido, B., & Pena, M. (1998). Help seeking for mental health care among poor Puerto Ricans. Medical Care, 36, 1047–1056. West, C. M., Kantor, G. K., & Jasinski, J. L. (1998). Sociodemographic predictors and cultural barriers to help-seeking behavior by Latina and non-Latino White American battered women. Violence and Victims, 13, 361-375. Young, N. K., Boles, S. M., & Otero, C. (2007). Parental substance use disorders and child maltreatment: Overlap, gaps, and opportunities. Child Maltreatment, 12(2), 137-149. Zima, B. T., Bussing, R., Yang, X., & Belin, T. R. (2000). Help-seeking steps and service use for children in foster care. Journal of Behavioral Health Services Research, 27, 271–285. Zimmerman, R. S., Khoury, E. L., Vega, W. A., Gil, A. G., & Warheit, G. J. (1995). Teacher and parent perceptions of behavior problems among a sample of African American, Hispanic, and non- Hispanic white students. American Journal of Community Psychology, 23, 181−197. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 24 Figure 1. Andersen’s behavioral model for health services use modified for use with immigrants reported to the child welfare system Service Receipt Needs Predisposing Characteristics: Parent Nativity Enabling Conditions: Parent Legal Status Child Welfare Context CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 25 Chapter Two (Study 1) Problematic Substance Use and Service Receipt among Latino Parents Reported to Child Welfare: The Influence of Nativity and Legal Status In preparation for the American Journal of Public Health (Megan Finno-Velasquez, Kristen Seay, Amy He) As a result of decades of increased immigration, the U.S. demographic is transforming. It is estimated that 28.6% % of the country's population will be Latino by 2050 (Colby & Ortman, 2015). With this population increase, the proportion of Latinos involved with child welfare systems is also on the rise; in 2013, 22.4% of maltreated children in the U.S were Latino, compared to 14.2 % in 2002 (U.S. Department of Health and Human Services (USDHHS), 2002, 2014). National probability estimates show that among Latino children reported to a child welfare agency, over a third have a primary caregiver who is an immigrant (Dettlaff, Earner and Phillips, 2009). Approximately 19% of these children live with at least one parent who is undocumented and an additional 11% live with a parent who is a non-citizen legal resident (Cardoso, Dettlaff, Finno-Velasquez, Scott, & Faulkner, 2014). Problematic substance use is a significant and enduring problem among caregivers with child welfare involvement; as many as 40% to 80% of families involved with child welfare systems engaged in problematic substance use (Osterling & Austin, 2008; Young, Boles, & Otero, 2007; Young, Gardner, & Dennis, 1998; Semidei, Radel, & Nolan, 2001). Within the high-risk child welfare population, no discernable differences exist in problematic substance use of Latinos compared to other ethnicities (Libby, Orton, Barth, Webb, Burns, Wood, & Spicer, 2006). Due to a lack of nationally established methods for collecting immigration information, there is a paucity of research examining the role of immigration in the substance use patterns of parents involved with the child welfare system. However, in the general population, ample evidence has shown immigrant status to be protective against substance use disorders for CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 26 various Latino groups (Alegria, Canino, Shrout, Wood, Duan, Vila…& Meng, 2008; Alegria, Mulvaney- Day, Torres, Polo, Cao, & Canino, 2007; Grant, Stinson, Hasin, Dawson, Chou, & Anderson, 2004; Vega & Scribney, 2005; Alvarez, Jason, Olson, Ferrari, & Davis, 2007; Warner, Valdez, Vega, de la Rosa, Turner, & Canino, 2006; Vega, Kolody, Aguilar-Gaxiola, Alderete, Catalano, & Caraveo-Anduaga, 1998). Limited reports from child welfare workers suggest that, within the child welfare population, the prevalence of problematic substance use may also be lower among immigrants (Berger-Cardoso et al., 2014; Dettlaff, Earner, & Phillips, 2009). A report to the child welfare system presents a unique opportunity for child welfare workers to connect families with many types of services, including drug and alcohol services, to prevent recidivism and repeat maltreatment, placement into foster care, and termination of parental rights (Oliveros & Kaufman, 2011). In regards to substance abuse treatment, some studies have shown Latinos to be underserved (Marsh, Cao, Guerrero, & Shin, 2009; Guerrero, Marsh, Duan, Oh, Perron, & Lee, 2013), while others indicate that Latinos have greater or equal access to treatment compared to Whites (Daley, 2005; Fosados, Evans, & Hser, 2007; Niv & Hser, 2006; Jacobson, Robinson, & Bluthenthal, 2006). There is also some evidence that language and cultural issues may reduce access to treatment for Latinos (Alegria, et al., 2006). Research on substance abuse treatment with the child welfare population is more limited; many demographic characteristics have been associated with receipt of treatment including age, gender, education, employment, number of children, and income, (Choi and Ryan 2006; Barth, Gibbons, & Guo, 2005; Grella, Hser, and Huang 2006), as well as the presence of risk factors such as intimate partner violence and mental health problems (Semidei et al. 2001; Grella, Hser, and Huang 2006; Grella, Needell, Hser, & Huang, 2009). Several recent national child welfare studies have uncovered barriers to Latinos receiving various types of services that can be accounted for by parent nativity and legal status (Dettlaff & Berger Cardoso, 2010; Finno-Velasquez, 2013; Finno-Velasquez, Berger Cardoso, Dettlaff, & Hurlburt, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 27 under review). Yet to date, the influence of immigration-related factors on drug and alcohol service receipt for Latinos in the child welfare population remains unexamined. This study used a nationally representative sample of children involved with child welfare systems to estimate patterns of problematic substance use and service receipt for US born and foreign born Latino parents, as well as for U.S. citizen, legal resident, and undocumented Latino parents. Methods Study Design The second round of the National Survey of Child and Adolescent Well-Being (NSCAW II) is a nationally representative study of 5,872 children aged 0 to 17 years who were subjects of investigations of child maltreatment conducted by a child welfare agency between 2008 and 2009. The sample was drawn using a two-stage cluster sampling approach. Analysis weights were used to make nationally representative inferences for the total Latino population of children who remain in the home following an investigation. Detailed information about the National Survey of Child and Adolescent Well-Being study design may be found elsewhere (Dowd, Dolan, Wallen, Miller, Biemer, Aragon-Logan, and Smith, 2012). Analytic sample Data were collected via interviews with biological caregiver parents and child welfare workers. Baseline interviews were completed 4 to 6 months after the completion of the child welfare investigation. Wave 2 follow-up interviews were conducted on average 18 months after the completion of the investigation. The parent is the unit of analysis. Self-reported data on parent alcohol and drug use is only available in cases where the children remained in the home following the baseline report. The analytic sample consisted of 842 biological caregivers who identified as Latino, whose children remained in the home following the initial investigation of maltreatment. The sample was reduced to 704 for analyses when including only caregivers who had complete data for all variables of interest. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 28 Variables All parent caregiver characteristics were reported at baseline. Nativity was categorized as U.S. born or foreign born. Legal status was categorized as U.S. citizen (U.S. born or naturalized), legal resident (permanent or temporary), or undocumented. Other caregiver characteristics examined include age, gender, number of children, years in the U.S., education, employment, and language. In the vast majority of cases, Spanish was the identified language spoken in the home other than English, with a few caregivers identifying a different language, most often an indigenous language, as the preferred language. Income was generated as a percent of the federal poverty level (<50% of the poverty level, 50-100% of the poverty level; 100-200% of the poverty level; >200% of the poverty level). Because a quarter of undocumented caregivers in the target sample had missing data for the income variable, in order to avoid disproportionately excluding undocumented caregivers from multivariate analyses, caregiver report of financial hardship, rather than income, was used as a measure of economic status in regression analysis. Other parent issues commonly associated with problematic substance use and substance abuse service receipt were also measured at baseline. Parental depression was measured using the Composite International Diagnostic Interview Short-Form (Kessler, Andrews, Mroczek, Ustun, & Wittchen, 1998; Ringeisen, Casanueva, Smith, & Dolan, 2011). A dichotomous variable was generated to indicate when a score met the clinical cutoff for major depression (1=Yes; 0=No). The physical health component of the Short Form Health Survey (SF-12), a standardized survey instrument designed to assess indicators of mental and physical health status was used to measure physical health of the parent (Ware, Kosinski, & Keller, 1998). The standardized score ranging from 0 to 100 was used for this analysis, with 50 representing the national norm. The CTS2 Physical Violence Scale (Straus, Hamby, Boney-McCoy, & Sugarman, 1996) was used to assess caregiver experiences with physical violence. Caregivers who reported CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 29 experiencing severe or minor violence in the previous year were classified as having experienced recent intimate partner violence (1=Yes; 0=No). The parent was interviewed about alcohol and drug use at baseline using the Alcohol Use Disorders Identification Test (AUDIT) and the 20-item Drug Abuse Screening Test (DAST-20). The AUDIT was developed by the World Health Organization using a six country collaborative (Australia, Bulgaria, Kenya, Mexico, Norway, USA) and is considered a standard measure across racial and ethnic groups and numerous countries (Saunders, Aasland, Babor, De la Fuente, & Grant, 1993). The psychometric properties of the AUDIT have been well established in a broad range of samples and settings, with high internal reliability, sensitivity, and specificity when using a cutoff score of 5 for women and 8 for men to detect harmful alcohol consumption (Berner, Kriston, Bentele, & Härter, 2007; Chuang, Wells, Bellettiere, & Cross, 2013; Meneses-Gaya, Zuardi, Loureiro, & Crippa, 2009; Reinert & Allen, 2002; Reinert & Allen, 2007), and performs reasonably well with Latinos with different acculturation levels in the U.S. (Cherpitel & Borges, 2000). A dichotomous variable was generated to indicate alcohol dependence when AUDIT scores were 5 or higher for women or 8 or higher for men (1=Yes; 0=No). The DAST-20 is designed to measure drug dependence. Internal consistency reliability, sensitivity, and specificity of the DAST-20 have been good when using a cutoff score of 6 for both men and women (Skinner, 1982; Cocco & Carey, 1998; Yudko, Lozhkina, & Fouts, 2007), including in studies of low-income minority women with majority Latino samples (El-Bassel, Gilbert, Witte, Wu, Gaeta, Schilling, & Wada, 2003). A dichotomous variable was generated to indicate drug dependence when DAST-20 scores were 6 or higher for both males and females (1=Yes; 0=No). Parents also self-reported whether they believed they needed substance abuse services in the previous year. The child welfare worker report was used to measure service referral and service receipt. Because the baseline interview took place 4-6 months after the completion of the child welfare investigation, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 30 baseline and 18 month follow up interviews were used to assess service referral and receipt. Caseworkers assigned to the case indicated whether agency staff had referred the caregiver for drug or alcohol problems (inpatient, detox, intensive day treatment, outpatient, 12-step program, or other), and whether caregivers received services for drug or alcohol problems as a result of a referral at either time point. Analyses Weighted descriptive statistics were obtained with analysis weights and Stata 12 using survey procedures. Weighted multivariate logistic regression was used to control for problematic substance use and other caregiver characteristics to isolate independent contributions of nativity and legal status to service receipt. Results Table 2.1 displays substance use patterns, service need, referral, and receipt among Latino caregivers investigated by a child welfare agency. Nearly 20% of caregivers were assessed to have an alcohol or drug problem, but only 2.8% self-identified needing services for substance problems in the previous twelve months. No significant differences were noted between immigrants and non-immigrants in assessments of problematic substance use. However, undocumented caregivers self-reported needing services at higher rates (9.5%) than U.S. citizens (1.4%) or legal residents (0.1%; p<.01). Of those who reported needing help for drug or alcohol problems, just 53.5% were referred and 51.0% received services. Caregivers were referred by agency staff for services in 13.2% of cases, but received services in only 6.7% of cases overall. Despite having similar self-reported rates of alcohol and drug problems, the foreign-born were referred for services as much lower rates (4.7%) than the U.S. born (18.4%; p<.001). Those who were undocumented were referred at rates much lower than the other groups (0.6%). Similarly, the foreign born received services (2.1%) at lower rates than the U.S. born (9.4%; p<.001). Compared to U.S. citizens CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 31 (8.1%) and legal residents (4.3%), those who were undocumented were the least likely to receive services (0.3%; p<.01). Table 2.2 displays sample characteristics and their relationships to substance abuse service receipt. In addition to nativity and legal status, caregiver age (p<=.01) and speaking a language other than English (p<.05) were negatively associated with service receipt. Number of years in the U.S. for the foreign born was significantly associated with service receipt, with those in the U.S. 10 years or less having the lowest rates of service receipt (p<.001). Table 2.3 shows results of multivariate logistic regression models. After adjusting for problematic substance use, socio-demographic characteristics, language use, and other characteristics that commonly present challenges to receipt of services among child welfare involved families, being foreign born did not influence the odds of service receipt. However, having an undocumented legal status, compared to having U.S. citizenship or legal residency, reduced the odds of service receipt by 95% (p<.01). Discussion The results of this study provide important information about problematic substance use and service receipt for drug and alcohol issues in a national probability sample of Latino parents reported to child welfare. First, in contrast to evidence of an “immigrant paradox” in the general population (Alegria et al., 2008; Alegria et al., 2007; Alvarez, et al., 2007; Grant et al., 2004; Warner, et al., 2006; Vega, et al., 1998; Vega & Scribney, 2005), a protective effect of immigrant status against problematic substance use does not appear to apply to child welfare-involved families. This may reflect the fact that this cohort represents a high-risk subset of Latino immigrant and non-immigrant caregivers whose risk profiles and stress exposure that contribute to problematic substance use (Turner, Lloyd and Taylor, 2008) may be more similar than in the general population. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 32 Second, in the overall sample, analyses revealed a substantial gap in service receipt for those in need; just 8.5% of those identified as having a drug or alcohol problem received services. 1 Although accessing substance abuse services has proven to be a challenge for all child welfare involved families (Oliveros & Kaufman, 2011), immigrant parents were referred by child welfare workers for substance abuse services, and received services, at lower rates than U.S. born parents. Separate analyses showed that immigrant parents were also much less likely to have substance abuse treatment as part of their case plan than U.S. born parents (1.0% versus 7.2% respectively; p<.001), and just 0.1% of undocumented parents had substance abuse treatment in their case plan 2 . Additionally, although proportions of each type of service used were too low to detect any significant differences in patterns of use, no immigrants in the study received inpatient treatment, intensive day treatment, or twelve step services, but rather were limited to outpatient and “other” services. Several factors may explain these findings. Taken with the fact that caregivers who did not speak English at home also had lower rates of service receipt, low acculturation may partially explain reduced service receipt, causing difficulties for immigrants in seeking help and navigating service systems with which they are unfamiliar. Another likely explanation highlights concern that child welfare workers often fail to detect problematic substance use and need for services (Chuang, Wells, Bellettiere, & Cross, 2013; Schroeder, Lemieux, & Pogue, 2008), which may disproportionately occur in their interactions with immigrant families. A post-hoc analysis revealed that child welfare workers indeed perceived U.S. born caregivers (8.1%) to have higher rates of problematic substance use than immigrants (1.2%; p<.001), despite caregiver self-report rates that were similar between immigrants and the U.S. born. 3 This finding could be a result of potential language barriers, preconceived beliefs about immigrants on the part of 1 See Table 2.4. 2 See Table 2.5 3 See Table 2.6 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 33 caseworkers, or cultural misunderstandings between workers and immigrant caregivers. It is also possible that workers disproportionately under identify problems in immigrant families out of concern about exposing immigrants to authorities and services that could jeopardize their status in the U.S. and risk separation from their children. Yet, these findings might also be reflective of agency bias against immigrants or fear of interfering with federal immigration enforcement activities that sends a message to workers to minimize efforts to facilitate receipt of needed services for such families. Third, an independent examination of parent legal status revealed that those with an undocumented legal status had the highest self-reports of need for services and lowest rates of service receipt. Controlling for need, nativity, language, and other explanatory factors, undocumented parents had the lowest odds of service receipt of all citizenship groups, suggesting that ineligibility for government funded programs, as well as fear and stigma around legal status, may be driving factors behind reduced service receipt for substance abuse issues among Latinos. Finally, the positive connection between criminal justice system involvement, or participation in “drug courts”, and substance abuse treatment entry and completion (Oliveros & Kaufman, 2011) may also explain why immigrants are less likely to receive services than non-immigrants. Immigrants who become involved with the child welfare system, especially those who are undocumented, probably have less history with the criminal justice system that could facilitate substance abuse treatment, because of a) fewer opportunities for lifetime exposure to law enforcement in the U.S.; and b) any sort of criminal involvement often leads to imprisonment and deportation, thus reducing the likelihood of interaction with child welfare services for such individuals. Limitations In the general population, there is considerable evidence of heterogeneity in patterns of substance use and in completion of substance abuse treatment among Latinos (Alegría et al., 2006; Amaro, Arévalo, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 34 Gonzalez, Szapocznik, & Iguchi, 2006; Vega & Sribney, 2005; Guerrero, Cepeda, Duan, & Kim, 2012) based on country or territory or origin. It is worth noting that the majority of Latino children in this sample were identified as of Mexican origin (60.7%), However, no significant differences were noted in patterns of problematic substance use or service use for different Latino subgroups, perhaps in part due to a lack of power and limitations in sample size. Future surveys of the child welfare population should consider oversampling various Latino subgroups. Additionally, the nativity and legal status of the secondary caregiver, if one was present, was not taken into consideration in this study. It is possible that the status of a secondary caregiver in the home might also influence experiences with services, but nativity information about a potential secondary caregiver was unavailable in over half of the cases, making it impossible to determine who resided in a mixed status family with accuracy. It is also possible that undocumented parents may be underrepresented in this sample due to potential fear of disclosing legal status. Furthermore, reliable reports of nativity and legal status of parents whose children were placed out of the home were unavailable because the caregiver interviewed in out of home cases was not the parent. Thus, results of this study were reflective only of parents whose children remained in the home. Finally, survey questions regarding service provision were limited. As such, conclusions cannot be drawn as to the quality, frequency, or completion of services received. Ongoing research should better measure and emphasize service quality within the high risk Latino population. Other factors known to affect substance abuse service receipt were unavailable for examination in the current study, including recent criminal involvement and prior receipt of treatment (Barth et al., 2005; Knight, Logan, & Sampson, 2001; Marsh et al., 2009). This study focused on individual and family risk factors associated with substance abuse service receipt, although a small but growing body of research is finding relationships between organizational factors that influence capacity to deliver culturally responsive services and access to services for Latino communities (Marsh et al. 2009; Marsh & Cao 2005; Alegria et CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 35 al. 2006; Guerrero and Andrews 2011; Guerrero, Campos, Urada, & Yang, 2012). Future studies of substance abuse services for Latinos involved the child welfare system should focus on organizational and service system capacity to deliver culturally competent services, as well as the policies that influence service receipt. Conclusion Consistent with Healthy People 2020’s goal to “reduce substance abuse to protect the health, safety, and quality of life for all, especially children,” providing timely access to drug and alcohol services is a national priority (U.S. Department of Health and Human Services, 2015), and is critical for the growing number of Latino families with child welfare involvement. Despite evidence that Latino parents involved with child welfare do not differ from other ethnicities in rates of service receipt (Libby et al., 2006), this highlights the disparities that exist in service receipt for immigrant parents, especially for those who are undocumented. Findings support the need to develop more culturally and linguistically competent services for substance abuse treatment (Guerrero et al., 2012a). However, efforts to integrate child welfare and substance abuse services in working with Latino families at the policy and programmatic levels also need to focus on removing the barriers that culture and legal status pose in providing parents substance abuse services for the purpose of promoting child safety and maximizing the likelihood of family preservation. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 36 References Alegría, M., Canino, G., Shrout, P., Woo, M., Duan, N., Vila, D., ... & Meng, X. L. (2008). Prevalence of mental illness in immigrant and non-immigrant US Latino groups. American Journal of Psychiatry, 165(3), 359-369. Alegría, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97(1), 68-75. Alegría,M., Page, J. B., Hansen,H., Cauce, A. M., Robles, R., Blanco, C., et al. (2006). Improving drug treatment services for Hispanics: Research gaps and scientific opportunities. Drug and Alcohol Dependence, 84, S76–S84, Alvarez, J., Jason, L.A., Olson B.D., Ferrari, J.R. & Davis, M.I. (2007). Substance abuse prevalence and treatment among Latinos and Latinas. Journal of Ethnicity in Substance Abuse, 6(2), 115-141, Amaro,H.,Arévalo, S.,Gonzalez, G., Szapocznik, J., & Iguchi,M.Y. (2006). Needs and scientific opportunities for research on substance abuse treatment among Hispanic adults. Drug and Alcohol Dependence, 84, S64–S75, http://dx.doi.org/10.1016/j.drugalcdep.2006. Barth, R. P., Gibbons, C., & Guo, S. (2005). Substance abuse treatment and the recurrence of maltreatment among caregivers with children living at home: A propensity score analysis. Journal of Substance Abuse Treatment, 30(2), 93-104. Berner, M. M., Kriston, L., Bentele, M., & Härter, M. (2007). The alcohol use disorders identification test for detecting at-risk drinking: a systematic review and meta-analysis. Journal of Studies on Alcohol and Drugs, 68(3), 461. Cardoso, J. B., Dettlaff, A. J., Finno-Velasquez, M., Scott, J., & Faulkner, M. (2014). Nativity and immigration status among Latino families involved in the child welfare system: Characteristics, risk, and maltreatment. Children and Youth Services Review, 44, 189-200. Cherpitel, C. J., & Borges, G. (2000). Performance of screening instruments for alcohol problems in the ER: A comparison of Mexican-Americans and Mexicans in Mexico. The American Journal of Drug and Alcohol Abuse, 26(4), 683-702. Choi, S., & Ryan, J. P. (2006). Completing substance abuse treatment in child welfare: The role of co- occurring problems and primary drug of choice. Child Maltreatment, 11(4), 313-325. Chuang, E., Wells, R., Bellettiere, J., & Cross, T. P. (2013). Identifying the substance abuse treatment needs of caregivers involved with child welfare. Journal of Substance Abuse Treatment, 45(1), 118- 125. Cocco, K. M., & Carey, K. B. (1998). Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients. Psychological Assessment,10(4), 408. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 37 Colby, S. L. & Ortman, J.M.. (2015). Projections of the Size and Composition of the U.S. : 2014-2060. Washington, DC: U.S. Census Bureau. Retrieved from http://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf Daley, M.C. (2005). Race, managed care, and the quality of substance abuse treatment. Administration and Policy in Mental Health, 32: 457–476. Dettlaff, A. J., Earner, I., & Phillips, S. D. (2009). Latino children of immigrants in the child welfare system: Prevalence, characteristics, and risk. Children and Youth Services Review, 31, 775–783. Donohue, B., Holland, J.M., Lopez, K., Urgelles, J., & Allen, D.N. (2014). Examination of illicit drug use frequency using multiple drug assessment methods in mothers referred to treatment by child protective services. Journal of Family Violence, 29, 911-919. Dowd, K., Dolan, M., Wallin, J., Miller, K., Biemer, J., Aragon-Logan, E., & Smith, K. (2012). National survey of child and adolescent well-being (NSACW): NSCAW II Combined waves 1-2 data file user’s manual, restricted release version. Ithaca, NY: National Data Archive on Child Abuse and Neglect, Cornell University. El-Bassel, N., Gilbert, L., Witte, S., Wu, E., Gaeta, T., Schilling, R., & Wada, T. (2003). Intimate partner violence and substance abuse among minority women receiving care from an inner-city emergency department. Women's Health Issues, 13(1), 16-22. Finno-Velasquez, M. (2013). The relationship between parent immigration status and concrete support service use among Latinos in child welfare: Findings using the National Survey of Child and Adolescent Well-being (NSCAWII). Children and Youth Services Review, 35(12), 2118-2127. Finno-Velasquez, M., Berger Cardoso, J., Dettlaff, A., & Hurlburt, M. (under review). Effects of parent nativity and immigration status on mental health service use Among Latino children investigated by child welfare. Fosados R, Evans E, Hser Y. (2007). Ethnic differences in utilization of drug treatment services and outcomes among proposition offenders in California. Journal of Substance Abuse Treatment, 33(4):391–399. Grant, B. F., Stinson, F. S., Hasin, D. S., Dawson, D. A., Chou, S. P., & Anderson, K. (2004). Immigration and Lifetime Prevalence of DSM-IV Psychiatric Disorders Among Mexican Americans and Non- Hispanic Whites in the United States: Results From the National Epidemiologic Survey on Alcohol and RelatedConditions. Archives of General Psychiatry, 61(12), 1226-1233. Grella, C. E., Hser, Y. I., & Huang, Y. C. (2006). Mothers in substance abuse treatment: Differences in characteristics based on involvement with child welfare services. Child Abuse & Neglect, 30(1), 55- 73. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 38 Grella, C. E., Needell, B., Shi, Y., & Hser, Y. I. (2009). Do drug treatment services predict reunification outcomes of mothers and their children in child welfare? Journal of Substance Abuse Treatment, 36(3), 278-293. Guerrero, E., & Andrews, C. M. (2011). Cultural competence in outpatient substance abuse treatment: Measurement and relationship to wait time and retention. Drug and Alcohol Dependence, 119(1), e13-e22. Guerrero, E. G., Marsh, J. C., Duan, L., Oh, C., Perron, B., & Lee, B. (2013). Disparities in completion of substance abuse treatment between and within racial and ethnic groups. Health Services Research, 48(4), 1450-1467. Guerrero, E. G., Campos, M., Urada, D., & Yang, J. C. (2012a). Do cultural and linguistic competence matter in Latinos’ completion of mandated substance abuse treatment. Substance Abuse Treatment, Prevention, and Policy, 7(1), 34. Guerrero, E. G., Cepeda, A., Duan, L., & Kim, T. (2012b). Disparities in completion of substance abuse treatment among Latino subgroups in Los Angeles County, CA. Addictive Behaviors, 37(10), 1162- 1166. Jacobson JO, Robinson PL, & Bluthenthal RN (2006). Racial disparities in completion rates from publicly funded alcohol treatment: Economic resources explain more than demographics and addiction severity. Health Research and Educational Trust, 42, 773–794. Kemper, K., Greteman, A., Bennett, E., & Babonis, T. (1993). Screening mothers of young children for substance abuse. Developmental and Behavioral Pediatrics, 14, 308–312. Kessler, R. C., Andrews, G., Mroczek, D., Ustun, B., & Wittchen, H. U. (1998). The world health organization composite international diagnostic interview short‐form (cidi‐sf). International Journal of Methods in Psychiatric Research,7(4), 171-185. Knight, D. K., Logan, S. M., & Simpson, D. D. (2001). Predictors of program completion for women in residential substance abuse treatment. American Journal of Drug and Alcohol Abuse, 27, 1 – 18. Libby, A. M., Orton, H. D., Barth, R. P., Webb, M. B., Burns, B. J., Wood, P., & Spicer, P. (2006). Alcohol, drug, and mental health specialty treatment services and race/ethnicity: A national study of children and families involved with child welfare. American Journal of Public Health, 96(4), 628. Marsh, J. C., & Cao, D. (2005). Parents in substance abuse treatment: Implications for child welfare practice. Children and Youth Services Review, 27(12), 1259-1278. Marsh, J. C., Cao, D., Guerrero, E., & Shin, H. C. (2009). Need-service matching in substance abuse treatment: Racial/ethnic differences. Evaluation and Program Planning, 32(1), 43-51. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 39 Meneses-Gaya, C. D., Zuardi, A. W., Loureiro, S. R., & Crippa, J. A. S. (2009). Alcohol Use Disorders Identification Test (AUDIT): an updated systematic review of psychometric properties. Psychology & Neuroscience, 2(1), 83-97. Niv N. & Hser Y. (2006). Navigating health care systems: Drug treatment service utilization and outcomes for Hispanic and White methamphetamine abusers. Health Research and Educational Trust, 41, 1242–1257. Oliveros, A., & Kaufman, J. (2011). Addressing substance abuse treatment needs of parents involved with the child welfare system. Child Welfare, 90(1), 25. Osterling, K. L., & Austin, M. J. (2008). Substance abuse interventions for parents involved in the child welfare system: Evidence and implications. Journal of Evidence-based Social Work, 5(1-2), 157- 189. Reinert, D.F. & Allen, J.P. (2002) The alcohol use disorders identification test (AUDIT): A review of recent research. Alcoholism: Clinical and Experimental Research, 26(2), 272-279. Reinert, D.F., & Allen, J.P. (2007). The alcohol use disorders identification test (AUDIT): An update of research findings. Alcoholism: Clinical and Experimental Research, 31(2), 185-199. Ringeisen, H., Casanueva, C., Smith, K., & Dolan, M. (2011). NSCAW II baseline report: Caregiver health and services. In OPRE report# 2011-27d. Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services Washington, DC. Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction, 88(6), 791–804. Schroeder, J., Lemieux, C., & Pogue, R. (2008). The collision of the Adoption and Safe Families Act and substance abuse: Research-based education and training priorities for child welfare professionals. Journal of Teaching in Social Work, 28, 227–246. Semidei, J., Feig-Radel, L., & Nolan, C. (2001). Substance abuse and child welfare: Clear linkages and promising responses. Child Welfare, 80, 109–128. Skinner, H. A. (1982). The drug abuse screening test. Addictive Behaviors, 7(4), 363–371. Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised conflict tactics scales (CTS2) development and preliminary psychometric data. Journal of Family Issues, 17(3), 283-316. Turner, R. J., Lloyd, D. A., & Taylor, J. (2006). Stress burden, drug dependence and the nativity paradox among US Hispanics. Drug and Alcohol Dependence,83(1), 79-89. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 40 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2002). Child Maltreatment 2000. Retrieved from http://www.acf.hhs.gov/programs/cb/pubs/cm00/cm2000.pdf U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2014). Child Maltreatment 2013. Retrieved from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2015). Healthy People 2020 Topics and Objectives: Substance Abuse. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse Vega, W. A., & Sribney, W. M. (2005). Seeking care for alcohol problems: Patterns of need and treatment among Mexican-origin adults in Central California. Alcoholism Treatment Quarterly, 23(2–3), 29– 51. Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55(9), 771-778. Ware, J. E., Kosinski, M., & Keller, S. D. (1998). How to score the SF-12 physical and mental health summary scales. Lincoln, RI: Quality Metric. Warner, L. A., Valdez, A., Vega, W. A., de la Rosa, M., Turner, R. J., & Canino, G. (2006). Hispanic drug abuse in an evolving cultural context: An agenda for research. Drug and Alcohol Dependence, 84, S8-S16. Young, N., Boles, S., & Otero, C. (2007). Parental substance use disorders and child maltreatment: Overlap, gaps, and opportunities. Child Maltreatment, 12(2), 137– 149. Young, N., Gardner, S., & Dennis, K. (1998). Responding to alcohol and other drug problems in child welfare. Child Welfare League of America, 105. Yudko, E., Lozhkina, O., & Fouts, A. (2007). A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. Journal of Substance Abuse Treatment, 32(2), 189-198. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 41 Table 2.1. Substance Use and Service Receipt among Latino biological caregivers of children remaining in the home following investigation by Nativity and Legal Status (N=842) + Total N (%) U.S. Born N=548 (57.6) Foreign Born N=294 (42.3) p U.S. Citizen N=632 (70.2) Legal Resident N=74 (10.7) Undocumented N=130 (19.0) p Variable Caregiver alcohol problem 81 (8.6) 57 (10.3) 24 (6.2) .32 59 (8.8) 7 (8.1) 15 (8.6) .97 Caregiver drug problem 135 (14.7) 86 (14.7) 49 (14.8) .99 104 (15.8) 10 (10.4) 19 (14.0) .74 Caregiver substance problem 187 (19.7) 125 (20.4) 62 (18.7) .75 144 (20.5) 16 (18.3) 25 (18.5) .94 Caregiver identified need for services 38 (2.8) 26 (1.4) 12 (4.6) .07 29 (1.4) 1 (0.1) 8 (9.5) <.01 Caseworker referred to services 181 (13.2) 154 (18.4) 27 (4.7) <.001 163 (15.8) 12 (11.0) 6 (0.6) .01 Caregiver received services 137 (6.7) 116 (9.4) 21 (2.1) <.001 123 (8.1) 10 (4.3) 4 (0.3) <.01 + Table presents unweighted N’s and weighted percentages; Pearson’s chi-square adjusted for weighting; CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 42 Table 2.2: Weighted bivariate Relationships between Covariates and Substance Abuse Service Receipt + Total N=842 N (%) Received Substance Abuse Services N=137 (6.7%) N (Row %) p value Caregiver characteristics Age (mean) 32.2 27.6 .01 Age 0.01 18-19 63 (1.1) 14 (26.9) 20-29 372 (40.6) 75 (9.2) 30-39 311 (44.7) 40 (5.0) 40+ 88 (13.6) 8 (2.7) Gender Female 762 (88.8) 127 (6.2) 0.53 Male 80 (11.9) 10 (10.0) Number of children (mean) 2.83 2.71 .54 Nativity <.001 US born 548 (57.7) 116 (9.4) Foreign born 294 (42.4) 21 (2.1) Legal status <.01 US citizen 632 (70.3) 123 (8.2) Legal resident 74 (10.7) 10 (4.3) Undocumented 130 (19.0) 4 (0.4) Years in US <.001 US born 548 (57.7) 116 (9.4) Less than 10 100 (9.9) 1 (0.2) 11 to 20 125 (19.2) 13 (4.6) More than 20 69 (13.3) 7 (0.9) Language at home 0.03 English 320 (33.8) 63 (9.5) Non-English 521 (66.2) 74 (4.9) Education 0.65 Less than HS 331 (43.3) 54 (6.0) HS Diploma 332 (36.8) 55 (8.0) More than HS 178 (19.9) 28 (5.4) Employment .49 Employed 313 (52.5) 46 (5.7) Not employed 437 (47.5) 91 (7.7) Income .37 < 50% of the fed poverty level 235 (24.7) 52 (8.8) 50-100% of fed pov level 272 (34.0) 37 (5.6) 100-200% of fed pov level 182 (23.6) 26 (8.8) More than 200% of fed pov level 72 (8.8) 8 (1.6) Poverty level missing 81 (8.8) 14 (4.8) CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 43 Substance Problems Alcohol dependence 81 (8.6) 16 (7.8) 0.75 Drug dependence 135 (14.7) 33 (8.7) 0.34 Other Caregiver Issues Financial Hardship 0.65 Struggling to make it 377 (48.8) 54 (6.1) Getting by or saving a little 461 (51.2) 82 (7.2) Depressed (CDI ) 194 (20.6) 40 (9.7) 0.22 Physical health (standardized) 48.8 50.1 0.31 Domestic violence 286 (31.7) 44 (6.1) 0.63 + Pearson’s adjusted chi-square tests conducted for categorical covariates, and adjusted Wald tests conducted for continuous covariates to account for weighting. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 44 Table 2.3: Weighted Multivariate Logistic Regression Models Predicting Substance Abuse Service Receipt + Nativity (N=706) Legal Status (N=704) 1 Odds Ratio 95% CI Odds Ratio 95% CI Caregiver characteristics Age (mean) .93 .86, 1.00 .92* .85, .99 PCG is female .44 .13, 1.46 .53 .15, 1.93 PCG is foreign born .37 .11, 1.21 Legal status (ref group=U.S. citizen) Legal resident .83 .17, 3.94 Undocumented .05** .01, .26 Non-English language spoken at home 1.06 .42, 2.67 .98 .39, 1.71 Education (ref group= Less than HS) HS Diploma .79 .24, 2.66 .74 .20, 2.64 More than HS .74 .18, 3.03 .68 .16, 2.79 PCG is employed (ref group= unemployed) .74 .34, 1.62 Substance problems Alcohol dependence 1.33 .26, 6.71 1.32 .23, 7.56 Drug dependence 1.60 .54, 4.67 1.40 .45, 4.33 Other caregiver issues Struggling to make it financially .91 .43, 1.93 .98 .46, 2.10 Clinical depression 2.21 .89, 5.49 2.25 .90, 5.60 Physical health (standardized) 1.04 .98, 1.09 1.04 .98, 1.10 Domestic violence in past year .49 .19, 1.25 .47 .18, 1.21 + *=p<.05; **p<.01; ***p<.001 1 Post hoc analyses using different base groups indicted that undocumented were also less likely than legal residents to receive services CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 45 Table 2.4: Weighted bivariate relationships between problematic substance use and substance abuse service receipt Received Substance Abuse Services N=137 (Weighted row percent) p value Caregiver Alcohol or Drug Problem Yes No 0.38 Yes 43 (8.5%) 126 (91.6%) No 92 (6.2%) 487 (93.8%) CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 46 Table 2.5: Weighted substance abuse treatment in case plan by nativity and immigration status Total N (%) U.S. Born N=548 (57.6) Foreign Born N=294 (42.3) p value U.S. Citizen N=632 (70.2) Legal Resident N=74 (10.7) Undocumented N=130 (19.0) p value Variable Substance abuse treatment in case plan 108 (4.6%) 97 (7.2%) 11 (1.0%) <.001 102 (6.2%) 4 (2.2%) 2 (0.1) <.001 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 47 Table 2.6: Weighted child welfare worker perceptions of problematic substance use among caseworkers by Nativity and Immigration Status Total N (%) U.S. Born N=548 (57.6) Foreign Born N=294 (42.3) p U.S. Citizen N=632 (70.2) Legal Resident N=74 (10.7) Undocumented N=130 (19.0) p Variable Caregiver alcohol problem 33 (1.5%) 25 (2.1%) 8 (0.4%) <.01 28 (1.8%) 1 (0.2%) 4 (0.5%) .02 Caregiver drug problem 102 (4.3%) 91 (6.5%) 11 (0.9%) <.001 95 (5.6%) 3 (1.1%) 4 (0.3%) <.01 Caregiver substance problem 122 (5.5%) 105 (8.1%) 17 (1.2%) <.001 111 (7.0%) 4 (1.3%) 7 (0.8%) <.001 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 48 Chapter Three (Study 2) Intimate partner violence and help-seeking services among Latino women with child welfare contact: Does immigrant status matter? In preparation for submission to the Journal of Interpersonal Violence (Megan Finno-Velasquez, Ijeoma Nwazubor Ogbonnaya) Intimate partner violence (IPV) is a social problem that transcends cultural and ethnic backgrounds, and is highly associated with other forms of family violence, including child maltreatment. A rise in the Latino population in the U.S. due to increased immigration over the past several decades has invoked increasing concern about the victimization of Latina women, partly because of stressors related to culture and legal immigration status (Bauer, Rodriguez, Quiroga, & Flores-Ortiz, 2000; Rizo & Macy, 2011). Although most recent national rates of IPV appear to be slightly lower for Latino women (8.4%) compared to Black (12.2%) and White (9.2%) women (Black, Basile, Breiding, Smith, Walters, Merrick…& Stevens, 2011), understanding circumstances around how abuse occurs within the Latino population has been difficult. Variable victimization rates exist in the literature for Latino women because studies have used different subgroup samples, operationalization of violence and victimization, and analytic methods, with overall lifetime rates ranging from 13-70% (Cuevas, Sabina, & Milloshi, 2012; Klevens, 2007; Bauer, Rodriguez, & Perez-Stable, 2000; Denham, Frasier, Hooten, Belton, Newton, Gonzalez…& Campbell, 2007; Hazen & Soriano, 2007; Ingram, 2007; Lown & Vega, 2001; Sorenson & Telles, 1991; Tjaden & Thoennes, 2000). Despite growing literature, many questions remain about patterns of risk as well as help- seeking behaviors with respect to the Latino population (Denham et al., 2007; Klevens et al., 2007; Rizo & Macy, 2011). For some of the highest risk Latino families, those involved with the child welfare system (CWS), very few studies have examined their experiences with IPV (Ogbonnaya, Finno-Velasquez, & Kohl, 2015; Dettlaff & Johnson, 2011; Dettlaff, Earner & Phillips, 2009; Cardoso, Dettlaff, Finno- CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 49 Velasquez, Scott, & Faulkner, 2014). In fact, the prevalence, predictors of risk, and help-seeking services for IPV issues among Latino women reported to the CWS, and the relative contribution of culture and immigration status to their experiences, remain unknown. This study attempts to address this gap in the literature. Risks for IPV among Latino women In studies of diverse community and population samples, risks factors for Latino women experiencing IPV appear to be similar to those of other ethnicities, with a couple exceptions. For one, a review of patterns of IPV determined that, unlike other ethnicities, substance abuse is not a strong predictor of IPV for Latinas (Klevens, 2007). Experts have also suggested that acculturation (Denham et al, 2007; Lown & Vega, 2001; Sorenson & Telles, 1991), or adapting to new cultural norms and practices as a result of immigration, and the role strain that accompanies changes to rigid traditional gender roles, may explain divergent rates of IPV among Latinos (Klevens, 2007; Perilla, Bakeman, & Norris, 1994). However, no clear link between immigration, acculturation, and IPV has emerged from existing literature (Klevens, 2007). Some empirical studies have found that immigrant and non-immigrant women experience similar rates of violence (Hazen & Soriano, 2007; Kaufman Kantor, Jasinski, & Aldarondo, 1994; Sorenson & Telles, 1991). Yet, others have shown immigrant women to experience higher rates of violence than non- immigrant women (Biafora &Warheit, 2007), while others have linked violence to increasing acculturation and more time spent in the U.S. (Caetano, Schafer, Clark, & Cunradi, 1998; Kaufman Kantor, et al., 1994; Lown & Vega, 2001; Sanderson, Coker, Roberts, Tortolero, & Reininger, 2004; Sorenson & Telles, 1991). Help-seeking for IPV Latino women are also unique in their response to and helping seeking for IPV. For instance, Torres (1991) found that Latino women return to their abusers more often than non-Latino White women, while Dutton, Orloff and Hass (2000) found that they take longer to leave their perpetrator than non-Latino CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 50 White women. Several other studies have indicated that Latino women, especially those who are less acculturated, may be less likely than others to consult with and receive informal support from family and friends (Rizo & Macy, 2011), as well as formal sources of assistance, such as shelters, mental health services, clergy and other social services (Ingram, 2007; Rizo & Macy, 2011). Factors related to immigrant experiences are also often explanations for inhibited use of IPV supports among Latinos. Immigrant women, especially those who are undocumented, may fear seeking help from authorities because of negative experiences in their home countries or fear of deportation (Bauer, et al., 2000; Rizo & Macy, 2011). Women have also reported obstacles to receiving IPV services to include language barriers, social isolation, and poor awareness of legal rights, law enforcement structures, and social services (Bauer, et al., 2000). IPV and child welfare involvement Women involved with the CWS are at particularly high risk for having experienced IPV (Herrenkohl, Sousa, Tajima, Herrenkohl, & Moylan, 2008; Kelleher, Hazen, Coben, Wang, McGeehan, Kohl, & Gardner, 2008; Hazen, Connelly,Kelleher, Landsverk, & Barth, 2004), with estimates showing that IPV is a significant problem for 30% to 40% of families in the CWS, according to victim self-report (Edleson, 1999; Hazen, et al., 2004). In the only national prevalence study of IPV experiences among child welfare involved families, almost a third of children who remained in the home had a female caregiver who reported being a victim of physical violence in the previous year, and almost 45% reported this type of abuse in their lifetime (Hazen, et al., 2004). While Latino women did not differ from women of other ethnic groups in experiences of violence (Hazen, et al., 2004), that study did not examine immigrant women separately from non-immigrants. In one of the only studies of CWS-involved Latino families, CWS workers identified IPV as a risk for maltreatment at higher rates for U.S. born Latino children compared to children born outside the U.S. (Dettlaff & Johnson, 2011). In another, undocumented women reported CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 51 similar rates of rates of IPV as U.S. citizens, but were more likely to have child maltreatment allegations involving domestic violence (Ogbonnaya, Finno-Velasquez, & Kohl, 2015). Latino child welfare families and service receipt Identifying IPV in the child welfare population is critical, because such families are uniquely positioned to receive support and linkage to services that resolve violence and prevent out-of-home placement of children. Yet, emerging evidence suggests that immigrant status may strongly inhibit Latino families reported to the CWS from receiving multiple types of needed assistance (Finno-Velasquez, 2013; Dettlaff & Berger-Cardoso, 2010). Therefore, an examination of the role that culture and immigration status may play in identifying patterns of risk for IPV and receipt of supportive services to address IPV issues among Latino families involved with child welfare is urgently needed. Current Study The present study contributes to the literature by examining experiences of physical IPV among Latino immigrant and non-immigrant female caregivers who are reported to the child welfare system for alleged child abuse or neglect. The study uses a nationally representative sample and is designed to answer the following questions: 1) Among Latino women involved with child welfare agencies, what is the incidence of partner physical violence?; 2) Among Latino women involved with child welfare agencies, what are the risks associated with IPV?; 3) Do culture and legal immigration status serve as barriers to receiving services for IPV? Methods Study Design Data from the second cohort of the National Survey of Child and Adolescent Well-being (NSCAWII) was used to examine the study’s research questions. The NSCAWII is a nationally representative sample of 5,872 children (ages 0 to 17.5) from families that were investigated by a child CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 52 welfare agency for alleged child abuse or neglect in 2008 and 2009. The sample was drawn using a two- stage cluster sampling approach. Children were first selected from child welfare agencies across 83 primary sampling units (counties or groups of counties) in 30 U.S. states, and were then randomly selected from completed maltreatment investigation cases in each of the PSUs. In order to make the sample nationally representative, a complex weighting design that accounted for stratification, clustering, weighting, and oversampling of certain subgroups was employed. Additional information regarding sampling procedures and methods may be found in Dowd et al. (2012). Analytic Sample Data were collected via face-to-face interviews with children, parents, non-parent adult caregivers, and child welfare workers. Baseline interviews with were completed 4 to 6 months after the closure of the child welfare investigation. Wave 2 follow-up interviews were conducted on average 18 months after the completion of the investigation. Data from parents and CWS workers were used in these analyses. The parent is the unit of analysis. Because the focus of this study is IPV among Latino mothers, the full sample for this study was comprised of female, biological caregivers whose children remained in the home following the maltreatment investigation at baseline (n=774). Cases with missing data on key variables used in multivariate analyses were excluded from analyses. Thus, the final analytic sample for analyses of the physical violence outcome was reduced to 516 mothers, whereas the final analytic sample for analyses of the service use outcome consisted of 569 mothers. Measures Dependent Variables. Physical Violence. The Conflict Tactics Scale 2 (Straus, 1990; CTS-2) was utilized to measure self- reported physical violence by an intimate partner. The CTS-2 physical abuse subscale consists of 13 items that measure minor abusive behaviors, including being pushed, grabbed, shoved, or slapped, and severe CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 53 violent behaviors including being choked, beaten up, and threatened with a knife or gun. Response categories for each violent act range from 0 (never) to 6 (more than 20 times), indicating the frequency of occurrence of each violent act in the preceding 12 months. Caregivers who reported violence in the previous year were classified as experiencing recent IPV, whereas those who did not were classified as experiencing no recent IPV. A variable was also calculated to represent the total number of violent episodes in the past year. For acts that did not occur in the previous 12 months, the respondent was asked to indicate if these events ever happened during their lifetime. CTS-2 physical abuse subscales have high reliability and validity for use with English-speaking and Spanish-speaking Latino women (˛= .74 and .84, respectively; Connelly, Newton, & Aarons, 2005). IPV Services. Following questions about physical violence, women were asked about experiences with IPV services received in the previous twelve months. First, they were asked if they had been referred to IPV services, such as a battered women’s shelter or a program to help deal with an abusive partner in the previous 12 months (yes or no). They were then asked if they had stayed in a shelter or received other DV services during the same time period (yes or no). The fact that the baseline interview occurred 4 to 6 months after the investigation completion suggests that many caregivers may have received services in the 12 months leading up to the baseline interview, but others did not receive services until after the baseline interview. Therefore, reports of IPV service use included responses from both the baseline and 18 month follow-up. A dichotomous variable was created to represent: 1= use of services at baseline or 18 month follow up; or 0= no use of services at either time period. 4 4 It should be noted that, although CWS workers also answered questions regarding physical violence in the home and service use, worker reports were not the focus of this study given the highly discrepant nature of reports of violence between CWS workers and victim caregivers (Kohl et al., 2005). CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 54 Independent Variables. Household Characteristics. Demographic and background information was gathered on a range of characteristics including caregiver age, marital status, education, number of children in the household, household membership, household income as a percentage of the federal poverty level, economic hardship, and language spoken in the home. Because almost one-quarter of undocumented female caregivers in the target sample had missing data on the income variable, income level was not included in multivariate analyses so at to retain as many cases of undocumented caregivers as possible in analyses. Perceived economic hardship (struggling to make it versus getting by or saving a little) was therefore also included in regression analyses as a representation of economic status. Information about parent nativity and immigration status was obtained through caregiver self- report. Women were first asked, “Were you born in the United States?”. If the response was “no”, a follow- up question about citizenship was asked; “Are you a U.S. citizen?”. Again, if the response was “no”, a follow-up question about legal status was asked; “Are you a legal resident of U.S.?” For the purpose of stratifying descriptive analyses, a dichotomous variable was created to indicate whether a caregiver was U.S. born or not. A three-category variable was also generated based on caregiver citizenship and legal immigration status, comprised of : (1) U.S. citizen; (2) legal resident; and (3) undocumented immigrant. U.S. citizens include those born in the United States, Puerto Rico, Guam, the U.S. Virgin Islands, Northern Marianas, or abroad to American parents, as well as those who became naturalized U.S. citizens. Legal residents included those with a green card, a work visa permit, or other legal immigration document. Undocumented immigrants included those who did not have any legal documentation. Caregiver functioning. Major depression was assessed using the Composite International Diagnostic Interview Short-Form developed by the World Health Organization (Kessler, Andrews, Mroczek, Ustun, & Wittchen, 1998). This instrument consists of 24 items pertaining to depressive CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 55 symptoms that were asked of women during the baseline NSCAWII interview (Dowd et al., 2012). CIDI- SF major depression sensitivity has been cited as 89.6 (SE=0.8) and specificity as 96.2 (SE=0.2; Kessler et al., 1998). A dichotomous variable was generated to indicate when a score met the clinical cutoff for major depression (1=Yes; 0=No). The Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST-20) were used to measure substance use disorders. The AUDIT was also developed by the World Health Organization and contains 10 items for identifying alcohol dependence. The psychometric properties of the AUDIT have been well-established with high internal reliability, sensitivity, and specificity when a cutoff score of 5 for women has been used to detect dependence (Berner, Kriston, Bentele, & Harter, 2007; Chuang, Wells, Bellettiere, & Cross, 2013; Meneses-Gaya, Zuardi, Loureiro, & Crippa, 2009; Reinert & Allen, 2007). The DAST-20 is a 20-item instrument designed to measure drug dependence. Internal consistency reliability, sensitivity, and specificity have also been good for the DAST- 20 when a cutoff score of 6 has been used (Cocco & Carey, 1998; Yudko, Lozhkina, & Fouts, 2007). A dichotomous variable was created to indicate whether women met criteria for a substance use disorder when AUDIT scores were 5 or higher, or DAST-20 scores were 6 or higher (1=Yes; 0=No). Physical health was assessed from response to the Short Form Health Survey (SF-12), a standardized survey measure designed to assess indicators of mental and physical health status. Only the physical health component was included in this study, which has a theoretical score ranging from 1 to 100, with 50 representing the national norm. The SF-12 has demonstrated good to adequate reliability and validity (Ware, Gandek, Kosinski, Aaronson, Apolone, Brazier,... & Thunedborg, 1998). The standardized score ranging from 0 to 100 was used for this analysis. Social support. Caregivers responded to questions about social support and related family resources adapted from the Duke–University of North Carolina Functional Social Support Scale (Broadhead, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 56 Gehlbach, DeGruy, & Kaplan, 1998). Eight items were asked about how much support women receive in different ways, with responses ranging from 1 (“I get much less that I would like”) to 5 (“I get as much as I like”). Individual scores were averaged and a mean social support score ranging from 1 to 5 was created for purposes of analysis. Child Welfare Related Factors. Information drawn from the CWS worker interview was used to derive a variable representative of history of involvement with child welfare services. During the baseline interview workers were asked, “Was there any prior child welfare service history, not including investigations?”