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To better understand the wide variation of performance among county health systems in Kenya, this study investigated their performance determinants. We selected five counties with varied performance and examined their performance across five domains containing 10 thematic areas. We conducted a stakeholder analysis, consisting of focus group discussions and key informant interviews, and administered a quantitative survey to quantify the magnitude of inefficiency. The study found that a shortage of funding was one of the most common complaints from counties, leading to inefficiency in the health system. Another major reason for inefficiencies was the delay in disbursing funding to health facilities, which affected the procurement of medical supplies and commodities essential for delivering healthcare to the population. In addition, lack of autonomy in procuring commodities and equipment was repeatedly mentioned as a barrier to delivering quality health services. Other reported common concerns contributing to the performance of county health systems were the lack of lab tests and equipment, low willingness to join health insurance, rigid procurement policies and lengthy procurement process, lack of motivation and incentives for service delivery, and poor economic status. Despite the common concerns among the five counties, they differed in some schematic areas, such as the county’s commitment to health and community mobilization. In summary, this study suggests various factors that determine county health system performance. Given the multifaceted nature of inefficiency drivers, it is necessary to adopt a holistic approach to address the causes of inefficiencies and improve the county health systems

The Child and Family Services Review (CFSR), created by the U.S. Department of Health and Human Services (USDHHS), was first implemented in 2000 to examine the effectiveness of public child welfare...

Purpose: The retention of foster homes remains a concern across the United States; therefore, this study sought to examine foster parent perspectives of their fostering experience, adding to a body...

Although family-centered practice has been implemented nationwide in child welfare, measures for evaluating family-centered practice have not been well-established. This study aimed to evaluate the factor structure of the Family-Centered Practice Questionnaire. Confirmatory factor analyses were conducted to examine the factor structure of the Family-Centered Practice Questionnaire. The five-factor and second-order five-factor models of the revised Family-Centered Practice Questionnaire with 31 items both demonstrated adequate fit. The higher order of this scale was family-centered practice and five factors were mutual trust, shared decision-making, family as a unit, strengths-based practice, and cultural competence and sensitivity. Findings suggest that the revised Family-Centered Practice Questionnaire may be helpful to practitioners and researchers seeking to measure the implementation of family-centered practice in child welfare settings.

This study is to examine the cost-effectiveness of deployment strategies of oral cholera vaccines (OCVs) in controlling cholera in Bangladesh. We developed a dynamic compartment model to simulate costs and health outcomes for 12 years for four OCVs deployment scenarios: (1) vaccination of children aged one and above with two doses of OCVs, (2) vaccination of population aged 5 and above with a single dose of OCVs, (3) vaccination of children aged 1-4 with two doses of OCVs; and (4) combined strategy of (2) and (3). We obtained all parameters from the literature and performed a cost-effectiveness analysis from both health systems and societal perspectives, in comparison with the base scenario of no vaccination.The incremental cost-effectiveness ratios (ICERs) for the four strategies from the societal perspective were $2,236, $2,250, $1,109, and $2,112 per DALY averted, respectively, with herd immunity being considered. Without herd immunity, the ICERs increased substantially for all four scenarios except for the scenario that vaccinates children aged 1-4 only. The major determinants of ICERs were the case fatality rate and the incidence of cholera, as well as the efficacy of OCVs. The projection period and frequency of administering OCVs would also affect the cost-effectiveness of OCVs. With the cut-off of 1.5 times gross domestic product per capita, the four OCVs deployment strategies are cost-effective. The combined strategy is more efficient than the strategy of vaccinating the population aged one and above with two doses of OCVs and could be considered in the resource-limited settings.

The transition into motherhood is a life stressor, and it can be more stressful for non-U.S. born mothers because of the intersections among migration, limited financial capabilities, and less social and family support to take care of children ( Dreby, 2015 ; Falicov, 2007 ; Paris, 2008 ). This study examined the predictors of non-U.S. born mothers' parenting stress across early childhood using data from the Fragile Families and Child Well-Being Study. Results of the longitudinal multilevel analysis indicated that support from extended family and friends; mothers' involvement, depression, age, and education; children's temperaments; and Asian race were significant predictors of maternal parenting stress over time. However, fathers' involvement did not significantly predict maternal parenting stress. Implications for research and practice are discussed.

