Child abuse & neglect · 2026
Services and supports for child-welfare involved children with medical complexity: Data from a national survey of child welfare agencies.
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Seltzer Rebecca R, Chung Joyce, Cruce Amanda, Sinha Aakanksha, Prichett Laura, Pecora Peter J
Аннотация
BACKGROUND: Children with medical complexity (CMC) are disproportionately represented in the child welfare system. Yet, little is known about how child welfare agencies care for CMC.
OBJECTIVE: To examine how child welfare agencies provide prevention and out-of-home care services to CMC.
PARTICIPANTS AND SETTING: US child welfare agencies.
METHODS: Agencies completed a Qualtrics survey. Responses related to service delivery, prevention services, and out-of-home care were included in analysis. Descriptive statistical analysis was applied to responses. Qualitative content and thematic analysis was applied to free text responses.
RESULTS: Surveys were completed by 30 agencies, representing 28 states and 2 major cities. Most CMC were referred to child welfare by a medical provider for medical neglect concerns. While some agencies offer tailored services, including use of nurse consultants and specialized training, most identify critical gaps in meeting CMC and caregiver needs and report it is challenging for families to access services. Nearly all agencies report difficulty recruiting and retaining foster parents for CMC, resulting in placement delays, delayed hospital discharge, and use of congregate care or out-of-state placements. Agencies highlight barriers to placement and permanency, including inadequate supports and poor coordination across child-serving systems of care.
CONCLUSIONS: Improving care for CMC requires both a sharpened focus within child welfare and a broader commitment from other systems. Child welfare agencies have a critical opportunity to enhance their role by investing in prevention services, expanding recruitment and training of foster caregivers for CMC, and strengthening care coordination through specialized staff and cross-system partnerships.
OBJECTIVE: To examine how child welfare agencies provide prevention and out-of-home care services to CMC.
PARTICIPANTS AND SETTING: US child welfare agencies.
METHODS: Agencies completed a Qualtrics survey. Responses related to service delivery, prevention services, and out-of-home care were included in analysis. Descriptive statistical analysis was applied to responses. Qualitative content and thematic analysis was applied to free text responses.
RESULTS: Surveys were completed by 30 agencies, representing 28 states and 2 major cities. Most CMC were referred to child welfare by a medical provider for medical neglect concerns. While some agencies offer tailored services, including use of nurse consultants and specialized training, most identify critical gaps in meeting CMC and caregiver needs and report it is challenging for families to access services. Nearly all agencies report difficulty recruiting and retaining foster parents for CMC, resulting in placement delays, delayed hospital discharge, and use of congregate care or out-of-state placements. Agencies highlight barriers to placement and permanency, including inadequate supports and poor coordination across child-serving systems of care.
CONCLUSIONS: Improving care for CMC requires both a sharpened focus within child welfare and a broader commitment from other systems. Child welfare agencies have a critical opportunity to enhance their role by investing in prevention services, expanding recruitment and training of foster caregivers for CMC, and strengthening care coordination through specialized staff and cross-system partnerships.