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Optimising community health worker (CHW) programmes requires evidence-based policies on their education,\ud deployment, and management. This guideline aims to inform efforts by planners, policy makers, and managers to\ud improve CHW programmes as part of an integrated approach to strengthen primary health care and health systems.\ud The development of this guideline followed the standard WHO approach to developing global guidelines. We\ud conducted one overview of reviews, 15 systematic reviews (each one on a specific policy question), and a survey of\ud stakeholders’ views on the acceptability and feasibility of the interventions under consideration. We assessed the\ud quality of systematic reviews using the AMSTAR tool, and the certainty of the evidence using the GRADE methodology.\ud The overview of reviews identified 122 eligible articles and the systematic reviews identified 137 eligible primary\ud studies. The stakeholder perception survey obtained inputs from 96 respondents. Recommendations were developed\ud in the areas of CHW selection, preservice education, certification, supervision, remuneration and career advancement,\ud planning, community embeddedness, and health system support. These are the first evidence-based global guidelines\ud for health policy and system support to optimise community health worker programmes. Key considerations for\ud implementation include the need to define the role of CHWs in relation to other health workers and plan for the\ud health workforce as a whole rather than by specific occupational groups; appropriately integrate CHW programmes\ud into the general health system and existing community systems; and ensure internal coherence and consistency\ud across different policies and programmes affecting CHWs.

Background & objectives Implementation frameworks are designed to articulate the actions and behaviors considered necessary for successful implementation of interventions, programs or services. Such frameworks have been increasingly used in social services for children, youth and families (which include family and parenting support, out-of-home care (foster care) placements, child protection, family violence, juvenile justice and community services). The purposes of this review were (a) to identify studies employing an implementation framework in this field; (b) map the literature to better understand these frameworks and the ways in which they are being applied; (c) to ascertain the ways in which implementation frameworks are being tested; and (d) to describe the current state of evidence surrounding their use in the field. Method For this scoping review, searches of the literature were conducted within PsycINFO, MEDLINE, CINAHL, ASSIA, Embase, Embase Classic, Social Work Abstracts, ERIC and Sociological Abstracts. Databases were searched for published, peer reviewed English language evaluation studies that applied - and reported on this application - implementation frameworks in the child, youth and family service sector. No limits were placed on years. Any type of study design was eligible from single case studies to randomized controlled trials. Results Out of a total of 8541 publications located, thirty-three met the inclusion criteria. They included eight frameworks that have been applied in the sector. Few of the identified frameworks were based on rigorous research designs. Common strategies used within the frameworks included staging implementation, key influences (e.g., competencies, organizational factors, leadership), stakeholder identification and engagement, and capacity measurement and building. Rarely were these approaches theoretically grounded or fully developed, and limited information was provided about their characteristics, development or interconnectedness. In short, research underpinning frameworks and their use has been meager, especially considering their proliferation in the field. Conclusions This review identifies a need to strengthen the conceptualization of core strategies that are integrated into implementation frameworks, including an articulation of their underlying logic. In the future, implementation science and practice may gain from moving away from comprehensive and complex implementation frameworks towards a more flexible, modular approach to implementation based on the application and combination of effective ‘implementation core strategies’. Future research may also draw a more complete picture of the state of implementation frameworks by expanding search terms to also include other sectors and domains into systematic reviews.

Background and objectives The ‘fit’ or ‘match’ between foster or adoptive children and their carers may be instrumental in determining the outcomes for children and the sustainability of their placement. Understanding components most likely to produce a successful match will assist professionals to support carer families and place children optimally. This Scoping Review investigated research relating to matching children needing care and adult carers. It sought to understand the extent of previous research, note key areas of matching interest and theoretical trends and identify gaps. Method Four databases, ASSIA, CINAHL, PsychInfo, and SocIndex, were searched for references in March 2020. Eligible studies included those that reported explicit or implicit matching elements, children in need of care and systematic data collection and recording. Research quality was not included in eligibility criteria. Results The systematic search returned 2802 results. After removing duplicates, eligibility screening and a close reading, only 31 studies published over a period of 81 years were deemed eligible. These studies demonstrate limited scholarly engagement with the concept of matching and changing foci on matching elements that shift from objective features to subjective features, and then to inter-subjective. Conclusions The area of matching carers and children is under-researched, fragmented and lacks consistent or rigorous theoretical frameworks. An increased understanding of matching would assist practitioners in child placement and support for adoptive and foster parents. This would contribute to the broader issue of placement sustainability and improved outcomes for children.