Although foster care homes play a crucial role in providing stable placements to children who enter the child welfare system due to maltreatment, there is currently no federal minimum rate nor standard methodology to establish adequate rates to support foster parents to meet these children's needs. Therefore, it is important to establish a model to estimate the real costs associated with caring for children to serve as a foundation for states to set adequate reimbursement rates. The objectives of this study are to: use the methodology of a 2007 study to establish foster care minimum adequate rates for children (MARC) based on the child's age and geographical location in every state; update the MARC with cost of living adjustments to 2016; examine changes in gaps between the MARC and the current foster care rates; and identify states that have made increases to their reimbursement rates, relative to the MARC over time. Results found that all but four states provide lower foster care reimbursement rates than the adequate costs in 2016. This study recommends that, at the federal level, enhanced precision in operational definitions of care categories could increase consistency in the way that states reimburse foster families. Additionally, findings provide policy suggestions to establish a national methodology standard and increase foster care rates to the level that will meet children's needs. This study will enhance the scant body of literature found on establishing an economic model to estimate foster care costs.

Health systems strengthening (HSS) interventions are increasingly being implemented to improve maternal and child health (MCH) services in low- and middle-income countries (LMICs). This study reviews global literature on cost-effectiveness of HSS interventions in improving MCH. A systematic review was conducted. Keywords, based on World Health Organization framework on health systems and prior studies, were applied to search in bibliographic databases and on the web. Articles that estimated cost-effectiveness of HSS interventions in LMICs were included in the analysis. Each of the 24 selected studies from 15 countries was assessed in terms of quality and biases using Cochrane's criteria. Review Manager and an Excel template were used to extract data and synthesize findings. HSS interventions concentrated on the components of service delivery, health financing, human resources and quality improvement. Within each component, there existed diverse strategies to strengthen health systems. Among the 24 studies, 15 were rated as high quality, 5 as medium and 4 as low quality. A majority of studies reported cost per disability-adjusted life year (DALY) averted or cost per quality-adjusted life year (QALY) gained; other studies reported cost per life saved or life year gained. However, studies used mixed perspectives of analyses. Compared with gross domestic product per capita, interventions in studies reporting cost per DALY averted or QALY gained were all cost-effective, including performance-based financing, health insurance and quality improvement. This review shows the diversity of HSS interventions in improving MCH, and their potential cost-effectiveness. However, the different perspectives employed in the studies, costing components included in the analyses, and heterogeneous measures of effectiveness and outputs, made it challenging to compare cost-effectiveness across all studies, calling for more and standardized cost-effectiveness studies. For policy making, it is critical to examine long-term cost-effectiveness of programs and cost-effectiveness of synergistic demand- and supply-side interventions.

The purpose of this study is to examine the impact of maternal level factors (maternal depression, maternal spanking, parenting stress) and child level factors (cognitive ability, attachment, child welfare involvement) with children's problem behavior trajectory from age 3 to age 9. The study used data from the Fragile Families and Child Wellbeing Study (FFCW), a 20-city sample of 4898 children born in urban areas in the United States between 1998 and 2001. Results indicate an association of all maternal and child level variables with Child Behavior Checklist (CBCL) scores. The multilevel model analysis indicates having an insecure attachment type at age 3 had the largest increasing impact on child behavior problems from age 3 to 9. Children's cognitive ability also had an increasing impact on child behavior problems over time and the impact of parenting stress at age 3 had a decreasing impact on behavior problems from age 3 to 9. Implications for research and practice are discussed.

A recent study estimated that over one-fourth of Chinese children have suffered maltreatment (Fang et al., 2015). However, the current child welfare policy in China is limited to orphans, abandoned children, and children with disabilities. Also, there is very little comparative research in China on Chinese and other countries’ child welfare systems. The purpose of this study was to analyze applicable US and Chinese child welfare policies, identify gaps in Chinese policy regarding child maltreatment, and make recommendations for a policy agenda for improving child welfare in China based on cultural values and existing policy structures. Results show that China has considerable capacity to make improvements in child protective services, foster care, and adoption policies. Based on the results of this study, several implications are provided to develop China's child maltreatment policy to increase children's outcomes of well-being, safety, and permanency. Key Practitioner Message: • To understand the background and system of current Chinese child maltreatment policy; • To review US child maltreatment policy and its implementation to identify gaps in the Chinese child maltreatment system; • To provide policy suggestions to develop Chinese child maltreatment policy and provide recommendations for social work education and practice in China.

