National Survey of Child and Adolescent Well-Being (NSCAW)

Expanding the focus for Child Protective Services to include physical and mental health and developmental needs

Client
U.S. Administration for Children and Families, Office of Planning, Research and Evaluation
Partner(s)
The University of North Carolina at Chapel Hill; Washington University in St. Louis

When the National Survey of Child and Adolescent Well-Being (NSCAW) was conceived in 1997, researchers sought to determine whether America was meeting the needs of children and families in the child welfare system who were involved in abuse and neglect investigations. At the time, the lack of available data about children’s well-being hindered policy development and improvements to child welfare practices.

A 10-year effort led by the Administration for Children and Families (ACF) and RTI, NSCAW studied the cognitive, physical, behavioral, and emotional well-being of children involved with the child welfare system. It also examined the needs of these children and their families and the services they receive while in the system.  

Conducting the Most Comprehensive Child Welfare System Study to Date

NSCAW selected its sample from all children investigated for maltreatment during the sampling period, whether or not their cases were substantiated, and followed them over time. A national sample of child welfare agencies across the country contributed to this effort. The first cohort included more than 6,200 children aged birth to 14 years who were followed for five to six years. The second cohort included more than 5,800 children aged birth to 17.5 years who were followed for three years. Survey data from children in the second cohort was linked to child welfare administrative data on maltreatment re-reports, out-of-home placements, and adoptions.

Firsthand reports from the children themselves, their caregivers, caseworkers, and teachers provided information about children’s functioning, risks and protective factors, service needs, and service receipt. The survey collects information on sensitive topics, such as substance abuse, involvement with the law, caregiver experience with intimate partner violence, and child exposures to violence. Of particular interest to NSCAW are children’s health, mental health, and developmental needs.

From 1999 to 2012, RTI conducted longitudinal data collection with two cohorts comprising approximately 12,000 children and 75,000 variables.

Resolving Unique Challenges with Innovations in Data Collection and Quality Monitoring

During the project we tackled a variety of data collection challenges, including obtaining cooperation from families just after a maltreatment investigation and gathering information on children’s developmental and cognitive abilities through the use of standardized child assessments.

One significant obstacle our research team discovered early on was that many of our subjects had unreliable access to a telephone. To resolve this issue, we developed a computerized mechanism that recorded random samples of interviews as an alternative to standard telephone verification procedures. The recordings could then be reviewed as part of our quality monitoring process.

This technology—computer audio-recorded interviewing, or CARI—became an invaluable resource for determining whether questions were asked as intended, probes and feedback to respondents were neutral, and respondent questions were answered correctly.

Massive Data Collection Effort Focuses Attention on Children’s Well-Being Needs

NSCAW is the only source of nationally representative data on the well-being of children and families in the child welfare system. Data from this project have been used in more than 500 publications, significantly expanding a body of rigorous, empirically based research that barely existed before 1997.

Most importantly, findings from this study have documented the high rates of behavioral and developmental problems among children who are reported for child maltreatment, as well as the gaps between their need for services and their ability to obtain those services. Publications and reports produced through NSCAW have drawn attention to topics such as the high rates of domestic violence among families involved with the child welfare system and the frequency of polypharmacy—the use of multiple psychotropic medications—among children living in foster care.

The people who devote their lives and careers to improving child welfare have used this information to expand their focus from a child’s basic safety to a much more holistic view that includes a child’s well-being, including developmental needs and physical and mental health.

NSCAW has been awarded the 2018 American Association for Public Opinion Research (AAPOR) Policy Impact Award, formal recognition of the myriad ways this research has impacted child welfare policy decisions and practice.

Moving Forward with a Third Study to Monitor Well-Being

Two federally-sponsored data systems provide ACF with information on the child welfare system’s ability to keep children safe and in permanent homes.  There is not yet an equivalent system to track well-being. To fill this gap, ACF has awarded us a contract to carry out a third iteration of NSCAW. This effort will provide ACF a lens into the child welfare system approximately a decade since the last NSCAW was initiated.

To increase the utility of the third NSCAW, child survey data will be linked to Medicaid claims data, including data on mental health services and medication data. Additionally, the study will include children who entered the child welfare system through a pathway other than a maltreatment investigation or assessment, such as delinquency or human trafficking.

A new national sample of child welfare agencies is participating, and baseline data collection began in November 2017.