Background: Following a decade of significant progress in implementation science, research efforts are increasingly focused on the investigation of implementation mechanisms and the adoption of multiple EBPs in service delivery systems. This calls for the development of a systems approach to learn about causal mechanisms in implementation systems and a formal methodology for evaluation of systems of care. Methods: We develop a multilevel decision juncture approach to study implementation systems based on advances in implementation research and methods developed in the literature on causal inference and program evaluation. Implementation phases are linked through a sequence of decisions made by relevant agents in the systems at various levels. Formulating the decision juncture as a system of structural equations, each describing a causal relationship between variables, causal mechanisms can be identified throughout the phases of implementation. We use a hypothetical case study of a parenting program in the child welfare sector to illustrate the approach following a staged process analysis model taken from the econometric literature. Following the research on causal inference in recursive structural models, we also demonstrate how graphical models can be used to identify treatment effects at different levels of the system. Results: The models presented make contributions to implementation research in two areas. First, structural systems focus on the causal mechanisms of implementation. This allows efficient selection of covariates and optimal choice of implementation strategies based on identified leverage points in the system. Second, structural models provide a rigorous approach to the evaluation of implementation success. Taking a system approach, implementation, systems and effectiveness outcomes can be investigated as causally linked parts of an implementation system. Conclusions: As implementation science shifts its focus towards large dynamic systems of care, structural causal models connecting actors’ choices and implementation phases across levels of the system provide a rigorous scientific approach to investigate implementation and intervention effectiveness as causally linked parts of the system. Furthermore, using this approach it is straight forward to extend static models of implementation to dynamic systems that can account for sustainment and provide an avenue to integrate continuous quality improvement cycles into implementation research.

This is the first Canadian longitudinal study to use province-wide clinical administrative data to explore when family reunification is most likely to occur and for whom. Clinical administrative child protection data were merged with the 2006 Canadian Census data for the province of Quebec; the final dataset included 24,196 children admitted to out-of-home care for the first time between April 1, 2002 and March 31, 2011, of which 80.2% (N = 19,412) return to live in their natural family milieu. The overall cohort was divided into two groups: children 0 to 9 years old (N = 8369) at initial placement of which 68.9% return to live in their natural family milieu; and children 10 to 17 years old (N = 15,827) at initial placement of which 86.3% return to live in their natural family milieu. Cox proportional hazard results indicate that younger children, specifically those aged 2 to 5 years old at initial placement, have the lowest likelihood of returning to live with their natural families over time. Irrespective of age at initial placement, the decreased likelihood of family reunification was statistically explained by a combination of psychological abuse, physical and health neglect, parents' high risk lifestyle, sexual abuse, school neglect, hospital referrals, placement instability, number of investigations, and neighborhood area socioeconomic disadvantages.

This is the first Canadian longitudinal study to use province-wide clinical-administrative data to explore the factors most associated with changing out of home placements. Clinical-administrative child protection data were merged with Canadian Census data for the province of Quebec and the final dataset included 29,040 children admitted to out-of-home care for the first time between April 1, 2002 and March 31, 2011. Cox proportional hazard results indicate that older youth, specifically those aged 10 to 13 years at initial placement, have the highest risk to experience the most placement changes over time. The increased risk of placement changes for older youth was statistically explained by a combination of male gender, behavioral problems, school truancy and school neglect, residential or group care at initial placement, request for youth criminal justice services, number of investigations, and neighborhood area socioeconomic disadvantages. Neighborhood area socioeconomic disadvantages were only considered a statistically significant predictor of older youth changing placements at least three times, but not for younger children, or for youth experiencing fewer placement changes.

In recent years, the child welfare field has devoted significant attention to siblings in foster care. Policymakers and practitioners have supported efforts to connect siblings via shared foster placements and visitation while researchers have focused on illuminating the empirical foundations of sibling placement and sibling intervention in child welfare. The current paper synthesizes literature on sibling relationship development and sibling issues in child welfare in the service of presenting a typology of sibling-focused interventions for use with foster youth. The paper provides two examples of current intervention research studies focused on enhancing sibling developmental processes and understanding their connection to child welfare outcomes. The paper concludes by presenting an emerging agenda informing policy, practice, and research on siblings in foster care.

Research on foster care focuses almost exclusively on maltreated youth and, to a lesser extent, on foster parents. There is very limited information about the experiences and outcomes of the sons and daughters of parents who choose to foster. The objective of this scoping review was to systematically identify and describe existing empirical research on sons and daughters of foster parents as a beginning effort at understanding this large but understudied population of children and youth. A comprehensive search was conducted that included four key sources: scholarly databases, hand-searches of reference lists, Google Scholar, and personal communications with key foster care stakeholders from North America, South America, Europe, and Australia. All empirical studies within samples that were comprised of sons and daughters of foster parents were included. Over 5500 articles were screened for inclusion. After removing the studies that were not about sons and daughters of foster parents, articles that did not match the inclusion criteria, articles that could not be located, and duplicates, there were 46 articles that met the inclusion criteria describing 39 different studies. An analysis of these indicates that: this literature is in the early stages of knowledge development; interviews/focus groups dominate data collection methods; nonprobability samples are almost always used; even basic demographic data is scarce; and the relationships among and between all participants in the fostering process likely to affect the quality of the fostering experience. As the first scoping review on sons and daughters of foster parents, this study describes much of the known research about this sub-population within foster homes. The results indicate that, more than a century after the first foster homes were established, we are still in the dark ages with respect to the experiences of this sub-population. This article provides a resource for researchers and practitioners to further develop this neglected area of child welfare services.

This study contributes to the growing child protection placement literature by providing the first Canadian provincial longitudinal study examining when and for whom initial out-of-home placement is most likely to occur. Anonymized clinical-administrative child protection data were merged with the 2006 Canadian Census data for the province of Quebec, and the final dataset included 127,181 children investigated for maltreatment for the first time between April 1, 2002 and March 31, 2010. Cox proportional hazard results indicate that the vast majority of investigated children do not experience a placement, but for the others, placement tends to occur immediately following the maltreatment investigation with only a slight increase in risk over time. The increased risk of placement for younger children aged 0 to 9 years was statistically explained by a combination of male gender, behavioral problems, parents' high risk lifestyles, hospital referral, the number of investigations and neighborhood area socioeconomic disadvantages. The increased risk of placement for older children aged 10 to 17 years was statistically explained by a combination of behavioral problems, police reporting, the number of investigations and neighborhood area socioeconomic disadvantages. Neighborhood area socioeconomic disadvantages significantly contributed to the increased risk of out-of-home placement for all children, but this factor is most influential when it comes to younger children.

Introduction The assessment of children at risk of abuse and neglect is a critical societal function performed by child protection workers in situations of acute stress and conflict. Despite efforts to improve the reliability of risk assessments through standardized measures, available tools continue to rely on subjective judgment. The goal of this study was to assess the stress responses of child protection workers and their assessments of risk in high conflict situations. Methods Ninety-six child protection workers participated in 2 simulated scenarios, 1 non-confrontational and 1 confrontational. In each scenario, participants conducted a 15-minute interview with a mother played by a specially trained actor. Following the interview, the workers completed 2 risk assessment measures used in the field at the time of the study. Anxiety was measured by the State-Trait Anxiety Inventory at baseline and immediately following the completion of each interview. Physiological stress as measured by salivary cortisol was obtained at baseline as well as 20 and 30 minutes after the start of each interview. Results Participants demonstrated significant stress responses during the 1st scenario, regardless of whether the interview was confrontational or not. During the second scenario, the participants did not exhibit significant cortisol responses, however the confrontational interview elicited greater subjective anxiety than the non-confrontational scenario. In the first scenario, in which the workers demonstrated greater stress responses, risk assessment scores were higher on one risk assessment tool for the confrontational scenario than for the non-confrontational scenario. Conclusion The results suggest that stress responses in child protection workers appear to be influenced by the novelty of a situation and by a parent's demeanor during interviews. Some forms of risk assessment tools appear to be more strongly associated than other with the workers’ subjective and physiological stress responses. This merits further research to determine which aspects of risk assessment tools are susceptible to the emotional elements of intake interviews.

