Increasing community and family participation in child welfare agencies as a way to improve families' use of health services Public Deposited

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  • March 21, 2019
  • Jolles, Mónica Pérez
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • Background. Many families in contact with child protective service agencies do not receive needed health services. Agencies have used community and family participatory practices as a way to improve services for families. We lack a better understanding of variation in these practices and on whether they improve health service use among caregivers and children. Conceptual Framework. The socio-technical systems framework underscores agency characteristics of the work environment as factors associated with variation in agency practices and agencies' ability to reach their goals. Research Objective. This research is divided into three studies: The first examines the association between agency characteristics related to quality-oriented culture, flexibility in procedures and caseworker strain on agency use of community review boards, and formerly served caregiver participation in planning/policy groups. The second study tests whether caregivers from an agency with these boards and/or planning/policy groups are more likely to be served through a participatory decision-making service practice. Finally, study three compares caregiver and child physical and mental health service use between caregivers served through a participatory practice and those who did not experience it. Methods. All study analyses are drawn from the National Survey of Child and Adolescent Well-Being (NSCAW). Multivariate logistic regressions incorporating weights and the complex survey design of the data as well as the implementation of propensity scores to address selection bias in study three are used to test the proposed associations.   Findings. In the first study, agency characteristics did not explain variation in agency use of community review boards or caregiver-based planning/policy groups. In the second study, caregiver participation in planning/policy groups was surprisingly negatively associated with caregiver inclusion in decision-making during service planning. In the last study, caregiver inclusion in participatory decision-making did not predict child health service use. Implications. Caregiver and family member inclusion in the discussions leading to decision-making during service planning meetings is a promising strategy for increasing health service use among children in contact with a CPS agency.
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  • In Copyright
  • Wells, Rebecca S.
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2014

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