. CWS workers also identified whether IPV was included as a separate allegation on the report of maltreatment that lead to inclusion in the study. Finally, CWS workers completed a risk screening tool in which a number of potential risks for maltreatment were assessed for their presence in each case. Individual maltreatment risks that are also relevant to physical violence experiences were divided into categories of risk, and included: history of arrest, family stress, low support, prior reports of maltreatment, caregiver history of maltreatment, excessive parental discipline, primary caregiver alcohol or drug abuse, primary caregiver mental health or cognitive problems, history of IPV, and active IPV in the home. Similar to approaches used in other NSCAW studies (eg Kohl et al., 2005), the total risk count was categorized into three levels (low=where 0-2 risks were identified; moderate=where 3-4 risks were identified; and high=where 5 or more of the total applicable risks were present). Analytic Plan All analyses were conducted using Stata 12 with analysis weights to adjust for the complex sampling design of the NSCAWII, allowing findings to be nationally representative of CWS-involved female Latino biological caregivers with children remaining in the home following an investigation. Full details of the NSCAWII weight derivations are available elsewhere (Dowd et al., 2012). In order to answer research questions, first bivariate analyses using the entire sample (n=774) examined the incidence, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 57 severity and frequency of physical violence experiences, along with patterns of referral for and use of IPV services, stratifying by mother nativity and legal immigration status. The Pearson chi-square statistic for tests of categorical independence was employed with the second-order correction of Rao and Scott (1984) to estimate between-group differences using design-based F tests and their associated p-values. Bivariate analyses examined relationships between the two outcomes of interest (recent physical violence and IPV service use) and other relevant covariates including household characteristics, caregiver functioning, and child welfare case variables. Because the proportion of mothers who experienced minor (less severe) violence alone was small (6.39%), and minor violence alone was not significantly associated with any covariates, analyses of recent physical violence used a dichotomous variable (minor or severe violence versus no violence). Thus, it should be noted that significant associations in analyses of recent physical violence are driven largely by acts of severe violence. Finally, weighted multivariate logistic regression models were run separately for recent physical violence and IPV service use to determine independent contributions of nativity and legal immigration status, as well as other key predictors of each outcome. Because bivariate analyses revealed very few significant relationships between covariates and outcomes, in addition to parent nativity and legal status, factors commonly associated with IPV in existing literature were included in regression analyses. First, nativity and legal status were entered as the sole variables in regression models predicting IPV and service use. Then, other household characteristics were added to the models, followed by caregiver functioning and physical violence experiences, and finally by child welfare case variables. The full models are presented. Results IPV and service use by nativity and immigrant status Table 3.1 displays patterns of IPV and service use by nativity and legal status among all Latino women with children remaining in the home following a child maltreatment investigation (n=774). At the CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 58 time of first interview, 40.9% reported having experienced some form of physical violence in her lifetime. Of those, (33.0%) reported being victimized within the previous year, with over a quarter (26.6%) experiencing severe violence in that period. Although no statistically significant differences existed in IPV during the lifetime or in the past year reported by immigrant mothers compared to non-immigrants, U.S. born mothers reported a higher average number of violent episodes in the previous year (5.59) compared to immigrant mothers (2.72; p<.05). Despite experiencing overall high rates of IPV in the previous year, during the same period only 16.8% of mothers reported being referred to services to address the issue. And, just 9.4% of mothers reported receiving services, such as shelter services or other support services, to address IPV issues during the 24 months surrounding the child welfare investigation. No differences in service use were noted between immigrant and non-immigrant mothers. Although rates of service use were lower for legal residents than for U.S. citizens and undocumented mothers, this difference was not statistically significant and may in part be a result of small sample size. Other sample characteristics Table 3.2 presents sample characteristics for the reduced samples with complete data for all predictors and dependent variables included in final multivariate models. The mean female age was 31 years, and each had an average of 3 children. U.S. born mothers made up around 61% of the sample, and immigrant mothers about 39%. Those who were undocumented comprised approximately 14% of the sample. More than a quarter were married at the time of interview, but over a third had never been married. Just over half of women reported living with a male intimate partner in their household. Over 40% had less than a high school education, and a majority lived below the federal poverty level. Over a fifth were assessed as having depression, while just 7% and 13% had alcohol or drug dependence, respectively. About 15% of households had secondary caregivers with a substance abuse problem. More than a quarter of CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 59 women had a history with child welfare services, and approximately 15% had IPV listed as an allegation on the current maltreatment report. Recent physical violence Table 3.2 also displays relationships between covariates and recent physical violence. A child welfare services history was associated with lower rates of physical violence. Just 15.6% of mothers who had previous involvement with CWS reported recent physical violence, compared to 37.5% of those without CWS history (p<.01). Depression was also associated with higher rates of physical violence; 53.7% of mothers with depression were recent victims (p<.01). Higher levels of social support were also associated with decreased rates of physical violence (p<.001). Table 3.3 presents results of multivariate analyses of recent physical violence. Adjusting for covariates, neither nativity nor legal status were predictive of experiences of physical violence. In both models, higher levels of social support decreased the odds of recent victimization by almost 40% (p<.01). Past receipt of CWS decreased the odds of recent physical violence by about 80% (p<.01). Mothers assessed as having clinical levels of depression had more than 3 times the odds of having experienced recent physical violence (p<.05). Use of Services for IPV Table 3.2 also presents bivariate associations of IPV service use. Self-reported recent victimization was highly associated with the use of services; 21.2% of those who reported violence received services, compared to just 2.7% of those who did not report being victimized at the time of initial interview (p<.001). Number of episodes of violence was also positively associated with service use (p<.05). Women in families with secondary caregivers with substance abuse issues had higher rates of service use (19.6%) compared to families without secondary caregiver substance use issues (6.6%) (p<.05). Mothers also received services at higher rates when maltreatment risk was assessed by the CWS worker to be high (5 or CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 60 more risks present; p<.01), and when IPV was listed as an allegation on the initial report of maltreatment (p<.001). Table 3.4 shows final results of multivariate models predicting the use of IPV services over a period of 24 months. Independent of experiencing recent physical violence, being a legal resident, compared to being a U.S. citizen, decreased the odds of service use by 78% (p<.05). However, this finding was not significant in simpler models containing fewer variables, indicating that the result may not completely stable. Both the presence of IPV as an allegation on the maltreatment report (p<.001) and the presence of five or more maltreatment risks (p<.05) each increased the odds of receiving services more than ten-fold. Discussion This study sought to understand the relationship between physical IPV and nativity and immigrant status among Latino women investigated by a child welfare agency, and whether immigrant status inhibited receipt of services to address IPV issues in this population. To our knowledge, this was the first study to examine the factors that influence IPV experiences and help-seeking patterns of Latino women investigated by the CWS. Recent IPV Overall, rates of physical violence among Latino women in this study were comparable to those of CWS-involved families of other ethnicities (Hazen et al., 2004; Kohl, Edleson, et al., 2005). Similar to other studies that have relied solely on the CWS worker report of IPV (Dettlaff, Earner & Phillips, 2009; Cardoso, Dettlaff, Finno-Velasquez, Scott, & Faulkner, 2014), results here showed no significant differences in severity and overall rates of physical violence between immigrants and non-immigrants, with the exception of the frequency of violence, where U.S. born women reported a higher number of incidents than immigrants, arguably placing the U.S. born at greater risk. This is an important finding, because despite the fact that immigrants tend to lack resources and struggle more financially, such challenges do CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 61 not appear to increase risk for IPV. This could be for a number of reasons, one being that the stressors tied to acculturation that increase mental health and substance use issues for the U.S. born also increase the probability of experiencing IPV. However, there may be other explanations as well. Because of traditional cultural norms that are more accepting of male dominant gender roles and tolerance of abuse, and the accompanying fear and shame associated with disclosure, immigrant women may be less likely than the U.S. born to report violence when it is occurring (Montalvo-Liendo, 2009; Raj & Silverman, 2002). It has also been suggested that immigrants might not disclose IPV when prompted due to language barriers, lack of information about their legal rights, the stress of adapting to a new culture, and difficulties resolving their immigration status (Robert Wood Johnson Foundation, 2014). However, another possible explanation for the lack of differences in IPV seen between immigrants and non-immigrants in this study is that the subpopulation of vulnerable Latino families at risk for child maltreatment may be less heterogeneous than the general population. For example, although a common risk for IPV is social isolation, something that immigrant women have long been thought to be at especially high risk for given their marginalized status, immigrant Latinas in this study did not appear to be more socially isolated than non-immigrants 5 . This is consistent with recent evidence showing that abused immigrants have similar levels of support, or lack thereof, as abused women who are U.S. born (Montalvo- Liendo, Koci, McFarlane, Gilroy, & Maddoux, 2013). Yet, similar to several other studies of IPV with Latinos (Cummings, Gonzales-Guarda, & Sandoval, 2013; Denham et al. 2007; Gonzalez-Guarda et al. 2010; Lown and Vega 2001), social support was negatively associated with violence in this study. This concurs with what is known about the cycle of violence in which the abusive partner often aims to isolate and restrict access of the victim to her family and friends (Denham 2007; Stark, 2007). On the flip side, women who have more social supports may be 5 Analyses available in Table 3.5. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 62 less vulnerable to getting into or staying in violent relationships, or potential perpetrators could be less likely to get away with abuse when there are more people aware and able to intervene. Because these are cross-sectional data, the direction of the relationship cannot be established, but it is possible that both factors play a role in the association between social support and IPV among Latino women (Denham et al., 2007). Contrary to much research highlighting an association between substance abuse and IPV (Kantor, 1997; Neff et al., 1995; Perilla et al., 1994; West et al., 1998; Caetano, Schafer, Clark, Cunradi, & Raspberry, 2000; Caetano, Cunradi et al., 2000), caregiver substance abuse was unrelated to the incidence of IPV in this study. This is a point worth discussing given that in a recent systematic review of literature among Latinos, alcohol or drug abuse were factors consistently related to the perpetration and victimization of violence (Cummings, Gonzales-Guarda, & Sandoval, 2013). One explanation for this finding could be that in this sample of CWS-involved families, the secondary caregiver may not always be the perpetrator of abuse. For example, the secondary caregiver could be a grandparent or non-residential father, whereas the perpetrator of abuse may be a boyfriend or acquaintance living outside of the home. Alternatively, it is possible that substance abuse consequences indeed have less explanatory value for the occurrence of IPV among Latinos compared with other groups (Klevens, 2007). It may be that while the use of alcohol and drugs serves as a coping mechanism for many women victims of violence, Latina women gravitate towards different methods for coping. Considering the results of this study, one could imagine that supports from extended families and friends in close-knit communities may play a more pivotal role in helping Latinas cope. It is not a surprise that depression was highly positively correlated with physical violence as well as service receipt in this study, given ample evidence supporting an association between IPV and mental disorders (eg Golding, 1999; Hazen et al., 2004). However, it is important to remember the cross-sectional CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 63 nature of this study, meaning that the relationship does not imply causality and that depression is likely not the cause of physical violence. Rather, it is more probable that victimization leads to higher susceptibility to depression (Hazen et al., 2004; Edleson, Hokoda, Ramos-Lira, 2007). The finding that those identified as having moderate cumulative risk, but not high risk, were more likely to report the occurrence of IPV, is perplexing. It is possible that those who come to the attention of the child welfare system with the most risk have multiple and compounding stressors that are not driven by issues of IPV. Alternatively, women with the highest number of risks may be less likely to be truthful about IPV if it is occurring, because the fear of losing their children may be greater. One result that supports this hypothesis is that women with a history of having received child welfare services were less likely to report IPV in the current maltreatment episode, in direct contradiction to past study findings involving all ethnicities (e.g. Hazen et al., 2004). At first blush, this implies that perhaps the CWS is successful at addressing issues related to IPV the first time Latino women are involved. Yet, it may be more likely that women with past experience with the CWS are actually more fearful or hesitant to disclose IPV, valuing unity with their children above their own safety (Kelly, 2009). Regardless of the reason, this appears to reflect a dynamic unique to Latino women, and merits further exploration. Services for IPV In regards to factors influencing help-seeking for IPV, nativity and legal immigrant status were unrelated to the use of services, an unexpected finding considering that recent research has found that immigrants investigated by the CWS to be less likely to receive a range of other services (Dettlaff & Berger Cardoso, 2010; Finno-Velasquez, 2013; Finno-Velasquez, Berger Cardoso, Dettlaff, & Hurlburt, under review;). Other studies of help-seeking behaviors for IPV issues have shown that immigrant women experience heightened barriers to leaving violent relationships and receiving help, including lack of financial means; fear of deportation and of losing custody of their children, or of their situation worsening; CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 64 beliefs that abuse must be tolerated or that institutions are oblivious to IPV or will discriminate against them; lack of awareness of available services; language difficulties; preferences for an intact family; and lack of transportation (Acevedo, 2000; Bauer et al., 2000; Dutton et al., 2000; Menjívar & Salcido, 2002; Amanor-Boadu, et al, 2012; Hass, Dutton, and Orloff, 2000). On the other hand, some research has cited the main factor influencing Latino women’s’ decisions about seeking help for IPV to be the well-being of their children (Kelly, 2009; Acevedo, 2000; Bauer et al., 2000; Torres, 1991). Especially in the context of a child welfare investigation, it is possible that the aforementioned barriers for immigrants are trumped by their concern for keeping their children safe and with them. Another finding deserving attention is that a much higher rate of women reported experiencing severe IPV (26.6%) relative to receiving IPV services (9.4%). Similar results have been found in other studies (Ogbonnaya, 2015; Kohl, Edleson, et al., 2005), and they are not entirely surprising considering past findings suggesting that CWS workers are inconsistent in their assessments and often under-identify IPV (Kohl, Barth, et al., 2005). Furthermore, CWS workers who identify cases of IPV are typically primarily concerned with addressing immediate safety issues, rather than referring women and children to specialized services (Shepard and Raschick, 1999), especially if maltreatment risk does not rise to the level of requiring out of home placement. However, a couple of factors contributed to an increased likelihood of receiving help. Specifically, women were more likely to receive services if IPV concerns were identified by the maltreatment reporting source in the initial CWS investigation. The odds of service receipt also increased if multiple other maltreatment risks were present in the case, signs of increased attention to a case that may lead CWS workers to spend more time and resources to connect families with specialized services. In fact, in this sample of caregivers whose children remained in the home, a referral to specialized services by the CWS CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 65 worker was highly correlated with service receipt 6 , highlighting the importance of the CWS worker’s role in obtaining needed services. Finally, despite the fact that social support decreased the risk of victimization in this study, it was directly unrelated to service receipt. However, it is prudent to point out that a significant relationship between social support and service use may have been unobserved because social supports may decrease need for services. Limitations Although this study sheds light on factors related to IPV and help-seeking for IPV among Latino women reported to the CWS, limitations exist in the ability to generalize results. Analyses comparing those women in the target analytic sample (n=774) to those who were eliminated from multivariate analyses due to missing data on one or more variables (n=258 for analyses of IPV; n=205 for analyses of service receipt) showed that those with missing data were more likely to be foreign-born, undocumented, speak Spanish, be assessed as having high risk, and have prior reports of maltreatment. However, cases excluded from analyses did not differ from included cases on indicators of IPV incidence or service outcomes. Nevertheless, it is important to note the possibility that final results might not be reflective of the experiences of some of the most marginalized immigrant women. It is also possible that undocumented immigrant women may be underrepresented in the sample because of fear of disclosing their legal status. In addition, some factors could be of special significance in this population but were unaccounted for in this study. First, this study did not examine the role of culture specifically, rather as a proxy through nativity, because a measure of acculturation was unavailable. A more nuanced examination of acculturation might validate research suggesting that more traditional cultural values, such as machismo, 6 Referral was excluded from final multivariate models because of high multi-collinearity with service receipt and with several case indicators of interest. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 66 male dominance, and tolerance of male violence, do influence women’s disclosure and help-seeking behaviors (Rizo & Macy, 2011; West et al., 1998). Another limitation is that this study did not contain information about the perpetrator. Approximately 81% of caregivers in this study identified a secondary caregiver present in the home, yet the percent of cases in which the secondary caregiver was also the perpetrator is unknown. This could be an important piece to the puzzle considering evidence suggesting that more acculturated men are more likely to be perpetrators of IPV than less acculturated men (Caetano, Schafer, Clark, Cunradi, & Raspberry, 2000; Sorenson & Telles, 1991). However, other research has argued that IPV among Latinos is not related so simply to traditional gender role attitudes and male dominance (Neff et al., 1995; Perilla et al., 1994; Sugarman & Frankel, 1996), but may be more likely to occur when gender roles change (Klevens et al., 2007; Morash, Bui, and Santiago, 2000). More research is needed to clarify the contribution of male dominance and role strain as risk factors for IPV in the Latino population (Klevens et al., 2007). This study did not examine how informal supports specifically for IPV may have been used in lieu of more formal specialized services. This could be particularly relevant in studying the help-seeking behaviors of Latinos, for whom there is evidence that those with more traditional cultural family values may more often use informal supports (i.e., talking to a friend about IPV, asking a family member to intervene when IPV is present; Brabeck & Guzman, 2009). Also, this study only considered physical violence, as information about other forms of abuse, such as emotional abuse, was unavailable, thus providing a limited scope of the kinds of IPV that occur in Latino households. Lastly, differences in profiles of IPV in various Latino subgroups depending on their country of origin are important to consider in developing interventions (Frias & Angel, 2005; Gonzalez-Guarda, Vermeesch, Florom-Smith, McCabe, & Peragallo, 2013). A better understand of victimization among Latinos requires a more detailed categorization and refined understanding of what violence looks like in different Latino subgroups. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 67 Conclusion The findings of this study suggest that CWS workers may need enhanced training to more accurately screen for IPV and successfully link Latino women who experience IPV to services that address their cultural and linguistic needs. The CWS may also find ways to better develop plans that include strengthening social supports to address the long-term safety and service needs of Latino women and children affected by IPV. Because immigrants may be more socially isolated and fearful of disclosing abuse, the CWS should be familiar with and sensitive to their vulnerabilities and be able to offer appropriate services and legal protections to such victims. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 68 References Acevedo, M. J. (2000). Battered immigrant Mexican women’s perspectives regarding abuse and helpseeking. Journal of Multicultural Social Work, 8, 243-282. Amanor-Boadu, Y.,Messing, J. T., Stith, S. M., Anderson, J. R., O'Sullivan, C. S., & Campbell, J. C. (2012). Immigrant and nonimmigrant women: Factors that predict leaving an abusive relationship. Violence Against Women, 18, 611–633. Bauer, H. M., Rodríguez, M. A., & Pérez‐Stable, E. J. (2000). Prevalence and determinants of intimate partner abuse among public hospital primary care patients. Journal of General Internal Medicine, 15(11), 811-817. Bauer, H. M., Rodriguez, M. A., Quiroga, S. S., & Flores-Ortiz, Y. G. (2000). Barriers to health care for abused Latina and Asian immigrant women. Journal of Health Care for the Poor and Underserved, 11(1), 33-44. Berner, M. M., Kriston, L., Bentele, M., & Härter, M. (2007). The alcohol use disorders identification test for detecting at-risk drinking: a systematic review and meta-analysis. Journal of Studies on Alcohol and Drugs, 68(3), 461. Biafora, F., & Warheit, G. (2007). Self-reported violent victimization among young adults in Miami, Florida: Immigration, Race/Ethnic and gender contrasts. International Review of Victimology, 14(1), 29-55. Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., … Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report. Atlanta, GA: Centers for Disease Control and Prevention,National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/ViolencePrevention/pdf/NISVS_Report2010-a.pdf Brabeck, K. M., & Guzmán, M. R. (2009). Exploring Mexican-origin intimate partner abuse survivors' help-seeking within their sociocultural contexts.Violence and Victims, 24(6), 817-832. Broadhead, W. E., Gehlbach, S. H., DeGruy, F. V. & Kaplan H. (1988). The DUKE-UNC Functional Social Support Questionnaire: Measurement of social support in family medicine patients. Medical Care, 26, 709-723. Caetano, R., Cunradi, C. B., Schafer, J., & Clark, C. L. (2000). Intimate partner violence and drinking patterns among white, black, and Hispanic couples in the US. Journal of Substance Abuse, 11(2), 123-138. Caetano, R., Schafer, J., Clark, C. L., Cunradi, C. B., & Raspberry, K. (2000). Intimate partner violence, acculturation, and alcohol consumption among Hispanic couples in the United States. Journal of Interpersonal Violence, 15(1), 30-45. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 69 Caetano, R., Schafer, J., Clark, C. L., & Cunradi, C. B. (1998). Intimate partner violence, acculturation and alcohol consumption among Latino couples in the US as cited in: Caetano R, Ramisetty-Mikler S, McGrath C 2004 Acculturation, drinking, and intimate partner violence among Latino couples in the United States: A longitudinal study. Hispanic Journal of Behavioral Sciences, 26, 60-78. Cardoso, J. B., Dettlaff, A. J., Finno-Velasquez, M., Scott, J., & Faulkner, M. (2014). Nativity and immigration status among Latino families involved in the child welfare system: Characteristics, risk, and maltreatment. Children and Youth Services Review, 44, 189-200. Chuang, E., Wells, R., Bellettiere, J., & Cross, T. P. (2013). Identifying the substance abuse treatment needs of caregivers involved with child welfare. Journal of Substance Abuse Treatment, 45(1), 118- 125. Cocco, K. M., & Carey, K. B. (1998). Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients. Psychological Assessment,10(4), 408. Connelly, C. D., Newton, R. R., & Aarons, G. A. (2005). A psychometric examination of the English and Spanish versions of the revised conflict tactics scale. Journal of Interpersonal Violence, 20, 1560– 1570. Cummings, A. M., Gonzalez-Guarda, R. M., & Sandoval, M. F. (2013). Intimate partner violence among Hispanics: A review of the literature. Journal of Family Violence, 28(2), 153-171. Cuevas, C. A., Sabina, C., & Milloshi, R. (2012). Interpersonal victimization among a national sample of Latino women. Violence Against Women, 18(4), 377-403. Denham, A. C., Frasier, P. Y., Hooten, E. G., Belton, L., Newton, W., Gonzalez, P., ... & Campbell, M. K. (2007). IPV among Latinas in eastern North Carolina. Violence Against Women, 13(2), 123-140. Dettlaff, A. J., & Berger Cardoso, J. (2010). Mental health need and service use among Latino children of immigrants in the child welfare system. Children and Youth Services Review, 32, 1373–1379. Dettlaff, A. J., Earner, I., & Phillips, S. D. (2009). Latino children of immigrants in the child welfare system: Prevalence, characteristics, and risk. Children and Youth Services Review, 31, 775–783. Dettlaff, A. J., & Johnson, M. A. (2011). Child maltreatment dynamics among immigrant and US born Latino children: Findings from the National Survey of Child and Adolescent Well-being (NSCAW). Children and Youth Services Review, 33(6), 936-944. Dowd, K., Dolan, M., Wallin, J., Miller, K., Biemer, J., Aragon-Logan, E., & Smith, K. (2012). National survey of child and adolescent well-being (NSCAW): NSCAW II Combined waves 1-2 data file user’s manual, restricted release version. Ithaca, NY: National Data Archive on Child Abuse and Neglect, Cornell University. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 70 Dutton, M. A., Orloff, L. E., & Hass, G. A. (2000). Characteristics of help-seeking behaviors, resources and service needs of battered immigrant Latinas: Legal and policy implications. Georgetown Journal on Poverty Law & Policy, 7, 245-305. Edleson, J. L. (1999). The overlap between child maltreatment and woman battering. Violence Against Women, 5(2), 134-154. Edelson, M. G., Hokoda, A., & Ramos-Lira, L. (2007). Differences in effects of domestic violence between Latina and non-Latina women. Journal of Family Violence, 22(1), 1-10. Finno-Velasquez, M. (2013). The relationship between parent immigration status and concrete support service use among Latinos in child welfare: Findings using the National Survey of Child and Adolescent Well-being (NSCAWII). Children and Youth Services Review, 35(12), 2118-2127. Finno-Velasquez, M., Berger Cardoso, J., Dettlaff, A., & Hurlburt, M. (under review). Effects of parent nativity and immigration status on mental health service use Among Latino children investigated by child welfare. Frias, S. M., & Angel, R. J. (2005). The Risk of Partner Violence Among Low‐Income Hispanic Subgroups. Journal of Marriage and Family, 67(3), 552-564. Golding, J. (1999). IPV as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14, 99-132. Gonzalez-Guarda, R. M., Vermeesch, A. L., Florom-Smith, A. L., McCabe, B. E., & Peragallo, N. P. (2013). Birthplace, culture, self-esteem, and intimate partner violence among community-dwelling Hispanic women. Violence against Women, 19(1), 6-23. González-Guarda, R. M., Peragallo, N., Lynch, A., & Nemes, S. (2010). Drugs, women and violence in the Americas: US results of a multi-centric pilot project (Phase 1). Revista Colombiana de Psiquiatria, 39, 46s-65s. Hass, G. A., Dutton, M. A., & Orloff, L. E. (2000). Lifetime prevalence of violence against Latina immigrants: Legal and policy implications. International Review of Victimology, 7(1-3), 93-113. Hazen, A. L., Connelly, C. D., Kelleher, K., Landsverk, J. & Barth, R. (2004). Intimate partner violence among female caregivers of children reported for child maltreatment. Child Abuse and Neglect, 28, 310-319. Hazen, A. L., & Soriano, F. I. (2007). Experiences with intimate partner violence among Latina women. Violence Against Women, 13(6), 562-582. Herrenkohl, T. I., Sousa, C., Tajima, E. A., Herrenkohl, R. C., & Moylan, C. A. (2008). Intersection of child abuse and children’s exposure to domestic violence. Trauma, Violence, & Abuse, 9, 84–89. doi:10.1177/1524838008314797 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 71 Ingram, E. M. (2007). A comparison of help seeking between Latino and non-Latino victims of intimate partner violence. Violence Against Women, 13(2), 159-171. Kantor, G. K. (1997). Alcohol and spouse abuse ethnic differences. In Recent developments in Alcoholism (57-79). Springer: US. Kaufman Kantor, G. K., Jasinski, J. L., & Aldarondo, E. (1994). Sociocultural status and incidence of marital violence in Hispanic families. Violence and Victims, 9(3), 207-222. Kelleher, K. J., Hazen, A. L., Coben, J. H., Wang, Y., McGeehan, J., Kohl, P. L., & Gardner, W. P. (2008). Self-reported disciplinary practices among women in the child welfare system: Association with domestic violence victimization. Child Abuse & Neglect, 32, 811–818. Kelly, U. A. (2009). "I'm a mother first": The influence of mothering in the decision-making processes of battered immigrant Latino women. Research in Nursing & Health, 32(3), 286-297. Kessler, R. C., Andrews, G., Mroczek, D., Ustun, B., & Wittchen, H. U. (1998). The world health organization composite international diagnostic interview short‐form (cidi‐sf). International Journal of Methods in Psychiatric Research,7(4), 171-185. Klevens, J. (2007). An overview of IPV among Latinos.Violence Against Women, 13(2), 111-122. Kohl, P. L., Barth, R. P., Hazen, A. L., & Landsverk, J. A. (2005). Child welfare as a gateway to domestic violence services. Children and Youth Services Review, 27(11), 1203-1221. Kohl, P. L., Edleson, J. L., English, D. J., & Barth, R. P. (2005). Domestic violence and pathways into child welfare services: Findings from the National Survey of Child and Adolescent Well- Being. Children and Youth Services Review, 27(11), 1167-1182. Lown, E. A., & Vega, W. A. (2001). Prevalence and predictors of physical partner abuse among Mexican American women. American Journal of Public Health, 91(3), 441. Meneses-Gaya, C. D., Zuardi, A. W., Loureiro, S. R., & Crippa, J. A. S. (2009). Alcohol Use Disorders Identification Test (AUDIT): an updated systematic review of psychometric properties. Psychology & Neuroscience, 2(1), 83-97. Menjívar, C., & Salcido, O. (2002). Immigrant women and domestic violence: Common experiences in different countries. Gender & Society, 16, 898–920. Montalvo-Liendo, N., Koci, A., McFarlane, J., Gilroy, H., & Maddoux, J. (2013). US-born compared to non-US-born abused women: analysis of baseline data. Hispanic Health Care International, 11(3), 111-118. Montalvo‐Liendo, N. (2009). Cross‐cultural factors in disclosure of intimate partner violence: an integrated review. Journal of Advanced Nursing, 65(1), 20-34. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 72 Morash, M., Bui, H. N., & Santiago, A. M. (2000). Cultural-specific gender ideology and wife abuse in Mexican-descent families. International Review of Victimology, 7(1-3), 67-91. Neff, J. A., Holamon, B., & Schluter, T. D. (1995). Spousal violence among Anglos, Blacks, and Mexican Americans: The role of demographic variables, psychosocial predictors, and alcohol consumption. Journal of Family Violence,10(1), 1-21. Ogbonnaya, I. N. (2015). Effect of Race on the Risk of Out-of-Home Placement Among Children with Caregivers Who Reported Domestic Violence. Journal of Family Violence, 1-12. Ogbonnaya, I. N., Finno-Velasquez, M., & Kohl, P. L. (2015). Domestic violence and immigration status among Latina mothers in the child welfare system: findings from the National Survey of Child and Adolescent Well-being II (NSCAW II). Child Abuse & Neglect, 39, 197-206. Perilla, J. L., Bakeman, R., & Norris, F. H. (1994). Culture and domestic violence: The ecology of abused Latinas. Violence and Victims, 9(4), 325-339. Reinert, D. F., & Allen, J. P. (2007). The alcohol use disorders identification test: an update of research findings. Alcoholism: Clinical and Experimental Research, 31(2), 185-199. Rizo, C. F., & Macy, R. J. (2011). Help seeking and barriers of Hispanic IPV survivors: A systematic review of the literature. Aggression and Violent Behavior, 16(3), 250-264. Rao, J. N., & Scott, A. J. (1984). On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. The Annals of Statistics, 46-60. Robert Wood Johnson Foundation (2014). Strengthening What Works: Preventing Intimate Partner Violence in Immigrant and Refugee Communities: Evaluation Summary. Available at http://www.rwjf.org/en/library/research/2012/04/strengthening-what-works.html Sanderson, M., Coker, A. L., Roberts, R. E., Tortolero, S. R., & Reininger, B. M. (2004). Acculturation, ethnic identity, and dating violence among Latino ninth-grade students. Preventive Medicine, 39(2), 373-383. Shepard, M., & Raschick, M. (1999). How child welfare workers assess and intervene around issues of domestic violence. Child Maltreatment, 4(2), 148-156. Sorenson, S. B., & Telles, C. A. (1991). Self-reports of spousal violence in a Mexican-American and non- Hispanic white population. Violence and Victims,6(1), 3-15. Stark, E. (2007). Coercive control: How men entrap women in personal life. Oxford University Press. Straus, M. (1990). Measuring physical and psychological maltreatment of children with the conflict tactics scales. Durham, NH: University of New Hampshire Family Research Laboratory. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 73 Sugarman, D. B., & Frankel, S. L. (1996). Patriarchal ideology and wife-assault: A meta-analytic review. Journal of Family Violence, 11(1), 13-40. Tjaden, P. G., & Thoennes, N. (2000). Extent, nature, and consequences of IPV: Findings from the National Violence Against Women Survey (1-62). Washington, DC: National Institute of Justice. Torres, S. (1991). A comparison of wife abuse between two cultures: Perceptions, attitudes, nature, and extent. Issues in Mental Health Nursing, 12, 113-131. Ware, J. E., Gandek, B., Kosinski, M., Aaronson, N. K., Apolone, G., Brazier, J., ... & Thunedborg, K. (1998). The equivalence of SF-36 summary health scores estimated using standard and country- specific algorithms in 10 countries: results from the IQOLA project. Journal of Clinical Epidemiology, 51(11), 1167-1170. West, C. M., Kantor, G. K., & Jasinski, J. L. (1998). Sociodemographic predictors and cultural barriers to help-seeking behavior by Latina and non-Latino White American battered women. Violence and Victims, 13, 361-375. Yudko, E., Lozhkina, O., & Fouts, A. (2007). A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. Journal of Substance Abuse Treatment, 32(2), 189-198. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 74 Table 3.1. Weighted patterns of physical violence and IPV service use by female Latino caregivers of children remaining at home following a child welfare investigation (n=774) Total N (%) US born N=507 (%) Foreign born N=267 (%) p US citizen N=585 (%) Legal Resident N=63 (%) Undocumented N=121 (%) p Mother Report Physical violence lifetime 327 (40.9) 214 (42.2) 113 (39.0) .71 245 (42.1) 28 (43.5) 53 (36.2) .81 Physical violence past yr Less severe 227 (28.6) 151 (30.8) 76 (25.4) .34 168 (28.3) 19 (32.2) 39 (28.6) .94 Severe 205 (26.6) 68 (28.4) 137 (25.4) .70 156 (27.0) 16 (27.0) 32 (26.0) .98 Any physical violence 266 (33.0) 178 (33.0) 88 (32.9) .98 200 (33.5) 22 (33.2) 43 (31.7) .97 Frequency of violence (mean) 2.86 5.59 2.72 .02 5.16 2.56 2.68 .08 Referred for IPV services a 150 (16.8) 91 (18.0) 59 (15.2) .60 109 (17.9) 19 (19.1) 21 (13.3) .76 Received services in past 24 months b 75 (9.4) 42 (8.6) 33 (10.5) .58 53 (9.2) 8 (2.2) 13 (13.9) .22 Child Welfare Report Reporting source listed DV as maltx type 115 (13.2) 69 (13.9) 46 (12.3) .73 89 (14.1) 9 (6.4) 17 (13.8) .56 Reporting source listed DV as most serious maltx type 90 (9.9) 55 (9.0) 35 (11.0) .65 71 (9.7) 7 (5.9) 12 (12.7) .61 a Referred for IPV services in the 12 months previous to the baseline interview b Received services in the 12 months previous to the baseline or 18 month follow up interviews CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 75 Table 3.2. Weighted bivariate relationships between household characteristics, caregiver functioning, child welfare contact, recent physical violence a & IPV service use b Total N=516 Recent physical violence Total N=569 Partner IPV service use N (%) p N (%) p Household characteristics CG nativity .83 .86 US born 346 (61.4) 131 (32.4) 386 (61.9) 32 (8.2) Foreign born 170 (38.6) 56 (30.5) 183 (38.1) 23 (8.9) CG legal status .54 .17 US citizen 403 (76.1) 148 (33.1) 446 (76.5) 41 (9.0) Legal resident 40 (9.7) 16 (35.2) 44 (9.6) 5 (1.1) Undocumented 72 (14.3) 23 (21.7) 77 (14.0) 9 (11.1) CG years in US .91 .97 US born 346 (61.4) 131 (32.4) 386 (61.9) 32 (8.5) Less than 10 61 (10.3) 19 (27.5) 65 (10.0) 7 (7.8) 11 to 20 68 (13.6) 25 (27.4) 74 (14.2) 12 (10.5) More than 20 41 (14.7) 12 (35.5) 44 (13.9) 4 (8.2) Language at home .28 .91 English 208 (38.7) 79 (36.9) 228 (37.8) 20 (8.8) Non English (308 (61.3) 108 (28.4) 341 (62.2) 35 (8.3) CG marital status .17 .57 Never married 254 (35.2) 97 (32.2) 285 (36.2) 25 (9.8) Married 123 (26.7) 27 (21.8) 126 (25.7) 8 (4.6) Separated/widowed/divcd 130 (38.0) 63 (38.2) 157 (38.1) 22 (9.9) Male intimate partner in hh .56 .21 Yes 248 (52.3) 76 (29.4) 251 (51.9) 24 (6.4) No 268 (47.6) 111 (34.2) 275 (48.1) 29 (11.5) CG education .45 .26 Less than HS 199 (41.3) 66 (29.3) 219 (40.8) 18 (4.9) HS Diploma 204 (35.7) 81 (37.0) 231 (37.1) 26 (12.6) More than HS 113 (23.0) 40 (27.7) 119 (22.1) 11 (8.2) Poverty status .74 .37 50% of fed poverty level 151 (26.8) 58 (34.3) 165 (26.1) 20 (5.8) 50-<100% of fed poverty level 184 (37.5) 67 (35.0) 195 (36.4) 19 (11.5) 100-200% of fed poverty level 92 (19.0) 31 (25.4) 106 (19.6) 10 (10.5) >200% of fed poverty level 42 (10.4) 15 (32.1) 48 (10.6) 4 (6.6) Poverty level missing 47 (6.4) 16 (18.8) 55 (7.3) 2 (0.4) Financial Hardship .24 .51 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 76 Struggling to make it 230 (46.7) 99 (36.2) 263 (48.2) 33 (10.0) Getting by or saving a little 286 (53.3) 88 (27.7) 305 (51.8) 22 (7.2) Physical Violence Experiences Recent physical violence <.001 Yes -- -- 205 (31.5) 41 (21.2) No -- -- 364 (68.5) 14 (2.7) Caregiver functioning CG major depressive disorder <.01 .28 Yes 132 (22.5) 77 (53.7) 145 (23.0) 21 (12.5) No 384 (77.5) 110 (25.3) 424 (77.0) 34 (7.3) CG alcohol dependence .21 .43 Yes 45 (7.0) 28 (44.4) 50 (7.2) 7 (13.8) No 471 (93.0) 159 (30.7) 519 (92.8) 48 (8.1) CG drug dependence .53 .74 Yes 79 (13.4) 28 (37.1) 87 (12.7) 8 (7.1) No 437 (86.6) 159 (30.8) 482 (87.3) 47 (8.7) SCG substance abuse .31 .01 Yes 100 (15.1) 44 (40.4) 107 (14.4) 18 (19.6) No 416 (84.9) 143 (30.1) 462 (85.6) 37 (6.6) Child Welfare Case Worker Variables CW services history <.01 .08 Yes 143 (26.7) 45 (15.6) 276 (31.0) 34 (14.9) No 373 (73.3) 142 (37.5) 293 (69.0) 21 (5.6%) Risk level .19 <.01 Low (0-2 risks) 245 (59.0) 73 (26.9) 267 (58.5) 12 (3.2) Moderate (3-4 risks) 162 (22.6) 58 (36.7) 187 (23.9) 17 (8.7) High (5 or more risks) 109 (18.4) 56 (40.7) 115 (17.7) 26 (25.8) Reporting source listed DV as an allegation of maltreatment .18 <.001 Yes 82 (15.6) 50 (43.0) 95 (15.5) 28 (33.7) No 434 (84.4) 137 (29.6) 474 (84.5) 27 (3.8) Recent physical violence (N=516) DV service use (N=564) Total (Mean) Yes No p* Total (Mean) Yes No p * Household characteristics Mother age 31.3 30.6 31.6 .37 31.4 29.4 31.6 .20 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 77 Number of children 3.1 3.2 3.1 .56 2.99 3.3 3.0 .16 Physical violence experiences Frequency of violence -- -- -- -- 4.18 18.81 2.83 .01 Caregiver functioning Physical health 48.7 47.2 49.4 .35 48.5 47.2 48.6 .53 Social support 3.65 3.19 3.86 <.001 3.63 3.44 3.65 .43 a Refers to physical violence reported to occur in the 12 months prior to the baseline interview b Received services in the 12 months previous to the baseline or 18 month follow up interview * Adjusted Wald test for weighted difference in means CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 78 Table 3.3 Weighted multivariate logistic regression models predicting past year IPV (N=516) Nativity Legal Status OR CI OR CI Household characteristics CG age (mean) .99 .92, 1.06 .98 .91, 1.06 PCG is foreign born 1.18 .46, 3.01 PCG legal status (ref grp=U.S. citizen) Legal resident 1.02 .16, 6.56 Undocumented .48 .13, 1.72 CG marital status (ref group=married) Never married 1.91 .54, 7.14 1.90 .55, 6.48 Separated/widowed/divorced 3.02 .88, 10.39 2.89 .85, 9.77 Male intimate partner in household .97 .35, 2.66 1.08 .36, 3.18 CG education (ref group=less than HS) HS Diploma 1.37 .68, 2.75 1.21 .57, 2.51 More than HS .76 .31, 1.87 .65 .26, 1.64 Struggling to make it .85 .34, 2.10 .95 .39, 2.31 Caregiver functioning Mother depression 3.54* 1.35, 9.32 3.21* 1.27, 8.13 Mother substance dependence 1.08 .49, 2.38 .99 .45, 2.20 Mother physical health .97 .94, 1.01 .98 .95, 1.01 Secondary caregiver substance abuse .90 .29, 2.82 .86 .23, 3.18 Social Support .62** .42, .82 .61** .46, .82 Child welfare case variables Cumulative risk (ref group=0-2 risks) 3-4 risks 2.09* 1.05, 4.14 2.02 + 1.00, 4.08 5 or more risks 1.56 .52, 4.68 1.59 .52, 4.90 CW services history .20** .07, .54 .18** .06, .53 + p=.05, * p<.05, **p<.01, ***p<.001 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 79 Table 3.4. Weighted multivariate logistic regression models predicting IPV service use over 24 months (N=569) Nativity Legal Status OR CI OR CI Household characteristics CG age (mean) .92 .83, 1.02 .94 .83, 1.07 PCG foreign born 1.89 .68, 5.23 PCG legal status (ref group= US citizen) Legal resident .12* .02, .60 Undocumented 2.27 .64, 8.09 CG education (ref group= Less than HS) HS Diploma 4.04 .69, 23.61 3.85 .76, 19.35 More than HS 3.21 .53, 19.40 3.14 .47, 20.96 Physical Violence Experiences Recent IPV 13.68* 2.82, 102.67 14.97** 2.51, 89.11 Frequency of violence 1.01 .98, 1.05 1.01 .98, 1.04 Caregiver functioning CG depression .14 .01, 1.33 .19 .02, 1.76 CG substance dependence 1.44 .26, 7.89 1.55 .26, 9.33 SCG substance abuse .83 .24, 2.85 .88 .22, 3.50 Child welfare case variables Reporting source listed DV as allegation on report 10.50*** 3.85, 28.61 9.20*** 3.10, 27.28 Cumulative risk (ref group= 0-2 risks) 3-4 risks 1.67 .31, 8.92 1.98 .39, 9.92 5 or more risks 10.96** 2.13, 56.31 11.82** 2.77, 5.40 CW services history 4.30 .77, 24.00 3.73 .72, 19.14 + p=.05, * p<.05, **p<.01, ***p<.001 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 80 Table 3.5: Weighted Social Support by Nativity and Immigration Status Total Mean (SE) (n=759) US born Foreign born p US citizen Legal Resident Undocumented p Social Support 3.62 (.06) 3.66 (.08) 3.56 (.11) .49 3.67 (.08) 3.44 (.26) 3.54 (.14) .41 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 81 Chapter Four (Study 3) Effects of Parent Immigration on Mental Health Service Use Among Latino Children Investigated by Child Welfare In Press at Psychiatric Services (Megan Finno-Velasquez, Jodi Berger Cardoso, Alan Dettlaff, Michael Hurburt) In 2013, roughly 6 million children were referred to child welfare agencies in the United States (1). Children in contact with child welfare services represent a group at distinct risk for mental health and behavioral concerns. Mental health issues are common both among children who have more extensive child welfare involvement and among those whose involvement is limited to an investigation (2,3). Even when not removed from the home, a child welfare referral is a notable marker for risks in the home environment that can increase the likelihood of mental health problems and opportunity to identify and address such concerns. Research on mental health service needs and use among children involved with child welfare has shown that nearly 80% of children placed in foster care receive mental health services (4,5). Children remaining at home also experience substantial rates of need, which range from 24%-48% (2,3). Yet, some estimates indicate that only one-quarter of those with clinically significant mental health issues receive services (2). Reasons for low rates of service use among children remaining at home after contact with child welfare services may be partially related to the unique experiences associated with families from different racial/ethnic backgrounds and how they interact with social service systems. Among families in contact with child welfare, large changes have occurred in demographics nationwide, and race/ethnicity is a common predictor of mental health service use (6,7). Consistent with demographic changes in the US population, Latino families constitute an increasing percentage of families involved with child welfare. In 2000, Latino children represented 14.2% of CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 82 confirmed cases of maltreatment (8) and by 2013 the proportion had risen to 22.4% (1). Latino families may have greater disposition to particular stressors related to the immigration experience that may increase their need for services. Exposure to acculturative stress, chronic poverty, neighborhood disadvantage, discrimination, and social isolation may elevate the need for mental health services for children in such families, particularly in those with undocumented members where fear of discovery may cause significant stress and insecurity for children (9,10). Yet, immigrant status, associated with resilience and traditional coping mechanisms and family ties, is protective of mental health issues in some Latino subgroups, with evidence that increased contact with U.S. cultural norms and lifestyles increases risk of experiencing mental health problems (11). On the other hand, immigrant families may also have poorer access to services when needed. Studies attribute parental nativity and legal status to deep inequalities in health and mental health service receipt in the general population (11-13), and growing evidence suggests that this may be true among Latino families in the child welfare system as well. Reasons for inhibited use of services by immigrants in child-serving systems have been theorized to include unfamiliarity with available services, difficulty navigating service systems and identifying culturally/linguistically congruent service providers, provider bias, and cultural differences in the understanding of symptomology and help-seeking behaviors (10, 14- 24). For children with undocumented parents, restrictive social policies that limit eligibility for government support and parent fear of exposure to public authorities, even when children are eligible for services, may serve as additional barriers to service use (12, 13). It is estimated that over two-thirds of children with immigrant parents involved with child welfare are Latino (24), so Latino families referred to child welfare may be especially likely to have such experiences. The current study examines how factors related to the immigration experience may influence the mental health needs and service utilization among children in Latino families investigated by child CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 83 welfare. We analyze how characteristics of the immigration experience influence mental health service utilization through the lens of Andersen’s help-seeking model, where service use is driven by a combination of family predisposing characteristics, as well as enabling conditions, needs, and contextual factors (25-27). Predisposing characteristics are those that are unmalleable, such as gender and age. We treat parent nativity as a predisposing characteristic because we are interested in whether children in families with caregivers born in the US have different patterns of service need and use than those of parents born outside the US. Enabling conditions are factors considered to be subject to change that may enable or inhibit service receipt, such as income and insurance status. We consider parent legal status as an enabling condition because we are interested in knowing whether a parent’s undocumented legal status inhibits child mental health service receipt. We examine these variables in the context of other predisposing and enabling characteristics, mental health need, and relevant child welfare variables. Methods Sample and Study Design The current study uses data from the second round of the National Survey of Child and Adolescent Well-Being (NSCAWII), a national probability study of families investigated by child welfare agencies for maltreatment (28). The NSCAWII cohort included children and youth from birth to 17.5 years at the time of sampling who had contact with the child welfare system during a 15-month period that began in February 2008. The final sample included 5,872 children. This research investigates a subset of Latino children (n=1,614), aged 3-17 (n=736), who remained in the home with a biological parent at the time of the initial interview (n=411), and had complete data for all predictors used in multivariate models (n=390). Procedures. The NSCAWII sample was drawn using a two-stage cluster approach in which children (one per family) were sampled from 81 child welfare jurisdictions (primary sampling units) in 30 states. Face-to-face interviews were conducted with children, caregivers, and child welfare workers. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 84 Baseline interviews were completed approximately 4-6 months after the onset of the child welfare investigation. Informed consent was obtained by trained field representatives at the time of the baseline interview. Wave 2 follow-up interviews were conducted on average 18 months after the onset of the child welfare investigation. Further details on the study design and procedures are available elsewhere (28). Approval for this study was obtained from the Institutional Review Board at the University of Southern California. Measures Predisposing Characteristics. Socio-demographic characteristics of children (age, gender) were derived from questions in child, caregiver, and caseworker interviews. Immigration-related variables (child nativity, parent nativity, parent years residing in the U.S.) were obtained from caregiver interviews. Enabling Conditions. Parent legal documentation status, education, single parenthood (secondary caregiver presence), language, income, child insurance type, and perceptions of economic hardship were obtained from the caregiver interview at baseline. Uninsured status in multivariate models refers to a caregiver reporting the child as uninsured at both baseline and follow up interviews. Child Mental Health Need. Need was assessed by caregivers at the baseline interview using the Child Behavior Checklist (CBCL). The CBCL is a widely used measure of behavior problems with established reliability and validity that has been standardized by age and gender with large child populations from different socioeconomic backgrounds (29). The CBCL has well-established reliability and validity for its use across cultures and racial/ethnic groups (30, 31). The internalizing and externalizing scales have strong concurrent validity for clinically diagnosed disorders in Latino youth (32), and convergent and divergent validity has also been established in multiethnic samples of American children (33). In studies of the NSCAW sample of Latino children, internal consistency reliability of the CBCL scales has also been good (34). For this study, two forms of the CBCL were used: one for children aged CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 85 three to five years and another for children aged six to eighteen years. Children were considered in need of mental health services if they scored in the clinical range (64 or above) of the CBCL. The more conservative clinical cutoff point, rather than the borderline range, was used to avoid inflating the estimate of need. Contextual Child Welfare Characteristics. The most serious type of alleged maltreatment in the investigation was obtained from the caseworker interview. Level of severity of risk to the child during the investigation was determined by the caseworker, who identified maltreatment risk as none, mild, moderate, or severe. A variable was created drawing from the caseworker interview to represent whether the family received child welfare services as a result of the investigation. Child welfare services included parent training, respite, child care, family preservation, or other services to prevent out-of-home placement. Use of Mental Health Services. Caregivers completed questions from the Child and Adolescent Services Assessment (CASA) to measure children’s use of mental health services in the following settings at baseline and follow up: specialty mental health services (inpatient psychiatric treatment, residential treatment, day treatment, community mental health center treatment, and treatment from private professionals, such as psychiatrists, psychologists, social workers, and psychiatric nurses); medical mental health services (from a hospital doctor or family doctor), and school-based mental health services. A dichotomous variable was created to indicate whether children received mental health services any time during the period in question, ranging from five months before to approximately 18 months after the initiation of the child welfare investigation. Data Analysis Descriptive statistics were used to describe predisposing, enabling, need, and contextual factors and service receipt variables. Bivariate weighted chi-square analyses were conducted to a) examine associations between mental health service use and relevant covariates based on previous literature (e.g., 35); and b) CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 86 estimate whether rates of need, service use, and types of services used differed depending on the nativity and legal immigration status of the parent. Variables with associations approaching significance (p<.20) were included in multivariate weighted logistic regression analyses. Multivariate models evaluated relationships between parent nativity and legal status and mental health service receipt, after adjusting for covariates. Parent report of financial need, in lieu of income levels, was used in multivariate models because a substantial proportion of undocumented parents were missing data on family income. A value of p<.05 was considered to be statistically significant. All analyses used STATA 12. Results Sample Characteristics Table 4.1 displays the sample’s weighted data. Just over half of the sample children were female (52.6%). The mean age of the sample was 8.48 years. Although 90% of children were U.S. born, more than a third (36.0%) had a foreign-born primary caregiver. Of the foreign born-parents, 14.0% had been living in the U.S. for more than 20 years, but 8.1% had resided in the U.S. 10 years or less. 75.0% of parents were U.S. citizens, 12.1% were legal residents, and 13.0% were undocumented. Just over half of caregivers (52.8%) had a high school degree. A preferred language other than English was spoken in 60.2% of households. Nearly half of parents reported struggling to make it financially, with over half of families below the poverty level. 17.1% of children reported no health insurance at the time of the first interview. Over a third (35.5%) of children had a primary maltreatment allegation of neglect, followed by physical abuse (16.9%), domestic violence (13.9%), and substance use issues (12.4%). More than a fifth (21.3%) of children fell within the clinical range for a behavioral/mental health problem. As presented in Table 4.2, differences in child mental health problems by parent nativity and citizenship/legal status were non- significant, although the percentage of children with clinical mental health problems was lower for those with immigrant parents compared to U.S. born parents, and lowest for those with undocumented parents. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 87 Mental Health Service Use Table 4.1 includes the proportions for children who received mental health services for each of the variable categories listed. Overall, 29.1% of the sample used mental health services. A gap in overall clinical need (10.3%) and service receipt (4.1%) was identified only for children with undocumented parents (Table 4.2). More than a third of children with a U.S. born parent received mental health services (35.4%), compared to 17.9% of those with a foreign-born parent (17.9%; F(1,69)=4.03; p<.05). Notably, just 4.1% of children with an undocumented parent received services (F(1.96, 135.27)=5.64; p<.01). Over a third of children whose parents had at least a high school degree (37.1%) received services, compared to just 20.2% of those whose parent did not complete high school (F (1,69)=7.58; p<.01). As expected, a much higher percentage of children who scored in the clinical range for a mental health or behavior problem received services (60.7%) than those who did not have a clinically significant mental health issue (20.6%; F(1,69)=41.25; p<.001). Table 2 presents the proportions for types of mental health services used by children depending on the nativity and legal status of the primary caregiver. Although no significant differences in mental health need were noted between groups, a significantly lower percentage of children of immigrants received mental health services (17.9%) than children of U.S.-born parents (35.4%; F(1,69)=4.03; p<.05). Specifically, 13.1% of children of immigrants received specialized mental health services, compared to 23.5% of children of U.S. born parents (F(1,69)=3.84; p=.05). Children of undocumented immigrant parents received services at a much lower rate (4.1%) than children with a U.S. citizen (33.6%) or legal resident (28.2%) caregiver (F(1.96, 135.27)=5.64; p<.01). In particular, children with undocumented parents received both specialized (3.6%; F(1.87, 129.31)=3.46; p<.05) and school-based (1.0%; F(1.30, 89.62)=8.07; p<.01) services at much lower rates than children of U.S. citizens and legal residents. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 88 Multivariate Analyses Table 4.3 presents separate multivariate models that examine the influence of parent nativity and legal status on child service use. Model 1 shows that, after adjusting for covariates, the odds of receiving services were 65% lower for children of immigrant parents (p=.05) than for children of U.S. born parents. Follow-up analyses adjusting for immigrant caregiver time residing in the U.S. found that this finding was specific to children whose immigrant parents had resided in the U.S. for 10 years or less 7 . Model 2, accounting for legal status, revealed that the odds of receiving services were 92% lower for children whose parents were undocumented compared to those whose parents were U.S. citizens (p<.05). Discussion A growing body of research in child welfare has begun to focus on issues affecting Latino immigrant families to gain a better understanding of their experiences and service needs (10, 14-19, 24). This study provides new information concerning the roles that parent nativity and legal status play in meeting the mental health service needs of Latino children involved with the child welfare system. Although children of immigrants had rates of clinical need that were not statistically different from those of children of U.S. born parents at the bivariate level, children of immigrants did have significantly lower rates of mental health service receipt within a 24-month period surrounding contact with the child welfare system. This finding is consistent with previous literature examining unmet mental health needs among children of immigrants (10). However, it should be noted that although rates of mental health need depending on parent nativity (24.2% for U.S. born vs. 16.1% for immigrant) and legal status (22.5% for U.S. citizens vs. 25.6% for legal residents vs. 10.3% for undocumented) were statistically insignificant, differences were substantial enough that reduced service receipt may be partially explained as a function of having less need. 7 See Table 4.4 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 89 Separate multivariate analyses that identified a positive association between number of years of residence in the U.S. and service receipt suggest that barriers related to acculturation issues may also serve as partial explanations for reduced service receipt among Latino children. Alternatively, such findings might also reflect provider bias in assessment or understanding of needs, or in beliefs about assisting children of immigrants, which may influence access to services (36, 37). Results of this study further advance previous analyses as they highlight that 1) a gap in rates of clinical need (10.3%) and service receipt (4.1%) is apparent only for children with undocumented parents; 2) after adjusting for need and other relevant variables, children of undocumented immigrants had the lowest odds of service receipt. A few explanations are immediately apparent. Given that a lack of child health insurance was not predictive of mental health service receipt, it appears that child ineligibility for services does not explain reduced service use in this population. Rather, data are consistent with arguments that the effects of stigma and fear of engaging with public agencies due to caregivers’ vulnerable status in the U.S. may deter parents from seeking services for their children (12,13,19-24). It is possible that such children receive referrals for services, but parents are too fearful to pursue them. Findings further revealed that children with undocumented caregivers were particularly less likely to receive school-based services than other children—a setting that typically serves those who may not have the opportunity to receive intervention in other outpatient settings. This suggests that such children’s needs remain under the radar of school officials or that caregiver hesitation to engage in government services may extend to those that are school-based. Strengths and Limitations This study has two major strengths: it represents a unique opportunity to study the influence of parent nativity and legal status on patterns of mental health service need in a nationally representative CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 90 sample of Latino children reported to child welfare. It also offers potential explanations for disparate mental health service use among children of immigrants. However, it is possible that bias was present in the reporting of parental legal status due to the sensitive nature of information obtained via self-report. Some of the most vulnerable immigrant families included in the sampling frame may have been more likely to decline participation in a national survey, potentially causing underrepresentation of this group. Additionally, the study did not account for all possible factors contributing to service receipt. Secondary caregiver nativity and citizenship information was not taken into consideration because over half of cases did not have this information for the secondary caregiver. Furthermore, this study was unable to explicitly examine the effects of acculturation on service receipt, as that information was not collected. Although years of residence in the U.S. is a crude proxy for acculturation, it alone does not represent the cultural factors that could be at play. For instance, it is unknown whether families sought out more culturally-congruent or traditional forms of assistance for mental health issues. Finally, the term “Latino” is a broad term representative of an ethnicity that contains much diversity within it. The majority of the Latino sample in this study was of Mexican origin. Future primary research is needed to examine varying linguistic, cultural, and legal mechanisms within different Latino subgroups that contribute to underutilization of mental health services identified in this study. Conclusions The results of this study contribute to growing discourse on Latino family needs and child mental health within the child welfare system. Analyses support previous findings regarding the effects of parent nativity on mental health service use by children reported to child welfare agencies, and advance the literature by identifying parent legal status as a unique inhibitor of service receipt. Alarmingly, data suggest that although percentages may be small, the mental health needs of children of immigrants, especially those CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 91 of children with undocumented parents, are not adequately met, and that disparities in service utilization seen in the Latino population may be driven by immigrant families. This is especially concerning at a time when children of immigrants represent an increasing number of children in the U.S. and in a context where immigrant families face unique stressors that contribute to risk for mental health issues and exclude them from the benefits of social welfare policies aimed at supporting vulnerable families and children. For immigrant families, a child welfare referral may provide a rare window through which to evaluate the mental health needs of children who may not access services in other circumstances. Unfortunately, this study suggests that the child welfare system and provider bias against immigrants cannot be eliminated as potential barriers to children receiving needed services. However, findings also present a clear message that parent legal status, with its associated fears and stigma, may be a prominent explanation for inhibited service use among Latino children, the vast majority of whom are U.S. born. Yet, it is also possible that immigrant families opt to engage in more traditional healing methods for mental health issues, and turn to religious leaders or folk healers for assistance in lieu of prescribed counseling or talk therapy. Understanding reasons for such barriers to service receipt will be a necessary step toward providing better quality services to Latino children and families. Regardless, child welfare agencies, as well as schools, may benefit from developing professional sensitivity to the fears of undocumented immigrants and strategies to reduce potential bias in decision-making and better engage them in services. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 92 References 1. U.S. Department of Health and Human Services, Administration for Children and Families, Administra- tion on Children, Youth and Families, Children’s Bureau. (2014). Child Maltreatment 2013. Available from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can. 2. Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 960-970. 3. McCue Horwitz, S., Hurlburt, M. S., Heneghan, A., Zhang, J., Rolls-Reutz, J., Fisher, E., ... & Stein, R. E. (2012). Mental health problems in young children investigated by US child welfare agencies. Journal of the American Academy of Child & Adolescent Psychiatry, 51(6), 572-581. 4. Clausen, J. M., Landsverk, J., Ganger, W., Chadwick, D., & Litrownik, A. (1998). Mental health problems of children in foster care. Journal of Child and Family Studies, 7(3), 283-296. 5. Farmer, E. M., Burns, B. J., Chapman, M. V., Phillips, S. D., Angold, A., & Costello, E. J. (2001). Use of mental health services by youth in contact with social services. Social Services Review, 75(4), 605-624. 6. Garland, A. F., Landsverk, J. A., & Lau, A. S. (2003). Racial/ethnic disparities in mental health service use among children in foster care. Children and Youth Services Review, 25(5-6), 491-507. 7. Garland, A. F., Hough, R. L., Landsverk, J. A., McCabe, K. M., Yeh, M., Ganger, W. C., & Reynolds, B. J. (2000). Racial and ethnic variations in mental health care utilization among children in foster care. Children's services: Social policy, research, and practice, 3(3), 133-146. 8. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2002). Child Maltreatment 2000. Retrieved from http://www.acf.hhs.gov/programs/cb/pubs/cm00/cm2000.pdf 9. Kouyoumdjian, H., Zamboanga, B. L., & Hansen, D. J. (2003). Barriers to community mental health services for Latinos: Treatment considerations. Clinical Psychology: Science and Practice, 10(4), 394-422. 10. Dettlaff, A. J., & Berger Cardoso, J. (2010). Mental health need and service use among Latino children of immigrants in the child welfare system. Children and Youth Services Review, 32, 1373–1379. http://dx.doi.org/10.1016/j.childyouth.2010.06.005 11. Alegria, M., Canino, G., Shrout, P. E., Woo, M., Duan, N., Vila, D., ... & Meng, X. L. (2008). Prevalence of mental illness in immigrant and non-immigrant US Latino groups. The American Journal of Psychiatry, 165(3), 359-369. 12. Capps, R., Fix, M., & Henderson, E. (2009). Trends in immigrants’ use of public assistance after welfare reform. Immigrants and Welfare: The Impact of Welfare Reform on America’s Newcomers (pp. 93- 122). New York, NY: Russell Sage Foundation. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 93 13. Fix, M. E., Capps, R., & Kaushal, N. (2009). Immigrants and welfare: Overview. In M. E. Fix(Ed.), Immigrants and Welfare: The Impact of Welfare Reform on America’s Newcomers (pp. 1–36). New York, NY: Russell Sage Foundation. 14. Ayón, C. (2009). Shorter time-lines, yet higher hurdles: Mexican families' access to child welfare mandated services. Children and Youth Services Review, 31, 609–616. 15. Ayón, C., & Aisenberg, E. (2010). Negotiating cultural values and expectations within the public child welfare system: A look at familismo and personalismo. Child & Family Social Work, 15(3), 335-344. 16. Cardoso, J. B., Dettlaff, A. J., Finno-Velasquez, M., Scott, J., & Faulkner, M. (2014). Nativity and immigration status among Latino families involved in the child welfare system: Characteristics, risk, and maltreatment. Children and Youth Services Review, 44, 189-200. 17. Earner, I. (2010). Double risk: Immigrant mothers, domestic violence and public child welfare services in New York City. Evaluation and Program Planning, 33(3), 288-293. 18. Earner, I. (2007). Immigrant families and public child welfare: Barriers to services and approaches for change. Child Welfare, 86(4), 63-91. 19. Finno-Velasquez, M. (2013). The relationship between parent immigration status and concrete support service use among Latinos in child welfare: Findings using the National Survey of Child and Adolescent Well-being (NSCAWII). Children and Youth Services Review, 35(12), 2118-2127. 20. Gudiño, O. G., Lau, A. S., & Hough, R. L. (2008). Immigrant status, mental health need, and mental health service utilization among high-risk Hispanic and Asian Pacific Islander youth. Child & Youth Care Forum, 37, 139−153. 22. Ho, J., Yeh, M., McCabe, K., & Hough, R. L. (2007). Parental cultural affiliation and youth mental health service use. Journal of Youth and Adolescence, 36, 529−542. 23. Lopez, C., Bergren, M. D., & Painter, S. G. (2008). Latino disparities in child mental health services. Journal of Child and Adolescent Psychiatric Nursing, 21, 137−145. 24. Dettlaff, A. J., & Earner, I. (2012). Children of immigrants in the child welfare system: Characteristics, risk, and maltreatment. Families in Society: The Journal of Contemporary Social Services, 93(4), 295-303. 25. Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9, 208–220. 26. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 1-10. 27. Andersen, R. (1968). A behavioral model of families' use of health services. Research Services, (25). CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 94 28. Dowd, K., Dolan, M., Wallin, J., Miller, K., Biemer, J., Aragon-Logan, E., & Smith, K. (2012). National survey of child and adolescent well-being (NSCAW): NSCAW II Combined waves 1-2 data file user’s manual, restricted release version. Ithaca, NY: National Data Archive on Child Abuse and Neglect, Cornell University. 29. Achenbach, R. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry. 30. Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-age forms & profiles: An integrated system of multiinformant assessment. Burlington, VT: ASEBA. 31. Ivanova, M. Y., Dobrean, A., Dopfner, M., Erol, N., Fombonne, E., Fonseca, A. C., & Chen, W. J. (2007). Testing the 8-syndrome structure of the child behavior checklist in 30 societies. Journal Clinical Child Adolescent Psychology, 36, 405–417. 32. Rubio-Stipec, M., Bird, H., Canino, G., & Gould, M. (January 1, 1990). The internal consistency and concurrent validity of a Spanish translation of the Child Behavior Checklist. Journal of Abnormal Child Psychology, 18, 393–406. 33. Nakamura, B. J., Ebesutani, C., Bernstein, A., & Chorpita, B. F. (2009). A psychometric analysis of the Child Behavior Checklist DSM-oriented scales. Journal of Psychopathology & Behavioral Assessment, 31, 178–189. 34. Martinez, J. I., Gudiño, O. G., & Lau, A. S. (2013). Problem-specific racial/ethnic disparities in pathways from maltreatment exposure to specialty mental health service use for youth in child welfare. Child Maltreatment, 1077559513483549. 35. Horwitz SM, Hurlburt MS, Zhang J. Patterns and predictors of mental health services use by children in contact with the child welfare system. In: Webb MB, Dowd K, Harden BJ, Landsverk J, Testa M, eds. Child Welfare and Child Well-Being: New Perspectives from the National Survey of Child and Adolescent Well-Being. New York, NY: Oxford University Press; 2009: 279–329. 36. Snowden, L. R. (2003). Bias in mental health assessment and intervention: Theory and evidence. American Journal of Public Health, 93, 239–243. http://dx.doi.org/10.2105/AJPH.93.2.239. 37. Snowden, L. R., & Yamada, A. -M. (2005). Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143–166. http://dx.doi.org/10.1146/annurev.clinpsy.1.102803.143846. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 95 Table 4.1: Weighted sample characteristics and mental health service receipt by Latino children aged 3-17 investigated by a child welfare agency a Total N=390 Received mental health services Total N= 130 b N % N % p value Predisposing Characteristics Child Age .19 3 to 5 112 30.4 18 18.9 6 to 10 147 33.3 55 34.8 11 to 17 131 36.2 57 32.5 Child Gender <.001 Male 187 47.4 76 38.9 Female 203 52.6 111 20.3 Child Nativity .08 U.S. born 362 91.1 125 31.4 Foreign-Born 28 8.9 5 8.5 Parent Nativity .04 U.S. born 257 64.0 100 35.4 Foreign born 133 36.0 30 17.9 Parent Years in U.S. (Foreign Born) .13 0-10 36 8.1 5 11.0 11-20 60 13.6 11 15.8 21+ 37 14.3 14 23.9 Enabling Conditions Parent Legal Status <.01 U.S. citizen 299 75.0 114 33.6 Legal resident 43 12.1 10 28.2 Undocumented 48 13.0 6 4.1 Secondary caregiver in home .56 Yes 320 80.9 106 29.9 No 70 19.1 24 26.0 Parent Education <.01 High school degree 235 52.8 89 37.1 No high school degree 155 47.2 41 20.2 Language Spoken at Home .54 English 175 39.8 65 32.4 Another language 215 60.2 65 27.0 Child Insurance Status at Time of First Interview .07 Medicaid/state funded 286 67.8 97 28.9 Employer-based 34 10.5 14 43.3 Military, Indian health, other 22 4.6 10 52.2 None 48 17.1 9 15.1 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 96 Income as a % of Federal Poverty Level (FPL) .02 50% of FPL 90 21.1 33 33.7 50-<100% of FPL 154 40.3 45 25.2 100-200% of FPL 84 20.0 32 45.6 >200% of FPL 39 11.1 15 18.2 Poverty level missing 23 7.5 5 9.5 Economic Hardship <.01 Struggling to make it 200 49.6 71 35.2 Just getting by or saving 190 50.4 59 23.4 Need Clinical Range CBCL (>64) <.001 Yes 90 21.3 60 60.7 No 300 78.7 70 20.6 Contextual Child Welfare Characteristics Maltreatment Type .86 Physical abuse 59 16.9 29 31.8 Emotional abuse 15 5.0 7 26.7 Sexual abuse 24 3.1 9 46.9 Substance abuse/Substance exposure 45 12.4 12 33.3 Domestic violence 56 13.9 19 27.1 Neglect 1 119 35.5 34 29.7 Other 2 68 13.2 19 20.5 Level of Risk .13 None to mild 224 69.9 75 26.5 Moderate to severe 166 30.1 55 35.2 Received Child Welfare Services .17 Yes 156 33.3 61 32.8 No 234 66.7 69 27.3 a Mental health services received over a 24 month period. N’s are unweighted, and percentages are weighted. b 29.1% of children received mental health services; SE=4.4 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 97 Table 4.2: Weighted percentages of mental health need and service receipt for Latino school-aged children by parent nativity and citizenship/immigration status a Nativity Citizenship/legal status Total N=390 U.S. Born N=257 Foreign born N=133 p value U.S. Citizen N=299 Legal Resident N=43 Undocumen ted N =48 p value CBCL clinical range (>64) 90 (21.3%) 68 (24.2%) 22 (16.1%) .23 76 (22.5%) 8 (25.6%) 6 (10.3%) .36 Any mental health service 130 (29.1%) 100 (35.4%) 30 (17.9%) .04 114 (33.6%) 10 (28.2%) 6 (4.1%) <.01 Specialized mental health services 1 89 (19.8%) 70 (23.5%) 19 (13.1%) .05 78 (21.9%) 8 (23.6%) 3 (3.6%) .03 Medical mental health services 2 40 (8.4%) 34 (10.1%) 6 (5.2%) .36 38 (10.3%) 2 (4.8%) 0 (0%) .30 School based mental health services 77 (19.0%) 59 (22.6%) 18 (12.6%) .11 67 (21.6%) 6 (22.1%) 4 (1.0%) <.01 a Mental health services received over a 24 month period. N’s are unweighted, and percentages are weighted. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 98 Table 4.3: Weighted logistic regression models of mental health service use by school-aged Latino children investigated by a child welfare agency a N=390 Model 1 Nativity Model 2 Citizenship/Legal Status Variables Odds Ratio CI (95%) Odds Ratio CI (95%) Predisposing Characteristics Child age (ref cat= age 3-5) 6 to 10 2.16 .96, 4.88 1.88 .79, 4.43 11 to 17 3.36 .66, 16.94 2.79 .57, 13.68 Child is male (ref cat=female) 3.10** 1.59, 6.03 2.82** 1.43, 5.55 Child is foreign born (ref cat= U.S. born) .57 .10, 3.07 .60 .12, 3.05 Parent is foreign born (ref cat=U.S. born) .35 + .11, .98 -- -- Enabling Conditions Parent Legal Status (ref cat= U.S. citizen) -- -- Legal resident .54 .10, 2.76 Undocumented .09** .01, .51 Parent has HS degree (ref cat=no HS degree) 2.66 .90, 7.86 2.65 .90, 7.80 Child is uninsured 1 (ref cat=insured) 1.10 .40, 2.97 .94 .33, 2.67 Economic hardship (struggling to make it; ref cat= getting by or saving) 2.01* 1.08, 3.74 2.09* 1.18, 3.72 Need Clinical Range CBCL (ref cat=<64) 5.15** 2.26, 11.71 5.46*** 2.45, 12.19 Contextual Child Welfare Characteristics Child at moderate to severe risk for maltreatment (ref cat= mild to no risk) 1.69 .74, 3.85 1.86 .85, 4.10 Family received child welfare services (ref cat= did not receive child welfare services) 1.51 .94, 2.41 1.56 .97, 2.52 a Significance levels are represented as: + p=.05; *p<.05; **p<.01; ***p<.001 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 99 Table 4.4: Weighted logistic regression models of mental health service use by school-aged Latino children investigated by a child welfare agency (Time in U.S.) a N=390 Time in U.S. Variables Odds Ratio CI (95%) Predisposing Characteristics Child age (ref cat= age 3-5) 6 to 10 2.15 .92, 4.99 11 to 17 3.23 .60, 17.36 Child is male (ref cat=female) 3.10** 1.5, 6.12 Child is foreign born (ref cat= U.S. born) .76 .11, 4.98 Time spent in U.S. (ref cat=U.S. born) 0 to 10 years .20* .05, .79 11 to 20 years .30 .08, 1.02 More than 20 years .44 .98, 1.98 Enabling Conditions Parent has HS degree (ref cat=no HS degree) 2.68 .94, 7.64 Child is uninsured 1 (ref cat=insured) 1.05 .36, 2.99 Economic hardship (struggling to make it; ref cat= getting by or saving) 2.06* 1.07, 3.96 Need Clinical Range CBCL (ref cat=<64) 5.14*** 2.31, 11.45 Contextual Child Welfare Characteristics Child at moderate to severe risk for maltreatment (ref cat= mild to no risk) 1.76 .83, 3.70 Family received child welfare services (ref cat= did not receive child welfare services) 1.52 .94, 2.44 CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 100 Chapter Five Conclusions, Implications, and Future Directions The goal of this dissertation study was to better understand the needs of high-risk Latino families with child welfare contact, whether immigrants’ needs differ from the U.S. born, and whether issues surrounding immigration and culture present as barriers to receiving services to meet those needs. Whether or not child maltreatment has actually occurred, families who come to the attention of the child welfare system often experience multiple stressors and complex challenges that can negatively impact their children. A report of abuse or neglect is a prime opportunity for families’ needs to be exposed to a system that can connect families with services that ameliorate negative child outcomes. Taking advantage of a child welfare investigation to accurately identify needs and link families to services may be especially critical for immigrant families, who often encounter obstacles to accessing services in other settings due to various cultural and socio-political factors dominant in U.S. society. Despite the increased role of Latino immigrants in the fabric of the U.S. economy and society over the past several decades, very little data exists that documents the experiences of vulnerable immigrant families and children involved with the child welfare system. A growing number of children reported to the child welfare system for abuse or neglect are of Latino ethnicity, many who are affected by immigration issues. However, because immigrant status is not recorded for federal reporting, there are no national statistics documenting how many maltreated children come from immigrant families. The second National Survey of Child and Adolescent Well-being (NSCAWII), the only national survey of families reported for child maltreatment, is also the first study of its kind to collect data on the nativity and immigration status of parents and children, allowing for national estimates to be generated for the immigration status of families. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 101 This research is especially timely given increased attention to, and political contention around, the status of immigrants in the U.S. over the past decade. Although several attempts have been made to reform the U.S. immigration system through federal legislation, Congress has remained stagnated and the future of families affected by immigration up in the air. Passage of the Affordable Care Act of 2010 has paved the way for expanding access to a range of health and behavioral health services for many who have not been enrolled in the past, but national regulations still prohibit many immigrants from accessing such services (National Immigration Law Center, 2015), as well as other federal public supports such as Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Medicaid, and the Children’s Health Insurance Program (CHIP; Yoshikawa, et al., 2014). This dissertation study took advantage of an opportunity to look at the service needs of Latino families reported to the child welfare system, highlighting immigration as a unique contributor to their experiences, a factor that has being surprisingly overlooked in most other NSCAWII studies. Expanding on recent research that examined patterns of risk and maltreatment in immigrant families (Dettlaff, Earner & Phillips, 2009; Dettlaff & Johnson, 2011; Johnson-Motoyama, Dettlaff, & Finno, 2012; Cardoso, Dettlaff, Finno-Velasquez, Scott, & Faulkner, 2014) as well as access to concrete services (Finno-Velasquez, 2013), this dissertation probed into Latino immigrants’ experiences with some of the most common issues in families reported to child welfare agencies: substance abuse; partner violence; and mental health problems. This final chapter presents some of the central findings from the three empirical papers and describes the limitations of the study. The chapter concludes by providing potential implications and recommendations for practice, policy, and future research. Major Findings Findings from this dissertation send a strong message that special focus should be placed on the service needs of immigrant families and children in child welfare policy and practice. A primary finding is CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 102 that rates of problematic issues for Latino immigrant parents referred to child welfare agencies are high, but appear to be statistically similar to those of non-immigrants. Nearly 20% of parents had a problem with drug or alcohol, and third of women experienced some form of physical violence in the previous year. In regards to Latino children’s needs, 21.3% had clinical range mental health problems. Although rates of mental health issues were lower among children of immigrants (16.1%) compared to children of the U.S. born (24.2%), this difference was not significant. Another point worth highlighting is that, overall, caregiver service use is low. Just 6.7% of parents received substance abuse services, and 9.4% of women received services for intimate partner abuse, revealing a large gap between need and service receipt. Differences in substance abuse service receipt were visible between the U.S. born (9.4%) and foreign born (2.1%), but those who were undocumented had lowest use of substance abuse services (0.3%) and highest self identified need for substance use services (9.5%). However, immigrant caregivers did not differ from non-immigrants in rates of service receipt for intimate partner violence. As for children, results were perhaps more promising, as 29.1% of all Latino children received mental health services, surpassing the conservative clinical range mental health problem cutoff scored by 21.3% of children. However, rates of mental health service receipt were far lower for children of immigrants (17.9%), especially for children of undocumented parents (4.1%). Indeed, a gap in rates of clinical need and service receipt, where rates of need were higher than rates of service receipt, was observed only for children of undocumented parents. Taken together, perhaps the most noteworthy finding is that parent nativity and legal immigration status significantly reduced the likelihood of receipt of substance abuse services and child mental health services, but not intimate partner violence services. Adjusting for other relevant explanatory variables, undocumented parents had 95% lower odds of receiving substance abuse services, and children of CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 103 undocumented parents had 91% lower odds of receiving mental health services compared to others. Together with findings from a previous study (Finno-Velasquez, 2013), this dissertation concludes that children in immigrant families, and especially those with undocumented parents, are indeed at higher risk of not receiving needed services when they come into contact with the child welfare system. As touched upon in previous chapters, there are several reasons why this may be, including linguistic barriers, unfamiliarity with how to navigate service systems, a preference to keep family issues private, or having forms of seeking help and coping that are inconsistent with dominant U.S. cultural practices. In mixed status families, or families with both immigrant and non-immigrant members or members with different legal statuses, even when children are eligible for services, parents may be afraid that enrolling in services will have negative consequences for exposing their immigrant status. In fact, most recent studies have found that families with undocumented parents live in near constant fear of being separated from their children and deported (Berger Cardoso, Scott, Faulkner, Alvarez, & Barros Lane, 2015; Faulkner Berger Cardoso, & Scott, 2015). However, reduced service use may also be a reflection of the communities where immigrants live. Some of the poorest, most vulnerable immigrant families likely reside where resources are scarce, reducing the likelihood of connecting to any services, let alone linguistically and culturally sensitive services. Challenges to service receipt are also likely a function of service providers’ and systems’ ability to effectively serve immigrant families. For example, as observed with experiences with substance abuse services in Chapter 2, caseworkers may be less likely to refer immigrant parents for substance abuse treatment out of fear of exposing them to criminal and immigration authorities and risking separation from their children. That study also found that parents who didn’t speak English in the home were less likely to receive substance abuse services, even though language didn’t influence partner violence services or child CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 104 mental health service receipt. This could be a reflection of an overall lack of substance abuse treatment services available in Spanish, disproportionately affecting Latino immigrants. Based on the results of this dissertation, it also appears that parental undocumented legal status, rather than the language and cultural challenges that often come with being foreign born, may be the most considerable barrier to parents and their children receiving services. Although receiving services does not necessarily always lead to more positive child outcomes (Barth, Gibbons, & Guo, 2005), institutional and systematic exclusion from services is certainly cause for alarm, as it signals that on top of the immigration- related stressors that children in immigrant households face, those who come to the attention to the child welfare system may be at risk for increased recidivism and long term challenges to well-being. Representing an increasing proportion of vulnerable children and stronghold of the future social and economic fabric of the U.S., it would be wise to use a child welfare investigation as an opportunity to reduce the stressors faced by children in families with undocumented members. That said, it also important to consider that barriers to service use for immigrants were not observed in services for intimate partner violence. Thus, it cannot be assumed that pathways to all services are alike. Results of this dissertation suggest that it may be particularly salient to consider the sociopolitical context under which services are offered. Specifically, it is possible that the policies influencing eligibility for and receipt of specific services contribute to the central findings of this dissertation. Data from this study were collected prior to implementation of the Affordable Care Act (2010). At the time of this survey mental health services and substance abuse services were in short supply in many areas of the country, and were funded through insurance and state and federal grants that, more often than not, deem undocumented immigrants ineligible for services. However, the federal Violence Against Women Act (2000) explicitly provides protections for immigrant women who have been victims of interpersonal violence (Orloff & Kaguyutan, 2002). Because of legislative protections for immigrant women in situations of partner CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 105 violence, outreach and available services may be more often targeted specifically for immigrant women, potentially making them feel more comfortable accessing assistance for this issue. Limitations & Future Research This section discusses several limitations of this research that also elucidate potential areas for additional research. First, although this dissertation elected to exclude the nativity and immigration status of the secondary caregiver from analyses, maltreatment risks present in mixed status families (or families that have two primary caregivers of different citizenship statuses) may not be characterized the same as families with two parents of the same status (Johnson-Motomaya, Dettlaff, & Finno, 2012). Also, it is possible that the status of the secondary caregiver may influence a family’s decision to seek out services. However, immigrant status information on the secondary caregiver was missing for nearly half of the cases in this sample, and for reasons also explained in Finno-Velasquez (2013), this dissertation study focused exclusively on the status of the primary caregiver. Second, growing evidence suggests that diversity in service needs exist within the Latino population, not only by immigration status, but by Latino subgroup. For example, in the general population, Puerto Ricans appear more similar to non-Latino whites in patterns of mental health issues, but not substance abuse issues (Alegria et al., 2008). A recent study of California child welfare administrative data highlights some important differences in patterns of maltreatment for children under 5 by Latino subgroup, one being that Puerto Ricans are more likely to be reported and substantiated than Mexicans and Central and South Americans (Johnson-Motoyama, Putnam-Hornstein, Dettlaff, Zhao, Finno-Velasquez, & Needell, 2014). In the NSCAWII study, the majority of Latino children are of Mexican origin (Berger Cardoso, Dettlaff, Finno-Velasquez, Scott, & Faulkner, 2014), but the sample sizes for other Latino groups were too small to make comparisons by immigrant status as well as Latino subgroup. Understanding differences in service experiences by Latino subgroup is an area that is ripe for future research. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 106 Third, caseworker information was limited to characteristics of the worker assigned to investigation, which lasts approximately thirty days. After a child welfare investigation, if a family is given a mandate for services, they are usually assigned a new caseworker who is responsible for carrying out case monitoring and follow up over time. It is that worker who is probably most influential in securing services for families, but such information was not available for a majority of cases. In none of the three dissertation studies did families who had ongoing contact with child welfare services post-investigation have an advantage in receiving substance abuse, intimate partner violence, or child mental health services. On the one hand, this could be viewed positively, suggesting that families who don’t require child welfare services may still be connected with key services that promote child well-being at levels equal to those with more extensive child welfare involvement. However, a more grim reality might be that families receiving child welfare services may have higher levels of need or risk of maltreatment, but ongoing involvement with the child welfare system does not necessarily link them to the services they need to prevent recurrence. Relatedly, a prior study of this population found that caseworkers’ ability to speak Spanish did not influence service receipt, although a large gap was found between Spanish-speaking families (over 90%) and Spanish speaking caseworkers (around half; Finno-Velasquez, 2013). Yet, the fact that there are not enough Spanish speaking child welfare workers to serve families nationwide remains concerning and may truly have an impact on assessment of family needs and decision-making. Although not presented in the final results of this dissertation, characteristics of the child welfare caseworker had no influence on whether families received services, despite previous research linking service receipt by Latinos to characteristics of service providers, such as Spanish language use, ethnic match, and cultural competence (Ayón & Aisenberg, 2010; Barona & Santos de Barona, 2003; Bernal & Scharró-del-Río, 2001; Earner, 2007; Kumpfer et al., 2002; McCabe, 2002; Snowden, 2003; Snowden & Yamada, 2005; Sue, Zane, & Young, CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 107 1994; van Ryn & Fu, 2003). As discussed in Finno-Velasquez (2013), the importance of worker ethnicity, language, and cultural training might not have been noted in this study due to relatively high acculturation levels of the sample, as the vast majority of parents were U.S. born or had resided in the U.S. for over 20 years. Furthermore, the ability to measure caseworker decision making, competence, and potential bias in working with Latino families was extremely limited, based only on three variables representing language, ethnicity, and hours of cultural training received annually. Because results of this dissertation do not support other literature suggesting that cultural competence enhances service delivery by facilitating the ability of workers to accurately identify needs and offer relevant services (Barona & Santos de Barona, 2003; Bernal & Scharró-del- Río, 2001; Earner, 2007; Kumpfer et al., 2002; McCabe, 2002; Snowden, 2003; Snowden & Yamada, 2005; Sue et al., 1994; van Ryn & Fu, 2003), a more thorough investigation of the potential contribution of caseworker bias and decision-making in connecting immigrant families with services is warranted. Although this study accounted for the fact that services were offered within the context of a child welfare investigation, it did not examine contextual factors specific to the organizational and sociopolitical environment that are certain to affect how services are delivered to immigrant families involved with child welfare (Garcia, 2009). Although not the focus of this study, the fact that experiences with services are critically driven by characteristics of the institutions with which individuals have contact must not be overlooked (Aarons, Hurlburt, & Horwitz, 2011). Child welfare and the broader service system’s organizational values, structures, and capacity to serve immigrants likely influence whether and how families engage with services. Service receipt may also be influenced by the cultural congruence of services offered and the availability of resources in areas where immigrants reside (Garcia, 2009). A current study is also underway to better understand the dynamics of maltreatment and service array in immigrant concentrated neighborhoods in Los Angeles and San Diego counties. More research is needed to CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 108 better understand the capacity of child welfare organizations and the broader service system to engage Latino families and accommodate their needs in service delivery in ways that are culturally and linguistically responsive. In addition to consideration of how organizations impact service receipt, it is equally important to examine how federal and local government policies may restrict access to services for vulnerable immigrant populations (Garcia, 2009). As discussed in the findings section above, national policies exist that make many immigrants ineligible to receive publicly funded health and behavioral health services, but not intimate partner violence issues. In spite of punitive federal policies, many state and local policies vary from or attempt to compensate for federal policies by offering services to immigrants through different funding mechanisms (Gelatt, Koball, & Pedroza, 2014; Yoshikawa et al., 2014). An examination of the relationships between state and local policies (and funding streams) and service receipt for immigrant families involved with child welfare, could comprise another study entirely, but may be an important next step to explaining the results of this study. A final limitation deserving attention is related to the outcome itself. This dissertation focused on various types of service receipt as dichotomous outcomes, but did not qualify the dose, frequency, or duration of services received, nor did it attempt to address issues of attrition or the relationship of service receipt to child and family outcomes. It also did not examine the quality of service received, including relevant factors such as the cultural and linguistic competence of treatment received. Finally, this study did not contain information on strategies that Latino families may be using to cope in lieu of formal agency services, such as informal and extended family supports, religious leaders or folk healers that are common sources of assistance in Latino cultures. All of these identified weaknesses are worthy of further inquiry. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 109 Implications and Recommendations Although obtaining services does not always lead to more positive child and family outcomes, disproportionate and systematic exclusion from services for any one vulnerable group is cause for alarm and merits attention in thinking about how to advance child welfare and the broader service system that protects all children in the U.S. Despite the lack of conclusive findings as to why immigrants are challenged in receiving some services and not others, this dissertation nevertheless provides some clear implications for child welfare policy, organizations, and practice. First of all, findings underscore the fact that primary goals of child welfare policies often clash with other social welfare policies in the way they impact immigrants. The values promoted by comprehensive child welfare laws, such as the Adoption and Safe Families Act (1997), place the safety, permanency, and well-being of all children in the U.S. front and center. However, other welfare policies like the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, and even the recent Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010, exclude many immigrants from eligibility for health and behavioral health services that promote and encourage child and family well-being. Even with the recent (November 2014) presidential executive action that provides temporary relief to 4.4 million immigrant parents of U.S. citizen and legal resident children (Immigrant Legal Resource Center, 2015), many more remain in the shadows fearing deportation and family separation. Yet, one existing policy, the Violence Against Women Act (2000) offers specific protections for immigrant women who have experienced intimate partner violence in order to encourage them to come forward, offering them a haven of safety that may provide an incentive to seek out services. In the absence of comprehensive immigration reform that provides a path to citizenship and eliminates immigrants’ fears of consequences of exposure to government authorities, a piecemealed solution could include access to service benefits covered under other large social welfare policies for immigrants who become involved CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 110 with the child welfare system. However, a more realistic direction, such as the one undertaken in California (Gelatt, Koball, & Pedroza, 2014), might be for state and county child welfare agencies to take on this challenge at the local level in jurisdictions where there is need. This study also has implications for child welfare systems. Involvement with the child welfare system represents an opportunity to connect families to needed health and social services. The need for better integration of child welfare services with other services has become increasingly apparent in recent years. In jurisdictions where formal regulations around serving immigrant families do not exist, efforts should be made to clarify institutional policies on the child welfare system’s reach and responsibility in assisting immigrant families in obtaining services. For instance, in the case of substance abuse services, monitoring through drug and probation courts has been identified as a way to increase access to treatment (Evans, Li, & Hser, 2008, 2009; Evans, Li, Urada, & Anglin, 2010; Longshore, Hawken, Urada, & Anglin, 2006;). While court-supervised treatment has proved effective with some groups (Guerrero, Capos, Urada, & Yang, 2012; Guerrero, Cepeda, Duan, & Kim, 2012), this may not be an appropriate strategy for engaging immigrant families who risk exposure to immigration authorities for prosecution and deportation. Barring comprehensive immigration reform, community based organizations and local jurisdictions will need to band together to determine the best solutions for obtaining services for immigrant families excluded from government-funded services. Local efforts should include taking a survey of clinics and non-profit agencies that serve immigrants in the area and pooling resources to meet their needs. Some areas with long histories of immigration, such as Los Angeles County and several other areas around the country, have devised some innovative and long-standing programs to serve immigrants in the health and mental health sectors, and may serve as useful resources to communities grappling with the issue for the first time (eg. Yoshikawa et al., 2014). Several national and state online resources now exist that provide expert consultation, information and practice toolkits/guidelines that specifically address the unique needs of CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 111 immigrant children and families (http://firstfocus.org/blog/new-acf-guidance-to-help-improve-outcomes- for-children-in-immigrant-families/; http://cssr.berkeley.edu/ucb_childwelfare/lpac/). Child and family serving systems should also consider coordinating and integrating services in ways that increase the probability of immigrant engagement. One promising strategy is the cultural mediators (Siegel, Jackson, Montana, & Rondero Hernandez, 2011) or mentoring models, comprised of programs that are designed to use lay community members, paraprofessionals, or other parent mentors, to provide education and outreach to Latino families, adaptable to assist immigrants navigate the child welfare system (Yoshikawa et al., 2014). Additionally, new evidence suggests that Latina immigrants may prefer receiving treatment for mental health issues in primary care settings, in locations familiar to them where they don’t have concerns with confidentiality (Kaltman, Hurtado de Mendoza, Gonzales, & Serrano, 2014). Local community initiatives aimed at maltreatment reduction or prevention might include community centers that present vulnerable immigrant parents with a variety of relevant services via the one-stop-shop model. Finally, efforts should be made on the part of service organizations to integrate Latino cultural values into their orientation to treatment, educational programs and agencies to recruit, train, and hire workers who speak other languages and have a deeper understanding of the challenges immigrants face in the U.S. Caseworker perceptions of a family’s problems significantly affect their experiences with the system. It is possible that immigrant families may be perceived by workers to have less need for services. Or, because of personal beliefs about immigration or bias against immigrants, workers might be less inclined to help immigrants obtain services they need. It is also possible that workers pass over referring an immigrant family for a service because of a desire to protect families from problems with government and immigration authorities. Enhanced child welfare workforce training should be aimed at increasing CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 112 understanding of resources for immigrants, reducing personal bias and developing sensitivity to their needs, behaviors, cultural norms, and fears. Conclusion The aim of this dissertation study was to create a broad base of empirical work that identifies service needs of immigrant families involved with the child welfare system. This study served as a platform to highlight and dialogue around service deficits for immigrant families reported to a child welfare agency, and helped to solidify key areas for future research. Additional studies involving children in immigrant families will benefit from qualitative inquiry and in depth analysis of the cultural and political challenges they face to having their family problems addressed. Future empirical work should bring focus to the organizational, systematic, and policy issues that contribute to immigrant experiences with the child welfare system. In child welfare studies, cultural issues have long been studied as an aside, or an afterthought. Issues surrounding immigration, culture, and language should be made front and center in future research questions aimed at improving the child welfare service system. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 113 References Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4-23. Alegría, M., Canino, G., Shrout, P., Woo, M., Duan, N., Vila, D., ... & Meng, X. L. (2008). Prevalence of mental illness in immigrant and non-immigrant US Latino groups. American Journal of Psychiatry, 165(3), 359-369. Ayón, C., & Aisenberg, E. (2010). Negotiating cultural values and expectations within the public child welfare system: A look at familismo and personalismo. Child & Family Social Work, 15, 335–344. Barona, A., & Santos de Barona, M. (2003). Recommendations for the psychological treatment of Latino/Hispanic populations. In Psychological treatment of ethnic minority populations (pp. 19– 23). Washington, DC: Association of Black Psychologists. Berger, L. M., Slack, K. S., Waldfogel, J., & Bruch, S. K. (2010). Caseworker-perceived caregiver substance abuse and child protective services outcomes. Child maltreatment, 15(3), 199-210. Berger Cardoso, J., Scott, J., Faulkner, M., Alvarez, S., & Barros Lane, L. (January, 2015). Parenting in the context of deportation: A study of undocumented families in Texas. Society for Social Work and Research, New Orleans, La. Bernal, G., & Scharró-del-Río,M. R. (2001). Are empirically supported treatments valid for ethnic minorities? Toward an alternative approach for treatment research. Cultural Diversity and Ethnic Minority Psychology, 7, 328–342. Earner, I. (2007). Immigrant families and public child welfare: Barriers to services and approaches for change. Child Welfare, 86, 63–91. Faulkner, M., Berger Cardoso, J., Scott, J. (January, 2015). Navigating parenthood without documentation: An exploratory study of deportation planning among undocumented Latino parents. Society for Social Work and Research, New Orleans, La. Cardoso, J. B., Dettlaff, A. J., Finno-Velasquez, M., Scott, J., & Faulkner, M. (2014). Nativity and immigration status among Latino families involved in the child welfare system: Characteristics, risk, and maltreatment. Children and Youth Services Review, 44, 189-200. Dettlaff, A. J., Earner, I., & Phillips, S. D. (2009). Latino children of immigrants in the child welfare system: Prevalence, characteristics, and risk. Children and Youth Services Review, 31, 775–783. Dettlaff, A. J., & Johnson, M. A. (2011). Child maltreatment dynamics among immigrant and US born Latino children: Findings from the National Survey of Child and Adolescent Well-being (NSCAW). Children and Youth Services Review, 33(6), 936-944. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 114 Evans, E., Li, L., & Hser, Y. I. (2009). Client and program factors associated with dropout from court mandated drug treatment. Evaluation and program planning, 32(3), 204-212. Evans, E., Li, L., & Hser, Y. I. (2008). Treatment entry barriers among California's Proposition 36 offenders. Journal of substance abuse treatment,35(4), 410-418. Evans, E., Li, L., Urada, D., & Anglin, M. D. (2010). Comparative effectiveness of California’s Proposition 36 and drug court programs before and after propensity score matching. Crime & Delinquency, 0011128710382342. Finno-Velasquez, M. (2013). The relationship between parent immigration status and concrete support service use among Latinos in child welfare: Findings using the National Survey of Child and Adolescent Well-being (NSCAWII). Children and Youth Services Review, 35(12), 2118-2127. Garcia, A. (2009). Contextual pathways to Latino child welfare involvement: A theoretical model located in the intersections of place, culture, and socio-structural factors. Children and Youth Services Review, 31(12), 1240-1250. Gelatt, J., Koball, H., & Pedroza, J. M. (2014, Oct). California’s Implementation of the Affordable Care Act. Washington DC: Urban Institute. Retrieved from http://www.urban.org/publications/2000015.html Guerrero, E. G., Campos, M., Urada, D., & Yang, J. C. (2012). Do cultural and linguistic competence matter in Latinos’ completion of mandated substance abuse treatment. Substance abuse treatment, prevention, and policy, 7(1), 34. Guerrero, E. G., Cepeda, A., Duan, L., & Kim, T. (2012). Disparities in completion of substance abuse treatment among Latino subgroups in Los Angeles County, CA. Addictive behaviors, 37(10), 1162- 1166. Immigrant Legal Resource Center (2015). Executive Action ("Administrative Relief") on Immigration. Retrieved from http://www.ilrc.org/policy-advocacy/executive-actionadministrative-relief Johnson-Motoyama, M., Dettlaff, A. J., & Finno, M. (2012). Parental nativity and the decision to substantiate: Findings from a study of Latino children in the second National Survey of Child and Adolescent Well-being (NSCAW II).vChildren and Youth Services Review, 34(11), 2229-2239. Johnson-Motoyama, M., Putnam-Hornstein, E., Dettlaff, A. J., Zhao, K., Finno-Velasquez, M., & Needell, B. (2014). Disparities in Reported and Substantiated Infant Maltreatment by Maternal Hispanic Origin and Nativity: A Birth Cohort Study. Maternal and child health journal, 1-11. Kaltman, S., Hurtado de Mendoza, A., Gonzales, F. A., & Serrano, A. (2014). Preferences for trauma- related mental health services among Latina immigrants from Central America, South America, and Mexico. Psychological Trauma: Theory, Research, Practice, and Policy, 6(1), 83. CHILD WELFARE, IMMIGRATION, AND SERVICE RECEIPT Finno-Velasquez 115 Kenney, G. & Huntress, M. (2012, April). The Affordable Care Act: Coverage Implications and issues for immigrant families [ASPE Issue Brief 19]. Washington DC: Urban Institute. Retrieved from http://aspe.hhs.gov/hsp/11/ImmigrantAccess/Coverage/ib.shtml Kumpfer, K. L., Alvarado, R., Smith, P., & Bellamy, N. (2002). Cultural sensitivity and adaptation in family-based prevention interventions. Prevention Science, 3, 241–246. Longshore, D., Hawken, A., Urada, D., & Anglin, M. D. (2006). SACPA COST-ANALYSIS REPORT (First and Second years). Los Angeles, CA: UCLA Integrated Substance Abuse Programs. McCabe, K. M. (2002). Factors that predict premature termination among Mexican–American children in outpatient psychotherapy. Journal of Child and Family Studies, 11, 347–359. National Immigration Law Center (2015). Immigrants and the Affordable Care Act. Retrieved from http://www.nilc.org/immigrantshcr.html Orloff, L. E., & Kaguyutan, J. V. (2002). Offering a helping hand: Legal protections for battered immigrant women: A history of legislative responses. Am. UJ Gender Soc. Pol'y & L., 10, 95. Siegel, D., Jackson, M., Montana, S., & Rondero Hernandez, V. (2011). Use of cultural brokers as an approach to community engagement with African American families in child welfare: An empirically based curriculum. Berkeley, CA: University of California at Berkeley, California Social Work Education Center. Snowden, L. R. (2003). Bias in mental health assessment and intervention: Theory and evidence. American Journal of Public Health, 93, 239–243. Snowden, L. R., & Yamada, A. -M. (2005). Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143–166. Sue, S., Zane, N., & Young, K. (1994). Research in psychotherapy with culturally diverse populations. In A. E. Bergin, & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 783– 820) (4th ed.). New York, NY: John Wiley & Sons. Van Ryn, M., & Fu, S. S. (2003). Paved with good intentions: Do public health and human service providers contribute to racial/ethnic disparities in health? American Journal of Public Health, 93, 248–255. Yoshikawa, H., Weiland, C., Ulvestad, K., Perreira, K. M., & Crosnoe, R. (2014). Improving Access of Low-Income Immigrant Families to Health and Human Services: The Role of Community Based Organizations. Washington D.C.: Urban Institute. Retrieved from http://www.urban.org/UploadedPDF/2000011-Improving-Access-of-Low-Income-Immigrant- Families-to-Health-and-Human-Services.pdf?RSSFeed=UI_Nonprofits.xml