To maximize benefits to children and their families, effective practices need to be used competently in child welfare settings. Since the 1990s, researchers and policy makers have focused attention on empirically supported interventions (ESIs). Much less attention has been paid to what is needed to implement these in a range of real-world settings. Without proper implementation, which includes an evaluation strategy from feasibility to fidelity to on-going work on moderators and mediators of program effects, established effective programs can be rendered ineffective in practical application. The paper will touch on progress, to date, of implementation science, its application to child welfare programs and practices, and will highlight a set of practical strategies for implementing empirically supported interventions in child welfare.

This article examines the evolution of the discourse surrounding domestic violence (DV), explores how that discourse intersects with public child welfare (PCW), and makes some suggestions for improving the quality and consistency of services for families involved with these systems in both the United States and Canada. In particular, the discourse at the intersection of the two systems has focused on whether or not children's exposure to DV is maltreatment and, further, if it warrants placement in foster care. Within the PCW system itself, data seem to point to divisions in worker beliefs over what circumstances necessitate removal of children and what solutions should be pursued in order to achieve permanence. Legislation and courts have spoken to this complex issue. Given the tension and new developments in the field, this article proposes that harm reduction (HR), evidence-based practice (EBP), and differential response (DR) approaches can bring the two systems together in order to better serve families.

Survival analysis has become one of the most common statistical techniques for analyzing longitudinal data in the social sciences, largely due to its ability to produce unbiased estimates in the presence of censored or incomplete data. A follow-up case record review of subjects ( N = 175) in a recent experimental study provides the opportunity to revisit original survival estimates and compare them to estimates generated using nearly complete data. Results indicate that Kaplan–Meier median estimates of survival time and parameter estimates using Cox Proportional Hazards Regression were relatively accurate despite differential censoring between the treatment and control groups. Estimated mean averages tended to be inaccurate in the presence of substantial censoring. Implications for research and practice are discussed.

The present study was undertaken to incorporate sibling information and account for sibling bias when modeling longitudinal child welfare outcomes using a generalized linear model such as logistic regression. The paper is divided into two parts. The first part examines recent studies that have included sibling data in their multivariate models, and references statistical literature that underscores a method–generalized estimating equations (GEE)–that accounts for non-independent, cluster-correlated observations in analyses where logistic regression might otherwise be considered. The second part of the paper applies this technique to examine the likelihood of reunification from foster care for a statewide sample of siblings who entered care for the first time in 2000 (n=15,517). Results indicate that some sibling-specific factors (e.g., being placed together in care) strongly predict reunification, while another (i.e., number of siblings), surprisingly, does not. Implications for child welfare policy, practice, and future research are discussed.

The preservation and maintenance of sibling relationships in child welfare settings have begun to come to the forefront of practice and policy considerations. While past research on families coming into contact with the child protective services system has largely focused on the parent–child relationship, an emerging body of literature indicates that the relationship between brothers and sisters cannot be ignored. This paper highlights recent and historical trends in the literature on siblings in foster care, reviews some of the legal issues surrounding conjoint sibling placement, proposes a constitutionally protected right of association among siblings in out-of-home care, and explores the multiple and complex methodological challenges facing researchers in this area.

Assessment in child welfare involves at least two distinct processes: an assessment of risk (prediction of future harm) and a contextual assessment of child and family functioning used to develop case plans. Both types of assessment are critical decision aids, yet there has been confusion in the field about their respective uses. Actuarial risk assessment instruments clearly have the greatest potential to reliably and accurately estimate the recurrence of child maltreatment. This type of risk assessment, however, does not indicate which clinical factors are most important to address and certainly does not indicate which services are most likely to be effective. The structured decision making (SDM) approach is an example of an effort to integrate predictive and contextual assessment strategies into child welfare practice. Clinical decision makers complete both an actuarial risk assessment and an objective assessment of family strengths and needs. Both assessments incorporate clinical input in their design and completion. Yet this is still not enough. Clinicians must translate information from both forms of assessment into the choice of a set of effective service interventions. The process of evidence-based practice and the establishment of structural supports for this practice model may be the next step in the evolution of child protective services.

Risk assessment studies in child welfare have largely focused on identifying individual or family risk factors associated with future harm or on the value of various assessment tools constructed of such factors, paying scant attention to the risk posed by the system and its larger context. These risks include services provided to children and families that have little or no evidence of effectiveness, lack of proper assessment of service needs, inadequate linkage of available services to desired outcomes, and an agency culture that is reactive rather than proactive in its pursuit of risk reduction. Drawing on related literature, this article introduces guidelines for the development and implementation of a comprehensive risk management system in child welfare.