Family Group Decision Making (FGDM) is a strategy to engage family members and social service professionals in child welfare to make decisions for the child and family (Olson, 2009). Family Involvement Meeting (FIM) is a mid-Atlantic state implementation of FGDM in the United States. The current study sample is comprised of 460 participants who attended FIMs at local Departments of Social Services (DSS). The objectives of this study are to examine relations among participants' engagement, facilitators' practices, and child and family service planning outcomes during the FIM. Results of ANOVA tests show that family members, DSS workers and supervisors, and other professionals have significant differences in engagement levels and evaluations of facilitators' practice; and facilitators' practice also varied significantly based on reasons for FIM meeting. Logistic regression results indicate that participants' engagement and facilitators' practice are significant predictors of service planning on achievement of family's goals and protection of child's safety. Results imply that facilitators should improve facilitation performance and make more efforts in engaging family members to improve FIM outcomes and child well-being.

•This study examined predictors of length of foster parenting duration.•Survival analysis using bivariate Kaplan-Meier survival curves and Cox proportional hazards regression models was conducted.•Age, number of children fostered, marital status, race, and education significantly impacted duration of fostering.•Implications identified effective foster parent recruitment and retention practices with regard to duration of fostering.

Children from age birth to 5 years in the child welfare system who experience trauma are at risk for mental health problems and developmental delays but often do not receive the service they need. The purpose of this systematic review is to identify research studies examining the prevalence of mental health and developmental needs among these children and the factors predicting mental health and developmental service use. Of the 1,147 studies screened, 38 were retained for full review with eight selected for systematic review. The results suggest that mental health need, developmental need, and child welfare placement are significant predictors of mental health and developmental service use. This study will contribute to developing implications for child welfare practice and research for early childhood development.

Background Children in kinship care may be placed in similar neighborhoods as their birth families, which are predominantly characterized as distressed neighborhoods with high poverty and crime rates, poor-quality housing conditions, and few social resources. Disordered neighborhoods are negatively correlated to social support, but this dynamic may vary by race or ethnicity. However, children’s previously established attachment and social bonding may offset the negative effects of distressed neighborhoods on child behavioral health. Objectives This study examined the relation between neighborhood disorder and children’s internalizing and externalizing problems among children in kinship care and tested caregivers’ social support as a potential mediator. Moreover, this study examined if race/ethnicity moderated the pathway from neighborhood disorder to social support, and from social support to children’s internalizing and externalizing problems. Participants and Setting This study used NSCAW II wave 3 data for a sample of children in kinship care. Methods Univariate, bivariate, and moderated mediation analyses were conducted using STATA 15. Results Neighborhood disorder was indirectly associated with children’s internalizing and externalizing problems through a mediator of social support. No racial/ethnic differences were identified. Conclusions Implications for improving social support for kinship caregivers to ameliorate the effects of neighborhood disorder on children’s behavioral health are discussed. Implementing effective neighborhood-level interventions could promote positive outcomes for children in kinship care.

The purpose of this article is to review the development and implementation of a revised quality assurance and continuous quality improvement (CQI) model for the child welfare system in one Mid-Atl...

Despite the emphasis on evidence-based practice (EBP) in child welfare services (CWS) as an emerging and inevitable trend, implementation factors such as child welfare worker attitudes towards implementing EBP have received little attention in CWS. Aaron's (2004) Evidence Based Practice Attitudes Scale (EBPAS) has been used in multiple studies across mental health and healthcare settings. However, it has rarely been used in CWS. A-Mid Atlantic State implemented the EBPAS in all child welfare jurisdictions to measure workers' performance. The purpose of this study is to examine the EBPAS applied in a large urban child welfare services setting using a confirmatory factor analysis. Based on prior literature, three models were tested: a four factor model, a five factor model, and a second order four factor model. The second order model provided the best fit to the data, suggesting the EBPAS can measure workers' global attitudes, as well as four attitude types, towards EBP in a CWS setting. This study validates the use of the EBPAS with child welfare workers. Implications for effective evidence based practice in child welfare are discussed.

This study describes factors associated with the implementation of family centered practice (FCP) across a state child welfare system. Using Multi-Level Model (MLM) analysis of self-report data from the child welfare workers and supervisors in one multi-jurisdiction state, individual and organizational factors that may influence successful implementation of innovative practice models are identified. Individual worker's characteristics such as social work degree, training, and age were all associated with higher levels of individual adoption of FCP principles. Organizational culture including innovation and flexibility and outward focus were associated with organization level implementation of FCP principles. Implications for child welfare practice and implementation of FCP are discussed.