Abstract (if available)

Abstract Families who come to the attention of the child welfare system typically experience multiple stressors and face complex challenges to child well-being, some of the most common being substance abuse, partner violence, and mental health issues. A maltreatment report to a child welfare agency represents a unique chance for families’ needs to be exposed and potential negative effects on children ameliorated by connecting families with a wide range of services. A growing number of children reported to the child welfare system for abuse or neglect are of Latino ethnicity, many of who are affected by immigration issues. However, Latinos tend to underutilize health and behavioral health services throughout the U.S. Immigrants, especially, encounter many obstacles to engaging in services and having their needs met, due to various cultural and socio-political factors dominant in U.S. society. Yet very little empirical data exists on the service experiences of some of the most vulnerable immigrant families and children, those involved with the child welfare system. ❧ This three-study dissertation aims to contribute to a greater understanding of the needs of high-risk Latino families with child welfare contact and the barriers that exist in receiving services to meet those needs. By taking advantage of a quantitative examination of the National Survey of Child and Adolescent Well-being (NSCAWII), and applying a modified version of Andersen’s behavioral model for health services use, each of the three papers attempts to explain to what extent culture and legal immigration status affect multi-dimensional needs and service receipt by Latino families reported to a child welfare agency. ❧ Chapter I presents a discussion of the immigrant experience in the U.S. that integrates the link between the three studies, briefly introducing the purpose and description of each, and providing an overview of the conceptual framework driving the three studies. Chapter II (Study 1) examines patterns of problematic substance use among immigrant and non-immigrant Latino parents reported to child welfare, as well as the relationship between immigration status and substance abuse service receipt. Chapter III (Study 2) determines the incidence of intimate partner violence in immigrant and non-immigrant Latino families reported to a child welfare agency, as well as correlates of partner violence service receipt in this population. Chapter IV (Study 3) presents findings of analyses examining the relationship between parent nativity and legal immigration status, child mental health needs, and mental health service receipt for Latino children with child welfare contact. Chapter V discusses conclusions garnered from the three studies, the broader importance of the findings, and implications of the dissertation for policy, practice, and future research.

