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An examination of child protective service involvement among offspring born to young mothers in foster care
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An examination of child protective service involvement among offspring born to young mothers in foster care
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OFFSPRING BORN TO MOTHERS IN CARE Eastman
i
AN EXAMINATION OF CHILD PROTECTIVE SERVICE INVOLVEMENT AMONG
OFFSPRING BORN TO YOUNG MOTHERS IN FOSTER CARE
By
Andrea Lane Eastman
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(SOCIAL WORK)
Dissertation Guidance Committee:
Dr. Emily Putnam-Hornstein, Chair
Dr. Jacquelyn McCroskey, Internal Member
Dr. Gary Painter, Outside Member
August 2018
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Table of Contents
Dedication ..................................................................................................................................... iv
Acknowledgements .........................................................................................................................v
List of Tables ................................................................................................................................ vi
List of Figures ............................................................................................................................. viii
Abstract .......................................................................................................................................... ix
Chapter 1: Introduction and Rationale .............................................................................................1
Introduction and Rationale ...................................................................................................1
Theoretical Framework .....................................................................................................14
Dissertation Structure.........................................................................................................17
References .........................................................................................................................19
Chapter 2 (Study 1): A Literature Review: Pregnant and Parenting Youth in Care and Their
Offspring ............................................................................................................................24
Introduction ........................................................................................................................24
Methods .............................................................................................................................27
Results ...............................................................................................................................28
Discussion ..........................................................................................................................33
References .........................................................................................................................41
Chapter 3 (Study 2): An Examination of Child Protective Service Involvement among
Offspring Born to Mothers in Foster Care .........................................................................46
Introduction ........................................................................................................................46
Methods .............................................................................................................................49
Results ...............................................................................................................................54
Discussion .........................................................................................................................57
References .........................................................................................................................65
Chapter 4 (Study 3): A Content Analysis of Case Records: Two-Generations of Child
Protective Services Involvement ......................................................................................73
Introduction .......................................................................................................................73
Methods .............................................................................................................................76
Results ...............................................................................................................................81
Discussion .........................................................................................................................97
References ........................................................................................................................112
Chapter 5: Conclusions, Implications, and Future Directions ....................................................118
Major Findings ................................................................................................................118
Limitations ......................................................................................................................121
Implications for Policy and Practice ...............................................................................123
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Implications for Research ................................................................................................125
Conclusions .....................................................................................................................126
References .......................................................................................................................128
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Dedication
To Karel Barta, a brilliant dreamer.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Acknowledgements
I am grateful to so many people who made this dissertation a reality. I would like to first
acknowledge the Doris Duke Fellowship, First 5 LA, and the Conrad N. Hilton Foundation for
generously funding my dissertation. The Doris Duke Fellowship for the Promotion of Child
Well-Being provided dissertation support and funding for two years, without which this paper
could not have been completed. Since I arrived at the University of Southern California (USC) I
have had the opportunity to work as a research assistant at the Children’s Data Network (CDN).
The CDN is a data and research collaborative focused on the linkage and analysis of
administrative records to generate knowledge and advance evidence-rich policies that will
improve the health, safety, and well-being of children. First 5 LA provides essential funding to
support the CDN’s linkage and analysis of administrative records related to young children and
families. The Conrad N. Hilton Foundation funding provides infrastructure and support for
analyses related to transition-aged youth who have spent time in foster care.
This project was possible thanks to an ongoing collaboration with the California Department of
Social Services, California Department of Public Health, and UC Berkeley’s California Child
Welfare Indicators Project. I am grateful for the work these organizations have done to further
research that will improve programs and policies for children in the child protection system. UC
Berkeley’s team was incredibly generous with their time and resources. Without the time and
support of Drs. Joe Magruder, Wendy Smith, and Daniel Webster, the qualitative analysis would
never have come to fruition.
I am deeply appreciative of my dissertation committee. My mentors, Drs. Emily Putnam-
Hornstein and Jacquelyn McCroskey, are the Co-Principal Investigators of the Children’s Data
Network and they have invested an immense amount of time and energy into my education.
These women have done innovative research that demonstrates how data can improve and
save the lives of vulnerable kids. I have learned from their incredible brilliance and even more
from their incredible kindness. I am grateful they chose to work with me because I now have not
only the passion to help at-risk youth, but the knowledge to develop research that can inform
policy and practice. I met my third committee member, Dr. Gary Painter from the Price School
of Public Policy, six years ago when I asked him for some career advice. He told me that based
on my career aspirations I should really consider getting a PhD. I feel lucky to have met him and
for our continued relationship.
The entire CDN team has been a source of support throughout my education and dissertation
process. Dr. Regan Foust, Dr. John Prindle, Jonathan Hoonhout, Tanya Gupta, Huy Nghiem, Dr.
Michael Mitchell, Dr. Stephanie Cuccarao-Alamin, and Ivy Hammond have all answered
questions and offered help. I would like to thank our fantastic interns, Raina Yusufova and Kayla
Robinson, for their phenomenal efforts to code the massive amount of qualitative data. I feel
lucky to be working with such a wonderful group of intelligent and caring individuals.
The Doris Duke Fellowship has been instrumental to this research not only because of the
funding provided, but more importantly, because of the resources and opportunities for
collaboration. My policy mentor, Mareva Brown, the policy consultant for the President Pro Tem
of the California State Senate, has been a source of valued insight. She helped me apply for
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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funding and guided my dissertation research to ensure the results would be policy relevant. I am
grateful I had the opportunity to work with her again and I am deeply thankful for all of her time
she took out of her incredibly busy schedule to further this work. My “peer” mentor, Dr. Lisa
Schelbe, provided essential guidance as I embarked on my second qualitative study. Her
expertise filled the gaps in my knowledge and it was truly an academic match made in heaven.
Both of these women provided emotional support as I struggled with the case records, which
were filled with details of traumatic experiences.
I would like to thank Cyndee Nieves and Carly Dierkhising for their friendship and for shaping
my career trajectory. I became dedicated to serving children in child welfare after spending years
working at the Contra Costa Receiving Center. The center was run by Cyndee and provided
emergency services for children immediately after being removed from the home due to
maltreatment. The memories from the experiences serving the children at the center motivate me
every day. Prior to USC, I worked as a legislative aide at the California State Senate writing laws
related to child welfare and juvenile justice. I was working with my friend, Carly, who was a
Doris Duke Fellow and I was her policy mentor. She is now Dr. Dierkhising and the experiences
working with her showed me that data can be a tool to help at risk youth.
My research has also been inspired by my family, who was resilient in the face of childhood
adversity. My husband is deserving of a special thank you for always supporting my work and
believing in what I can accomplish. Around the time I started writing this dissertation we became
pregnant with our daughter, Aurora. She is the light of our lives. She is intelligent,
compassionate, and no one could ever call her an easy baby. I want to thank her for showing me
what an extremely difficult and truly humbling experience it is to be pregnant and parenting.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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List of Tables
Table 2.1 Summaries of studies .................................................................................................... 44
Table 3.1. Demographic characteristics of first offspring born to mothers between 2009 and 2012
who were pregnant or Parenting while in Foster Care .................................................................. 69
Table 3.2. Measures of model fit for latent class analysis ............................................................ 70
Table 3.3. Constellation of risk factors across classes.. ............................................................. .. 71
Table 4.1 Descritpion of the contents of the case files ............................................................... 116
Table 4.2 Themes related to mother-child dyads. ....................................................................... 117
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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List of Figures
Figure 3.1. Diagram of birth and CPS record linkages ................................................................. 72
Figure 3.2. Proportion of offspring with CPS involvement by age 3.. ......................................... 72
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Abstract
Nationally, the rate of teen births has dropped significantly over the past quarter century
and currently stands at a historic low. However, females in foster care, and those who recently
exited from care, have increased birth rates during their teen years in comparison to peers.
Research in California found that among females in foster care at age 17, 11.4% had given birth
at least once before age 18 and 28.1% by age 20. Due to federal laws that have extended foster
care services to non-minor dependents, there may be a growing population of pregnant and
parenting youth under the supervision of child protective services (CPS) in the years to come.
Yet, the number of pregnant and parenting youth in care were not systematically documented by
the child protection system nationally prior to 2016 and little is known about the outcomes of the
offspring.
Although interviews with young parents in foster care indicate they are motivated to
prevent two-generation CPS involvement for their children, the risk may be increased because of
the lack of financial, emotional, social, and parenting support. A study in Illinois found that 39%
of offspring born to parents in care were investigated by age 5. This paper is organized as a
three-study dissertation focused on young mothers in foster care and the two-generation risk of
CPS involvement for their children.
Study 1: Literature Review (Prepared for the Journal of Child and Adolescent Social Work)
All studies related to pregnant and parenting mothers in foster care and their offspring
published between 2011 and 2017 were identified by two reviewers using four search methods.
Studies were included if findings were published by research entities, government agencies, or in
OFFSPRING BORN TO MOTHERS IN CARE Eastman
x
a peer-reviewed journal. These studies provide a strong case for the need for leadership in child
welfare to take on sexual and reproductive health interventions. Findings suggest that efforts that
successfully delay pregnancies among girls in care would be associated with improved outcomes
for both mothers and children. Studies focusing on parents in care detailed the need for
comprehensive supportive services for parents that are tailored to address their unique parenting
experiences and highlighted the resilience of these parents. Key solutions and next steps were
described.
Study 2: Linked, Administrative Data (Prepared for the Journal of Adolescent Health)
Using probabilistically linked birth and CPS records from California, this population-
based study examined all mothers who (1) gave birth before age 21 between 2009 and 2012 and
(2) were in foster care on or after the estimated date of conception. Using a second data linkage,
offspring born to identified mothers were followed for the first 3 years of life to assess CPS
involvement. Between 2009 and 2012, 2,067 offspring born to mothers in foster care were
identified. The data linkages revealed that 52.6% of all offspring experienced a CPS report by
age 3 (n=1,102). Trends over time documented that offspring CPS involvement decreased while
the proportion of mothers remaining in care at older ages increased. A Latent Class Analysis
(LCA) was used to identify 3 distinct classes of mother-child dyads named (1) Non-minor
mothers with long, stable placements, (2) Minor mothers with short placements, and (3) Mothers
with long, unstable placements and mental health conditions. A second LCA included an
offspring CPS report by age 3 as a distal outcome to examine the association between class
membership and the risk of two-generation involvement. Class 1 was the lowest risk for a CPS
report; about a third of offspring were reported by age 3. More than half of offspring were
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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reported in Class 2 and 68% of offspring in Class 3 were reported by age 3. This study was first
to develop profiles of mother-child dyads that vary in the risk of a two-generation CPS
involvement. This work calls attention to the unique service needs that exist for mothers and
offspring and shows that information collected in birth and child welfare records are indicators of
the family’s needs.
Study 3: Content Analysis of Case Records. (Prepared for Children and Youth Services Review)
Building upon the LCA conducted in Study 2, Study 3 leveraged unstructured, case
narrative fields in child welfare records to enhance knowledge about CPS involvement among
offspring born to mothers in care. The unstructured fields contained caseworker narratives and
documentation of young mother’s and offspring’s involvement with CPS, typically due to
allegations of abuse or neglect that spanned years. A content analysis was conducted to assess
reasons described for CPS involvement among offspring who were (1) born to mothers who were
in foster care on or after the estimated date of conception and (2) reported to CPS during the first
3 years of life. Thirteen mother-offspring dyads from each of the 3 classes identified in Study 2
were selected for a detailed examination of mother and child case records (N=39). Content
analysis was selected for this investigation because is a method that organizes data (in the form
of language) into specific and broad concepts (patterns or themes) to enhance understanding of a
phenomenon. The study ensured trustworthiness by extracting large amounts of longitudinal
data, using multiple coders, and by reporting content. The study highlighted the significant life
difficulties mothers in care and their offspring face and also offered hope for success. Results
show that class membership varies based on the mother’s earlier experiences in care and the
reasons for the offspring’s maltreatment report. These findings add substantial depth to the
understanding of factors associated with the maltreatment of offspring born to mothers in foster
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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care and demonstrate the importance of developing two-generation strategies to effectively
address needs of both the mother and child. Members of each class differ from members of the
other classes in a number of important ways. While mothers in all classes have faced significant
stressors, the long-term trajectory is influenced by early and continued support and placement
stability. Although further research is needed to understand what can be done to improve long-
term outcomes, the findings support the need to develop a range of two-generation, trauma-
informed services to target parents in care and their offspring.
Importance
This dissertation extends existing literature by: (1) analyzing the most recent
administrative data for which 3 full years of follow-up are available, (2) conducting person-
centered analyses, and (3) leveraging unstructured data fields. Prior work has documented high
rates of two-generation involvement among children born to mothers in care, but has not yet
examined the rates among non-minor dependents. This study was the first to employ a LCA to
identify classes of mother-child dyads that vary in the risk of a two-generation CPS involvement.
This method incorporates interactions between multiple factors and allows for a holistic
perspective of individual functioning. Finally, this study is the first the first to use unstructured
case notes from child welfare case records to examine maltreatment reporting dynamics among
offspring born to mothers in foster care. The use of CPS case record notes makes this study
particularly powerful as these data have not yet been used to generate qualitative insights that
can accompany population-level quantitative data. The ultimate goal of this research is to present
findings that may be useful when developing policies and programs for a population at high risk
for experiencing child maltreatment in early life.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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CHAPTER 1
Introduction and Rationale
The transition to parenthood is swift, and for many, the adjustment takes time. Many
youths in foster care are transitioning from adolescence to adulthood at the time they are also
becoming parents and ageing out of care (Schelbe, & Geiger, 2016). Despite the difficulties these
youth face, there is limited research concerning mothers in foster care and the outcomes of their
offspring (Connolly, Heifetz, & Bohr, 2012; Geiger & Schelbe, 2014; Lieberman, Bryant,
Boyce, & Beresford, 2014; Schelbe, & Geiger, 2016; Svoboda, Shaw, Barth, & Bright; 2012).
Policy and practice decisions related to parents in care are often made without data (Lieberman,
Bryant, Boyce, & Beresford, 2014). Until very recently, even basic incidence birth rates among
girls in care were unknown and the estimates ranged widely, from 16 to 50% (Svoboda, Shaw,
Barth, & Bright; 2012). The difficulty in measuring the number of pregnant and parenting youth
in foster care has been cited as a major challenge in developing effective pregnancy prevention
programs and policies (Connolly, Heifetz, & Bohr, 2012; Svoboda, Shaw, Barth, & Bright,
2012). Geiger, & Schelbe (2014) echoed the need for information to demonstrate the necessity
for improved programs and policies related to parenting supports. New state and federal laws
require states to document the number of pregnant and parenting youth in care as of 2016 (SB
794, Chapter 425, Statues of 2015; P.L. 113–183, 2014), but knowledge prior to this year is
lacking.
While there is limited empirical literature on parents in care (Svoboda, Shaw, Barth, &
Bright; 2012), even less is known about offspring (Shpiegel, & Cascardi, 2015; Lieberman,
Bryant, Boyce, & Beresford, 2014). This population is challenging to study because acquiring an
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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adequately-sized sample is challenging. Only recently have rigorous, prospective, population-
level analyses based on administrative data emerged to examine the link between an adolescent
mother’s history of maltreatment and an offspring’s risk (Putnam-Hornstein, Cederbaum, King,
Eastman, & Trickett, 2015; Dworsky, 2015). Dworsky (2015) found that among those who gave
birth in Illinois while in care between 2000 and 2008, 39% of offspring were investigated, 17%
were substantiated, and 11% were placed in out of home care by age 5. The study highlights the
importance of improving knowledge related to child protection involvement among offspring
born to parents in foster care.
Newer analyses on mothers in care and their children are particularly important given
recent policy changes that have increased the age limit for youth in care (Finigan-Carr, Murray,
O'Connor, Rushovich, Dixon & Barth (2015). The Federal Fostering Connections to Success Act
encourages states to adopt a policy which allows foster youth to access extended foster care
services until age 21, under certain circumstances (Pub. Law No. 110-351, 122 Stat. 3949, 2008).
In 2011, California was among the first states to adopt the federal option to extend foster care
services for non-minor dependents (Assembly Bill 212, Chapter 259 of 2011). As a result, a large
proportion of youth who were in care at age 17 are remaining in care as non-minor dependents.
In California, 67% of youth in child welfare supervised foster care at age 17 were still in care at
age 19 in 2012 (post-policy implementation) (Eastman, Putnam-Hornstein, Magruder, Mitchell,
& Courtney, 2016). One consequence of this change is that there may be a growing population of
pregnant and parenting youth under child protection supervision in states where these policies
have been adopted (Putnam-Hornstein, Hammond, Eastman, McCroskey, Webster, 2015).
Longitudinal data have not been used to assess the rate of parenthood among non-minor
dependents in care (Shpiegel, & Cascard, 2015).
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Schelbe & Geiger’s 2016 ethnography, which followed parents ageing-out of care and
their children, highlighted the heterogeneity in the population. Unfortunately, this diversity in
characteristics and service needs has not been reflected in research, policies, or practice.
Research examining youth in care (or exiting from care) have shifted away from a “one-size fits-
all” approach and have focused on examining the needs of vulnerable subpopulations (Courtney,
Hook, & Lee, 2012; Courtney, Hook, & Lee, 2012; Keller, Cusick, & Courtney; 2007; Shpiegel
& Ocasio 2015; Yates and Grey 2012). Variable-oriented approaches (such as regression
techniques) examine how specific variables relate to outcomes, but fail to capture the
multidimensional nature of the youths’ functioning (Keller, Cusick, & Courtney; 2007). Person-
oriented approaches (such as Latent Class Analysis, “LCA”) aim to address this weakness. LCA
is based on the assumption that no factor can be understood in isolation and should be considered
in light of relationships with other factors and domains (Courtney, Hook, & Lee, 2012). The
findings of person-centered analyses can be helpful when matching youth to services based on
need. Identifying classes of offspring at risk for a second generation maltreatment allegation can
inform program and policy development, especially for those at greatest risk for two-generation
CPS involvement. By identifying groups whose needs are dissimilar, a plan for distinct sets of
services can be developed (Keller, Cusick, & Courtney; 2007). Person-oriented analyses have
not yet been used to examine mothers in care and their children.
There is also a need to explore new data sources to enhance understanding about mothers
in foster care and their offspring. Knowledge about parents in care and two-generation CPS
involvement has been gleaned from structured fields in child welfare case records (Dworsky,
2015; Dworksy & DeCoursey, 2009; Eastman, Palmer, Hammond, Putnam-Hornstein, in
progress) or through interviews and observation with families (Aparicio, Pecukonis, & ONeale,
OFFSPRING BORN TO MOTHERS IN CARE Eastman
4
2015; Schelbe, & Geiger, 2016). Administrative data are used to describe large populations, but
often lack depth. Meanwhile, interviews and observational data can generate rich insights, but
these studies tend to be costly and difficult due to sensitivities with accessing child protection
populations. Generalizability is also limited. To date, no studies have examined the unstructured
fields of child welfare case records, which may contain useful information about the context
within which the maltreatment reports are made and the family’s needs and protective factors.
Case records reflect the official documentation of an individual’s contact with CPS, typically due
to allegations of abuse or neglect. California’s case records include information about the reason
for the report, court activities, factors contributing to removal decisions, and services offered.
Building on earlier administrative analyses from California and the Midwest, this
dissertation leveraged linked, administrative birth and child welfare records to develop new
knowledge about children born to young mothers in foster care, including two-generation risk of
CPS involvement. A literature review and mixed-method design were conducted, using both
structured and unstructured fields in child protection administrative records. The research
questions addressed and statistical methods used in this three study dissertation are as follows:
Study 1 What have recent studies documented about pregnant and parenting youth in foster
care and their offspring? (Literature Review)
Study 2 (a) How many offspring were born to mothers in California’s foster care system
between 2009 and 2012? (Descriptive Statistics)
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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(b) Among offspring born to mothers who were in care on or after the estimated date of
conception, what is the rate of CPS involvement for offspring during the first 3 years
of life? (Descriptive Statistics)
(c) What sociodemographic, birth, and maternal foster care case characteristics are
associated with two-generation risk of CPS involvement during the first 3 years of
life for the offspring? (Bivariate Statistics)
(d) Can distinct classes of offspring be identified? If so, what is the makeup of these
classes? Do they vary in their risk of two-generation CPS involvement? (Latent Class
Analysis)
Study 3 What information can be gleaned from CPS case records concerning the nature of
the offspring’s CPS report, the family’s risks and resiliencies, and any documented service
provision? (Content Analysis)
The overall aim of this dissertation research was to enhance understanding about two-
generation CPS involvement among offspring born to mothers in foster care, an understudied and
high-risk population. This dissertation builds upon existing literature in three significant ways.
First, the systematic literature review and analysis of linked, administrative data was the most
recent examinations conducted on this topic. This work is timely given the growing interest in
rigorous research and national policies related to parents in care and offspring. The analyses used
the most recent birth cohorts for which 3 full years of CPS follow-up are available (e.g., through
2016). The recency of the data used for the current investigation allow for an assessment of CPS
involvement among offspring born to mothers who remain in care as non-minor dependents pre
and post-implementation of the Fostering Connections to Success Act. Second, this dissertation
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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research is the first to employ LCA (a person-centered approach) to develop multi-dimensional
profiles of mother-child dyads, documenting varying risk of two-generation CPS involvement
based on factors known at birth. This method incorporates interactions between multiple factors
and allows for a holistic perspective of individual functioning. Finally, this study is the first the
first to use unstructured notes from child welfare case records to examine maltreatment reporting
dynamics among offspring born to mothers in foster care. Case records of children born to
mothers in foster care had not yet been examined and this source contains information useful for
informing policy and practice aiming to reduce the risk of two-generation CPS involvement in
the future. Given that this investigation is the first to use LCA as an analytic technique, alongside
case record notes to enhance knowledge about two-generation maltreatment, the third study is
exploratory in nature and specific hypotheses were not proposed. The ultimate goal of this
research is to present findings useful to developing policies and programs for a population at
high risk for experiencing child maltreatment in early life.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Background
Pregnant and Parenting Youth in Care
Nationally, the rate of teen pregnancies dropped significantly over the past quarter
century and currently stands at a historic low (Hamilton, & Mathews, (2016). However, there are
still adolescent subgroups at increased risk for early parenthood. Child abuse has been correlated
with adolescent pregnancy (Stevens-Simon et al., 1994; Boyer & Fine., 1992). Specifically,
sexual abuse during childhood doubles the likelihood that a youth will experience pregnancy in
adolescence (Young, 2010). Girls who have been maltreated are more than two times as likely to
become adolescent mothers compared to peers without a history of child abuse or neglect (Noll
& Shenk, 2013).
Research has consistently found that early pregnancy is more common among girls in
foster care or those who recently exited from care in comparison to their peers (Boonstra, 2011;
Connolly, Heifetz, & Bohr, 2012; Carpenter, Clyman, Davidson, Steiner, 2001; Svoboda, Shaw,
Barth & Bright, 2012; Dworsky & Courtney, 2010; Putnam-Hornstein, & King, 2014; Turpel-
Lafond, & Kendall, 2009). Research in the Midwest found that among females in an out-of-home
placement at age 17, half reported having experienced a pregnancy by age 19 (Dworsky &
Courtney 2010) and 71% by age 21 (Courtney, Dworsky, Cusick, Havlicek, Perez, & Keller,
2007). In contrast, only one third of women in the comparison group of peers had been pregnant
by age 21. Repeat pregnancies are also common among young mothers in foster care. The
Midwest Study found that an estimated 46.4% of females who had been in care at age 17 had
experienced a repeat pregnancy by age 19 (Dworsky & Courtney 2010) and 62% by age 21
(Courtney et al., 2007).
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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As a result, many youths with a history in foster care are parents in young adulthood.
Using a national sample, Shpiegel, Cascardi, & Dineen, (2016) found that among young women
emancipating from foster care, 21% had given birth by age 19. Research in California examining
birth rates found that among females in foster care at age 17, 11.4% had given birth at least once
before age 18 and 35.2% had given birth before age 21 (Putnam-Hornstein, Hammond, Eastman,
McCroskey, Webster, 2016). One study found that a little more than half of girls who were in
foster care the year they gave birth were pregnant before entering the out of home placement
(King, Putnam-Hornstein, Cederbaum, & Needell, 2015). In Maryland in 2008 there were 92.7
births per 1,000 girls in out of home care, almost three times higher than the birth rate for girls in
the general Maryland population (Shaw, Barth, Svoboda, & Naeem; 2010). Half of the young
women from the Midwest Study were parents by age 21 (Courtney et al., 2007). Factors
associated with an increased risk of childbirth include being a person of color, placement in a
relative foster home, a history of running away from care, emancipation from foster care by age
19, and a history of incarceration (Shpiegel, Cascardi, & Dineen, 2016). Being enrolled in school
and employment were negatively associated with the risk of early pregnancy and parenting.
Early parenthood places stress on both the mother and child. Adolescent mothers have
increased rates of mental health disorders, low educational achievement, usage of welfare, low
workforce participation, and being low income in comparison to older mothers (Boden,
Fergusson, & John Horwood, 2008; Beers & Hollo, 2009). Meanwhile, in comparison to peers
with older mothers, children born to young mothers are at increased risk for substance use, gang
membership, unemployment, early parenthood (Pogarsky, Thornberry, Lizotte, 2006), childhood
death, hospitalizations, lower academic achievement, and poor social outcomes (Jutte, 2010).
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Importantly, early motherhood is associated with an increased risk of child abuse and neglect for
the offspring (Noll, 2009, Dixon, et al., 2005).
The stress of early parenthood is compounded by the difficulties youth in care face.
Youth in foster care have a higher risk of victimization and internalizing and externalizing
behaviors in comparison to peers (Coleman-Cowger, Green, & Clark, 2011; Oswald, Heil, &
Goldbeck, 2010). More than half of youth in care meet the criteria for at least one mental health
diagnosis (Taussig & Culhane, 2010). Older youth in care are at risk of ageing-out of care, a time
when a time when a sizeable proportion may become parents. Youth who age-out of care face
economic hardship, housing instability, employment difficulties, low educational attainment, and
increased risk for drug or alcohol issues (Courtney et al., 2007).
Despite the stressors these youth face, a number of reasons youth in care are motivated to
become parents have been identified (Svoboda et al, 2012; Connolly, Heifetz, & Bohr; 2012).
These youths choose to become parents because they want to have a family, maintain a romantic
relationship, become a parent that is different from their own, have something that belongs to
them, and fill an emotional void. Interviews with parents suggests that motherhood can be a
healing experience for youth in care (Aparicio, Pecukonis, & ONeale, 2015). Radey et al. (2016)
reported that providers felt youth became pregnant in order to access services that they would
otherwise be ineligible to obtain.
While some youth hope to become parents, other factors associated with placement in
care are related to the increased rate of pregnancies and births. Courtney et al. (2012)
interviewed former foster youth and among those who had been pregnant, about a third reported
that they definitely did not want to have a baby, about a quarter reported that they definitely
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wanted to have a baby, and over a quarter said that they neither wanted nor did not want to have
a baby. A review of the literature identified challenges in reducing the rates of pregnancy among
youth in foster care such as difficulties discussing sexual activities (due to potentially strained
relationships with biological and foster parents), disruptions in placements (which may hamper
social support and be detrimental to relationships with adults who may provide reproductive
guidance), heavy caseworker caseloads (which may limit time to address clients’ reproductive
needs), and lack of consensus in the field about who should provide sexual education (Manlove,
Welti, McCoy-Roth, Berger, & Malm, 2011). Svoboda, Shaw, Barth, & Bright (2012) found lack
of social support from caring adults, which was related to access to reproductive health and
information, was associated with increased risk for pregnancy and parenthood while in care.
While not all parents in care are planning to become parents, interviews suggest that
mothers are committed to being good parents and benefit from parenthood (Radey, Schelbe,
McWey, Holtrop, & Canto 2016; Schelbe & Geiger’s 2016). Specifically, parents hoped their
children would have a better life than they had (Schelbe & Geiger’s 2016), reported a desire to
be a good role model (Schelbe & Geiger’s 2016), and wanted to develop parenting skills (Radey
et al., 2016). Schelbe & Geiger found youth were proud to be parents even when the pregnancy
was unintended (2016). Parents felt more responsible and were inspired to continue education,
get off public assistance, and move to safer neighborhoods. They expressed love and enjoyment
of their children and parenthood and reported that their children were a source of happiness.
Importantly, parents expressed fear of child protection system involvement and a desire to end
the cycle of maltreatment and foster care placement (Aparicio, 2016; Aparicio, Pecukonis, &
ONeale, 2015; Schelbe & Geiger’s 2016; Connolly et al., 2012).
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Although youth with a history of foster care placements are motivated to prevent two-
generation CPS involvement, the risk of may be increased because of the lack of financial,
emotional, social and parenting support. Research suggests single mothers who are ageing out of
care are “struggling to survive” (Schelbe & Geiger’s 2016, p. 61; Connelly et al, 2012; Courtney
et al., 2012; Radey et al., 2016). In large numbers, parents lived in poverty (Aparicio, Pecukonis,
& ONeale, 2015; Schelbe & Geiger, 2016), relied on welfare (Schelbe & Geiger, 2016; Courtney
et al., 2016; Radey et al., 2016), experienced unemployment (Schelbe & Geiger, 2016), and had
unstable housing (Connolly, Heifetz, & Bohr, 2012; Schelbe & Geiger, 2016). Relatedly, an
overwhelming number of parents did not have reliable and safe child care (Schelbe & Geiger,
2016). Even parents who had more than one job struggled to purchase basic child necessities
(Schelbe & Geiger, 2016; Radey et al., 2016). They faced additional emotional challenges in
comparison to older mother or mothers not in care (Connolly, Heifetz, & Bohr, 2012; Lieberman,
Bryant & Boyce; 2015, Svoboda, Shaw, Barth, & Bright, 2012). A retrospective examination of
youth in care found that adolescents who reported higher internal mental distress were more
likely to report a past pregnancy (Coleman-Cowger, Green, & Clark, 2011). Of great concern is
the dearth social support available to mothers in care (Connolly, Heifetz, & Bohr, 2012; Radey et
al., 2016; Schelbe & Geiger, 2016). Parents in foster care reported feelings of abandonment both
by their biological families and by the child protection system (Connolly, Heifetz, & Bohr,
2012). Due to conflicts within the parent’s family of origin that lead to child protection
involvement, many mothers in care have not witnessed healthy and nurturing family
environments (Connolly, Heifetz, & Bohr, 2012). Many mothers were single parents who did not
have help from the baby’s father (Schelbe & Geiger’s 2016; Connolly et al, 2012; Radey et al.,
2016) and youth reported having conflict with the child’s other parent (Schelbe & Geiger’s
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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2016). Parents transitioning out of care had limited parenting skills and knowledge about child
care (Radey et al., 2016; Schelbe & Geiger 2016, Svoboda, Shaw, Barth, & Bright (2012). Many
felt unprepared to be parents (Schelbe & Geiger, 2016).
Intergenerational Risk for Maltreatment
In light of these findings, concerns have long been raised about the risk of maltreatment
among children with parents in foster care (Shpiegel, & Cascardi, 2015; Radey et al., 2016).
Intergenerational maltreatment has been the subject of research for decades (Dixon, Browne, &
Hamilton-Giachritsis, 2005; Egeland, Jacobvitz, & Papatola, 1987; Hunter & Kilstrom, 1979;
Korbin, Anetzberger, & Austin, 1995; Leifer, Kilbane, Jacobsen, & Grossman, 2004; Widom,
Czaja, & DuMont, 2015). The integrational transmission hypothesis suggests that an individual
who experiences maltreatment in childhood will be more likely to maltreat their offspring
(Schelbe, & Geiger, 2017; Widom, Czaja, & DuMont, 2015). A review of the literature by
Thornberry, Knight, & Lovegrove (2012) suggests that much of the research has not been
rigorous enough to link a history of maltreatment to two-generation CPS involvement. There is
still much to learn about the transmission of maltreatment across generations (McCloskey, 2017;
Schelbe, & Geiger, 2017). Researchers have often used different measures and definitions of
child abuse and neglect, small samples, and uncontrolled cross-sectional, retrospective methods.
It is clear that the intergenerational transmission of maltreatment is a complex process and is
impacted by many risk and protective factors (McCloskey, 2017). Numerous risk factors have
been identified including early parenting, parent mental health or substance abuse, and social
isolation, among others (Schelbe, & Geiger, 2017). Research suggests these factors are related
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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and co-occur, however little research has examined the interactions between multiple risk factors
(Schelbe, & Geiger, 2017; Institute of Medicine and National Resource Council 2014).
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Theoretical Framework
The Life Couse Theory
This dissertation research is guided by the life course perspective, which provides a
useful frame for the current studies given the use of longitudinal, administrative data sources.
Administrative data refer to information that is generated through normal agency operations.
Digital data are produced and can be used to track outcomes, examine the effect of programs,
and answer policy relevant questions. Record linkage of multiple administrative data resources
can augment knowledge found in one source. When data from multiple agencies are assembled
longitudinally the person can be examined over time.
The present investigation expands knowledge about the conditions related to two-
generation CPS involvement among offspring born to mothers in foster care. Few studies have
examined this (Dworsky, 2015 is an exception) and this dissertation is the first to study reasons
for maltreatment reports using unstructured case record data. The Life Course Theory provides
an organizing framework for this work. This Theory provides a temporal approach which
explains lives longitudinally and explores the relationship between social structures and the
effect time, place and history have on an individual’s trajectory (Giele & Elder, 1998). The
Theory has five key principles: (1) time and place, (2) life-span development, (3) timing, (4)
agency, and (5) linked lives. “Time and place” refers to the way lives are shaped by an
individual’s place in time and location, factors related to the specific culture. “Life span
development” suggests that individual develop in biological, social, and psychological ways as
they age. “Timing” refers to the order in which life events occur. “Agency” suggests individuals
make decisions that alter the life course and these decisions are influenced by the other key
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principles. The concept of “linked lives” suggests that social relationships influence individuals
and their life course development. For example, social relationships such as family members,
friends, and community members shape how individuals view their life events. The theory also
suggests that individuals accumulate advantages and disadvantages over the life course. Negative
life events, such as childhood trauma or family dysfunction can have long-term developmental
ramifications. Similarly, early, off-time transitions, such as an early child birth or being forced to
exit the foster care system due to age, can compound adversity and threaten functioning.
Family Life Course Theory
The Family Life Course Theory builds upon the Life Course Theory and helps explain
high rates of CPS involvement among offspring born to girls and young women in foster care.
Specifically, how the child’s risk is associated with factors, such as the mother’s experiences in
foster care. Bengtson & Allen (2009) applied the life course perspective and family development
theory to family structure and relationships. This framing allows for the examination of families
over time. They theorized that the family is a social group that provides its members with
meaning to events over time, therefore, the perceptions of its members can be passed on through
the linage. This thought gave birth to the concept “Family Life Course” where family behaviors
are passed across generations. In line with the Life Course Perspective, the Family Life Course
Theory indicates that these advantages or disadvantages may be transmitted across generations.
When applied to the current study, offspring born to mothers in care who had more adverse
experiences in out-of-home placements (e.g., as indicated by multiple placements), fewer
resources (e.g., as indicated by late prenatal care, or precocious transitions (e.g., as indicated by
young maternal age), may be at increased risk for two-generation CPS involvement.
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Two-Generation Theory of Change
Advances in Developmental Neuroscience, Social Learning Theory, Attachment Theory,
and Developmental-Psychoanalytic Perspectives can be leveraged to develop two-generation
models for service delivery (Shonkoff & Fisher, 2013). The Two-Generation Theory of Change
focuses on enhancing the developmental potential for both parent and child (Ascend of the
Aspen Institute, 2016). Two-generation approaches are rarely implemented but they provide
opportunities to meet the needs of the child and the parents together. Ascend at the Aspen
Institute suggests two-generation strategies should build education, economic assets, social
capital, and health and well-being to pass from one generation to the next (2016) The key
components of a two-generation logic model includes (1) opportunities to provide
complementary activities for parent and child which produce positive outcomes for each; (2)
service delivery models with mutually reinforcing activities, such as parent skill building classes
that enhance child academic achievement; and (3) services that result in improved outcomes
even after the program has ended. Currently, service delivery systems are constructed to offer
services for the primary client, either the mother or child (or another caregiver), and delivery is
not orchestrated for the mother-child dyad. The current study examines the mother-child dyad as
a unit and will illuminate ways to address whole family needs.
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Dissertation Structure
This dissertation develops new knowledge about children born to young mothers in foster
care, including two-generation risk of CPS involvement. A literature review and mixed-method
design are used that pull from both structured and unstructured fields in administrative records.
This dissertation has been organized as a three study project with 5 chapters as described below:
Chapter 1 provides an overview of the dissertation and details of each Chapter.
Chapter 2 presents a literature review of pregnant and parenting mothers in foster care
and their offspring (Study 1). Key findings and recommendations of identified articles are
summarized, research designs noted, common themes identified, and implications for future
research described.
Chapter 3 consists of an epidemiological analysis of two-generation CPS involvement
among offspring born to mothers in foster care (Study2). Birth records from California (2009–
2012) were used to identify all mothers younger than 21 at the time of birth. These records were
then probabilistically linked to CPS records to identify mothers who were in foster care on or
after the estimated date of conception. Babies born to mothers in care were then followed
prospectively through age 3 years to calculate rates of CPS involvement. The analysis examines
factors associated with two-generation CPS involvement and identifies distinct classes of
mother-child dyads at varying levels of risk. Data were analyzed using χ2 tests, generalized
linear models, and Latent Class Analysis (LCA).
Chapter 4 summarized findings from a content analysis of selected case records (Study
3). Case records are documentation of an individual’s contact with CPS, typically due to
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allegations of abuse or neglect. The results describe reasons described for CPS involvement
among offspring who were (1) born to mothers who in foster care on or after the estimated date
of conception and (2) reported to CPS in the first three years of life. The nature of the offspring's
CPS report, the family's identified risks or protective factors, and any documented service
provision before or immediately after the report were detailed.
Chapter 5 summarizes all chapters and details the implications for pregnant and parenting
mothers in foster care and their offspring.
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CHAPTER 2 (Study 1)
A Literature Review: Pregnant and Parenting Youth in Care and Their Offspring
Authors: Andrea Lane Eastman, Lindsey Palmer & Eunhye Ahn
Prepared for the Journal of Child and Adolescent Social Work
Introduction
In recent decades the national teen pregnancy rate has dropped significantly (Hamilton, &
Mathews, 2016), however, specific adolescent subgroups remain at an increased risk of
adolescent parenthood. Children who have been maltreated are at increased risk for adolescent
pregnancy (Boyer et al., 1992; Stevens-Simon et al., 1994). Not only is maltreatment history a
risk factor, but research has consistently found that early pregnancy is more common among
girls in foster care and those who recently exited from care in comparison to their peers
(Boonstra, 2011; Carpenter, Clyman, Davidson, Steiner, 2001; Connolly, Heifetz, & Bohr, 2012;
Dworsky & Courtney, 2010; Putnam-Hornstein, & King, 2014; Svoboda, Shaw, Barth & Bright,
2012; Turpel-Lafond, & Kendall, 2009). Research in the Midwest found that among females in
an out-of-home placement at age 17, half reported experiencing a pregnancy by age 19 (Dworsky
& Courtney 2010) and 71% by age 21 (Courtney, Dworsky, Cusick, Havlicek, Perez, & Keller,
2007). In contrast, a third of women in the comparison group had been pregnant by age 21.
The stress of early parenthood is compounded by the difficulties faced by youth in care.
Youth in foster care have a higher risk of victimization and internalizing and externalizing
behaviors in comparison to peers (Coleman-Cowger, Green, & Clark, 2011; Oswald, Heil, &
Goldbeck, 2010). More than half of youth in care meet the criteria for at least one mental health
diagnosis (Taussig & Culhane, 2010). Older youth in care are at risk of ageing-out of care, at a
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time when a sizeable proportion may become parents. Youth who age-out of care face economic
hardship, housing instability, employment difficulties, low educational attainment, and increased
risk for drug or alcohol issues (Courtney et al., 2007).
Svoboda, Shaw, Barth and Bright (2012) and Connolly, Heifetz and Bohr (2012)
conducted the most recent literature reviews of pregnant and parenting youth in foster care,
examining research through 2010. Svoboda, Shaw, Barth and Bright (2012) identified the
quantitative and qualitative research published between 1989 and 2010 related to pregnant and
parenting girls in CPS and summarized key findings and recommendations. They identified
similar themes across studies related to (1) barriers and opportunities, (2) mental and physical
health needs of youth, (3) influences of trauma on sexual development, (4) risks due to lack of
financial supports, and (5) the disruption of relationships and living environments for youth in
foster care. The authors noted a wide range in the estimated rate of pregnancy among young
women in foster care from 16 to 50%. In addition, identified studies highlighted the lack of data
collection related to pregnant and parenting youth in care and sufficient pregnancy prevention
policies for youth in care.
Connolly, Heifetz and Bohr (2012) conducted a metasynthesis of qualitative studies
published between 2000 and 2010 relating to pregnant and parenting mothers with CPS contact.
They identified risk, protective factors, and resiliencies that characterize the mothers in foster
care. Seven themes were identified falling into these three categories. Themes associated with
risks included (1) offspring and parenthood filling an emotional void, (2) inconsistent education
(academic and sexual), (3) maternal adversities (financial needs, low social support, mental
health issues, instable housing), and (4) system distrust due to stigma (e.g. fear of judgement by
social workers or being labeled “at risk” which leads to reluctance to ask for support and share
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needs). Support in the form of financial assistance and social connections was protective and led
to improved outcomes for the mother. For example, mothers who felt that pregnancy and
parenting was a positive experience had financial support and social support with a romantic
partner, family member, or social worker. Two resiliency themes identified were described as (1)
mothers who felt that motherhood was positive and stabilizing and (2) mothers who felt a sense
of achievement and who were motivated to “do better” due to parenthood. These mothers
assumed a sense of purpose, responsibility, and enjoyment after becoming parents, which led to
fewer unhealthy behaviors and motivation to provide a better life for their children.
The current investigation builds upon the work of both Svoboda, Shaw, Barth and Bright
(2012) and Connolly, Heifetz and Bohr (2012). While a number of studies were identified by
Svoboda, Shaw, Barth and Bright (2012) and Connolly, Heifetz and Bohr (2012), many were
based on small convenience samples. Both reviews noted the lack of knowledge about the
incidence of pregnant and parenting youth and suggested that pregnancy prevention efforts
would be more effective in the context of improved understanding about this at-risk population.
The present analysis mirrors the review by Svoboda, Shaw, Barth and Bright (2012) and
summarizes newer research (published in 2011-2017) related to the risk, outcomes, and needs of
pregnant and parenting mothers in foster care and their offspring. This review excludes research
related to sexual health outcomes and sexual risk behaviors because it was covered recently by
Winter, Brandon-Friedman and Ely (2016). A review of the research allows for a deeper
understanding regarding pregnant and parenting youth in care, important next steps for policy
and practice, and directions for future work.
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Methods
Two researchers employed four search methods to identify studies related to pregnant and
parenting youth in foster care. First, electronic databases were searched to identify empirical
articles. Searched databases included Google Scholar, PubMed, Online Contents, Picarta, ERIC,
PsychInfo and Web of Science. Search terms were selected based on the relevance to the
population of pregnant/young mothers and included: adolescent/young/youth/teen/teenage and
pregnancy/mothers/parents. Words indicating foster care placement such as foster/out-of-home
care, child welfare/protection and child protective services were added. Specific keywords such
as baby, child and offspring were tested, as well. Two researchers conducted the same searches
of electronic databases to ensure all studies were identified.
Each time an article showed up as a match, the Google Scholar search tools “related
articles” and “cited by” were used. Citations in relevant studies were then reviewed to determine
if any referenced articles fit the search parameters. Building off the work by Svoboda, Shaw,
Barth, and Bright (2012), the current investigation extends their research and reviewed studies
published in 2011 through 2017. Studies were included if findings were published by research
entities, government agencies, or in a peer-reviewed journal and related to mothers in foster care
or their offspring. Because of differences in international child protection practices, only those
studies using US data were included. If multiple studies used the same dataset, only the most
relevant study was included. 73 studies were reviewed and 18 methodologically diverse
manuscripts were included in the present analysis. Table 1 includes the studies identified, a
description of the population, and a summary of key findings relevant to pregnant and parenting
youth in care. A description of each paper, common themes and identified solutions are detailed.
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Results
Pregnancy Rates
Interviews with youth, national surveys, and linked administrative data were used to
document high rate of early pregnancy and parenthood among youth in care. Interviews with
former foster youth suggest about half of these young women had been pregnant in early
adulthood and a quarter had given birth. One hundred women and 115 men with a history in
foster care were interviewed about pregnancy and parenthood (Combs, Begun, Rinehart, &
Taussig, 2017). Forty-nine percent of the women reported having been pregnant and 33% of men
reported getting someone pregnant by age 21. A quarter became parents. The CalYOUTH study
followed 611 youth in foster care and interviewed the sample at age 19 (Courtney, Opych,
Charles, Mikell, Stevenson, Park, & Okpych, 2016). Almost half of females had ever been
pregnant by age 19 and over a quarter reported giving birth. Sixteen percent had been pregnant
twice. Oshima, Narendorf and McMillen (2013) interviewed transition-aged youth in foster care
and found by age 19, more than half of females had been pregnant and nearly a quarter of males
had fathered a child. Zhan, Smith, Warner, North, Wilhelm and Nowak, (2017) examined
younger youth and found lower rates of pregnancy. A cross sectional study was conducted by
administering a survey to 113 adolescents (age 13-18) and found 9% of adolescents in foster
family homes reported that they had ever been pregnant or gotten someone pregnant.
Studies using national databases to estimate the incidence of births were fairly consistent.
An examination using data from the National Youth in Transition Database and Adoption and
Foster Care Analysis and Reporting System found that among females emancipating from care
21% had given birth by age 19 (Shpiegel, Cascardi, & Dineen, 2016). Research in California
based on linked birth and child welfare records has examined birth rates among foster youth.
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King and Van Wert (2017) identified all girls in California who spent time in foster care after
their 10th birthday (N=30,339) who also gave birth between 1999 and 2010. They found 18%
(n=5,567) had an adolescent birth. Putnam-Hornstein, Hammond, Eastman, McCroskey, and
Webster (2016) built upon this study by following youth though age 21. They identified all
females who were in foster care at age 17 between 2003 and 2007 and found 19.0% had given
birth at least once before age 19 and 35.2% had given birth before age 21. These findings were
slightly lower than what was reported by youth in interviews.
Risk Factors Associated with Pregnancy and Childbirth
Risks associated with pregnancy and childbirth among youth in care were examined in a
number of studies. King and Van Wert (2017) found that girls with Latina, Black or Native
American race/ethnicity, and those with a history of running away from care were at greatest risk
for pregnancy. Placement in a nonrelative foster home or congregate care predicted higher birth
rates compared with girls living with kin, a guardian, or in another arrangement. Other studies
found a runaway history (Shpiegel, Cascardi, & Dineen, 2016; Zhan, Smith, Warner, North,
Wilhelm, & Nowak, 2017) and being a person of color (Combs, Begun, Rinehart, & Taussig,
2017; Shpiegel, Cascardi, & Dineen, 2016) were associated with both pregnancy or childbirth.
In contrast to the King and Van Wert (2017) study, Shpiegel, Cascardi and Dineen (2016) found
placement in a relative foster home was associated with an increased risk of childbirth in
comparison to non-relative foster homes, as were emancipation from foster care and a history of
incarceration. Oshima, Narendorf and McMillen (2013) examined factors associated with
pregnancy risk among youth transitioning out of foster care and found few factors were uniquely
associated with pregnancy risk as the risk for all youth was high. For females, early sexual
intercourse and history of delinquency were associated with increased risk. Coleman-Cowger,
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Green and Clark (2011) used pooled data from 13 adolescent and adult substance abuse
treatment programs offered across the United States (n=12,124). Among these youth, 366 had
been in foster care in the past year. Youth were asked if they had ever been/gotten someone
pregnant. Results showed that youth who had been in care in the past year were at increased risk
for becoming/getting someone pregnant (p<.001) and higher internal mental distress was
associated with past pregnancy. Milbrook (2012) hypothesized that a lack of stable adult
relationships presented as a risk for repeat pregnancies among teen mothers. Results indicated a
correlation between teen mothers that had a subsequent teen pregnancy and greater instability in
placements, schools, and case managers. Findings from a study by Leve, Kerr and Harold (2013)
suggest interventions can influence pregnancy rates among girls in care. They conducted a
randomized control trial to compare the effects of Multidimensional Treatment Foster Care
(MTFC) relative to group care (GC) on adolescent pregnancy and found that significantly fewer
pregnancies were reported in the 2-year follow-up for girls in the treatment group.
Risks Associated with Early Parenthood
These findings are welcome given that studies found that becoming a parent in early
adulthood is associated with negative outcomes for the parent. Combs, Begun, Rinehart, and
Taussig (2017) found that adolescent parenthood was associated with lower educational
attainment, less employment (for women only), homelessness, and decreased likelihood to
having a checking or savings account. Dworsky & Gitlow (2017) interviewed 45 parents who
had recently emancipated from care and found parents were not immune to the generally poor
outcomes observed for youth after exiting care and found parents were often unemployed and
had unstable work histories. There was a relationship between poor employment outcomes and
younger age at first birth, African-American ethnicity, runaway history, and past criminal justice
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system involvement. Courtney, Hook, & Lee (2012) conducted a latent class analysis of former
foster youth and one class emerged as “Struggling parents.” They stated, “We refer to this group
as Struggling Parents because it appears that their experience is dominated by their parenting,
often under very difficult circumstances.” (p.414). This subgroup was largely parents (98%) who
had low educational attainment and employment, used government benefits and had the lowest
level of social support and high institutionalization.
Identified Needs for Parents
Schelbe and Geiger (2016) and Radey et al. (2016) interviewed parents aging out of care
and found they lacked financial, emotional, social and parenting support. Parents in both studies
reported they often relied on welfare, experienced unemployment, had unstable housing and
needed reliable and safe child care. Even parents who worked struggled to purchase basic child
necessities. They faced additional emotional challenges in comparison to older mothers or
mothers not in care. Of great concern was the lack of social support. Many mothers are single
parents who did not have help from the baby’s father (Schelbe & Geiger’s 2016; Radey et al.,
2016) and youth reported having conflict with the child’s other parent (Schelbe & Geiger’s
2016). Parents transitioning out of care had limited parenting skills and knowledge about child
development (Schelbe & Geiger’s 2016; Radey et al., 2016) and many felt unprepared to be
parents (Schelbe & Geiger, 2016).
Narendorf, Munson and Levingston (2013) identified a positive and negative
bidirectional relationship between parenting and mental health for former foster youth. Parents
experienced increased symptoms because they stopped medication during pregnancy, had
postpartum depression, and were frequently stressed by their child’s needs. However, parents
were also motivated to take psychotropic medication so they could parent better and found that
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interacting with their children made them happy. These parents found that access to mental
health services helped them connect with parenting supports. While these parents identified
barriers to services such as having time and hours of availability but they reported that they
became a better parent because of the mental health counseling.
Identified Parent Resiliencies
Despite articles overwhelmingly focusing on the negative aspects of early parenting
among foster youth, interviews suggest that young mothers are committed to being good parents
and may benefit from the transition into parenthood (Radey, Schelbe, McWey, Holtrop, & Canto
2016; Schelbe & Geiger’s 2016). For example, parents hoped their children would have a better
life than they had (Schelbe & Geiger’s 2016), reported a desire to be a good role model (Schelbe
& Geiger’s 2016), and expressed the need for improving parenting skills (Radey et al., 2016).
Schelbe and Geiger (2016) found youth were proud to be parents even when the pregnancy was
unintended. Parents felt more responsible and were inspired to continue education, get off public
assistance, and move to safer neighborhoods. They expressed enjoyment and love for their
children and parenthood and reported that their children were a source of happiness. Parents
expressed fear of child protection system involvement and a desire to end the cycle of
maltreatment (Aparicio, 2016; Radey et al., 2016; Schelbe & Geiger, 2016).
Offspring Outcomes
Although offspring may be at increased risk for maltreatment and next generation child
welfare involvement, little research focuses on the offspring. The CalYOUTH study found that
among parents interviewed who were 19 year-old former (and sometimes current foster youth),
89% of young women and 43% of young men lived with their children at the time of the
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interview (Courtney et al., 2016). More than a third of females reported living with the other
parent. Mothers who did not live with their child reported seeing the child a few times a month.
Approximately 40% of children who were not living with their mothers were living with
adoptive or foster parents. Fifteen percent of offspring were wards of dependency court.
Similarly, Combs, Begun, Rinehart, and Taussig (2017) found that 84% of mothers and 45% of
fathers with a history in care lived with their children full or part time. Using Illinois state
administrative data, Dworsky (2015) documented CPS involvement among offspring and found
39% of the children were investigated by CPS, 17% had a substantiated report and 11% were
placed in out of home care before age 5. Nearly one-third of children were investigated while
their parent was in care, and 14% of the children whose parent had exited care were investigated
after the parent’s exit from care. Factors associated with increased risk for two-generation
involvement include younger maternal age at birth, for mothers in care (as compared to fathers),
parental placement instability, and shorter stays in care. Leve, Kerr, & Harold (2013) also
examined child welfare involvement among parents, comparing girls who were given
Multidimensional Treatment Foster Care (MTFC) to girls placed in group care and did not find a
significant difference in the risk of two-generation involvement. However, the treatment
significantly delayed pregnancy and early pregnancy.
Discussion
There has been significantly more research on pregnant and parenting youth in foster care
since Svoboda, Shaw, Barth, & Bright (2012) conducted their review of the literature. The
present literature review modeled the search for studies after Svoboda, Shaw, Barth, & Bright
(2012), who identified 16 relevant studies between 1989 and 2010. The current study identified
18 relevant studies published between 2011 and 2017. Overall, studies found pregnancy was
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common among girls in care, early parenthood was associated with negative outcomes for
mother and child, and families were in need of a variety of supportive services. Key solutions
and next steps are described and divided into four main areas: 1) the need to reduce early
unintended pregnancies; 2) the need to improve circumstances for young parents in care; 3)
successful interventions; 4) and future research.
First, studies emphasized the importance of reducing the number of early, unintended
pregnancies as a way of improving outcomes for both mother and offspring (Dworsky, 2015;
Leve, Kerr, & Harold, 2013; Schelbe & Geiger, 2016). There is consensus that sexual health and
education efforts, as well as access to contraceptives, are needed for all youth in care, although
there is no consensus about the most critical period for delivery. Oshima, Narendorf & McMillen
(2013) underscored the need for sexual health education and prevention efforts for all youth
transitioning out of care, highlighting ages 17 to 19 as a key period for pregnancy prevention.
Putnam-Hornstein, Hammond, Eastman, McCroskey and Webster (2016) suggest age 18 is a
critical window for service delivery due to the high rate of births between ages 18 and 21 among
transition-aged youth. King and Van Wert (2017) suggest that social workers and health care
professionals need to talk to youth in care about sexual and reproductive health early. Their
findings suggest that girls who enter care between ages 13 and 16 should be targeted because age
of entry into care was a significant predicator of early childbirth. They also found that pregnancy
commonly occurs shortly after girls enter care, which suggests intensive programming may
reduce the risk of adolescent births among teen girls who enter care. Girls living in nonrelative
and congregate homes were at increased risk of pregnancy, suggesting these placements could be
targeted for training and intervention. Shpiegel, Cascardi and Dineen (2017) proposed that sexual
health and pregnancy prevention programs should be used to target youth who already have
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children in order to prevent rapid, repeat births. These authors also found adolescents with prior
criminal involvement who were placed with biological families are in need of targeted supports.
Combs, Begun, Rinehart and Taussig (2017) voice the need to reach all males and females in
foster care because risk of early pregnancy is universally common.
Second, once youth become parents, studies highlight the need to develop effective
interventions for parents in care and offspring. Radey (2016) identified three areas for parent
success: basic needs, social support, and effective parenting skills. A number of studies support
this claim. Schelbe and Geiger (2016) found parents in care had limited resources and that basic
items such as cribs, clothes, and car seats were needed to provide adequate care. Dworsky &
Gitlow (2017) highlighted the importance of parenting youth having access to child care in order
to be successfully employed. Parents identified needs such as housing and health insurance and
reported that they had benefitted from services related to independent living skills and budgeting
(Dworsky & Gitlow, 2017). The interviews with parents in three studies, Aparicio (2016), Radey
et al. (2016), and Schelbe and Geiger (2016), highlighted the lack of social support for mothers
aging out of care. The mothers, many of whom were single parents, reported a lack of support of
even one caring adult and many were single mothers. Radey et al (2016) found that both parents
and providers expressed the value of peer and mentoring support. Similarly, Schelbe & Geiger
(2016) highlighted the need for parents to learn to develop and sustain relationships, particularly
with caring adults who can support parenting efforts. Among all parents identified by the
CalYOUTH study, only 2% were married to the child's other parent at birth (Courtney, M. E.,
Okpych, N. J., Charles, P., Mikell, D., Stevenson, B., Park, K., ... & Okpych, N. J., 2016).
Schelbe and Geiger (2016) found that parents aging out of care lack knowledge about child
development and parenting skills and are in need of programs that will provide them with skills
OFFSPRING BORN TO MOTHERS IN CARE Eastman
36
needed. They emphasize that parents need specific knowledge about child development,
appropriate expectations, non-physical discipline, and empathy.
Studies also flagged the need for substance abuse (Aparicio, Pecukonis, & ONeale, 2015;
Coleman-Cowger, Green, & Clark, 2011) and mental health treatment (Aparicio, Pecukonis, &
ONeale, 2015; Narendorf, Munson, & Levingston, 2013). Parents reported that they struggled
with substance abuse issues, which negatively impacted parenting. Aparicio (2015) highlighted
the need to discuss possible substance abuse issues with parents. Mental health concerns are
common among youth in care (Eastman, Putnam-Hornstein, Magruder, Mitchell & Courtney,
2016) and mental health services may improve the mother’s ability to successfully parent
(Narendorf, Munson, & Levingston, 2013). Narendorf, Munson, & Levingston (2013)
highlighted the need to provide mental health interventions for parents because investment in
mental health services may improve the life course trajectories for both mothers and offspring.
Barriers such as access to mental health services and concerns about stigma must also be
addressed to improve outcomes for these parents and offspring (Aparicio, Pecukonis, & ONeale,
2015).
Due to the stressors and circumstances for parenting youth in care, there was a general
agreement that coordinated service delivery may be necessary to address their specific needs
(Courtney et al., 2016; Dworsky & Gitlow, 2017; Radey et al., 2016). Radey et al., (2016)
highlighted the importance of being in tune with the specific concerns of parents' aging out of
care in order to be effective in meeting their needs. The study shows that these young parents are
primarily concerned with meeting basic needs, and tend to deal with crises as they arise. The
authors suggest that these parents would benefit from coordinated financial and supportive
services to both address basic needs and prepare for crises. Courtney et al. (2016) and Dworsky
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37
& Gitlow (2017) suggest that in order to improve outcomes child welfare agencies should
coordinate with state and local agencies in delivering services. In addition, Schelbe & Geiger
(2016) noted that in order to increase the likelihood of service usage parents need to be taught to
navigate service delivery systems. If parents have supports, the results may yield two-generation
benefits.
Third, a number of programs that may delay births and improve parenting supports were
detailed. Making Proud Choices! is an evidence-based sex education curriculum for youth in
foster care (Dworsky, 2015) and the Multidimensional Treatment Foster Care (MTFC) program
reduces pregnancies in this high-risk population (Leve, Kerr, & Harold, 2013). The Illinois
Department of Children and Family Services provides coordinated services for parents in care by
conducting new birth assessments by observing parent-child interactions, providing parenting
education, identifying unmet needs and safety concerns, connecting parents with community
resources and assessing risk for child abuse or neglect (Dworsky, 2015). Similarly, the Los
Angeles County Department of Children and Family Services provides a voluntary Pregnant and
Parenting Teen (PPT) conference to pregnant and parenting youth under their care. These PPT
conferences use a team-based approach to identify needs and connects parents with supportive
services and resources (i.e. early home visiting programs) (Dworsky, 2015). Radey et al. (2016)
suggested The Incredible Years curriculum as a possible fit for parents in care because it utilizes
peer based relationships, modeling, and evidence supported parenting techniques which
addresses parents’ needs for peer mentors, positive parenting skills, and social support. Inwood
House Theory of Change (IHTOC) is an intervention designed to cover the spectrum of services
needed including pregnancy prevention, prenatal support and parenting services. An evaluation
by Lieberman, Bryant, & Boyce (2015) found that participation in IHTOC was associated with
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38
an increase in parenting empathy, birth control utilization, job skills, and positive relationships.
While services designed specifically for this population are in their infancy Lieberman, Bryant,
& Boyce (2015) suggest that interventions must be developmentally appropriate, theory driven
and focus on reducing unintended pregnancies, improving parental success, and decreasing two-
generation CPS involvement.
Fourth, studies highlighted the lack of knowledge about pregnant and parenting youth in
care and their offspring and noted the importance of improving the knowledge base for this
vulnerable population (Aparicio, Pecukonis, & ONeale, 2015; Combs, et al. (2017); Radey et al.,
2016; Schelbe & Geiger, 2016). Shpiegel, Cascardi and Dineen (2016) called for an examination
into the cause of rapid repeat births given that it occurs frequently among mothers in care.
Authors also suggested that an evaluation of access to long term birth control could inform
practitioners. Zhan et al. (2017) suggested future research should compare the effectiveness of
different birth control methods. Combs et al. (2017) and Radey et al. (2016) highlighted the lack
and importance of research related to fathers. Radey et al. (2016) identified a need to understand
how foster care placements and services are related to parenting. Schelbe and Geiger (2016)
underscored the need to identify risk and protective factors for parents in foster care and those
aging out of care. Combs, et al. (2017) described the need to conduct longitudinal work to
identify risk factors associated with parenting outcomes and long-term trajectories. Aparicio,
(2015) and Radey et al. (2016) expressed the need for a better understanding of the mechanism
through which two-generation CPS involvement occurs.
Importantly, studies highlighted the need for evidenced based interventions that target
pregnancy prevention and parenting supports be evaluated for youth and young parents in foster
care (Combs, Begun, Rinehart, and Taussig, 2017; Dworsky, 2015; Narendorf, Munson, &
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39
Levingston, 2013, Schelbe & Geiger, 2016. Specifically, Combs et al (2017) stated an
examination of strategies child welfare agencies use to address early pregnancy and parenting is
needed. Narendorf, Munson, & Levingston, 2013 highlighted the need to identify programs that
are successful for parents with mental health needs. Schelbe & Geiger (2016) flagged the need
for more knowledge about the parenting practice of youth aging out of care and the development
of interventions that target parenting skills for this population. Aparicio (2015) recommended a
study related to patterns of community support that effectively improve the ability to parent.
Dworsky (2015) noted that future research should also examine the effect of changes in
child welfare policy and practice on the risk of offspring maltreatment. For example, many states
now offer non-minor foster youth the option to remain in foster care until their 21
st
birthday. This
extension of foster care has been highlighted as a policy in need of further examination in
relation to pregnant and parenting youth in care. Shpiegel, Cascardi, & Dineen (2016) suggest an
examination of the risk of childbirth is needed among girls who remain in extended foster care.
Putnam-Hornstein, Hammond, Eastman, McCroskey, Webster (2016) indicated it is necessary to
determine if youth are differentially selecting to remain in extended care given that extended care
can now be offered during a critical birth window. Furthermore, the fact that non-minor youth
are opting to remain in care in many states provides an opportunity for intervention and an
assessment of the effect of the change.
Conclusion
These studies demonstrate a need for pregnancy prevention services and supports for
parents as well as future research that focuses on identifying programs that improve two-
generation outcomes. The majority of studies focused on pregnancy and the factors associated
with increased risk of early births among girls in care. These studies provide a strong case for the
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40
need for leadership in child welfare to take on sexual and reproductive health interventions to
delay pregnancies among girls in care. Studies focusing on parents in care detailed the need for
comprehensive supportive services for parents that are tailored to address their unique parenting
experiences and highlighted the resilience of these parents. Most recently, Holtrop, Canto,
Schelbe, McWey, Radey, & Montgomery (2018) published the first study about the process of
adapting an evidenced-based parenting intervention for parents in care. The study highlights the
difficulties with implementation and the need for continued efforts to developing programs that
fit the needs of these parents. Though limited, literature has examined parents in care, however,
to date very little is known about offspring. Interviews with parents showed that parents were
aware that their children were at increased risk of CPS involvement and were dedicated to
breaking the cycle (Radey et al., 2016). There is a need for information that can demonstrate the
necessity for improved programs and policies related to pregnant and parenting youth in care and
their children. The momentum continues to build.
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41
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Coleman-Cowger, V. H., Green, B. A., & Clark, T. T. (2011). The impact of mental health
issues, substance use, and exposure to victimization on pregnancy rates among a sample
of youth with past-year foster care placement. Children and Youth Services Review,
33(11), 2207-2212.
Combs, K. M., Begun, S., Rinehart, D. J., & Taussig, H. (2017). Pregnancy and childbearing
among young adults who experienced foster care. Child maltreatment,
doi:1077559517733816.
Connolly, J., Heifetz, M., & Bohr, Y. (2012). Pregnancy and Motherhood Among Adolescent
Girls in Child Protective Services: A Meta-Synthesis of Qualitative Research. Journal of
Public Child Welfare,6(5), 614-635. doi:10.1080/15548732.2012.723970
Courtney, M. E., Charles, P., Okpych, N. J., Napolitano, L., & Halsted, K. (2014). Findings from
the California Youth Transitions to Adulthood Study (CalYOUTH): Conditions of foster
youth at age 17. Chicago, IL: Chapin Hall at the University of Chicago
Courtney, M.E., Dworsky, A., Ruth, G., Havlicek, J., Perez, A., & Keller, T. (2007). Midwest
evaluation of the adult functioning of former foster youth: outcomes at age 21. Chicago:
Chapin Hall Center for Children
Courtney, M. E., Hook, J. L., & Lee, J. S. (2012). Distinct subgroups of former foster youth
during young adulthood: Implications for policy and practice. Child Care in Practice,
18(4), 409-418.
Dworsky, A. (2015). Child welfare services involvement among the children of young parents in
foster care. Child abuse & neglect, 45, 68-79.
Dworsky, A., & Courtney, M. E. (2010). The risk of teenage pregnancy among transitioning
foster youth: Implications for extending state care beyond age 18. Children and Youth
Services Review,32(10), 1351-1356. doi:10.1016/j.childyouth.2010.06.002
Dworsky, A., & Gitlow, E. (2017.) Employment outcomes of parenting foster youth. Children
and Youth Services Review, 72, 133-140.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
42
Hamilton, B. E., & Mathews, T. J. (2016). Continued declines in teen births in the United States,
2015. NCHS data brief, 259, 1-8.
Holtrop, K., Canto, A. I., Schelbe, L., Mcwey, L. M., Radey, M., & Montgomery, J. E. (2018).
Adapting a Parenting Intervention for Parents Aging out of the Child Welfare System: A
Systematic Approach to Expand the Reach of an Evidence-Based Intervention. American
Journal of Orthopsychiatry. doi:10.1037/ort0000308
King, B., & Van Wert, M. (2017). Predictors of Early Childbirth Among Female Adolescents in
Foster Care. Journal of Adolescent Health.
Leve, L. D., Kerr, D. C., & Harold, G. T. (2013). Young adult outcomes associated with teen
pregnancy among high-risk girls in a randomized controlled trial of multidimensional
treatment foster care. Journal of Child & Adolescent Substance Abuse, 22(5), 421-434.
Lieberman, L. D., Bryant, L. L., & Boyce, K. (2015). Family Preservation and Healthy
Outcomes for Pregnant and Parenting Teens in Foster Care: The Inwood House Theory
of Change. Journal of Family Social Work, 18(1), 21-39.
Milbrook, N. (2012). Factors contributing to subsequent pregnancies among teen parents in child welfare
(Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No.
3533388)
Narendorf, S. C., Munson, M. R., & Levingston, F. (2013). Managing moods and parenting:
Perspectives of former system youth who struggle with emotional challenges. Children
and Youth Services Review, 35(12), 1979-1987. doi:10.1016/j.childyouth.2013.09.023
Oshima, K. M. M., Narendorf, S. C., & McMillen, J. C. (2013). Pregnancy risk among older
youth transitioning out of foster care. Children and youth services review, 35(10), 1760-
1765.
Putnam-Hornstein, E., Hammond, I., Eastman, A. L., McCroskey, J., & Webster, D. (2016).
Extended foster care for transition-age youth: An opportunity for pregnancy prevention
and parenting support. Journal of Adolescent Health, 58(4), 485-487.
Putnam-Hornstein, E., & King, B. (2014). Cumulative teen birth rates among girls in foster care
at age 17: An analysis of linked birth and child protection records from California. Child
Abuse & Neglect,38(4), 698-705. doi:10.1016/j.chiabu.2013.10.021
Radey, M., Schelbe, L., McWey, L. M., Holtrop, K., & Canto, A. I. (2016). “It's really
overwhelming”: Parent and service provider perspectives of parents aging out of foster
care. Children and Youth Services Review, 67, 1-10.
Schelbe, L., & Geiger, J. M. (2016). Parenting under pressure: Experiences of parenting while
aging out of foster care. Child and Adolescent Social Work Journal, 1-14.
Shonkoff, J. P., & Fisher, P. A. (2013). Rethinking evidence-based practice and two-generation
programs to create the future of early childhood policy. Development and
psychopathology, 25(4pt2), 1635-1653.
Shpiegel, S., Cascardi, M., & Dineen, M. (2016). A Social Ecology Analysis of Childbirth
Among Females Emancipating from Foster Care. Journal of Adolescent Health.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
43
Stevens-Simon, C., & Mcanarney, E. R. (1994). Childhood victimization: Relationship to
adolescent pregnancy outcome. Child Abuse & Neglect,18(7), 569-575.
doi:10.1016/0145-2134(94)90083-3
Svoboda, D. V., Shaw, T. V., Barth, R. P., & Bright, C. L. (2012). Pregnancy and parenting
among youth in foster care: A review. Children and Youth Services Review, 34(5), 867-
875.
Taussig, H. N., Culhane, S. E., Garrido, E. F., & Raviv, T. (2010). Cumulative risk exposure and
mental health symptoms among maltreated youth placed in out-of-home care. Child
Abuse & Neglect,34(10), 742-751. doi:10.1016/j.chiabu.2010.02.011
Wilson, E., Casanueva, C., Smith, K. R., Koo, H., Tueller, S. J., & Webb, M. B. (2014). Risk of
early sexual initiation and pregnancy among youth reported to the child welfare
system. Child welfare, 93(1), 127.
Winter, V. R., Brandon-Friedman, R. A., & Ely, G. E. (2016). Sexual health behaviors and
outcomes among current and former foster youth: A review of the literature. Children
and Youth Services Review,64, 1-14. doi:10.1016/j.childyouth.2016.02.023
Zhan, W., Smith, S. R., Warner, L. C., North, F., Wilhelm, S., & Nowak, A. (2017). Sexual
behavior and pregnancy among adolescents in foster family homes. International Journal of
Adolescent Medicine and Health, 0(0). doi:10.1515/ijamh-2016-0155
OFFSPRING BORN TO MOTHERS IN CARE Eastman
44
Study Population/Sample Summary
Aparicio, E. M. (2017). ‘I want to be better than
you': lived experiences of intergenerational child
maltreatment prevention among teenage
mothers in and beyond foster care. Child &
Family Social Work, 22(2), 607-616.
18 in depth interviews with six women (ages 19-22)
who gave birth while in foster care were assessed
using interpretive phenomenological analysis.
Females were age 15.5 at the first pregnancy 16.6 at the first birth,
10.6 at placement, and experienced 6.8 placements. Women were
asked about experiences aimed at preventing two-generation
maltreatment and two themes were identified (1) treating children
well/avoiding CPS and (2) relying on social support.
Coleman-Cowger, V. H., Green, B. A., & Clark, T.
T. (2011). The impact of mental health issues,
substance use, and exposure to victimization on
pregnancy rates among a sample of youth with
past-year foster care placement. Children and
Youth Services Review , 33(11), 2207-2212.
17,124 youth on substance abuse treatment
programs were interviewed using the Global
Appraisal of Individual Needs assessment tool. Of
them, 366 had been in foster care in the past year.
The youth who had been in foster care differed in regards to
gender, race/ethnicity, level of substance abuse care, weekly drug
use, comorbidity, past victimization, and pregnancy status.
Externalizing disorder symptoms, substance use, and victimization
did not predict past year pregnancy within the foster care group.
Adolescents reporting higher internal mental distress (IMD) were
more likely to have been/gotten someone pregnant in the past.
Combs, K. M., Begun, S., Rinehart, D. J., &
Taussig, H. (2018). Pregnancy and childbearing
among young adults who experienced foster
care. Child maltreatment , 23(2), 166-174.
215 young adults (ages 18–22) with a history of
foster care (100 were women). Eight cohorts of
youth were sampled who were enrolled in the
Fostering Healthy Futures (FHF) study between
2002 and 2009 during preadolescence.
49% of the women became pregnant and 33% of men reported
getting someone pregnant by age 21. A quarter became parents
and parenthood was associated with lower educational
attainment, less employment (women only), not having a checking
or savings account, and homelessness. Hispanic/Latina and
American Indian women were more likely to experience
parenthood than other racial/ethnic groups. Fathers were more
likely than mothers to be employed.
Courtney, M. E., Hook, J. L., & Lee, J. S. (2012).
Distinct subgroups of former foster youth
during young adulthood: Implications for policy
and practice. Child Care in Practice, 18(4), 409-
418.
The data for this study come from the Midwest
Evaluation of the Adult Functioning, a longitudinal
study of former foster youth in the Midwest
(Midwest Study). Baseline interviews occurred in
2002–2003 of young people when they were 17/18
years old and in foster care (n= 732). Follow-up
interviews were completed at ages 19 (N = 603), 21
(N = 591), and 23 or 24 (N = 602). These data used
584 of the 602 youth interviewed at 23 and 24 who
had complete data. Latent Class Analysis was used
to identifying subgroups of former foster youth at
age 23 and 24.
Over half the “Accelerated adults” subgroup were parents. They
had a fairly stable living situation and were faring well across
indicators of education, employment, social support, and mental
health, yet a third had been homeless or relied on food supports.
“Struggling parents” were described as a subgroup that was
largely parents (98%) who had low educational attainment and
employment, used government benefits, had the lowest level of
social support and high institutionalization. “Troubled and
troubling” group was mostly male, with histories of housing
instability, mental illness, substance abuse issues, and
incarceration. 48% of these parents had nonresidential children.
Courtney, M. E., Okpych, N. J., Charles, P.,
Mikell, D., Stevenson, B., Park, K., ... & Okpych,
N. J. (2016). Findings from the California Youth
Transitions to Adulthood Study (CalYOUTH):
Conditions of Youth at Age 19 . Chicago, IL:
Chapin Hall at the University of Chicago.
CalYOUTH followed 611 youth in foster care
through age 21 using in-person interviews and
conducted online surveys of California child welfare
workers about youth and services. 121 of the youth
reported they were parents (19.8).
Almost half of the females had been pregnant by 19 and a quarter
gave birth. 16% had been pregnant twice. 2% were married to the
child's other parent at birth and two-thirds wanted to marry the
partner. Nearly a third started prenatal care after the first trimester
with 13% who did not get any prenatal care. About a third said
they wanted to become pregnant. 81% of youth reported feeling
"very prepared" to meet parenting goals. Youth reported the
highest levels of satisfaction with parenting programs among all
life skills services.
Dworsky, A. (2015). Child welfare services
involvement among the children of young
parents in foster care. Child abuse & neglect ,
45 , 68-79.
Illinois state administrative records were used to
identify children born to youth in foster care
between 2000 and 2008 (n=2,487) and documented
investigated child maltreatment reports and
placements in out of home care.
39% of the children were investigated by CPS, 17 % had a
substantiated report, and 11% were placed in out of home care
before age 5. Nearly 1/3 of children were investigated while their
parent was in care and 14% of the children whose parent had
exited care were investigated after the parent’s exit.
Dworsky, A., & Gitlow, E. (2017.) Employment
outcomes of parenting foster youth. Children
and Youth Services Review , 72, 133-140.
Telephone interviews were conducted with parents
who emancipated from foster care in 2014 and 2015
to assess: education, employment, housing,
financial management, benefit receipt, support
systems, and children (n=45).
Low rates of employment/unstable work histories were common
among parents in care. Being younger at first birth was associated
with lower earnings. Runaway histories and dual system
involvement (not placement instability) were associated with
poorer employment outcomes. Parents identified factors that
aided in the transition from care: the opportunity to live
independently, having support or advice, and learning how to
budget.
King, B., & Van Wert, M. (2017). Predictors of
early childbirth among female adolescents in
foster care. Journal of Adolescent Health, 61(2),
226-232.
All girls in California who spent time in foster care
after their 10th birthday (N=30,339) who gave birth
between 1999 and 2010. About 18% (n=5,567) had
an adolescent birth (ages 12-19) in this time frame.
Girls who entered care between 13 and 16 years, girls with Latina,
Black or Native American race/ethnicity, and those with a history
of running away from care were at greatest risk for pregnancy.
Placement in a nonrelative foster home or congregate care
predicted higher birth rates compared with girls living with kin, a
guardian, or in another arrangement.
Table 2.1 Summaries of Studies
OFFSPRING BORN TO MOTHERS IN CARE Eastman
45
Study Population/Sample Summary
Leve, L. D., Kerr, D. C., & Harold, G. T. (2013).
Young adult outcomes associated with teen
pregnancy among high-risk girls in a randomized
controlled trial of multidimensional treatment
foster care. Journal of Child & Adolescent
Substance Abuse , 22(5), 421-434.
166 girls were recruited to participate in the
randomized control trial. The population included
girls ages 13 to 17 years, who were living in out-of-
home care due to delinquency, and not currently
pregnant.
The girls were assigned to Multidimensional Treatment Foster
Care (MTFC) or relative to group care (GC) and followed into
young adulthood. A pregnancy within the first 2 years after
placement in either MTFC or GC was related to drug use, a new
pregnancy that resulted in a miscarriage, and involvement in the
child welfare system (as a parent).
Lieberman, L. D., Bryant, L. L., & Boyce, K.
(2015). Family preservation and healthy
outcomes for pregnant and parenting teens in
foster care: The Inwood House Theory of
Change. Journal of Family Social Work , 18(1),
21-39.
Pregnant and parenting teens in foster care (18 and
younger) were examined. 130 girls and young
women living in a residential program based Inwood
House Theory of Change (IHTOC) and a
comparison group (n=103).
The program was evaluated using pretest, posttest, and face to
face interviews of pregnant teens and was associated with
improved job skills and resources, parenting empathy, receipt of
birth control, and relationships with supportive adults, peers, and
family members.
Milbrook, N. (2012). Factors contributing to
subsequent pregnancies among teen parents in
child welfare (Doctoral dissertation). Retrieved
from ProQuest Dissertations and Theses
database. (UMI No. 3533388)
100 female, who were all 21 years of age, of the state
of Illinois. They had at least one child prior to the
age of 20 and never been married. Participants were
selected from a listing of women who aged out of
the Teen Parenting Service Network.
42 had one child and 58 had at least two children at the age of 21.
The average age at birth of first child was 18. 8 had a documented
DSM-IV diagnosis, 90 lived in placements approved by their case
management agencies, and 41 had either enrolled or completed in
a High School program while 59 were classified as dropouts.
Narendorf, S. C., Munson, M. R., & Levingston,
F. (2013). Managing moods and parenting:
Perspectives of former system youth who
struggle with emotional challenges. Children
and Youth Services Review , 35(12), 1979-1987.
doi:10.1016/j.childyouth.2013.09.023
28 parents between ages 18 and 25 years with a
mood disorder diagnosis and service system use
prior to age 18. More than half of participants had
been involved in the child welfare system (n = 17)
and all youth had been involved with multiple
systems of care as children.
Emotional difficulties presented challenges for parenting and
parenting presented challenges for managing the disorder.
Parents also described experiences using mental health services
as parents. Parenthood was cited as a source of motivation to
manage the disorder.
Oshima, K. M. M., Narendorf, S. C., & McMillen,
J. C. (2013). Pregnancy risk among older youth
transitioning out of foster care. Children and
youth services review , 35(10), 1760-1765.
325 older youth in foster care at age 17 in Missouri
were interviewed at age 17 and 19.
For females, early sexual intercourse and history of delinquency
were associated with pregnancy risk. Use of birth controls was
not protective against pregnancy (which was largely condoms).
By age 19, more than half of females had been pregnant and
nearly a quarter of males had fathered a child.
Putnam-Hornstein, E., Hammond, I., Eastman, A.
L., McCroskey, J., & Webster, D. (2016).
Extended foster care for transition-age youth:
An opportunity for pregnancy prevention and
parenting support. Journal of Adolescent
Health , 58(4), 485-487.
Linked child protection and birth records were
linked to identify all adolescent girls in foster care at
age 17 years in California (2003-2007, N = 20,222).
11% of girls in care at age 17 had a first birth before age 18. 19%
before age 19, 28% before age 20, and 35% before age 21. The
rates varied across county and the mother's race/ethnicity.
Radey, M., Schelbe, L., McWey, L. M., Holtrop,
K., & Canto, A. I. (2016). “It's really
overwhelming”: Parent and service provider
perspectives of parents aging out of foster
care. Children and Youth Services Review , 67, 1-
10.
Group interviews with parents (n=15) who were
aging out of care and (separately) service providers
(n=14) in Florida.
Parents face risk factors but they are motivated to take care of
their children and prevent next-generation maltreatment.
Providers were concerned about the parent's difficult living
environments, economic dependency on public assistance, and
lack of positive parenting role models. Three areas were identified
as essential for parent success: basic needs, social support, and
effective parenting skills.
Schelbe, L., & Geiger, J. M. (2017). Parenting
under pressure: Experiences of parenting while
aging out of foster care. Child and Adolescent
Social Work Journal , 34(1), 51-64.
33 parents aging out of care were interviewed about
parenting experiences (21 mothers, 12 fathers, ages
17 to 23 years). Parents were recruited from local
agencies who worked with the aging out population
and purposely sampled.
This ethnographic study observed parents. Six themes were
identified: "(1) balancing the joys and challenges of parenthood;
(2) limited parenting skills; (3) wanting a better life for their
children; (4) limited resources and support; (5) threat of system
involvement; and (6) children as a source of motivation." p. 54
Shpiegel, S., Cascardi, M., & Dineen, M. (2017).
A social ecology analysis of childbirth among
females emancipating from foster care. Journal
of Adolescent Health , 60(5), 563-569.
National data from the National Youth in Transition
Database and Adoption and Foster Care Analysis
and Reporting System on females in foster care at
age 17 (N=3,474) in 2011. Females were followed
through 19.
21% of females gave birth by 19. Increased risk of birth was
associated with race/ethnicity, placement with relatives, runaway
history, early emancipation from care, and prior incarceration. A
birth before age 17 was the greatest predictor of birth between 17
and 19.
Zhan, W., Smith, S. R., Warner, L. C., North, F.,
Wilhelm, S., & Nowak, A. (2017). Sexual
behavior and pregnancy among adolescents in
foster family homes. International Journal of
Adolescent Medicine and Health , 0(0).
doi:10.1515/ijamh-2016-0155
A random sample of children who had been placed
in foster family homes were asked to complete a self-
administered questionnaire related to risk behaviors
(sexual behavior, running away and pregnancy
involvement). 147 adolescents took the
supplemental survey and were included in the
analysis.
9% adolescents in foster family homes reported that they had ever
been pregnant or gotten someone pregnant. High school students
in foster family homes were significantly more likely to have ever
been pregnant or gotten someone pregnant (11% vs. 2%, p =
0.01). A history of running away from a foster home was
associated with pregnancy involvement (OR: 7.64; 95% CI:
1.87–31.18).
Table 2.1 (continued) Summaries of Studies
OFFSPRING BORN TO MOTHERS IN CARE Eastman
46
CHAPTER 3 (Study 2):
An Examination of Child Protective Service Involvement among
Offspring Born to Mothers in Foster Care
Authors: Andrea Lane Eastman & Emily Putnam-Hornstein
Prepared for the Journal of Adolescent Health
Introduction
The rate of teen births has dropped over the past quarter century and stands at a historic
low (Hamilton, & Mathews, 2016), yet many youths with a history of placements in foster care
still become parents during their teen and young adult years. Using a national sample, Shpiegel,
Cascardi, & Dineen (2016) found that among females emancipating from foster care, 1 in 5 had
given birth by age 19. Research in California examining birth rates found that among females in
foster care at age 17, 19.0% had given birth at least once before age 19 and 35.2% had given
birth before age 21 (Putnam-Hornstein, Hammond, Eastman, McCroskey, Webster, 2016).
As a result, many youths in foster care are transitioning from adolescence to adulthood
when they are also becoming parents and ageing out of care (Schelbe, & Geiger, 2016). Early
parenthood places stress on both the mother (Boden, Fergusson, & John Horwood, 2008; Beers
& Hollo, 2009) and child (Pogarsky, Thornberry, Lizotte, 2006; Jutte, 2010). Importantly, early
motherhood is associated with an increased risk of offspring abuse and neglect (Noll, 2009,
Dixon, et al., 2005).
The stress of early parenthood is compounded by the difficulties youth in care face.
Youth in foster care have a higher risk of future victimization, internalizing and externalizing
behaviors (Coleman-Cowger, Green, & Clark, 2011; Oswald, Heil, & Goldbeck, 2010), and
mental health diagnoses (Taussig & Culhane, 2010) in comparison to peers. Older youth in care
OFFSPRING BORN TO MOTHERS IN CARE Eastman
47
are at risk of ageing-out of care, a term used when youth exit care not because permanency has
been achieved but because they reach the legal age limit for placement. Youth are at risk of
ageing out at a time when a sizeable proportion may become parents. This population faces
economic hardship, housing instability, employment difficulties, low educational attainment, and
increased risk for drug or alcohol issues (Courtney et al., 2007). Historically, the age limit had
been the legal age of majority, but many states have been increasing opportunities for youth to
remain in care as non-minor dependents, through age 21. In 2011, California was among the first
states to extend foster care services through age 21 (Assembly Bill 212, Chapter 459 of 2011). In
2012, 67.2% of youth in care at age 17 were still in care at age 19 in California (Eastman,
Putnam-Hornstein, Magruder, Mitchell, & Courtney, 2016). Analyses on mothers in care and
their children are timely given these policy changes (Finigan-Carr, Murray, O'Connor,
Rushovich, Dixon & Barth, 2015).
Despite the difficulties parents in care face, the number of births to youths in care was not
documented by states prior to 2016 (Senate Bill 794, Chapter 425, Statues of 2015; P.L. 113–
183, 2014) and little is known about offsprings’ outcomes (Shpiegel, & Cascardi, 2015;
Lieberman, Bryant, Boyce, & Beresford, 2014). Only recently have prospective, population level
analyses examined the link between an adolescent mother’s history of maltreatment and an
offspring’s risk (Dworsky, 2015; Dworksy & DeCoursey, 2009; Putnam-Hornstein, Cederbaum,
King, Eastman, & Trickett, 2015; Wall-Wieler, Brownell, Singal, Nickel, Roos, 2018). Dworsky
(2015) found that among those who gave birth in Illinois while in care, 39% of offspring were
investigated, 17% were substantiated, and 11% were placed in out of home care by age 5. Wall-
Wieler et al. (2018) examined adolescent mothers in Manitoba County and found that mothers
who were in care when they gave birth were more than seven times as likely to have their child
OFFSPRING BORN TO MOTHERS IN CARE Eastman
48
placed in out-of-home care before age two than mothers who were not in care. These findings
highlight the importance of improving knowledge related to child protection involvement among
offspring born to parents in care.
The present investigation identifies subpopulations of mother-child dyads that may vary
in their risk of a maltreatment report to Child Protective Services (CPS) during the first three
years of life based on factors recorded at birth. In California, offspring born to mothers in care
are not reported due to the mother’s placement in care and offspring are not placed in out-of-
home care to allow for the mother and child to reside in the same placement. This study used
Latent Class Analysis (LCA) to examine how risk factors cluster among mother-child dyads in
care. LCA allows for a person-oriented, instead of variable-oriented, examination of a population
(Bergman & Magnusson, 1997). Variable-oriented approaches examine how specific variables
relate to outcomes, but do not capture the multidimensional nature of the youths’ functioning
(Keller, Cusick, & Courtney; 2007). Person-oriented approaches address this weakness. LCA is
based on the assumption that no factor can be understood in isolation and should be considered
in light of the relationships with other domains (Courtney, Hook, & Lee, 2012). This method has
been successfully used in examining individual characteristics in the behavioral sciences such as
studies that assess depression and describe poverty as a multidimensional construct (Lanza,
Collins, Lemmon, & Schafer, 2007). The findings of person-oriented analyses can help generate
insights that are relevant and nuanced for policy and practice.
LCAs have also focused on youths in foster care (Keller, Cusick, & Courtney, 2007;
Courtney, Hook, & Lee, 2012), specifically the needs of vulnerable subpopulations. Courtney,
Hook, & Lee (2012) identified four classes of former foster youth based on indicators concerning
the transition to adulthood. Almost a quarter of youth fell into a class termed “struggling
OFFSPRING BORN TO MOTHERS IN CARE Eastman
49
parents.” Three-fourths were female, more than half were black, and nearly all had a child living
with them. Although the class of youth who were institutionalized had the most deleterious
outcomes, struggling parents had the next highest rates of adversities in education, employment,
and social support compared to other classes. The results highlight that many former foster
youths are parenting at young ages and have a range of needs.
The Current Study
Offspring born to mothers in foster care were identified using linked, administrative data.
The proportion of CPS reports during the first three years of life was documented among
offspring born between 2009 and 2012. This study followed offspring for the first three years of
life due to the developmental importance of this period. Young mothers who remained in care as
non-minor dependents pre and post-implementation of the Fostering Connections to Success Act
were examined. Research has documented the heterogeneity among parents and offspring in
care (Geiger & Schelbe, 2016) and this investigation will be the first to employ a cluster analysis
to examine this population. The aim of identifying subgroups within this population is to develop
targeted services and nuanced policies.
Methods
Data Sources
Using probabilistically linked birth and CPS records from California, this study examined
all pregnant and parenting mothers in care and offspring CPS involvement. Birth records
between 2009 and 2012 were used to identify all those with a mother who was under age 21 at
the time of birth. The birth records were then subset into two files, one for the mothers and a
OFFSPRING BORN TO MOTHERS IN CARE Eastman
50
second for the offspring.
1
The first linkage identified all mothers who were in care on or after the
estimated date of conception. In the second data linkage, offspring were followed prospectively
to identify any CPS involvement occurring in the first three years of life. Lastly, the two linkages
were matched using the offspring’s birth identifier to create one dataset with mother and
offspring variables. Two open sourced probabilistic linkage software programs were employed to
conduct probabilistic linkages that identified pairs of records in the birth and child protection
data files representing the same individual.
2
To ensure the accuracy of the matches, additional
clerical review was conducted to determine if the second births were possible given the dates of
birth (birth spacing) and that offspring CPS reports didn’t occur before the date of birth.
Additionally, case files were examined of 45 randomly selected cases to manually check
matches. It was determined that all matches were accurate.
Variables
The outcome variable was the presence of a report for alleged abuse or neglect in the first
three years of life (yes, no). The proportion of all CPS involvement was examined across birth
1
Data Access and Security: The Children’s Data Network (CDN) is a university–agency data and research
collaborative focused on the linkage and analysis of administrative records. Records are encrypted when they are
transmitted to the CDN lab for processing; data are then de-identified for statistical analyses. Once the data are
coded, analytic files are transferred to the CDN’s secure server. CDN researchers then have restricted access to
private project directories for approved research activities. Data access falls within existing state data-use
agreements and both state (CPHS 13-10-1366) and university (UP-13-00455) institutional review board protocols.
The Human Subjects application is included as Appendix 1.
2
Record linkage: Record linkages are typically done to organize an existing data set (e.g. removing duplicates) or
when linking two or more separate datasets (Fellegi, & Sunter, 1969). For a linkage to be successful, records from
the separate datasets must contain common identifying information. This analysis used first, middle and last names,
social security numbers (where available), and birth dates to link individuals in one dataset to the second dataset.
Probabilistic linkage uses a variety of identifiers and is based on estimated linkage weights. Linkage weights are
calculated based on the amount of agreement and disagreement between the identifiers in each set and indicates how
likely it is that the records refer to the same individual. Probabilistic record linkage scores are computed based on
Fellegi and Sunter’s theoretical framework for record linkage (1967; 1969). A value is assigned to each possible
record pair based on a function of the ratio of two conditional probabilities. The ratio is based on the likelihood of
agreement after taking into consideration all possibilities of agreement and disagreement. The theory for record
linkage suggests a there should be fixed error levels to minimize error (Fellegi, & Sunter, 1969). The cutoff values
are set a priori and used to separate pairs that should be considered matched based on the weight and those that
require manual review. Once the manual review was completed, data were deidentified and exported for analysis.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
51
cohorts and included CPS reports, investigations, substantiations, and removals. A CPS report is
made when an individual contacts CPS because they are concerned the child is maltreated. If the
hotline determines the report warrants concern, the case is investigated. If there is evidence that
maltreatment occurred, the case is substantiated. If the case worker determined the child’s safety
is at risk, the child may be removed from the home and placed in out-of-home care. The
variables selected were associated with risk of offspring CPS involvement based on prior studies
examining adolescent mothers both in (Dworsky, 2015) and out of foster care (Putnam-
Hornstein, Cederbaum, King, Eastman, & Trickett, 2015).
Demographic characteristics were obtained from the birth record and include the
maternal race and ethnicity (White, Black, Hispanic, and Other), maternal age at the time of birth
(Minor and Non-minor), and the presence or absence of paternity on the birth record
(Established, Missing). Black race and Hispanic ethnicity have been associated with early
childbirth among youth in care (Shpiegel & Cascardi, 2015). Maternal age at birth was coded
based on the age of majority because minors and non-minors are qualitatively different both
developmentally and legally. Paternity was included because paternity and marital status are
established proxy protective against child welfare involvement (Parrish, Young, Perham-Hester,
& Gessner, 2011; Putnam-Hornstein, Cederbaum, King, Eastman, & Trickett, 2015).
The mother’s child welfare case characteristics prior to the birth included history of
documented mental health condition (None, Present). The code was based upon the federal
definition of mental health disabilities for the Adoption and Foster Care Analysis and Reporting
System (Federal Register, 2016). The mother’s child welfare case characteristics prior to the
birth included AWOL history (None, Present), time in care and placement stability (<=1 year, >1
year and 1-2 placements, >1 year and 3+ placements), and allegation type. The mother’s AWOL
OFFSPRING BORN TO MOTHERS IN CARE Eastman
52
history was coded if the mother experienced a placement move due to running away from care.
The time in care and placement stability were coded as one variable because these factors are
highly correlated. The categories were determined after examining one-way analysis of variances
to identify statistically significant differences among groups. A history of sexual abuse was
dichotomously coded to reflect if the mother has ever been reported for sexual abuse (No, Yes)
prior to giving birth. The child welfare case records data were left censored to 1998 because it
was the first year records were maintained in the Child Welfare Services/Case Management
System (CWS/CMS). To maintain a consistent look-back window across birth cohorts, the
analysis was restricted to maternal child welfare histories from age 9 forward.
Variable Selection
Descriptive statistics were used to characterize mothers in care. Differences between
reported and unreported offspring were examined using χ2 tests. The LCA identified subgroups
of offspring born to mothers in care at increased risk of CPS involvement. Race/ethnicity was
run as a post-hoc analysis so that stratifications across classes could be examined. Additionally,
given the assumption of local independence (Collins and Lanza, 2010), variables that were
highly related to one another were not included in the same model. AWOL history was
associated with the number of placements because it was only coded if the mother experienced a
placement move due to a run away, so it was excluded from the LCA. Sexual abuse was highly
correlated with lack of established paternity and the mother’s mental health history. The final
model included maternal age at birth, paternity, mental health condition, and time in care and
placement stability.
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53
LCA Model Fit
After variables were selected, multiple models with an increasing number of classes were
examined and the quality of fit and interpretability of each was assessed. The principle of
parsimony suggests that if everything else is equal, the simpler model (e.g. fewer classes) is
preferred. The model of best fit was selected based on a number of measures of best model fit
(Nylund, Asparouhov, & Muthén, 2007) and interpretability. The Bayesian information criterion
(BIC), entropy, parametric bootstrapped likelihood ratio test (BLRT), and Vuong-Lo-Mendell-
Rubin likelihood ratio test (VLMR LRT) were used to examine model fit. The information
criteria score is used to assess relative model fit and find the balance between fit and parsimony
when choosing the number of classes (Collins and Lanza, 2010). The BIC measures how
parsimonious the model is and dropping BIC scores indicate improved model fit. Entropy ranges
from 0 to 1. A score of 1 is optimal fit and indicates a good degree of separation between classes
(Vermunt & Magidson, 2002). The likelihood ratio statistics determines absolute model fit, and
significant finding suggests that more classes have improved the model in comparison the model
with fewer class. The fit of a 1-class model (assuming homogeneity) was examined and the
number of latent classes was increased until there was no benefit to adding more classes.
Distal Outcome
After identifying appropriate number of latent classes, the relationship between the distal
outcome, an offspring maltreatment report by age 3, was examined as it related to the
constellation of characteristics. In LCA, the distal outcome provides information about how the
subgroup characteristics predict the outcome (Lanza, Tan, & Bray, 2013). The auxiliary setting
used for the mixture model was DCAT, the preferred method for categorical distal outcomes
(Asparouhov, & Muthén, B, 2014). This process treats the distal variable as a covariate and is the
OFFSPRING BORN TO MOTHERS IN CARE Eastman
54
preferred method when the distal outcome is categorical. Variables were coded using Stata-MP,
version 14.0 and analyses were conducted using Mplus version 7.3.
Results
Between years 2009 and 2012, 2,124 offspring were born to 2,067 pregnant or parenting
mothers in foster care. Fifty-seven mothers (2.7%) gave birth more than once. Seventeen births
were twins (8 pairs); there was one set of triplets.
3
The analysis was restricted to first births
(n=2,094). The number of births decreased from 543 in 2009 to 497 in 2012.
As displayed in Table 1, the majority of mothers were Hispanic and almost two-thirds
were under age 18 at the time of birth. Roughly one in three mothers had been diagnosed with a
mental health condition and half had run away from care. Nearly two-thirds had been in care for
more than a year and more than a quarter had experienced three or more placements. About two-
thirds of mothers experienced a sexual abuse report. All characteristics were significantly
associated (p<.05) with the risk of an offspring report in the first three years of life except for
race. Protective factors included being older at the time of birth, and having established paternity
at birth. Risk factors for offspring reports included a documented mental illness and a history of
running away. Mothers who recently entered care had the greatest proportion of reported
offspring. Although not displayed, mothers were in care for an average of 3 years and 4 months
and the median number of placements was 2 before birth.
Following offspring until age three, 52.6% had a CPS report (n=1,102). Over half of
reported offspring experienced a first report within the first 5 months of life. After a
3
After restricting to first births, the average time between births was median 19.5 months, mean 20.3 (9 to 39, sd
8.0). 35 of the 57 mothers who gave birth twice had rapid repeat births (defined as a second birth less than 24
months after the first.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
55
maltreatment report was made, 48.6% of offspring reports were investigated by CPS (meaning a
face to face interview with the child and caretaker occurred), 25.8% were substantiated as there
was evidence that maltreatment occurred, and 18.8% were placed in out of home care. As shown
in Figure 1, the proportion of offspring CPS involvement decreased over time. Specifically,
63.0% of offspring born in 2009 were reported by age 3 compared with only 45.5% of those born
in 2012. Likewise, roughly a quarter of the 2009 birth cohort was placed in out of home care
versus only 16.5% of offspring born in 2012. A χ2 test for trends showed the declines were
statistically significant over time (p<.01).
Among reported offspring, 40% were first reported when the mother was in a care
placement and 60% of offspring were reported after the mother had exited.
4
The reporter type
differed between offspring who were reported while the mother was in care and for offspring
who were reported while the mother was not in care. 28.3% of offspring who were first reported
while the mother was in care were reported by a child welfare worker. 37.0% were reported by
someone designated as “other professional” and 12.7% by a medical professional. 16.0% of
offspring who were first reported while the mother was not in care were reported by a medical
professional. Nearly 30% were reported by someone designated as “other professional,” 15.9%
by a medical professional, and 12.9% by a child welfare worker.
Analysis of the measures of model fit indicate that the 3-class model was the best fitting
solution compared to the 1-, 2-, 4- and 5-class solutions (see Table 2). The fit statistics support
the 3-class model based on the lowest BIC score (111675.9), high entropy (0.75), and significant
4
Among offspring first reported while the mother was in a foster are placement, 16.5% were had an allegation for
physical abuse, 68.0% for neglect, 7.5% for caretaker absence, and 8.0% for emotional abuse. Similarly, among
mothers who were reported while not in foster care 11.2% were reported for physical abuse, 79.2% for neglect, 4.5%
for caretaker absence, and 5.1% for emotional abuse.
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56
likelihood ratio tests (p<.001). As displayed in Table 3, class membership probabilities of this 3-
class solution show that 30.1% of mother-child dyads fell into Class 1, 46.6% in Class 2, and
23.3% in Class 3.
Characteristics significantly differed across classes and were assigned descriptive labels.
Class 1 was labeled “Non-minor mothers with long, stable placements.” None of the mothers
were minors at the time of birth, the large majority had paternity established at birth, one third
had a mental health diagnosis, and nearly half had been in care for more than a year with fewer
than three placements. Class 2 was the largest and named “Minor mothers with short
placements.” Almost one in nine were minor mothers at the time of birth. Less than half had
paternity established and few had a mental health diagnosis (13.2%). Nearly 40% had been in
placement for less than a year. The highest risk group, Class 3, was termed “Mothers with long,
unstable placements and mental health conditions.” More than three-fourths of mothers were
minors and 58% did not have paternity established. Nearly all had mental health conditions. All
of these mothers were in care for more than a year and 71% experienced more than three
placements.
Post-hoc analyses documented notable differences across class probabilities by
race/ethnicity, sexual abuse history, and experiences running away from care. Table 3 shows that
57.3% of mothers in Class 1 were Hispanic, 18.8% were black, and 14.6% were white. More
mothers in Class 2 were Hispanic and Class 3 had the smallest proportion of Hispanic mothers.
Although not displayed in the table, sexual abuse was more common in Class 3 (86.0) versus
Classes 1 (54.8%) and 2 (60.0). Likewise, Class 3 mothers had the highest proportion of runaway
mothers (81.7%) compared with Class 1 (43.3%) and 2 (29.5%).
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57
The distal outcome ran as a second LCA and examined the association between class
membership and the risk of two-generation involvement. Class 1 (Non-minor mothers with long,
stable placements) had the lowest proportion of offspring reported to CPS by age 3 (36%).
Meanwhile, in Classes 2 (Minor mothers with short placements) and 3 (Mothers with long,
unstable placements and mental health conditions), more than half of offspring were reported by
age 3 (55% and 68%, respectively). Analyses also show that relative differences in outcomes
across were similar for investigations, substantiations and removals. In Class 1, 31.7% of
offspring were investigated, 11.0% substantiated, and 5.8% were placed in out of home care. For
Class 2, 52.4% of offspring were investigated, 29.6% substantiated, and 19.6% were placed in
out of home care. In the highest risk group Class 3, 66.5% of offspring were investigated, 43.1%
substantiated, and 35.1% were placed in out of home care.
Discussion
This study was the first to develop multi-dimensional class profiles of two-generation
CPS involvement among mother-child dyads. This work is timely given the growing interest in
research on national policies related to parents in care and offspring. Federal law allows states to
extend foster care services to age 21, a time when many youths become pregnant (Putnam-
Hornstein, Hammond, Eastman, McCroskey, Webster, 2016). This policy change has
tremendous potential as parents and offspring may now receive additional supports through
extended care. This creates an opportunity to engage parents with supports and services during
the early parenting period that may improve two-generation outcomes. This study highlighted
four key findings that are relevant to policy, practice, and research.
First, there is an early and concentrated risk of CPS involvement among children born to
mothers in foster care. The present investigation found 53% of offspring born to mothers in care
OFFSPRING BORN TO MOTHERS IN CARE Eastman
58
were reported by age 3, a proportion higher than the state’s general population of three-year-old
children (10%; Putnam-Hornstein, Mitchell, Hammond, 2014). It is also higher than the
proportion of offspring reported by age 5 (a bigger window) who were born to teen mothers
(24%; Putnam-Hornstein, Cederbaum, King, Eastman, & Trickett, 2015), and teen mothers with
a history of substantiated maltreatment (44%). The findings suggest offspring born to mothers in
care are a uniquely vulnerable population.
Although California comparisons are possible, there are no national data on offspring born to
parents in care and only one other state has examined two-generation CPS involvement. In
Illinois, the proportion of two-generation CPS involvement among offspring born to parents in
care was lower than what was observed among those in California even though children in
Illinois were followed for a longer time horizon (through age 5) (Dworsky, 2015). In Illinois,
39% were investigated (compared with 49% in California). This finding may be due to the state
differences including demographic characteristics (Dworsky’s study included older mothers,
fathers, and a large African American population), levels of surveillance, service delivery
strategies, and policies. Also, Illinois has been aggressively pursuing policies and implementing
programs targeting parents in care. Both studies highlight that a high proportion of offspring
born to parents in care experience CPS involvement in early life and underscore the great
opportunity to reduce CPS involvement among offspring.
Second, findings call attention to the heterogeneity of the population and the dissimilar
service needs that exist for mothers and offspring. The LCA documented three distinct classes of
mother-child dyads: (1) Non-minor mothers with long, stable placements, (2) Minor mothers
with short placements, and (3) Mothers with long, unstable placements and mental health
conditions. The results of the distal outcome, offspring CPS reports, illuminated the increasing
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59
risks. More than a third of offspring in Class 1 were reported and nearly 70% in Class 3 were
reported. These findings indicate that the characteristics of classes are qualitatively distinct and
signaled a need for a slate of services for pregnant and parenting youth in care. The heightened
risks for offspring born to the youngest mothers stood out. The large majority of mothers in the
two higher risk classes were minors and, in contrast, all mothers in Class 1 were non-minor
dependents. Thirty-nine percent of all mothers were 16 years of age and younger at the time of
birth. More than half of young mothers (ages 16 years and younger) were not in care at the time
of birth, 12% were in kin placements, and 9% were in congregate care. Offspring born to young
mothers in congregate care placements were at greatest risk for a CPS report. Two-thirds of
offspring were reported whereas about half of offspring born to mothers in kin placements were
reported. These findings underscore the importance of finding supportive placements for young
mothers. Mothers giving birth in their early to mid-teens may benefit from stable placements
with adults who can aid their parenting efforts, until they are developmentally able to parent
independently.
Mothers in Class 3 with long, unstable placement histories likely need significant supportive
resources to address comorbid issues (i.e. mental health conditions and past sexual abuse
trauma). A history of mental health conditions characterized nearly all mothers in Class 3, the
subgroup at highest risk for an offspring CPS report.
5
Unstable placements could be the result of
mental health conditions, or those conditions may emerge as a result of placement instability.
Either way, there is a population of mothers with a history of multiple placements and mental
5
Narendorf, Munson & Levingston (2013) interviewed young parents with mood disorders, some of whom had
history in child welfare, and identified a bidirectional relationship between parenting and mental health. Parents’
mental health was negatively affected by parenthood because they stopped medications during pregnancy,
experienced post-partum depression, and had no time alone to address personal needs. However, parents were also
motivated by their children to find better ways of coping.
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60
health conditions, both of which are known at birth. The treatment and service interventions
should reflect these identifiable needs and the LCA demonstrated the need to develop distinct
services.
Third, not only are there differences in the characteristics of the mother-child dyads, but
information collected in birth and child welfare records was related to offspring outcomes across
all classes. The mother’s history of running away from care was associated with an increased risk
of an offspring’s CPS report. Prior studies have identified a relationship between a runaway
history and both early childbirth (Shpiegel & Cascardi, 2015) and two-generation maltreatment
(Dworsky, 2015) among youth in care. Zhan, Smith, Warner, North, Wilhelm, & Nowak (2017)
suggest running away may indicate mother’s prosocial bonds; therefore, strengthening those may
reduce the risk of an offspring report.
The current study also provides further evidence that a sexual abuse history is prevalent
among mothers in care; specifically, 68% had a past allegation of sexual abuse. Prior literature
has shown that sexual abuse is associated with adolescent pregnancy (Noll & Shenk, 2013;
Blinn-Pike, Berger, Dixon, Kuschel, & Kaplan, 2002). Caseworkers and caregivers may need
additional training to address the reproductive and health needs of girls in care, with particular
focus on those with a history of sexual abuse. As noted by Wilson, Casanueva, Smith, Koo,
Tueller, & Webb (2014), sexual activity is common and begins at very young ages among youth
in care. Medical professionals need to be informed about the needs and experiences of girls in
care, so they are aware of the risk of sexual abuse and can provide information about forms of
birth control best suited for this population given placement instability. Access to reproductive
information and contraception is needed but once girls become mothers, trauma informed
services should be delivered to address needs and improve parenting.
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61
Fourth, although still high, the proportion of offspring who were reported to CPS for
maltreatment has declined over time, from 63.0% in 2009 to 45.5% in 2012. Although a
statistically significant trend, the period was relatively short and therefore conclusions drawn
should be done so cautiously. While two-generation rates of CPS involvement decreased, the
proportion of mothers remaining in care at older ages increased. In 2009 22.2% of youth
remained in care until age 19 and 1.5% until age 21. In 2012 51.9% of youth remained in care
through age 19 and 13.2% until age 21. That said, the decline in offspring CPS reports remained
significant even after restricting the sample to minor mothers. Recent policies aimed at
supporting parents in care may be related to the shrinking proportion of offspring reports over
time in California. In 2005 California implemented SB 500, which places children with their
parents whenever possible when the parents are in foster care or probation placements called
“Whole Family Foster Homes” (WFFH). WFFH caregivers assist parents with providing a safe,
permanent home for offspring and transitioning to independence. The funding for WFFHs was
expanded in 2012 (Assembly Bill 12, 2010).
6
Strengths and Limitations
Pregnant and parenting youth in care and their offspring are challenging to study because
of the nature of data collected by child welfare systems, the size of the population relative to
overall foster care caseloads, and the loss to follow-up common in longitudinal studies of
vulnerable populations. Structured fields of child welfare data focus on the primary client and
information about pregnancy and births is more likely to be found in unstructured case notes.
6
Senate Bill 528 (2013) guarantees resources for pregnant youth in care and improves access to child care. AB 2668
(2014) encourages custodial non-minor dependent parent living in an independent living placement to enter into a
“Parenting Support Plan” with an identified responsible adult, such as a mentor or relative to identify ways in which
the responsible adult will assist the youth and the baby. As incentive, the non-minor dependent parent’s foster care
payment is increased by $200 dollars each month.
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62
Even though birth rates are relatively high among adolescents in foster care, acquiring an
adequately-sized sample to study the offspring is challenging because the absolute number of
births is low relative to the overall caseload. Following these families overtime can be even more
difficult as the parents tend to be transitory and wary of oversight (Schelbe & Geiger, 2017). The
present study overcame these challenges by using large-scale, linked, state data sources and
analyzing the most recent data for which three full years of follow-up were available. The size of
the state’s population allows for a deep dive into subgroup dynamics. The prospective design
minimizes bias to which retrospective designs are susceptible. However, findings will need to be
understood in the context of several limitations.
Although vital records are the official source of all birth information and CPS records are
the official source of information on maltreated children, administrative data are subject to
human data-entry errors that may compromise probabilistic match rates and subsequent analyses.
To address this limitation, estimates were developed that incorporate different assumptions
regarding missing data and out-of-state attrition. For example, the robustness of the model was
tested first using the full population, then after excluding foreign-born mothers, and again after
excluding any mothers who were not born in California. Results were consistent across all
populations. Data used were limited to fields available in birth and CPS records, even though
information from other data sources (e.g., mental health records, medical records, education)
may also be relevant to the questions examined. Relatedly, LCAs are sensitive to the variables
used in the analysis. When variables were modified (e.g. including sexual abuse instead of
mental health diagnosis) the model profiles of the subgroups remained the same, which provides
further evidence of the robustness of model.
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63
The generalizability of findings is unknown given that these data are limited to
California; however, this study can serve as an exemplar of how data sources can be linked to
study this issue. Children born to mothers in foster care will undoubtedly be subject to greater
surveillance than children born to mothers who are not in foster care. Although this bias cannot
be controlled, differences in two-generation outcomes among children reported while the mother
lived in foster care were examined, potentially highlighting factors associated with increased
oversight. The current study includes paternity as a covariate but focused primarily on mothers.
This decision was made because paternity is more difficult to determine using birth records given
the high proportion of offspring with missing paternity at birth. Future research should examine
fathers in care as paternity emerged as a strong protective factor.
While state policies improve outcomes for offspring born to mothers in foster care given that
CPS involvement is decreasing over time, the present study was unable to determine how many
families were benefitting from the programs. WFFHs may provide support for mothers, but the
number of homes statewide is unknown. More than a third of the mothers in the present
investigation lived in Los Angeles County at the time of removal (N=760 over 4 years), yet as of
2017 no more than 25 WFFH exist in the county (personal communication, Department of
Children and Family Services, Los Angeles, November 6, 2017). Further, neither the state nor
county collect data on youth served by WFFH, making it difficult to assess the effectiveness of
programs.
Among all 17-year-old youth in care in California 67% remained in care through age 19
in 2012 (Eastman, Putnam-Hornstein, Magruder, Mitchell, & Courtney, 2016), a higher rate than
what was observed among mothers in care. Courtney, Hook, & Lee (2012) hypothesized that
remaining in care as a non-minor dependent may be more difficult for foster youth mothers
OFFSPRING BORN TO MOTHERS IN CARE Eastman
64
because they may be unable to fulfil the educational and employment requirements due to
childcare responsibilities. Future research should examine reasons why mothers do not remain in
care as non-minor dependents because the findings of the current investigation suggest that
mothers and offspring may benefit from ongoing services and supports.
Conclusions
Pregnant and parenting youth in foster care have increasingly come to the attention of
service providers, researchers, and policymakers. The current study highlights the need to
develop programs that fit the needs of mothers in care, assess the effectiveness of these
programs, and replicate policies that are improving outcomes for parents and offspring. Programs
that may improve outcomes include reproductive health prior to the pregnancy and wraparound
services once youth become parents. The present study focuses on outcomes after a birth and
demonstrates the need to develop a range of programs that fit the needs of parents, given that the
mothers’ experiences in care, mental health needs, and parenting skills vary widely.
Additionally, the population-level data show the risk of two-generation CPS involvement
has decreased over time, suggesting that policies that have increased permanency for older
youth, extended services to non-minor dependents, and expanded WFFHs may yield two-
generation benefits. However, the concentrated risk of offspring CPS involvement suggests that
more work needs to be done to address needs. The Fostering Connections to Success Act,
landmark legislation for transition aged youth in care, makes no mention of pregnant or
parenting youth which is problematic given the rates of early pregnancy among transition aged
youth. States should ensure that the eligibility for the extension of foster care allows new
mothers to participate and that resources are available. Identifying ways to support mothers’
needs may improve two-generation outcomes for mother-child dyads.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
65
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(N=1,102) 52.6%
col% n row %
p-value
Maternal Race/Ethnicity
White 14.4 164 54.3 p=0.109
Black 24.9 287 55.1
Hispanic 51.7 543 50.1
Other 9.0 108 57.5
Maternal Age at Birth
Minor 64.6 783 57.9 p<.001
Nonminor 35.4 319 43.1
Paternity
Established 58.8 615 49.9 p=.003
Missing 41.2 487 56.5
Mental Health Condition
None 66.0 694 50.2 p=.002
Present 34.0 408 57.3
AWOL History
None
49.3 485 47.0 p<.001
Present 50.7 617 58.1
Time in Care and Placement Stability
<=1 year 36.0 255 56.5 p<.001
>1 year and 1-2 placements 36.7 262 51.5
>1 year and 3+ placements 27.3 585 51.6
Sexual Abuse Allegation
No 35.6 355 47.7 p<.001
Yes 64.4 747 55.4
χ
2
Table 3.1. Demographic characteristics of first offspring born to mothers between 2009 and
2012 who were pregnant or parenting while in foster care
Offspring reported in the first
3 years of life
Note: The χ2 was used to assess the pairwise differences between children who were reported
and those who were not reported by covariates. The resulting p-values are reported.
All mother-
child dyads
(N=2,094)
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Table 3.2. Measures of model fit for latent class analysis
Model BIC Entropy BLRT VLMR LRT
1 Class 12815.3 NA NA NA
2 Classes 11746.2 0.81 p<.001 p<.001
3 Classes 11675.9 0.75 p<.001 p<.001
4 Classes 11710.2 0.75 p=.1132 p=.0839
5 Classes 11754.0 0.69 p=.999 p=.8095
Measures of Model Fit
Note: These acronyms stand for the Bayesian Information
Criterion (BIC) and Vuong-Lo-Mendell-Rubin likelihood
ratio test (VLMR LRT).
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Table 3.3. Constellation of risk factors across classes.
Class 1:
Nonminor
mothers with
long, stable
placements
Class 2:
Minor with
short
placements
Class 3:
Mothers with
long, unstable
placements
and mental
health
conditions
Class Membership Probabilities 631 (0.301) 976 (0.466) 487 (0.233)
Distal Outcome
CPS Re-report 0.36 0.55 0.68
Item Response Probabilities
Maternal Race/Ethnicity*
White 0.15 0.12 0.17
Black 0.19 0.17 0.31
Hispanic 0.57 0.65 0.40
Other 0.09 0.06 0.12
Maternal Age at Birth (minor, nonminor)
Minor 0.00 0.88 0.78
Paternity (established, missing)
Missing 0.19 0.45 0.58
Mental Health Condition (none, present)
Present 0.34 0.13 0.98
Time in Care and Placement Stability
<=1 year 0.00 0.38 0.00
>1 year and 1-2 placements 0.48 0.33 0.29
>1 year and 3+ placements 0.53 0.29 0.71
* Race/ethnicity was measured post hoc analysis
Class Name
3 Classes: Membership and Item Response
Probabilities
Note: All probabilities may not sum to 1.00 due to rounding. The level of risk refers to
the likelihood of a CPS re-report. The class membership probabilities show the
proportion of individuals falling into each class. The distal outcome was run in a second
LCA and reflects the proportion of youth in the class who were rereported in five years.
Item response probabilities present the distribution of individuals within each covariate
level in a given class.
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Figure 3.1 Diagram of birth and CPS record linkages
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
2009 2010 2011 2012
Birth Cohort Year
Figure 3.2. Proportion of offspring with
CPS involvement by age 3
Reported Investigated Substantiated Removed
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CHAPTER 4 (Study 3):
A Content Analysis of Case Records:
Two-Generations of Child Protective Services Involvement
Authors: Andrea Lane Eastman, Lisa Schelbe & Jacquelyn McCroskey
Prepared for Children and Youth Services Review
Introduction
Two-generation approaches consider both children and their parents, acknowledging that
their needs and successes are intrinsically connected. Policies and service delivery systems rarely
are implemented using a two-generation approach, but doing so can provide opportunities to
improve the well-being of the child and the parents together and create better outcomes. Children
born to mothers in foster care have increased rates of reports of alleged abuse or neglect in
comparison to children born to mothers who are not in care (Dworsky, 2015). Young mothers in
and aging out of foster care have been found to be resilient, yet have substantial needs (Schelbe
& Geiger, 2017). These mother-child dyads could benefit from a two-generation approach that
addresses the whole family.
A study in Illinois found that by age five, 39% of children born to mothers in care were
investigated for alleged maltreatment by child protective services (CPS; Dworsky, 2015). A
study from California documented rates that were even higher; by age 3, 49% of offspring had
been investigated for alleged maltreatment and 19% had been placed in out of home care by age
3 (“Study 2,” Eastman & Putnam-Hornstein, in progress). This study found that 53% of children
had been reported and in comparison, 10% of children born in California overall were reported
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for maltreatment (Putnam-Hornstein, Mitchell, Hammond, 2014). Eastman & Putnam-Hornstein
(in progress) highlighted the opportunity to provide resources for this parenting population now
that youth may remain in foster care as non-minor dependents due to new policies that allow
states to extend placement from age 18 to 21. A study of 19-year-oldswho had been in care at
age 17 post-implementation of the extension of care in found that 15% of offspring born to
mothers in care at age 17 were wards of dependency court California (Courtney, Okpych,
Charles, Mikell, Stevenson, Park, & Okpych, 2016). A Canadian study recently published an
examination the risk of two-generation foster care placement and found that almost half of babies
born to mothers in care were placed in foster care by age two (Wall-Wieler, Brownell, Singal,
Nickel, Roos, 2018) Beyond this work, there is little known about the CPS involvement,
maltreatment experiences, or out of home placement of children born to mothers in care.
While research on children born to parents in care is lacking, there has been significant
research examining parents in care. This body of work has identified significant life stressors for
mothers and fathers, including lack of employment, child care, housing, social support, and
knowledge of child development (Aparicio, 2016; Dworsky & Gitlow, 2017; Radey, Schelbe,
McWey, Holtrop, & Canto 2016; Schelbe & Geiger, 2017). At the same time, this work has
identified parent resiliencies (Aparicio, 2016). Interviewed parents and found that parents are
aware that their children are at increased risk for CPS contact, but are motivated to prevent it
(Aparicio, 2016; Radey, Schelbe, McWey, Holtrop, & Canto 2016; Schelbe & Geiger, 2017).
Schelbe & Geiger’s 2017 ethnography, which followed parents aging-out of care and their
children for almost two years, found parents were optimistic about parenting, found joy in being
parents, and wanted to provide their children with a better life, despite challenges.
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Research also highlights the heterogeneity of the population of parents in care (Schelbe &
Geiger, 2016; Courtney et al., 2016; Aparicio, 2016). The work by Eastman & Putnam-
Hornstein (in progress) built upon these findings by using linked, administrative data and a
person-centered analysis to identify subpopulations of mother-child dyads among pregnant and
parenting youth in care. Three qualitatively distinct classes were identified through Latent Class
Analysis (LCA) and the rates of two-generation CPS involvement, examined as a distal outcome
and treated as independent from the class modeling process, were notably different across
classes. Offspring in Class 1 had the lowest risk of a CPS report; 36% were reported by age
three. Meanwhile, more than half (55%) of offspring in Class 2 and 68% of offspring in Class 3
were reported by age three. These results identified qualitatively distinct classes and the range of
offspring risk underscores the dissimilar service needs that exist for mothers in care and their
offspring. Findings demonstrated the heightened risks for offspring born to mothers who were
minors and for mothers who had unstable placement histories and mental health conditions.
However, there is still little information about the offspring’s CPS involvement.
Knowledge about young parents in foster care and two-generation CPS involvement has
been gleaned almost exclusively from structured fields in child welfare case records (Dworsky,
2015; Dworksy & DeCoursey, 2009) or through interviews and observation with families
(Aparicio, Pecukonis, & ONeale, 2015; Schelbe, & Geiger, 2016). To date, case narratives that
typically accompany structured fields in child welfare case records are rarely used in research
(English, Edleson, & Herrick, 2005; Hartley, 2002) and have not been examined for the
population of interest. Case narratives may contain useful information about the context within
which maltreatment reports are made, such as and the family’s needs and protective factors. Case
narratives document children and families’ contact with CPS, typically due to allegations of
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abuse or neglect. These data have the potential to inform policy and practice for a population at
high risk for two-generation CPS involvement.
Current Study
The current study is exploratory and leverages case records of both mothers in foster care
and their offspring to generate new knowledge concerning the circumstances of these mother-
child dyads. A content analysis of case records was conducted to assess reasons described for
CPS involvement among offspring who were 1) born to mothers who were in foster care on or
after the estimated date of conception and 2) reported to CPS in the first three years of life. The
following questions were examined: 1) What information can be gleaned from CPS case records
concerning the conditions that led to two-generation CPS involvement?; 2) Why were the
offspring reported?; 3) What are the mothers’ identified risks or needs?; 4) What are the mothers'
identified resiliencies or protective factors?; and 5) Was there any documented service provision
for the mothers while they were pregnant or parenting? The ultimate goal of this research was to
inform policies and programs for mothers in foster care and their children, who are at high risk
for experiencing child maltreatment in early life. Additionally, this exploratory analysis sought
to assess the utility of the case narratives in case records to learn about the two generations of
offspring born to mothers in care and their mothers.
Method
Sample
This examination builds upon an earlier study that used linked birth and child welfare
records to identify all pregnant and parenting mothers in foster care and their offspring among all
births in California between 2009 and 2012 (Eastman & Putnam-Hornstein, in progress). The
study identified three classes of mother-child dyads using LCA and examined the risk of a CPS
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report in the offspring’s first three years of life for each class. For more details about the LCA
and classes, please see the study by Eastman & Putnam-Hornstein (in progress).
The current population was restricted to a sample of mother-child dyads in which there
was a documented report of alleged maltreatment for the offspring between birth and age three.
Dyads were sampled from the three classes that emerged from the LCA (i.e. non-minor mothers
with long, stable placements; minor mothers with short periods in care; and mothers with long,
unstable placements and mental health conditions (Eastman & Putnam-Hornstein, in progress).
Thirteen mother-offspring dyads from each class were randomly selected for a detailed
examination of mother and child case records. Estimating adequate sample size is directly related
to saturation (Marshall, Cardon, Poddar, & Fontenot, 2013). Sampling 13 dyads from each class
allowed for saturation to be reached for each class. Saturation is achieved when the point of
diminishing returns is reached; more data does not lead to more information (Mason, 2010).
7
Although there was an unequal distribution of mother-child dyads across classes in the LCA (the
largest proportion of mothers fell into class 2), and examination of thirteen cases allowed for
saturation to be achieved given the depth and quality of the information. The information was
both rich in detail and reflected information gathered over the course of what was often years of
child welfare involvement for the mother and offspring. The total sample was 39 cases.
Sample characteristics. The median age of mothers at the time of birth in the sample
was 17 and varied by class. In Class 1 the average age of birth was 19 (range: 18 to 20 years), 16
7
Onwuegbuzie and Leech (2007) contend that sampling size is as essential to qualitative research
as quantitative research because in both instances data may be used to make inferences about a
population. Quantitative researchers use formulas and sampling techniques to determine sample
size but this process is more complex with qualitative research because the decision is not
mathematical (Onwuegbuzie, & Leech, 2005). Rather, decisions about sampling size should take
into consideration the number of participants, the number of contacts with each participant, and
the length of each contact (Onwuegbuzie & Leech, 2007).
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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among mothers in Class 2 (range: 13 to 17 years), and 17 among mothers in Class 3 (range 15 to
17 years). Due to the data sharing agreement and maintaining confidentiality, details about the
sample by the different classes cannot be shared. However, characteristics about the entire
sample of 39 mothers and their children can be provided. On average, the mothers had been in
care for four and a half years at the time of birth. Forty-four percent of mothers had a mental
health condition, 60% had a sexual abuse history, and 62% had run away from care. Half of all
offspring had established paternity at the time of birth. Importantly, among those who had a
report by age 3 half of the offspring were reported by age one. Other demographic information
cannot be divulged given the need to protect client identities and data sharing specifications,
however, mother-child dyads sampled for each class had similar demographics to the entire
population of pregnant and parenting youth in care and offspring (information available in
Eastman & Putnam-Hornstein, in progress). The sample for the current study included more
mothers with Black race/ethnicity and fewer Hispanic mothers in comparison to the full
statewide population of pregnant and parenting mothers in care. This may be because
race/ethnicity varied by class and an equal number of individuals were selected for each class
(i.e. the largest class also had the greatest Hispanic population). It should also be noted that a few
children in the sample died. The exact number of deaths cannot be shared to maintain
confidentiality.
Data Collection
Case-level data were accessed from California’s Child Welfare Services/Case
Management System (CWS/CMS), the state’s child welfare information database. The
CWS/CMS is used to track case management, service planning, and information gathering
related to child welfare activities. Case narrative data are entered or collected by county child
OFFSPRING BORN TO MOTHERS IN CARE Eastman
79
welfare staff; records are oriented around a focal child, with supporting information for parents,
perpetrators, and other individuals.
The system has eleven components: Intake, Client
Information, Service Delivery, Case Management, Placement, Court Processing, Caseload,
Resource Management, Program Management, and Adoptions and Licensing. Each component
contains both structured and unstructured fields where case notes can be recorded in the form of
structured data or case narratives that correspond to that particular part of the process.
Data were available through a long-standing university–agency data-sharing agreement
with the California Department of Social Services. Data access falls within existing state data-
use agreements and both state (CPHS 13-10-1366) and university (UP-13-00455) institutional
review board protocols. Confidential data from CWS/CMS are hosted at the Data Center located
within Center for Social Services Research, located at the University of California at Berkeley.
The first author retrieved case narratives onsite at the Data Center. The process of
searching the case files for each client was systematic. The “screener” narrative, “investigative”
narrative, and associated documents were reviewed for each referral of the mother and offspring.
A full description of the contents of these files is detailed in Table 1. Non-identifying
information was extracted for each referral and the information was organized in one electronic
file per dyad for analysis.
Data Analysis
Content analysis is a research method that organizes qualitative data into specific and
broad concepts to enhance understanding of a phenomenon (Elo, & Kyngäs, 2008; Cavanagh
1997; Hsieh, & Shannon, 2005). From these identified concepts, meaning can be developed.
Content analysis was selected for the analysis because it is sensitive to content and can be used
to analyze large volumes of qualitative data (Elo, & Kyngäs, 2008).
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To analyze the large amount of information found across case records for mother-child
dyads, a deductive and inductive coding process was used following the process described by
Elo, and Kyngäs (2008). First a deductive approach was used to create a structure for gathering
content based upon extant knowledge about the phenomena (Elo, & Kyngäs, 2008; Kyngäs &
Vanhanen 1999). From there an inductive approach was used to ensure previously unknown
concepts are identified and included (Elo, & Kyngäs, 2008; Lauri & Kyngäs 2005). This dual
inductive and deductive approach was used to identify concepts emerging from the data by
drawing upon language observed in the case records.
First, the lead author was immersed in data by reading over narrative sections of case
records before developing categories (Elo, & Kyngäs, 2008; Hsieh, & Shannon, 2005). Once
data were reviewed, a categorization matrix for coding data was developed based on categories
that emerged in the “screener” and “investigative” narratives. The matrix was organizational and
formatted as a cross-tabulation of information about the data (Dey, 1993). Next, data were coded
based on the initial concepts in the matrix. Because this examination was exploratory due to the
lack of existing literature on narrative child welfare records generally and especially as they
relate to two-generation research the matrix was “unconstrained,” meaning the matrix grew and
evolved as cases were examined and additional concepts were created (Elo, & Kyngäs, 2008).
Next, categories were grouped into subtopics with the goal of sorting information to reduce the
number of concepts and to ensure each concept was distinct (Dey, 1993). The categorization of
concepts helped describe the experiences of mother-child dyads with the goal of enhancing
understanding (Harwood & Garry 2003). This process entailed developing descriptions for each
concept using words that were characteristic of the content within the concepts (Elo, & Kyngäs,
2008). Using qualitative data analysis software, NVivo11, each case was reviewed for meaning
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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and categories by two trained research assistants who coded independently. After each case was
coded, the lead author reviewed the coding and provided feedback to the coder.
The study ensured rigor by using a sample with similar characteristics to the population
of mother-child dyads and sampling across classes identified by the LCA with qualitatively
distinct characteristics. Large amounts of longitudinal data for both mother and offspring were
available, adding to the depth of the data. On average there about 40 pages of documentation per
dyad and some dyads had a couple hundred pages of documentation. Data in case narrative files
included information from multiple sources such as multiple caseworkers, police documentation,
court filings, and reports from family members and caregivers. Having data from participants in
different roles allowed for the triangulation of data. Trustworthiness was established by having
multiple people analyze the data, ensuring all coding was reviewed by the lead researcher, and
reporting content to enhance transparency (Hsieh, & Shannon, 2005).
Results
The content analysis showed that themes were similar within classes. Although there
were significant differences across classes, a few themes were common independent of class. As
they are overarching patterns identified and often were mentioned briefly in the case records,
quotes are not used to expand upon the common themes. After exploring the similarities across
the classes, the differences across classes are detailed. The themes are exemplified with quotes
written by caseworkers, medical personnel, educators, public safety officials, and lawyers found
in the case narrative notes. The themes are summarized in Table 2 and presented in order of
salience and relevance to the classes, from most salient and relevant to least.
Themes Independent of Class
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Some common themes were independent of class. Mothers in child welfare are a uniquely
vulnerable and disadvantaged population, yet, there were identifiable factors that enhanced risks
or improved the wellbeing of the mother-child dyads. Substance use disrupted the mother’s
parenting and was as issue across all classes. However, the amount of substance use, type of
substance used, effect on parenting, and willingness to receive treatment varied, as detailed in the
following sections. Homelessness was documented for a handful of non-minor mothers (in Class
1 non-minor mothers with long, stable placements and Class 3 mothers with long, unstable
placements and mental health conditions). Several non-minor mothers who were reported to CPS
after the mothers had exited care were living with their mother but the family was currently
homeless. There was little additional information in the case files about the homelessness
because it was not the primary concern that led to the offspring’s maltreatment report. The report
was instead related to the mother’s substance use, severe neglect, or physical abuse. The study
focuses on the mother-child dyad of the mother and her first child, however, multiple reports
named more than one child. The case records indicated that mothers in Class 1 and 3 had more
than one child.
Repeat sexual abuse of mothers was common. The majority of the mothers’ case files
included a mention of one sexual abuse allegation but many contained descriptions of ongoing
and extensive sexual abuse. For example, there were instances of repeated rapes, incest, and
human trafficking. Additional details about the sexual abuse are provided in the forthcoming
descriptions of the classes. Mothers’ case notes commonly mentioned that the mother had run
away from foster care placements. These runaway experiences occurred before, during, and after
the pregnancy. In a few cases, the runaway was associated with possible child trafficking and in
one instance the mother was raped while she was away from care. Several times the mother ran
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away from care with the child. These were mothers who typically did not want to remain in
contact with CPS and some mothers did not return to care. There were other examples where the
mother would run from a foster home placement and leave the child with the foster parent for a
few days. In these instances, the offspring were safe with the foster parent but mothers were not
caring for their children’s needs.
Finally, nearly all mothers received some services while pregnant and parenting. Those
services ranged from parenting classes, intimate partner violence classes, independent living
services, financial aid, health and mental health services, pregnancy support groups, life skills
training, early home visiting, and contraceptives. While some mothers rejected voluntary
services from child welfare as non-minor dependents the majority of mothers continued
receiving services. These mothers were eligible for transitional housing services, counseling,
college support, bus passes, financial services, and case management. However, services did not
appear to be comprehensive as each mother had only a few services documented in her file. Only
six cases documented that caseworkers facilitated access or referrals to child care services. These
themes show that mothers across all classes face significant stressors that may impair parenting
and demonstrate the need to identify supports and unaddressed needs.
Class 1: Non-minor Mothers with Long, Stable Placements
The mother-child dyads in Class 1 made up 30% of the population of pregnant and
parenting youth in California born between 2009 and 2012 based on the LCA. The case file of
mother-child dyads in Class 1, termed “Non-minor mothers with long, stable placements”
showed: (1) offspring maltreatment reports were less serious in nature than reports the other two
classes, (2) mothers benefitted from strong extended family support, (3) father involvement was
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related to cohabitation and domestic violence, and (4) mothers were fearful of CPS involvement
with their offspring.
Offspring maltreatment reports. In general, offspring were reported to CPS due to
concerns about parenting skills and child supervision. In some cases, the mother lacked some
knowledge about parenting skills, often related to the child’s behavioral concerns. There were
also reports suggestive of heightened surveillance given that some reports were mild and may not
have been made if the mother had not been under CPS supervision. For example, a visit from a
case worker is described below:
This worker made an unannounced visit to Hospital in response to an Immediate
Response referral on 2009. This worker first spoke to Hospital Social Worker, prior to
meeting the parents. reported the child tested negative for drugs and presented as
healthy. reported the father was present with the mother at the hospital and appeared
invested in the mother and child's well being.
Based on the information provided in this case record, the cause for concern was not
immediately present. Specifically, the offspring was healthy and tested negative for substances
and there was an involved father. It appears possible that the report was due to the mother’s
placement in foster care. In the following case, the mother’s parenting skills are presented as
appropriate, although she had a temper.
…[Mother] loses her temper easily with son (age 2). Her discipline style is to redirect
son when he is acting out or she puts him on a timeout for one minute. The undersigned
observed [Son] asleep on the couch in clean clothes. [Son] appeared healthy and was
free from any visible signs of bruising.
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This case may not have come to the attention of CPS had the mother not already been in the
system. While the quotes above are examples of reports commonly made for this class, it should
be noted that there were also reports more serious related to exposure to domestic violence,
substance abuse, serious lack of supervision or neglect.
Extended family support. Many of the mothers in this class appeared to be parenting
successfully and the case narratives showed that these mother-child dyads have strong extended
family support. Specifically, a number of these mothers had an identifiable “co-parent,” an
individual who was able to support the mother with child care and enable her to attend school or
obtain employment. The co-parent was typically an adult such as the maternal grandmother or
foster parent and sometimes the father of the offspring. This high level of social support of
mothers in Class 1 is exemplified by the following quote about a mother who was supported by
her foster mother:
[Mother] was moved to a bigger room to prepare for the baby's arrival. [Mother]
continues attending therapy once a week. Foster parents appear to be very supportive
and very dedicated to [Mother’s] wellbeing. Foster mother stated that they intent to keep
[Mother] and her baby after she emancipates. She plans to provide [Mother] the support
that she needs to overcome. Caregiver [Mother] reports that paternal grandmother has
been very supported.
The case note captured how the relationship between the mother and foster mother encouraged
the mother to become self-sufficient while supported with needed resources. Another case file
quote emphasized this mother’s relationship with the foster mother, “Ms. [Foster Mother] has
been raising [Mother] as though she is her own daughter, as [Baby] at this point continues to
view Ms. [Foster Mother] as her grandmother.”
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Many mothers were able to successfully parent if they had a co-parent, an adult able to
support their parenting. This was particularly effective if the caring adult was able support the
mother with continuing her education or employment by providing child care, which was often
the case with mothers in Class 1. This is evident in the following excerpt from the case file,
“Caregiver, [Foster Mother] is currently not working and thus, she will provide care for minor
mother's infant when she has to attend school.” There were a number of examples similar to the
quote above that demonstrated how the support of the caregiver furthered the mother’s ability to
achieve goals. Two examples from separate case files of how mothers continued their
educational progress post pregnancy are below:
Minor also stated that she is trying to make up her grades and graduate early.
Furthermore, that she may have to attend continuation school to make up her grades.
The second file stated:
[Mother] says she is doing well in school and getting ready to transfer to [College]. She
is working on her GED. She has three tests to take.
Mothers continued their education and prepared to transition to higher education programs.
Extended family support, which included support with housing, parenting, child care, careers and
education emerged as a strong protective factor for these mothers and offspring.
Father involvement. Mothers in Class 1 were the most likely to cohabitate with the
fathers of their children; about half of mothers lived with the fathers at some point. Fathers of the
offspring provided social support for these mothers and financial benefits in some cases. For
example, the following was documented in the case noted: “mother reported [Father] is a good
father.”
While fathers provided some caregiving and emotional support, many had prior or
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current substance issues and past criminal justice involvement for low-level offenses. One case
file described the father’s engagement with drug testing, “[Father] said he is drug testing for his
Probation Officer, randomly once a month. [Father] was resistive to the idea of having to
submit to weekly drug testing or participate in services.” A similar file described the father’s
criminal justice involvement due to substance use, “The mother reported he was arrested for
possession of drugs 6 months prior and served 6 months at Jail.” Another mother reported to her
caseworker that “she was concerned that the father was not taking proper care of the children
because he smoked Pot and drank a lot of beer every day.” Mothers in Class 1 reported the
father’s substance use to caseworkers when they were concerned about the effect on parenting.
Perhaps due to the father’s presence there was conflict between parents and intimate
partner violence was common among mothers who cohabitated with fathers. One case record
noted, “The father has multiple arrests for domestic violence. The child was in the home when
the father woke up in a bad mood and choked the mother and hit her.” This case narrative
documented chronic and severe intimate partner violence and was not the only one to mention
strangulation. This event was the reason the offspring experienced CPS involvement. Other cases
documented less serious intimate partner violence but provided evidence of conflict. One
investigator reported, “[Mother] reported that during a verbal argument, [Father] spit on her.”
Although there was conflict in this family, the parents continued to cohabitate.
Fear of CPS involvement. Perhaps because of their experiences in care and their desire
to be good parents, mothers in Class 1 were fearful that their children would experience
involvement with the CPS. Social workers documented the mother’s concerns. One caseworker
wrote “She informed [Social Worker] that she was a former foster child and does not want her
son to be in the system like the way that she did.” Another mother repeatedly confronted her
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social worker about the risk of two-generation foster care placements and stated "Just tell me this
is you going to take my children. I don't want my children in the system."
Mothers in Class 1 sometimes did not remain in extended foster care due to the fear that
contact with the system could lead to the removal of their child or because of a desire to live with
the father of the child. Instead, mothers exited care and stopped receiving services at age 18.
Once caseworker documented her contacts with a minor mother, “She stated [Father] talked her
into leaving the placement and at the time it seemed like a good idea because she had this idea
they would all be together as a family.” Fathers were not always eligible to live in transitional
housing programs with the mother and child, which led mothers to decide to decline services and
supports. Mothers and fathers lived together either in their own apartment or at a family
member’s house. Parents sometimes lived with the father’s mother (the offspring’s parental
grandmother) who provided parenting support for the offspring.
Class 2: Minor Mothers with Short Periods in Care
Mothers in Class 2, defined by their young age and short periods of time in care, were the
largest class identified by the LCA (47% of mothers). Common class themes included that (1)
mothers had experienced recent maltreatment and recent entry to care, (2) the mothers’ trauma,
young age, and developmental delays seriously compromised parenting, (3) offspring were
reported to CPS due to neglect and mothers’ lack of knowledge of child development, (4)
mothers were dependent upon parenting support from adults, and (5) fathers were often absent or
abusive to offspring.
Mother’s recent maltreatment. Mothers in this class were placed in out of home care
around the time of conception or the birth because of recent maltreatment physical, emotional, or
sexual abuse. Some mothers were in care due to the circumstances surrounding the pregnancy.
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One caseworker summarized a case by stating, “The child, [Mother] (age 13), was removed from
her parents’ custody in March 2010 as a result of sexual abuse by her brother and her parents’
failure to protect her from said abuse.” This mother was removed from her home due to her
family’s inability to provide adequate supervision from a known sexual abuse perpetrator that
resulted in a pregnancy at a very young age. In another case record, the social worker reported,
“…Sexual Abuse to [Mother] (age 12) by unknown perpetrator was substantiated. [Mother] was
six-months pregnant.” Mothers in Class 2 were often very young and conception was not the
result of consensual sex.
Offspring maltreatment reports. Offspring were commonly reported to CPS due to the
mother’s lack of knowledge of child care responsibilities. One worker described her interaction
with the mother as follows:
This worker asked her where the baby's car seat was and she stated she did not have one
and thought it was no big deal. She blamed the taxi cab driver for allowing her to put the
baby in the car without a car seat. This worker told her that she was the parent and
responsible for not breaking the law by not having her one year old in a car seat.
The mothers were unaware of basic child needs and some were unable to be responsible enough
to care for a child.
[Baby] (9 months old) is left alone and unsupervised in the bed room on the bed for two
or three hours at the time. The mother leaves the residence while [Baby] is sleeping and
when he wakes up, he often falls off the bed and crawls around on the floor.
As exemplified in the above quote, neglect was common as mothers seemed to be unaware of or
unable to provide appropriate care.
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Mother’s trauma, young age, and developmental delays. Trauma, young age, and
developmental delays negatively affected the ability to parent for mothers in Class 2.
Specifically, recent sexual abuse experiences, some that led to the pregnancy, had not yet been
resolved. Likewise, these mothers were young and, as a result, developmentally ill prepared to
take on the responsibilities of being a parent. One caseworker visited the mother in the hospital
after the birth and reported, “… thirteen year old mother demonstrated during the investigative
interview with that she is not developmentally mature enough to provide for the basic care and
control of the newborn child.” The mother was so young she was physically unable to easily hold
the child and she sometimes dropped the baby. The adolescent mothers were also sometimes
self-focused and neglected child care, common behaviors for this developmental stage. One
investigator reported:
Severe Neglect. Mother has on a continuous basis put her teenage & personal want
above her son ... Mother leaves child unattended in unsafe environments while
mother sleeps or socializes, neglectful w/ feeding when hungry, leaves baby in soiled
diapers long term, refuses to hold baby when feeding him a bottle, mom would rather
prop bottle or baby is flat unattended which is a choking hazard, mom refuses to stay
home and care for baby when sick, mom posts pictures of baby on mother's dating
website, mom yells & growls at baby when he is crying & won't go to sleep.
This mother had little knowledge of child development and put her own needs above her child’s,
placing her child in serious danger.
Some mothers were not only young but also developmentally delayed. One social worker
interviewed a nurse and noted, “Nurse reported the mother did not understand that she was in
labor and required Nurse to explain the delivery process using a scaled back vocabulary that she
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determined to be on a nine year old level of communication.” This mother also did not know how
she had become pregnant, had not received prenatal care, and had little to no knowledge of how
to care for an infant.
Need for parenting support. Not surprisingly, given their very young age, mothers were
dependent upon assistance from others. These mothers wanted to keep their children and
acknowledged they will need help to do so. Caseworker notes in one file noted the mother
“Wants to live with aunt and have baby.” Another case file said “[Mother] stated she is able and
willing to care for [Baby], but she also understands that she needs the assistance of her mother.”
Support was almost always requested by the mother and sometimes the mothers were fully
supported. When there was support, there were signs parenting was going well. One social
worker visited the family and documented, “[Social Worker] made contact with maternal
grandmother and she stated the children are safe in the care of mother. She also stated paternal
grandmother and the father of the children are additional support systems to help with raising
the children.” This parenting support was essential for offspring of very young mothers.
Relationship with fathers. Fathers of the children of mothers in Class 2 were absent or
unknown and they tended to be significantly older than the mothers. Caseworkers documented
the mother’s lack of knowledge about the fathers “[The mother] was asked about paternity and
stated, “I have no idea who the father is and I don't want to know." In this entry in the case file,
the caseworker documented having asked about the father and the mother emphasized not
wanting to know the paternity. In another record, less information related to the mother’s feeling
about the paternity was documented, yet the father’s age was included: “the father of the baby
will be Male Doe age (35).” Few fathers were involved, supportive, and of a similar age.
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Some fathers who were involved appeared to pose a threat to the safety of the children.
One investigator met with the family and documented the mother’s statements, “Mom reported
that her boyfriend is physically abusive to their 2 eldest children (4) and (2). He allegedly spanks
both of them too hard and every week. He also yells at them too loudly.” The investigator
substantiated the maltreatment because there was evidence the father was abusing the children.
Another instance of a child being maltreated by the father was documented by an investigator:
Saturday Father hit the child on the head with his fist several times. [The reporter] said
the child acted as if it was an every day occurrence. The child was trying to pick up a
stick and dad yelled to him and said "did you hear me nigger you mother fucker put down
the stick".
This case file described a father that regularly physically and emotionally abused his son. There
was little evidence that fathers were supportive to mothers and offspring in Class 2.
Class 3: Mothers with Long, Unstable Placements and Mental Health Conditions
Class 3representing 23% of the statewide population of mother-child dyads as identified
by the LCA and was at highest risk for offspring CPS involvement in the first three years of life.
This class was defined by their long, unstable foster care placement history and mental health
conditions. Key themes emerged from these case records including (1) offspring were reported
for serious child safety concerns, (2) mothers had documented comorbid mental health and
substance abuse issues, (3) mothers lacked social support from fathers and adults, and (4)
mothers had negative and sometimes abusive experiences in foster care that led them to refuse
CPS services.
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Offspring maltreatment reports. Case narratives documented serious concerns that led
to CPS involvement. These reports were commonly related to the mother’s use of drugs or
alcohol and mental health conditions. One child maltreatment hotline worker wrote:
It was reported that mother and baby tested positive for heroin and methamphetamine.
Mother states that she uses heroin daily and wants to breast feed the baby. Mother is not
interested in drug treatment. It was reported that the mother had only one prenatal visit.
The case described a mother with substance abuse needs that were untreated. Another mother
was described by a social worker who documented concerns about the mother’s parenting
abilities due to her serious mental illness:
[Mother] has shown increased aggressive outburst within the past several weeks.
[Mother] throws objects, and she has shown extreme mood swings which occur about
three times a week. The most recent event took place today. [Mother] has previously
locked herself in the room for seven hours with her child, [Baby], and would not allow
anyone in the room to help her. The reporting party is concerned that [Mother] can’t
control her anger and she may accidentally hurt [Baby].
The mother was struggling with mental illness, placing the child at risk. After the report, this
mother was offered treatment, but it was unclear if she entered services. Not surprisingly, babies
born to mothers who were suffering from serious mental illness or had dependency issues with
hard drugs had great and imminent safety concerns at the time of the report. These were cases
where intervention and supports were needed immediately.
Comorbid issues. Among those in Class 3, the offspring’s case history shows serious
issues impairing parenting related to the mother’s mental health issues, substance use, and
criminal justice involvement. Mothers experienced significant mental health issues pre and post
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childbirth. Mothers were often taking psychotropic medications and in the sample of only 13
mothers in Class 3 there were three suicide attempts and hospitalizations. Serious mental health
illnesses were documented including Paranoid Schizophrenia, mood disorders, Bipolar Disorder,
Post Traumatic Stress Disorder, and Borderline Personality Disorder. The following case records
notes demonstrate the effect these mental health issues had on parenting:
[Caseworker] asked [Mother] about her current mental health. [Mother] stated she is
not currently taking medications. She stated her psychiatrist is aware of this and is
monitoring her closely. [Mother] stated she sees her psychiatrist monthly and she has
also been referred to a bi-polar support group that she is supposed to attend every two
weeks. [Mother] stated she had been taking her medications through most of her
pregnancy, but stopped right after she had the baby. [Mother] stated she waited through
her entire pregnancy to feel the same extreme depression symptoms she had felt with her
first baby, but still has not had the feelings she had before. She stated before she was
extremely depressed and could not care for her first baby at all (that is why he was taken
from her), but she feels different this time and feels OK without her medications.
This mother reported positive mental health with the second child although her mental health
issues led to the removal of her first born. While mothers struggled with mental illness most
mothers with mental health concerns were actively engaged in treatment such as individual
session, family therapy, or medication.
In many cases, mental health issues and substance abuse issues co-occurred. Identified
drugs used by mothers in Class 3 included prescription medications abuse, amphetamines,
ecstasy, and heroine, among others. One mother with past mental health issues was also a
serious drug user, as was the father, as was documented in the case file:
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Mother and newborn tested positive for amphetamines, methamphetamines, father test
positive for same drugs.
Substance use was related to the mother’s criminal justice involvement in many cases. The
mother’s criminal and juvenile justice system involvement was due to substance use, truancy,
fighting, burglary, and commercial sexual exploitation. In line with findings related to the baby’s
maltreatment reports, babies born to mothers with comorbid needs were reported for issues that
reflected serious safety concerns.
Lack of Social Support. Among mother in Class 3, case narratives documented limited
social support. Fathers were not engaged with the mothers or offspring. Records commonly
described the fathers’ lack of engagement. One social worker reported, “The father’s
whereabouts are unknown at this time.” Another case file noted, “Father does not have contact
with the child.” There was little detail as to why the fathers were disengaged.
The mothers were also unable to connect with adults in placements, such as adults from
the biological family, in kin or foster home placements, or caseworkers. In one case note a
mother stated “that she does not have any family support and feels isolated and alone.” Another
record documented a mother attempted to move in with her maternal grandmother, however, she
was rejected because there was a restraining order preventing the mother from entering the
residence. Another case note reported the lack of stability, support, and trust and the mother’s
behaviors in response:
Placement move. [Mother] said this is "bullshit" and she is not going anywhere.
[Mother] said "fuck" all of you. [Mother] said she is going to pack her "shit" and she is
leaving. At that time, [Mother] shut down all communications and she would not speak
with anyone.
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This case narrative described a mother who had little social support. She also experienced
multiple placements and her anger and frustration appeared to intensify at each placement move.
Mothers’ experiences in care. Several mothers in Class 3 experienced maltreatment in
out of home care. Some of the abuse experienced in care was extensive, as documented in one
file:
Reporter stated that minor informed her that she ran away from her previous foster
father (where she resided in for 8 months, and went AWOL from there) sexually
abused/raped her repeatedly.
Similar sexual abuse occurring while the girls were in foster care placement was noted in three
separate case files Once the foster father was the perpetrator, another time the mother was
assaulted by other youth in the placement, and once the perpetrator was not specified. Emotional
and physical abuse also occurred, as documented by one caseworker’s notes “emotional abuse
and general neglect by foster mother.” One case of medical neglect noted “The [Reporter]
alleged that foster mother, neglected minor [Mother] by not taking her to see a doctor when the
minor told her that she was feeling very ill.” This mother had to be hospitalized because of the
caregiver’s inaction. Other similar instances of neglect and abuse were described.
Many mothers were unhappy with their experiences in care and were unable to connect
with any caregivers for long periods of time. Mothers in Class 3 expressed concerns about
remaining in care as a non-minor dependent or remaining in contact with CPS after the birth of
the child. These mothers did not see a benefit to remaining in contact with the system. As a
result, mothers rejected voluntary, supportive services. One social worker documented the
mother’s reasons for closing her case, “[Mother] stated to [Social Worker] that she needs her
case to be closed. She stated that she has been on her own for the past few months, and does not
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need any further assistance from DCFS.” This mother did not see a benefit to the services
offered by child welfare and chose to close her case. A few young mothers exited care as minors
as exemplified by this case note, “Stated that she would like to emancipate from the system
before she turns 18.” By closing their cases early, mothers were not able to receive services. One
social worker described the problem in the case narrative:
[Mother] needed to go apply for WIC, enroll into a parenting class that CSW provided
for her and enroll back into school. CSW asked had [Mother] been in contact with
Occupational Therapy Training Program coordinator and she said no. CSW stated to
[Mother] that she needs to make an effort to get in contact with the providers that CSW
has given to her. This is her responsibility to get the information that is needed for her.
She wants everyone to help her but she has to help herself as well. [Mother] became
angry.
The mother refused services for which she was eligible and would seem to have been helpful.
Both the mother and social worker appeared to be frustrated which each other and in the end the
mother emancipated without services. In other instances, the mother’s behavior led to the end of
services. One social worker documented, “Learned about [Mother] being kicked out of her THP+
[Transitional Housing Plus] program and she has been asked to leave.” This mother was unable
to access housing services after this instance although the reason she was asked to leave was not
found in the case file. Overall, mothers significant faced difficulties in their homes of origin,
out-of-home placements, and as parents.
Discussion
The current study produced new information and insights about two-generation CPS
involvement among children born to mothers in foster care. The study is unique because it
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leveraged qualitative data in the form of case records sampled from a prior quantitative analysis
that identified distinct classes of mother-child dyads with varying risk of offspring CPS
involvement. Prior research indicated that offspring born to mothers in foster care are a high risk
group for maltreatment (Dworsky, 2015, Eastman & Putnam-Hornstein, in progress). The
findings from the present investigation identified common experiences and stark contrasts among
different classes of mother-child dyads; highlighted barriers to service provision, and supported
the utility of analyzing child welfare case narrative records.
Commonalities and heterogeneity across classes. The study identified commonalities
and heterogeneity among mother-child dyads. As demonstrated in prior studies, parenting was
often negatively affected by the mother’s substance abuse (Leve, Kerr, & Harold, 2013;
Stephens, & Aparicio, 2017) and mental health issues (Narendorf, Munson, & Levingston, 2013)
or unresolved trauma related to extensive or recent sexual abuse. Mothers across classes often
ran away from foster care placements and experienced homelessness after exiting care. Recent
maltreatment appeared to have a profound effect on parenting abilities, which is in line with
work that suggests the timing of maltreatment matters and is related to long term outcomes
(English, Graham, Litrownik, Everson, & Bangdiwala, 2005). Prior literature has shown that
sexual abuse is associated with increased risk of adolescent pregnancy (Blinn-Pike, Berger,
Dixon, Kuschel, & Kaplan, 2002) and the current study provides further evidence that a sexual
abuse history is common among mothers in care, indicating a need to provide trauma-informed
services The lack of a stable placement or home were noted in offspring CPS reports as a reason
for concerns about child safety. The stressors mothers in care experienced (e.g. substance abuse,
mental health issues, homelessness, runaways, and sexual abuse) were exacerbated when
mothers had more than one child, which was common among those in Class 1 and 3, as indicated
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by offspring case records. These themes were common across all classes demonstrate the
extremely difficult circumstances mothers experienced well before their children were born. The
prior experiences of these mothers combined with the stressors of parenting indicate
comprehensive services are warranted. A nuanced understanding of experiences, protective
factors, risks and needs emerged when each class was reviewed. Similar to work by Courtney,
Hook, and Lee (2012) which used LCA to examine youth aging out of care, heterogeneity exists
among pregnant and parenting mothers in care.
In case records of mothers in Class 1, the class with the lowest risk of an offspring CPS
report in the first three years of life, extended family support emerged as a strong signal of
family resilience. Typically, this support was from the adult that the mother lived with in her
long-term placement or the father of the offspring. These findings mirror prior research that
identified the importance of social support among mothers in care (Aparicio, 2016; Love,
McIntosh, Rosst, Tertzakian, 2005; Radey, Schelbe, McWey and Holtrop, 2017). Radey,
Schelbe, McWey and Holtrop (2017) conducted group interviews of mothers aging out of care
and service providers to examine social capital defined, based on the work of Bourdieu (1986),
as, “the actual or potential resources available from one’s social network” (p. 982). The authors
found the mothers lacked beneficial social relationships and did not have adequate
encouragement from others, emotional support, or practical supports (e.g. financial assistance,
child care assistance, transportation). Similarly, mothers in the current study appeared to benefit
significantly from supportive relationships with caring adults who assisted with childrearing.
Dworsky and Gitlow (2017) also highlighted the importance of parenting youth having access to
child care in order to be successfully employed. The present investigation showed that not only
was extended family support important for mothers and offspring, but also having a family
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member or caregiver provide child care while the mother was at work or school appeared to be a
strong protective factor for the dyad.
Perhaps due to the wealth of support mothers in Class 1 received, offspring CPS reports
were commonly related to concerns that could be addressed with additional supports. The
reasons for some maltreatment reports were seemingly mild and indicated that if the mothers had
not been in a foster care placement with enhanced surveillance by mandated reporters, then
offspring may not have experienced CPS involvement. Prior literature has found evidence that
offspring of parents with a history of maltreatment are at risk for childhood neglect and sexual
abuse, but surveillance bias may account for the greater likelihood of CPS reports (Widom,
Czaja, & DuMont, 2015).
Class 1 mothers also maintained contact with the fathers of the offspring who were a
source of social support but whose involvement also led to conflict and intimate partner violence,
another reason offspring were reported. The intimate partner violence was serious as there were a
few instances of choking and nonfatal strangulation is associated with later homicides (Jurik &
Winn, 1990; McFarlane, Parker, & Soeken, 1995). There were also many signs of support and
resiliency for these mothers in light of the stress and conflicts in their lives. It seems likely that if
mothers receive parenting classes, relationship counseling, and continue to have help from a
supportive co-parent many will be successful parents and their children will be safe.
Offspring CPS records in Class 2 showed that offspring were reported due to parenting
difficulties related to the mothers’ development and recent trauma. Some of the mothers were
victims of sexual assault and may have been targeted due to their young age or developmental
delays. Many of these mothers had been recently maltreated as evidenced by recent entries into
care. Overall, mothers in this class very much hoped to continue parenting with the support of an
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adult, but without a supportive adult co-parent they failed to meet the child’s basic needs, which
resulted in CPS involvement and sometimes a child removal or termination of parental rights.
Lack of knowledge of child development and child care have been identified as key
concerns in studies examining mothers in care (Schelbe & Geiger, 2016; Svoboda, Shaw, Barth,
& Bright, 2012). By not providing mothers who want to keep their children with necessary
information about child development and child care there is a missed opportunity for family
preservation. Geiger & Schelbe (2014) recommended that child welfare offer universal parent
education programs. The data from the current study suggest that mothers may be in need of
supports as non-minors, as well. Mothers in Class 2 were young at the time of birth and were
only followed for three years post birth so there were few who were in the study after turning 18.
These mother-child dyads may benefit from services as non-minors; however, the current study
could not determine if mothers in this class would access extended voluntary, extended services
or identify barriers to access. Much remains unknown about how outcomes can be improved for
offspring born to very young mothers in care.
Offspring in Class 3, the class at highest risk for an offspring CPS report in the first three
years of life, were reported for reasons that indicated the offspring may be in imminent danger.
The offspring risk was related to the mothers’ significant comorbid substance abuse and mental
health needs. Substance abuse (Aparicio, 2015; Coleman-Cowger, Green, & Clark, 2011) and
mental health issues (Aparicio, 2015; Narendorf, Munson, & Levingston, 2013) have been
identified as concerns in earlier literature examining pregnant and parenting youth in care. These
issues have been associated with child maltreatment risk in the general population (Magura, &
Laudet, 1996; O'donnell, Maclean, Sims, Morgan, Leonard& Stanley, 2015) and are of great
concern to mothers in care because these are young mothers with limited support and resources,
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102
amplifying risks. However, only one study has been published that examined the process of
adapting an evidenced-based parenting intervention specifically for parents in care (Holtrop,
Canto, Schelbe, McWey, Radey, & Montgomery, 2018). Effective programs are essential given
that literature consistently finds that mothers in care hope to be good parents and want to prevent
child maltreatment (Aparicio et al. 2016; Radey et al., 2016) This current study supports prior
work highlighting the importance of developing evidenced-based interventions that address the
needs of mothers in care. Importantly, the findings in all three classes show that mother and
offspring outcomes are tied together, suggesting a two-generation approach to interventions is
required.
Barriers to services. The barriers to service provision and reasons mothers have for
opting out of extended foster care were identified including (1) the desire to live with the father,
(2) negative experiences in care, and (3) fear of CPS surveillance. Mothers chose to live with the
father instead of receiving housing services through child welfare when the father was not able to
live in transitional housing designed for non-minor dependents. Several mothers in the current
study were maltreated while they were in care and were eager to exit the system. Mothers were
untrusting of others and determined to prevent two-generation CPS involvement. Radey,
Schelbe, McWey and Holtrop (2017) noted how the distrust and fear of the system may prevent
mothers aging out of care from accessing services for which they may be eligible. They found
that mothers lacked the ability to develop healthy relationships and advocated for mentoring
programs that prioritize relationship building and sustainability. Fear of system surveillance was
a concern documented by prior work examining parents in care (Aparicio, 2016; Schelbe &
Geiger, 2016).
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Given the needs identified and the high risk of CPS involvement, it seems likely that
mothers and offspring may benefit from voluntary, supportive services. Taking into
consideration the educational and employment requirements that youth must comply with to
receive services as a non-minor dependent, it stands to reason that mothers may be less able to
fulfil requirements than youth who are not parents. However, the case records examined suggest
that early termination of services was not due to difficulties with eligibility, but rather, it was
related to fear and distrust. Mothers were not trusting of individuals who provided services
through the CPS given negative experiences in care and because they were fearful that their own
children could be reported or removed. Efforts to incorporate the perspectives of the mothers in
the design and adaptation of interventions may increase the likelihood of the mothers’
involvement and the effectiveness of programs (Holtrop et al., 2017).
Utility of case records. The present investigation shows that case records contain
detailed information that is useful for understanding CPS involvement among offspring born to
mothers in foster care. The information contained in the case narratives augmented what was
known about these dyads and generated insights not available from structured data. Longitudinal
studies examining pregnant and parenting mothers in care face significant challenges
maintaining contact with these families over time because former foster youth move often and
the system does not provide resources to follow youth after exiting care (Lieberman, Bryant, &
Boyce, 2015). The use of case records partially addresses this concern because the large majority
of case records contained information about mothers and offspring dating back to the mother’s
childhood and through the offspring’s early childhood. Case narratives contain rich details about
the mother’s history and family need and resiliencies. Importantly, these files documented
conversations with key stakeholders related to offspring maltreatment investigations.
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The child welfare system has been criticized for its failure to engage fathers in the child
protection process (Scourfield,2006). Concerns have been raised that mothers are the focus of
scrutiny and fathers are denied meaningful involvement related to the decisions about the child.
This process is thought to be historical, as the system was designed at a time when fathers were
typically sole breadwinners. More recently there has been pressure to reform policies and
practice to include fathers. The data unearthed demonstrate that caseworkers consistently made
efforts to document relationships with fathers and engage extended family members.
Information gleaned provides insight as to what services may benefit these mother-child dyads to
prevent two-generation CPS involvement.
Limitations
The use of CPS case narratives makes this study particularly powerful as these data have
not yet been used to enhance knowledge about CPS involvement among offspring born to
mothers in care. Yet, this study must be considered in light of the limitations. Importantly, the
data analyzed were child welfare case records which were collected to support decision making
in the CPS system and not intended for research purposes. Likewise, the case records are almost
certainly incomplete and dependent upon the narrative details contained in the file. As a result,
the data may be subject to bias and inaccuracies. Content analysis is largely descriptive and relies
on the availability of data, thus information not contained in case narratives cannot be analyzed.
The present analysis used case documentation and therefore the secondary data were somewhat
removed from the contexts of the individual foster care settings where mothers and children were
placed. Prior qualitative investigations have obtained data from foster care settings (Aparicio,
2016; Lieberman, Bryant, & Boyce, 2015). The study is not generalizable to the population of
mothers in foster care because the data originate from one state. However, it should be stressed
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the demographic characteristics of mother-child dyads in the sample generally reflect the
characteristics of the full population of pregnant and parenting youth examined in the study by
Eastman & Putnam-Hornstein (in progress).
Implications for Policy, Practice, and Research
The investigation demonstrates a need for two-generation, trauma informed services.
Importantly, the data show that the mother’s past experiences are tied to the child’s outcomes. As
a result, services offered must meet the needs of the whole family. Two-generation approaches
are rarely implemented but they provide opportunities to meet the needs of the child and the
parents together (Ascend of the Aspen Institute, 2016). The key components of two-generation
programs include (1) opportunities to provide complementary activities for parent and child
which produce positive outcomes for each; (2) service delivery models with mutually reinforcing
activities, such as parent skill building classes that enhance child academic achievement; and (3)
services that result in improved outcomes even after the program has ended. Currently, the
service delivery systems are constructed to offer services for the primary client, either the mother
or child, and delivery is not orchestrated for the mother-child dyad. One two-generation pilot was
implemented in Los Angeles County, named Imagine LA (personal communication, Lead
Evaluator, Imagine LA, April 16, 2018). This two-generation program was implemented in
conjunction with the County Department of Children and Family Services, to supports pregnant
and parenting youth as they exit foster care with a mentoring program for the mother-child dyad.
The program has demonstrated improved outcomes for both mother and child. In the first year of
the pilot only one of the eleven dyads was reported to CPS. The findings from the current
investigation illustrate why the needs of mothers and children must be integrated.
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The data highlight the importance of tailoring services specifically for mothers in foster
care that include parenting classes; housing, mental health and substance abuse treatments; child
care; and family planning services among others. Case notes indicated that all mothers could
benefit from parenting classes related to child development. Offering mothers information about
child rearing practices and parenting skills may reduce risk of child maltreatment. The patterns
of homelessness and runaways indicated that mothers could benefit from improved housing and
placement stability. Housing options that facilitate cohabitation of the mother and father may
increase the likelihood that mothers remain engaged with CPS as a non-minor dependent.
Substance abuse, mental health issues and sexual abuse were comorbid, indicating that mothers
may have multiple needs that must be addressed. Service providers and caregivers may need
additional training to address the needs of mothers in care using a trauma informed approach,
with particular focus on those with a history of sexual abuse. Likewise, trauma-informed sexual
education and parenting programs should be developed specifically for these mothers.
The current study supports prior research which highlighted the importance addressing
the sexual and reproductive health needs among children in child welfare (Wilson, Casanueva,
Smith, Koo, Tueller, & Webb, 2014) by noting the young maternal ages at birth and large
number of identified siblings born young mothers in the current investigation. The CalYOUTH
study (Courtney et al., 2016) found that among those who had been pregnant, about a third
reported that they definitely did not want to have a baby, about a quarter reported that they
definitely wanted to have a baby, and over a quarter said that they neither wanted nor did not
want to have a baby. Those who hope to delay pregnancy should be equipped with the skills and
resources to do so. Not providing youth in care with knowledge and resources is a missed
opportunity.
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Overall, the data from the current investigation show that there is a need for continued
efforts to develop programs and policies that fit the needs of mothers in care with varying needs.
The examination of individual classes showed that mothers in foster care are heterogeneous.
Mothers in Class 1 could benefit from relationship counseling and conflict resolution training
given that the fathers were often present and there were documented instances of intimate partner
violence. The maltreatment reports and subsequent investigations suggest these mother-child
offspring were doing well and less surveillance could be warranted. That said, there were
legitimate reports due to the mother’s lack of parenting knowledge and many mothers in this
class may benefit from parenting interventions.
Mothers in Class 2 were very young and both social workers and mothers indicated that
these mothers needed parenting support from an adult to be successful due to the mother’s age,
development, and recent trauma. California places offspring with their parents whenever possible
when the parents are in foster care or probation placements. These placements, called “Whole
Family Foster Homes” (WFFH), have caregivers certified to assist young parent in developing
the skills necessary to provide a safe, permanent home for children. The program, established by
Senate Bill 500 (Kuehl, 2005), provides a higher payment to cover the costs of the care and
supervision provided, and includes a financial incentive for caregivers who choose to develop a
Shared Responsibility Plan (SRP). The SRP is an agreement between the parent in foster care
and WFFH caregiver about the rights and responsibilities for the parent’s non-dependent child.
The purpose of the SRP is to assist the parent with a successful transition to independence and a
nurturing placement for both the young parent and the child. Importantly, none of the placements
in the case narratives were described as WFFHs in the currently study. This may be an indication
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of the lack of implementation and due to the fact that only reported offspring were examined for
the analysis and children placed in WFFHs may be less likely to be reported to CPS.
Mothers in Class 3 could also benefit from an established SRP in concert with other
support. Mothers in Class 3 looked similar to mothers in Class 1 as far as trauma history;
however, mothers in Class 3 did not have a relationship with a supportive adult and had never
found a stable placement. Radey, Schelbe, McWey, Holtrop, & Canto (2016) highlighted the
importance of identifying positive parenting role models. In 2014 California developed a policy,
Assembly Bill 2668, which funds Parenting Support Plans between non-minor dependents and
adult mentors who agree to assist the parent and offspring. If implemented appropriately, such a
policy could benefit mothers in need of mentorship and support. The lack of stability altered the
mother-child dyad’s long-term trajectory, having cascading effects for the offspring. In 2016 Los
Angeles County adopted a project to enhance family finding strategies for children in child
welfare (LA DCFS, 2017). This project included family search and engagement training,
implementation tracking, and practice changes. Initial data are promising and have demonstrated
and increase in relative placement averages. This is consistent with prior research as Shpiegel
and Ocasio (2015) found that youth placed in care at earlier stages of adolescence that were
relatively stable, family-based settings had better functioning at age 17 as indicated by a range of
measures including parenthood, incarceration, and homelessness. Mothers in Class 3 also often
had mental health conditions and substance abuse issues, which negatively affected their
parenting abilities. As a result of these serious concerns, offspring reports were often serious and
the safety concerns were imminent. Case narratives documented the need to address mental
illness and substance abuse issues in order to keep the offspring safe. Adoption of policies that
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109
promote placement stability, support mental health needs, and address substance abuse could
result in two-generation benefits.
Given the vulnerabilities identified in the mother-child dyads, it stands to reason that
mothers may benefit from supportive services. The federal policy which allows states to extend
child welfare services to non-minor dependents does not mention parenting youth. There should
be a national effort to link parents to services in young adulthood, ensure services provided meet
their unique needs, and address barriers to service provision. As described previously, mothers in
the current study rejected services as non-minor dependents. While mothers studied in the
current investigation could not live with the fathers of the offspring if housing was offered
through child welfare California recently adopted Senate Bill 612 in 2017 to address the needs of
co-parenting couples when only one parent is a dependent. The legislation clarified that
participants may share a bedroom with an approved roommate. National adoption of this policy
could increase the likelihood that parents and offspring access ongoing supports.
Efforts should be made to reestablish trust between mothers and child welfare service
providers. Schelbe and Geiger (2016) stated that the mothers’ fear of CPS involvement is
legitimate fear given the potential for a surveillance bias among adults in care and research that
has documented the offspring’s increased risk of CPS involvement. Mothers should also be
offered services delivered outside of the child welfare system, which may be more appealing to
them. Illinois’s Teen Parent Service Network (TSPN) provides coordinated service delivery for
pregnant and parenting youth in care (Illinois Department of Children & Family Services, 2018).
In this state, parents in foster care are offered home visiting services that are separate from the
child welfare system. The effort to provide supports from a separate system is intentional and
serves as a model for other states.
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The findings from the present qualitative analysis show there is an opportunity to learn
more about the mothers using linked, administrative data from multiple sources and examining
the case narratives within those datasets. The qualitative data show that many mothers in care
experienced sexual abuse, substance abuse, mental illness, and criminal justice involvement.
Data linkages to substance abuse treatment programs, mental health services, and probation will
provide information about the delivery of services and the relationship with long term outcomes
for mothers and offspring. Additionally, if community based, preventative services can be linked
to administrative datasets the effectiveness of programs can be examined. In addition to high
rates of child welfare involvement, offspring born to mothers in foster care may be at increased
risk for death. Fewer than ten cases of Sudden Infant Death Syndrome (SIDS) were identified in
the sample, however, the current data linkage does not allow for an examination of the risk of
infant death among offspring born to mothers in foster care.
Conclusion
The current study extends the knowledge base on pregnant and parenting youth in care by
using case narrative records to detail differences across three classes of mothers that were
identified using a LCA. The process highlighted the significant life difficulties mothers in care
and their offspring face and also offered hope for success. Results show that class membership
varies based on the mother’s earlier experiences in care and the reasons for the offspring’s
maltreatment report. These findings add substantial depth to the understanding of factors
associated with the maltreatment of offspring born to mothers in foster care and demonstrate the
importance of developing two-generation strategies to effectively address needs of both the
mother and child. Members of each class differ from members of the other classes in a number of
important ways. While mothers in all classes have faced significant stressors, the long-term
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111
trajectory is influenced by early and continued support and placement stability. Although further
research is needed to understand what can be done to improve long-term outcomes, the findings
support the need to develop a range of two-generation, trauma-informed services to target
parents in care and their offspring.
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The maltreatment incident (e.g. severity, frequency, description
of injury)
Child characteristics (e.g. age, special circumstances, behavior)
Caretaker characteristics (e.g. child interactions, knowledge,
substance abuse, criminal behavior, mental health)
Family factors (e.g. support systems, environmental conditions,
family strengths)
Domestic violence or abuse factors (e.g. weapons in the home,
prior emergency medical response, medical neglect)
Interview summaries from family members, reporter, or
perpetrator
A social history for the family describing social, cultural or
physical factors associated with caregiving
Any of the child’s developmental needs
Information about referrals or services offered
An assessment of the child’s level of risk
Reasoning for the disposition (this described if the investigation
was determined to be unfounded, inconclusive or substantiated
based on the interviews and other collected information)
The “screener” narrative summarized the presenting
problem, the reason for the CPS involvement (Luna,
2001 ). The data were collected when the
maltreatment report was made and were used to
determine if an in person investigation was warranted.
Details on the following topics were included:
The “investigative” narrative was created when a
child welfare case worker conducts and in person
interview and investigation, typically following a child
maltreatment report. The guidelines for the
“investigative” narrative included a summary of the
“screener” narrative, information about prior
involvement with CPS, and documentation about the
investigation process. Other information that was
typically presented included:
Note: Associated documents included court documents, placement documents, and service delivery logs. These files
were reviewed for additional details but the large majority of the information was previously found in the case narrative.
Table 4.1 Description of contents of case records.
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Category Themes
Common Across all Classes
Substance abuse: Substance abuse was common and negatively affected the ability to
parent, however the extent and type of substance used and effect on parenting varied
across classes.
Homelessness : Homelessness was common among nonminor mothers but was not
typically the primary concern that led to the maltreatment report.
Multiple children : Mothers had multiple children, especially in classes 1 and 3.
Sexual abuse : Nearly all of the mothers’ case notes included a mention of one sexual
abuse allegation but many contained descriptions of ongoing and extensive sexual abuse.
Runaways : Mothers’ case notes commonly mentioned that the mother had run away
from foster care placements. These runaway experiences occurred before, during, and
after the pregnancy.
Services : Nearly all mothers received some services while pregnant and parenting.
Services offered varied and appeared insuffecient given needs.
Class 1: Nonminor Mothers with Long, Stable Placements
Offspring maltreatment reports : Reports to CPS were typically due to parenting skills
and child supervision. There was evidence of surveillance bias.
Strong social support: Many mothers had an identifiable “co-parent,” who supported
the mother with child care and enabled her to attend school or obtain employment.
Father involvement : These mothers were the most likely to cohabitate with the fathers
of their children and intimate partner violence was common.
Signs of resilience: Information in the case records signaled that parents and children
were doing well.
Fear of CPS involvement : Perhaps because of their experiences in care and their desire
to be good parents, mothers in Class 1 were fearful of two-generation CPS involvement.
Class 2: Minor Mothers with Short Periods in Care
Mother’s recent maltreatment : These mothers were placed in out of home care around
the time of conception or the birth of their child because of recent maltreatment. Some
mothers were in care due to the circumstances surrounding the pregnancy.
Mother’s trauma and developmental concerns : Trauma, young age, and
developmental delays negatively affected the ability to parent for mothers in Class 2.
Offspring maltreatment reports : Offspring were also commonly reported to CPS due
to the mothers' lack of knowledge of child care responsibilities.
Need for parenting support : Mothers were dependent upon assistance from others.
These mothers wanted to raise their children and acknowledged they needed help to do
so.
Relationship with fathers: Fathers were absent or unknown and tended to be much
older than the mothers.
Class 3: Mothers with Long, Unstable Placements and Mental Health Conditions
Offspring maltreatment reports: Serious concerns led to CPS involvement. These
reports were commonly related to the mother’s use of drugs and/or alcohol and mental
health conditions.
Comorbid needs: Serious issues impaired parenting related to the mother’s mental health
issues, drug use, and criminal justice involvement.
Lack of social support : Fathers were not engaged with the mothers or offspring.
Mothers were not connected with adults in placements.
Mothers’ experiences in care : Mothers had negative and sometimes abusive
experiences in care that led to discontinued CPS service use and early exits from care.
Offspring placed in out-of-home care : In a number of cases, the offspring was placed
in kin guardianship placements by the parents.
Table 4.2 Themes related to mother-child dyads.
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118
CHAPTER 5
Conclusions, Implications, and Future Directions
Major Findings
This dissertation highlights the tremendous potential to improve outcomes for mothers in
care and their offspring and addresses a significant gap in the literature related to understanding
two-generation child welfare involvement. In this dissertation, classes of mother-child dyads
were identified based on key characteristics known at birth and maltreatment experiences were
described. The current study was the first to (1) use administrative data to identify the
constellation of risk factors associated with child abuse and neglect among offspring and (2)
leverage case narratives to understand the circumstances of CPS involvement among offspring.
This three-study dissertation also includes the most recent review of literature on pregnant and
parenting youth in care and their offspring. Building upon previous work, this work highlights
that parents aging out of foster care are struggling across a range of domains. These findings
provide a justification for evaluating the effect programs may have on outcomes for this acutely
vulnerable population and calls attention to the dissimilar service needs that exist for mothers
and offspring. The findings also indicate that understanding classes of mother-child dyads may
promote informed service delivery and policy development.
This dissertation had three major findings that may be used to improve policy and
practice for mothers in foster care and their offspring. First, population-level case records
documented the high, concentrated risk of CPS involvement for offspring born to mothers in
foster care, although the proportion reported is decreasing over time. Fifty-three percent of
offspring were reported whereas among all children born in California only 10% are reported by
age three (Cuccaro-Alamin, Hammond, McCroskey, Webster, & Putnam-Hornstein, 2015).
OFFSPRING BORN TO MOTHERS IN CARE Eastman
119
While the risk was high, findings offer hope that policies aimed at improving outcomes among
parents in foster care may be working, as evidenced by the reduction in births, reports,
substantiations and removals. The proportion of offspring who were reported to CPS for
maltreatment has declined over time, from 63.0% in 2009 to 45.5% in 2012. A number of
policies have been passed recently aimed at supporting parents in care that may be related to the
shrinking proportion of offspring reports over time in California. Importantly, the proportion of
offspring reported decreased across stages of implantation for the extension of foster care to non-
minor dependents.
Second, findings highlight the commonalities and heterogeneity among mother-child
dyads across identified classes at varying risk for offspring CPS involvement. The population-
level bivariate analyses suggest information collected in administrative records that are known at
the time of the offspring’s birth are indicators of the family’s needs. Mother’s whose child
welfare case records showed a history of a mental health diagnosis, sexual abuse, and running
away were more likely to experience and offspring report in the first 3 years of life. The current
study also provides further evidence that a sexual abuse history is common among mothers in
care; specifically, 68% of mothers in care had a past allegation of sexual abuse. The LCA
identified three distinct classes of mother-child dyads named (1) Non-minor mothers with long,
stable placements, (2) Minor mothers with short placements, and (3) Mothers with long, unstable
placements and mental health conditions. The risk of offspring CPS reports ranged widely across
classes, from 36% in Class 1 to 68% in Class 3.
In case records of mothers in Class 1, the class with the lowest risk of an offspring CPS
report in the first three years of life, extended family support emerged as a strong signal of
family resilience. Typically, this support was from the adult that the mother lived with in the
OFFSPRING BORN TO MOTHERS IN CARE Eastman
120
long-term placement. The individual was able to provide the mother with child care so she could
continue to pursue education and employment opportunities. Perhaps due to the wealth of
support mothers in Class 1 received, offspring CPS reports were commonly related to concerns
that could be addressed.
Offspring CPS records in Class 2 showed that offspring were reported due to parenting
difficulties related to the mothers’ age, development, and recent trauma. Overall, mothers in this
class very much hoped to continue parenting with the support of an adult, but without a
supportive adult co-parent they failed to meet the child’s basic needs, which resulted in CPS
involvement and sometimes a child removal or termination of parental rights.
Offspring in Class 3, the class at highest risk for an offspring CPS report in the first three
years of life, were reported for reasons that indicated the offspring may be in imminent danger.
The structured records showed a mother’s history of a mental health condition characterized
nearly all mothers in the subgroup at highest risk for an offspring CPS report in the first 3 years
of life. The case narratives documented that offspring risk was related to the mothers’ significant
comorbid mental health and substance abuse needs. Importantly, these findings demonstrate the
heightened risks for offspring born to minor mothers. All mothers in Class 1 were non-minor
dependents but the large majority of mothers in the two higher risk classes were non-minors. A
plan for distinct sets of services can be developed for these dissimilar classes given specific
needs identified.
Third, case narratives contained detailed longitudinal data that were useful for
understanding CPS involvement among offspring born to mothers in foster care. The large
majority of case records contained information about mothers and offspring dating back to the
mother’s childhood and through the offspring’s early childhood. Information gleaned provides
OFFSPRING BORN TO MOTHERS IN CARE Eastman
121
insight as to what services may benefit these mother-child dyads to prevent two-generation CPS
involvement. Importantly, the data show that the mother’s past experiences are tied to the child’s
outcomes. As a result, services offered must meet the needs of the whole family. Two-generation
approaches are rarely implemented but they provide opportunities to meet the needs of the child
and the parents together (Ascend of the Aspen Institute, 2016). Currently, the service delivery
systems are constructed to offer services for the primary client, either the mother or child, and
delivery is not orchestrated for the mother-child dyad. The findings from the current
investigation illustrate why the needs of mothers and children must be integrated.
Additionally, these case records identified barriers to service provision. Mothers were
unwilling to remain in contact with child welfare because they hoped to live with the father of
the offspring, did not trust the system, and were fearful that their children would be reported.
Mothers chose to live with the father instead of receiving housing services through child welfare
when the father was not able to live in transitional housing designed for non-minor dependents.
Several mothers in the current study were maltreated while they were in care and were eager to
exit the system. Mothers were untrusting of others and determined to prevent two-generation
CPS involvement. Fear of CPS involvement was a concern documented by prior work examining
parents in care (Aparicio, 2016; Schelbe & Geiger, 2016). Given the needs identified and the
high risk of offspring CPS involvement it seems likely that mothers and offspring may benefit
from voluntary, supportive services. Case narratives examined suggest that early termination of
services was not due to difficulties with eligibility but rather it was related to fear and distrust.
Limitations
This dissertation is methodologically strong due to the large size, prospective design, and
use of new data sources. The population-base of California, a highly populated and diverse state,
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enables the examination of this relatively rare phenomenon and enhances the generalizability of
the results. The prospective design, which follows a population of offspring for the first three
years of life, minimizes bias to which retrospective designs are susceptible. The use of CPS case
record notes makes this study particularly powerful as these data have not yet been used to
enhance knowledge about CPS involvement among offspring born to youth in care. However,
findings will need to be understood in the context of several limitations.
Although vital records are the official source of all birth information and CPS records are
the official source of information on maltreated children, administrative data are subject to
human data-entry errors that may compromise probabilistic match rates and subsequent analyses.
To address this limitation, efforts were made to develop estimates that incorporate different
assumptions regarding missing data and out-of-state attrition. For example, the robustness of the
LCA model was tested first using the full population, then after excluding foreign-born mothers,
and again after excluding any mothers who were not born in California. Additionally, the
qualitative analysis validated the data linkage process as all links were verified by case narrative
data. Data used in this dissertation was limited to fields available in birth and CPS records, even
though information from other data sources (e.g., mental health records, medical records) may
also be relevant to the questions examined. Although this limitation was not addressed directly,
this dissertation provides evidence highlighting the need future data linkage work and identifies
relevant sources.
The generalizability of findings is unknown given that these data are limited to
California; however, this study can serve as an exemplar of how these two data sources can be
linked to study this issue. Similarly, Dr. Courtney’s landmark Midwest Study on transition-aged
foster youth has served as a national example for evaluating youth outcomes using linked
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administrative education, employment, government aid, health care, and criminal justice data
(Courtney, Charles, Okpych, Napolitano, Halsted, Courtney, & Hall, 2014). Children born to
mothers in foster care are undoubtedly subject to greater surveillance than children born to
mothers who are not in foster care. Although this bias cannot be controlled, differences in two-
generation outcomes among children born to mothers in foster care were examined, highlighting
factors associated with heightened child risk. The current study included paternity as a covariate
but focused primarily on mothers in care. This decision was made because paternity is more
difficult to determine and a child may be unknown to the father or caseworker. Future research
should examine case records of children born to fathers in care to address the lack of literature on
fathers in care.
Implications for Policy and Practice
This dissertation demonstrates that the lack of pregnancy prevention and parenting
support programs for girls and young women in care has significant ramifications as evidenced
by the high risk of CPS involvement for offspring. The literature review highlights the need to
provide youth in care with access to reproductive information and contraception. Prior literature
focused on pregnancies and the factors associated with increased risk of early births among girls
in care. These studies made a strong case for the need for leadership in child welfare to take on
sexual and reproductive health interventions and delay pregnancies among girls in care.
The linked, administrative data and case narratives underscore the need for parenting
support programs by documenting the mothers’ comorbid needs. Mental health issues, substance
abuse issues, homelessness, and criminal justice involvement were common. Extensive sexual
maltreatment was pervasive and findings suggest that the trauma may have an effect on parenting
abilities. Therefore, programs and policies should be developed to support young mothers and
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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offspring with comprehensive services that are trauma informed. Thus far only one study has
been conducted examining the process of adapting a parenting program for parents in care
(Holtrop, Canto, Schelbe, McWey, Radey, & Montgomery, 2018).
Given that mother-child dyads are in need of supportive services, it is important to
understand barriers to service provision. The case narrative detailed barriers to service provision.
Allowing parents to cohabitate increases the likelihood that mothers will remain in care as non-
minor dependents. Efforts to reestablish trust between parents and providers of child welfare
services may address negative past experiences and increase service utilization. Findings also
indicate that parents may be more accepting of supports that are offered outside of child welfare
due to fears that their children will be reported or removed. If policy changes can address the
reasons mothers reject voluntary services, mother-child dyads may benefit.
Linked, administrative data showed that the risk of maltreatment may be decreasing over
time, suggesting that new policies may be supporting these mothers. California policies that were
implemented during the study window include (1) extending care to non-minor dependents
through age 21, (2) increased funding for Whole Family Foster Homes, (3) the establishment of
guaranteed resources for parents in care, (4) the development of a parenting support plan, (5)
adoption of policies that clarify that mothers can live in transitional housing with nondependent
fathers, and (6) new policies that promote sexual health and access to contraceptives. While this
work is promising, additional policies are needed to improve outcomes for offspring and
mothers. Importantly, the federal Fostering Connections to Success Act allows states to extend
care to non-minor dependents but does not mention pregnant and parenting youth or establish
policies to support the parents and offspring. States should ensure that the eligibility for the
extension of foster care allows for new mothers to participate and that resources are available to
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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meet needs. Identifying ways to delay births, support parents’ needs, and replicate effective
programs and policies may improve two-generation outcomes.
Implications for Research
This dissertation provides evidence that more rigorous evaluations and documentation of
programs and services are needed related to pregnant and parenting youth in care. In order to
effectively address offspring risk, data on relevant programs and policies must be collected and
evaluated so families can be offered programs that work. Linked, administrative data are
powerful because data can be assembled longitudinally to assess outcomes and cost
effectiveness. This dissertation provides evidence that linkages with WFFHs, early home visiting
programs, mental health services, and substance abuse treatments could demonstrate which
programs are most effective at reducing offspring risk. In addition to high rates of child welfare
involvement, offspring born to mothers in foster care may be at increased risk for death. While a
few cases of Sudden Infant Death Syndrome (SIDS) were identified in the analysis of case
narratives, the current data linkage does not allow for an examination of the risk of infant death
among the statewide population of offspring born to mothers in foster care. If birth, child
welfare, and death records are linked this examination could enhance knowledge about risks so
they can be addressed.
Additionally, studies should examine dependent fathers. Linked, administrative data
indicated that that when paternity was established on the birth record, the risk of offspring CPS
involvement was lower. At the same time, case narratives showed that the presence of a father
was sometimes related to intimate partner violence and child maltreatment. A deeper exploration
is warranted to understand the relationship between father involvement and offspring
maltreatment risk.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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Finally, future research should examine pregnancy risk and the risk of offspring
maltreatment among cohorts of births post-full implementation of the extension of foster care.
Dworsky, Aherns, & Courtney (2013) found that remaining in care as a non-minor dependent is
associated with increases in health insurance coverage, use of family planning services, and
knowledge about birth control. The linked, administrative analysis showed that the risk of CPS
involvement decreased across stages of implementation of the extension of foster care. Future
work should examine this relationship in other states to determine if the policy is associated with
improved mother and offspring outcomes.
Conclusions
Pregnant and parenting youth have increasingly come to the attention of service
providers, researchers, and policymakers. This mixed-methods dissertation leveraged powerful
longitudinal, population level data and analyzed new data sources to extend the knowledge base
on pregnant and parenting youth in care. This dissertation demonstrates the power of linked,
administrative data by examining two-generation CPS involvement and identifying ways to
support this high risk population. A massive amount of rich, digital data are produced by
agencies through the process of delivering services and administering programs. Coulton,
Goerge, Putnam-Hornstein, & de Haan (2015) remind us that these data largely remain unused
and state, “A grand challenge for social work is to build the capacity to deploy these powerful
digital resources to discover and apply social solutions to benefit society” (p. 3). The linkage and
analysis of existing administrative data sources led to informed and nuanced program, policy,
and research recommendations for this vulnerable population.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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The current study highlights the need to develop programs that fit the needs of mother-
child dyads, assess the effectiveness of programs delivered to these families, and replicate
policies that are improving outcomes for parents in care and offspring. Classes of mother-child
dyads were identified and case narrative records detailed differences across the three classes.
This work highlights the significant life difficulties mothers in care and their offspring face and it
also offers hope for success. Results show that group membership varies based on the mother’s
earlier experiences in care and the reasons for the offspring’s maltreatment report. These findings
add substantial depth to the understanding of factors associated with the maltreatment of
offspring born to mothers in foster care. Members of each class differ from members of the other
classes in a number of important ways. While mothers in all classes have faced significant
stressors, the long-term trajectory for mother-child dyads is influenced by maternal age, social
support, placement stability, and mental health conditions. Information gleaned provides insight
as to what services may benefit these mother-child dyads to prevent two-generation CPS
involvement.
OFFSPRING BORN TO MOTHERS IN CARE Eastman
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References
Ascend of the Aspen Institute (2016). Making tomorrow better together. Retrieved May 21, 2018
from http://ascend.aspeninstitute.org/resources/making-tomorrow-better-together/
Coulton, C. J., Goerge, R., Putnam-Hornstein, E., & de Haan, B. (2015). Harnessing big data for
social good: A grand challenge for social work. American Academy of Social Work and
Social Welfare, Paper No. 11.
Courtney, M. E., Charles, P., Okpych, N. J., Napolitano, L., Halsted, K., Courtney, M. E., ... &
Hall, C. (2014). Findings from the California Youth Transitions to Adulthood Study
(CalYOUTH): Conditions of foster youth at age 17. Chicago, IL: Chapin Hall at the
University of Chicago.
Dworsky, A., Ahrens, K., & Courtney, M. (2013). Health insurance coverage and use of family
planning services among current and former foster youth: implications of the health care
reform law. Journal of health politics, policy and law, 38(2), 421-439.
Abstract (if available)
Abstract
Nationally, the rate of teen births has dropped significantly over the past quarter century and currently stands at a historic low. However, females in foster care, and those who recently exited from care, have increased birth rates during their teen years in comparison to peers. Research in California found that among females in foster care at age 17, 11.4% had given birth at least once before age 18 and 28.1% by age 20. Due to federal laws that have extended foster care services to non-minor dependents, there may be a growing population of pregnant and parenting youth under the supervision of child protective services (CPS) in the years to come. Yet, the number of pregnant and parenting youth in care were not systematically documented by the child protection system nationally prior to 2016 and little is known about the outcomes of the offspring. ❧ Although interviews with young parents in foster care indicate they are motivated to prevent two-generation CPS involvement for their children, the risk may be increased because of the lack of financial, emotional, social, and parenting support. A study in Illinois found that 39% of offspring born to parents in care were investigated by age 5. This paper is organized as a three-study dissertation focused on young mothers in foster care and the two-generation risk of CPS involvement for their children. ❧ Study 1: Literature Review (Prepared for the Journal of Child and Adolescent Social Work) All studies related to pregnant and parenting mothers in foster care and their offspring published between 2011 and 2017 were identified by two reviewers using four search methods. Studies were included if findings were published by research entities, government agencies, or in a peer-reviewed journal. These studies provide a strong case for the need for leadership in child welfare to take on sexual and reproductive health interventions. Findings suggest that efforts that successfully delay pregnancies among girls in care would be associated with improved outcomes for both mothers and children. Studies focusing on parents in care detailed the need for comprehensive supportive services for parents that are tailored to address their unique parenting experiences and highlighted the resilience of these parents. Key solutions and next steps were described. ❧ Study 2: Linked, Administrative Data (Prepared for the Journal of Adolescent Health) Using probabilistically linked birth and CPS records from California, this population-based study examined all mothers who (1) gave birth before age 21 between 2009 and 2012 and (2) were in foster care on or after the estimated date of conception. Using a second data linkage, offspring born to identified mothers were followed for the first 3 years of life to assess CPS involvement. Between 2009 and 2012, 2,067 offspring born to mothers in foster care were identified. The data linkages revealed that 52.6% of all offspring experienced a CPS report by age 3 (n=1,102). Trends over time documented that offspring CPS involvement decreased while the proportion of mothers remaining in care at older ages increased. A Latent Class Analysis (LCA) was used to identify 3 distinct classes of mother-child dyads named (1) Non-minor mothers with long, stable placements, (2) Minor mothers with short placements, and (3) Mothers with long, unstable placements and mental health conditions. A second LCA included an offspring CPS report by age 3 as a distal outcome to examine the association between class membership and the risk of two-generation involvement. Class 1 was the lowest risk for a CPS report
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Eastman, Andrea Lane
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An examination of child protective service involvement among offspring born to young mothers in foster care
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08/07/2018
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