Purpose: Bivariate and logistics regression analyses were conducted to examine the effectiveness of child welfare agencies’ Family Group Decision-Making (FGDM) practices focused on strengthening families and positive outcomes for children. This study evaluates one mid-Atlantic state’s implementation of a FGDM called family involvement meetings (FIMs) to improve family strengths and their active engagement in the service planning process. Methods: Through use of a FIM Feedback Survey, participants provided satisfaction feedback on the general FIM process and what factors are associated with their satisfaction and decision-making at the meeting. Results: Multiple factors of participant’s engagement, incorporating family strengths, and the FIM facilitator’s knowledge and skills had significant impacts on the participant’s decision-making and overall FIM satisfaction score. Discussion: This study will contribute to examining FGDM facilitators’ practices and effective outcomes of FIMs to improve the well-being, safety, and permanency outcomes for children and their families.

The pandemic of Coronavirus Disease 2019 (COVID-19) highlights the importance of early detection of disease outbreaks, taking swift and decisive public health actions, and strengthening public health systems. Preventive medicine, as a specialty of medicine, trains students on both clinical medicine and public health and is of a particular need in battling against this pandemic. In China, preventive medicine plays a unique role in the disease control system where preventive medicine graduates represent a large share of the workforce. However, there is a shortage of qualified staff in the Chinese disease control system. The reasons for such a shortage are multifaceted. From the human resource perspective, the undergraduate preventive medicine curricula and exclusive public health training for preventive medicine postgraduates limit their clinical capacities. A series of disease control and public health education reforms may further incapacitate preventive medicine graduates' clinical skills, unintentionally widening the gap between public health and clinical medicine and thus posing threats to effective disease detection and control. The authors call for reforming and optimizing preventive medicine to bridge the gap between clinical medicine and public health by strengthening curricula on clinical medicine, diversifying curricula on public health, enhancing preventive medicine residency programs, and rectifying regulations that restrict preventive medicine graduates from practicing curative medicine.

Financial hardship is one of the most challenging issues faced by kinship foster care families. Temporary Assistance for Needy Families (TANF) benefits and foster care payments are potential sources of financial assistance for kinship families. This study used wave 2 of the National Survey of Child and Adolescent Well-Being II (NSCAW II) to develop a new typology of kinship care based on financial mechanisms, including: (1) families that received TANF only (TANF only); (2) families that received foster care payments only (FC only); (3) families that received both TANF benefits and foster care payments (TANF + FC); and (4) families that received no payments (None). This study further divided the None group into two subgroups: None + Below Poverty and None + Above Poverty. To examine factors associated with receiving TANF and foster care payments, results from logistic regression analyses indicated that maltreatment type, children’s externalizing problems, married caregivers, and receiving social services were significantly associated with receiving foster care payments. Living below the federal poverty line and in a single-adult household were associated with receiving TANF benefits. Additionally, this study found that children of other race/ethnicity, such as Asian/ Pacific Islanders or Native American families, children’s internalizing problems, and employed caregivers were associated with lower odds of receiving foster care payments. Being a licensed foster caregiver was associated with lower odds of receiving TANF benefits. The results suggest that child welfare workers and policy makers should consider how to increase kinship caregivers’ awareness of financial resources and to make appropriate resources accessible for kinship caregivers.

Over the last two decades, the issue of income inequality has taken center stage in discussions of the economy and how workers’ perceptions of their relative pay affect their overall life satisfaction. Using National Study of Changing Workforce data from 1997 to 2008, this study examined how income inequality affects workers’ life satisfaction in the U.S. Income inequality was measured by calculating each state’s Gini coefficient, a representative inequality index. Results from analysis of multilevel ordered logit models suggest a significant association between income inequality and workers’ self-rated life satisfaction. As income inequality in the U.S. grew dramatically between 1997 and 2008, workers’ self-reported life satisfaction decreased by 33.8 %. Interestingly, this negative impact of income inequality is significant for men, but not for women when analyzed separately. Implications for policy and practice are discussed.

Despite an increased reliance on immigrants to fill important jobs within the United States, research is lacking with regard to job satisfaction among immigrant employees. Using data from the 2002 and 2008 National Study of the Changing Workforce ( n = 559), the authors examined how immigrant status affects determinants of job satisfaction. Hierarchical linear regression was used to uncover whether income satisfaction, autonomy, learning opportunities, supervisor, and coworker support predict U.S.-born and immigrant workers’ job satisfaction and how immigrant status moderates the relationship between each predictor and job satisfaction. Results showed the moderating effects of immigrant status for income satisfaction and autonomy on the job. The relationship between income satisfaction and job satisfaction was stronger for immigrants and the relationship between autonomy on the job and job satisfaction was negative for immigrants who lack English proficiency. These results add to the limited knowledge about the ever growing immigrant workforce within the United States.

This study explored changes in net disposable income for low-income single-mother families before and after the 1996 welfare reform in the USA. Although many studies on welfare reform have focused on employment or total family income as a way to measure low-income single-mother families’ economic well-being, little is known about their net income after expenses related to entering the workforce. This study analyzed net disposable income after tax deductions and childcare costs to provide a more accurate understanding of income changes using data from the Survey of Income and Program Participation conducted by the US Census Bureau. The results revealed that while low-income single mothers were working more after welfare reform, their net disposable income decreased during this time because their earnings were low and offset by an increase in childcare costs and a decline in means-tested benefits, including Temporary Assistance for Needy Families benefits. Key Practitioner Message: ● To understand effects of the 1996 welfare reform on low-income families’ economic well-being; ● To understand comprehensive income sources and work related expenses of low-income families; ● To provide policy suggestions for comprehensive childcare subsidies to support low-income single mothers’ employment.

As child welfare systems move toward evidence-based practice, one state implemented a statewide program to amass data on child welfare outcomes and child welfare workers’ performance. This measurement tool, called the Local Supervisory Review Instrument (LSRI), was used on the individual level to provide feedback to case workers as well as on a county and statewide basis to monitor trends on select indicators of child safety, permanency and well-being. The purpose of this study is to review the design and development of the LSRI, including data from throughout the state and to examine a reliability analysis of the instrument. For the differing program areas of the LSRI, descriptive statistics were used to assess response rates and mean rating score. Cronbach's alpha (α) for internal consistency was used to assess the reliability of the LSRI. The results indicate that the reliability of the LSRI is moderate or high, although there are significant exceptions as well. With revisions of some items, the LSRI c...

In an effort to improve health service delivery and achieve better health outcomes, the World Health Organization (WHO) has called for improved efficiency of health care systems to better use the available funding. This study aims to examine the efficiency of national health systems using longitudinal country-level data. Data on health spending per capita, infant mortality rate (IMR), under 5 mortality rate (U5MR), and life expectancy (LE) were collected from or imputed for 173 countries from 2004 through 2011. Data envelopment analyses were used to evaluate the efficiency and regression models were constructed to examine the determinants of efficiency. The average efficiency of the national health system, when examined yearly, was 78.9%, indicating a potential saving of 21.1% of health spending per capita to achieve the same level of health status for children and the entire population, if all countries performed as well as their peers. Additionally, the efficiency of the national health system varied widely among countries. On average, Africa had the lowest efficiency of 67%, while West Pacific countries had the highest efficiency of 86%. National economic status, HIV/AIDS prevalence, health financing mechanisms and governance were found to be statistically associated with the efficiency of national health systems. Taking health financing as an example, a 1% point increase of social security expenses as a percentage of total health expenditure correlated to a 1.9% increase in national health system efficiency. The study underscores the need to enhance efficiency of national health systems to meet population health needs, and highlights the importance of health financing and governance in improving the efficiency of health systems, to ultimately improve health outcomes.

Family foster homes are a critical resource for children involved in the child welfare system. However, high dropout rates and a shortage of foster homes are an enduring concern for most child welfare agencies (Chipungu & Bent-Goodley, 2004). To address this problem, agencies must determine the most effective methods for preparing and supporting foster parents. Using survey data of foster parents, this study examines the child welfare agency initiatives that were associated with foster parents' perception of the effectiveness of the agency in preparing them for their role. Results suggest that training and support are the most important factors.

Objectives: The purpose of this study was to explore perceptions of Family-Centered Practice (FCP) among child welfare workers who are expected to use FCP principles in their work with children and families. Method: Nine focus groups were conducted among child welfare workers across seven different regions within one state to assess caseworker’s experiences with FCP. Results: Themes related to time, resources and opportunities, work climate, and engagement emerged from the analysis in relation to the implementation of FCP. Conclusions: Implications of the implementation of the FCP framework for social work policy and practice are discussed.