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Interagency collaboration: cultivating resources and strengthening substance use service delivery in child welfare

PDF

Mental health service use by children and youth in the child welfare system: a focus on need and predisposing factors and caregiver type

PDF

County of San Diego Child Welfare Services Hotline Redesign

PDF

Multilevel influences on organizational adoption of innovative practices in children's mental health services

PDF

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

PDF

Delineating the processes and mechanisms of sustainment: understanding how evidence-based prevention initiatives are maintained after initial funding ends

PDF

Brazos Abiertos: addressing mental health stigma among the Latino Catholic community

PDF

Implementation of peer providers in integrated health care settings

PDF

Racial/ethnic diversity and disparities in the child welfare system: a multilevel perspective

PDF

Assessing implementation of a child welfare system practice change

PDF

Strength-Based Reporting: a trauma-informed practice for mandated reporters, to address behavioral health concerns in children at risk of child welfare involvement

PDF

The impact of psychosocial rehabilitation services on recovery outcomes for racial/ethnic minorities with severe mental illness

PDF

Mindfulness and resilience: an investigation of the role of mindfulness in post-9/11 military veterans' mental health-related outcomes

PDF

Exploring the development of psychological empowerment among survivors of intimate partner violence: does the Personal Empowerment Program live up to its name?

PDF

Successful reentry among formerly incarcerated women: a mixed methods analysis

PDF

Psychological distress behavioral patterns and mental health service use among Latinos in the 2012 National Health Interview Survey: a latent class analysis

PDF

A study of depression disclosure among Latino older adults in Los Angeles

PDF

The link between maternal depression and adolescent daughters' risk behavior: the mediating and moderating role of family

PDF

Incarceration trajectories of mothers in state and federal prisons and their relation to the mother’s mental health problems and child’s risk of incarceration

PDF

The nature of middle-class Latino/a students' cultural capital in a fifth-grade classroom's reading and writing activities

Asset Metadata

Creator Finno-Velasquez, Megan (author)

Core Title Immigrants at a loss: the need for services that promote child well-being among Latino families with child welfare contact

School School of Social Work

Degree Doctor of Philosophy

Degree Program Social Work

Publication Date 07/22/2015

Defense Date 04/15/2015

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

Tag Child welfare,immigrant,Latino,OAI-PMH Harvest,services

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hurlburt, Michael S. (committee chair), Palinkas, Lawrence (committee chair), Esparza, Nicole (committee member)

Creator Email finno@usc.edu,megfinno@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-602589

Unique identifier UC11299565

Identifier etd-FinnoVelas-3673.pdf (filename),usctheses-c3-602589 (legacy record id)

Legacy Identifier etd-FinnoVelas-3673.pdf

Dmrecord 602589

Document Type Dissertation

Format application/pdf (imt)

Rights Finno-Velasquez, Megan

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA