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December 2015Vol. 16, No. 9Spotlight on the Affordable Care Act

The 2016 Affordable Care Act (ACA) open enrollment period is currently underway, and the final deadline to sign up for 2016 coverage is January 31, 2016. Providing children and youth in foster care with appropriate health care is vital to ensuring their overall well-being and positive outcomes. This month, CBX highlights resources and tools on the ACA and health-care services for children and youth in foster care.

Issue Spotlight

  • Reconnecting Young Adults With Medicaid Coverage

    Reconnecting Young Adults With Medicaid Coverage

    A January 2015 provision of the Patient Protection and Affordable Care Act (ACA) enables young adults in every State who have aged out of foster care to be insured through Medicaid until age 26. However, many young people who are eligible for coverage are unaware of how to access care and are uninsured. An article in Youth Today discusses this disconnection and, while it focuses on youth and young adults in New York, the information and message applies nationally to all youth in, formerly in, and currently aging out of foster care.

    Approximately 1,300 youth age out of New York's foster care system annually. Young adults who exited care after January 2014 were automatically enrolled in Medicaid. Those who left prior to this date need to actively sign up on their own through the Department of Social Services or the State's Internet marketplace. The Schuyler Center for Analysis and Advocacy estimates that there are 5,000 youth formerly in foster care in New York City—10,000 statewide—eligible for Medicaid who have not signed up.

    This issue is especially concerning because published research has shown that 60 percent of youth in foster care have chronic health conditions, such as asthma. When these uninsured young adults visit emergency rooms and free clinics seeking services, it places a preventable strain on the country's health-care system.

    Child welfare and youth services workers believe it is partly a matter of misinformation. Many youth were under the impression that Medicaid coverage was ongoing, not realizing that coverage expired once they aged out of care (prior to January 2014) and that they were required to reapply. Other young adults who are contacted and informed of these benefits may be distrustful of the system they left and, therefore, reluctant to enroll.

    Reaching out to foster care alumni, educating them about their health-care options, and empowering this population to reenroll in Medicaid is a challenging but critical job. New York City's Administration for Children's Services and the State's Office of Child and Family Services have undertaken a variety of outreach efforts in an attempt to reconnect young adults with the Medicaid coverage and care they need.

    The article, "Many Former Foster Youth Unaware of New Health Care Benefits," by Audrey McGlinchy and Colin Archdeacon, is available in Youth Today, a nationally distributed newspaper geared toward professionals in the youth service field. To read more, visit the publication's website at

  • Boosting Foster Care Alumni Health-Care Enrollment

    Boosting Foster Care Alumni Health-Care Enrollment

    Under the Patient Protection and Affordable Care Act (ACA), youth who have aged out of foster care at age 18 on or after January 1, 2014, are guaranteed health insurance coverage under the Medicaid program until they turn age 26. Yet many former foster youth either fail to enroll or fail to maintain their enrollment until they reach age 26.

    In a new issue brief, The Affordable Care Act and Youth Aging Out of Foster Care: New Opportunities and Strategies for Action, authors Dina Eman and Olivia Golden provide an overview of this provision and offer steps States can take to boost enrollment of eligible youth. First, the authors summarize some important provisions of the ACA, including the requirements for all States:

    • To extend Medicaid eligibility, starting on January 1, 2014, to youth formerly in foster care who were in foster care under the responsibility of the State and receiving Medicaid when they turned 18 (or the applicable higher age in a State that provides foster care assistance to a later age), and have not turned 26, regardless of income
    • To provide streamlined methods for eligibility determination, enrollment, and retention
    • To extend Medicaid coverage to age 26 for those eligible youth who aged out of foster care in their State, with the option of extending coverage to a youth who resides in the State but aged out in another State

    The authors then suggest steps that States can take to improve participation in Medicaid:

    • Ensure that youth currently in foster care are enrolled through automated systems as they age out, without having to take action or provide verification themselves
    • Find and enroll youth who aged out before 2014, but are under age 26 as of January 1, 2014, and are still eligible for coverage
    • Train child welfare and Medicaid staff and relevant community partners in Medicaid enrollment and reenrollment for transitioning youth
    • Train child welfare staff and partners to help youth use their new health-care coverage, not just enroll
    • Shape the benefit package to best meet the needs of youth aging out of foster care
    • Promote continuity of services, as well as enrollment, for these youth by making continued enrollment in Medicaid until age 26 as automatic as possible
    • Choose the policy option to cover youth who aged out in other States and develop partnerships with other States that are frequent destinations
    • Explore potential State and Federal options for health insurance for youth who achieve permanency through guardianship before age 18

    Dina Emam is a research associate at the Urban Institute. Olivia Golden is the Executive Director at the Center for Law and Social Policy. The issue brief was published by the State Policy and Advocacy Reform Center, an initiative supported by the Annie E. Casey Foundation and the Jim Casey Youth Opportunities Initiative.

    The Affordable Care Act and Youth Aging Out of Foster Care: New Opportunities and Strategies for Action is available at (226 KB).

  • Tips and Tools: Increasing Coverage for Children, Youth, and Families

    Tips and Tools: Increasing Coverage for Children, Youth, and Families

    Many of the children, youth, and families that come in contact with State and Tribal child welfare agencies are in need of health-care services. The Patient Protection and Affordable Care Act (ACA) opens new pathways to eligibility and provisions that support children, youth, young adults, and caregivers—including birth parents, foster parents, relative guardians, and adoptive parents—in accessing health-care services. Title IV-B and IV-E agencies can provide support and assistance to ensure these populations apply for and receive the health insurance coverage they need and for which they are eligible.

    During the 2016 ACA open enrollment period, the Child Welfare Capacity Building Center for States is making information available for child welfare agencies and community-based organizations to raise awareness of how the ACA provides health-care opportunities for those in contact or at risk of contact with the child welfare system, as well as for young adults who have transitioned out of foster care.

    To help agencies and community-based organizations understand the ways these individuals or families may be eligible for health insurance coverage and to assist eligible persons in applying for and receiving coverage, the Center for States is connecting child welfare staff to a series of resources and information.  For more information, visit

    Among the resources are a recently released Information Memorandum (ACYF-CB-IM-15-08) on Medicaid and Children's Health Insurance Program (CHIP) eligibility and new ACA provisions, enrollment tip sheets, promotional tools for agencies to point visitors to the Federal Government's health insurance marketplace, and links to additional health insurance-related topics and guidance.

  • Information Gateway Brief: Health-Care Coverage for Youth in Care

    Information Gateway Brief: Health-Care Coverage for Youth in Care

    Noting that changes in the nation's health-care laws have increased access to and affordability of health care for some of our most vulnerable children and youth—those involved with child welfare—Child Welfare Information Gateway published an issue brief reviewing the eligibility pathways for children and youth in foster care to receive health-care coverage. The new brief explores how youth in foster care can access Medicaid or other coverage, as well as some of the benefits available to them through the Patient Protection and Affordable Care Act.

    The brief highlights health-care needs of children and youth in foster care, who is eligible for Medicaid and how, and other health-care coverage (non-Medicaid) benefits available to children and youth in foster care. A discussion of some ways that States and jurisdictions have addressed issues such as communicating the changed benefits to youth and ensuring that they receive optimal health-care coverage, in addition to links to tools for helping to inform youth and families about health-care options, is also provided.

    Health-Care Coverage for Youth in Foster Care—and After is available on the Child Welfare Information Gateway website at

  • Barriers to Accessing Preventive Services in the ACA

    Barriers to Accessing Preventive Services in the ACA

    Young people between the ages of 15 and 24 are more likely to experience unplanned pregnancy and sexually transmitted infections (STIs) than individuals in most other age groups; therefore, increasing access to preventive health-care services can make a significant difference in their lives. The Affordable Care Act (ACA) has made it possible for many young people to access a broad range of sexual and reproductive health-care services. The ACA requires most health plans to cover preventive services without cost sharing (when the patient pays for a portion of his or her own health-care costs not covered by health insurance), such as screenings for STIs and HIV, contraceptive and pregnancy-related care, and HPV immunizations. While the ACA has improved access to critical health-care services, there remain a number of obstacles to the successful implementation of the preventive services provisions of the ACA.

    A November 2014 paper by Advocates for Youth, an organization dedicated to promoting effective adolescent reproductive and sexual health programs and policies in the United States and internationally, analyzes the preventive services afforded to young people through the ACA and provides recommendations for policymakers, providers, and advocates on what they can do to help ensure young people have access to the health care they need. Advocates for Youth staff conducted interviews with a variety of State-level experts in Georgia, North Carolina, South Carolina, and Massachusetts to assess the effect of ACA implementation on young people's access to confidential sexual and reproductive health-care services.

    The paper provides ACA background; an overview of the preventive services available without cost-sharing, exempt plans/exceptions to the no cost-sharing requirement, and scenarios when individuals could still pay out of pocket for preventive services; a review of preventive services and Medicaid; and it outlines which Federal and State agencies are responsible for enforcing the ACA preventive services provisions and implementation.

    Perhaps most notable to professionals in the youth services field are the sections that discuss the barriers to access to preventive health services for young people and the issue of awareness, or lack thereof, of benefits under the ACA. Even with appropriate health coverage, many young people still encounter obstacles to accessing no cost-sharing preventive services. This paper examines the three main barriers: lack of awareness of eligible benefits, lack of confidentiality and consent, and discomfort and stigma. In an effort to address these challenges, the authors present a number of recommendations for policymakers, service providers, and advocates/program planners. The paper also includes an appendix of ACA regulations affecting youth.

    Ensuring Young People's Access to Preventive Services in the Affordable Care Act was written by Kashif Syed, Reproductive Justice Fellow, with Assistance from Hilary O'Brien, Associate, Teen Pregnancy Prevention, and based on research by Amber Morley Rieke, M.P.H., George Washington University. It is available on the Advocates for Youth website at

  • Comparing Federal Laws Providing Medicaid Coverage

    Comparing Federal Laws Providing Medicaid Coverage

    Both the Fostering Connections to Success and Increasing Adoptions Act of 2008 (Fostering Connections, P.L. 110-351) and the Patient Protection and Affordable Care Act of 2010 (the ACA, P.L. 111-148) extend Medicaid coverage to eligible youth beyond age 18. In a recent Practice Bulletin, the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance (AAICAMA) compares the provisions of the two laws as they relate to Medicaid eligibility.

    The Fostering Connections Act is a child welfare law that:

    • Gives States the option to extend title IV-E eligibility for youth to remain in foster care to ages 19, 20, or 21 as long as they meet certain educational or work requirements
    • Allows States to provide title IV-E adoption/guardianship assistance to youth adopted or placed with a guardian at age 16 or older
    • Expands Medicaid coverage to all youth in foster, adoption, and guardianship placements as Medicaid is mandatory for all title IV-E recipients in all States

    The ACA is a medical assistance law that:

    • Requires States to provide Medicaid coverage to age 26 to youth who aged out of State or Federal foster care while Medicaid eligible and who continue to live in the foster care State
    • Gives States the option to extend Medicaid eligibility to age 26 to youth who were in foster care in another State
    • Applies to only title IV-E and State-funded former foster youth

    An explanation of the Fostering Connections' work and education requirements is provided in the bulletin. The publication also includes a quick-reference, side-by-side comparison chart of the major provisions of the two laws, as well as citations of the laws and policies on which the comparisons are based.

    AAICAMA's Practice Bulletin, 2(4), December 2014, is available at (157 KB).

    Recent Issues

  • April 2024

    Spotlight on National Child Abuse Prevention Month

    Spotlight on National Child Abuse Prevention Month

  • March 2024

    Spotlight on Diversity and Racial Equity in Child Welfare

    Spotlight on Diversity and Racial Equity in Child Welfare

News From the Children's Bureau

In this month's "Commissioner's Page," two young adults formerly in foster care share their experiences in receiving health-care services during and after care.

  • Examining Behavioral Health Services Under the Affordable Care Act

    Examining Behavioral Health Services Under the Affordable Care Act

    State behavioral health agencies are responsible for the delivery of quality, evidence-based services for individuals with mental health and substance use disorders. Two Federal laws—the Mental Health Parity and Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act (ACA) of 2010—require insurers to provide parity of coverage for behavioral health care and extend insurance coverage to millions of individuals through expansions of Medicaid, the government subsidization of insurance purchased through Marketplace Exchanges, and other insurance reforms. A new report describes the experiences, successes, and barriers encountered by a select group of State agencies working on effective service delivery under the ACA.

    While health-care reforms may have improved the funding of State behavioral health services, State agencies still face many challenges in providing services to everyone in need of behavioral health care. To provide guidance and the lessons learned from the experiences of these early-innovator States—Arizona, Kentucky, Maryland, Oklahoma, and Washington—structured interviews were conducted with agencies to collect information regarding three policy areas:

    • Implementation and adoption of evidence-based practices
    • Improvement of business practices for mental health and substance use disorder service providers
    • Integration of behavioral health services with physical health care

    The overall purpose of this publication is to examine these policy issues across multiple States and to highlight areas where States need guidance and technical assistance. The States that were studied showed progress in the following areas:

    • Creating active partnerships with State Medicaid, public health, and child welfare agencies
    • Addressing infrastructure challenges as new insurance coverage brings new consumers into the behavioral health systems, including training and workforce availability
    • Making certain that evidence-based practices are an integral part of insurance benefit packages and delivery mechanisms under expanded Medicaid and integrated behavioral health and physical health-care systems
    • Implementing health information technology and other efficient business approaches
    • Demonstrating that they are providing cost-effective services with measurable outcomes
    • Ensuring that State funds and block grant dollars are not spent paying for services for which insurance is available
    • Integrating behavioral health and physical health care through working closely with the State Medicaid agency to redesign funding systems and to ensure that behavioral health is treated in the context of the entire person
    • Establishing electronic sharing of behavioral health and primary care data within the restrictive context of existing legislative limitations

    Case Studies of Three Policy Areas and Early State Innovators: 2014 State Profiles, published by the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration at the U.S. Department of Health and Human Services, is available at (4 MB).

  • Compendium of Instruments to Measure Child Welfare Outcomes

    Compendium of Instruments to Measure Child Welfare Outcomes

    Children's Bureau discretionary grantees have used numerous standardized instruments to assess child welfare outcomes and evaluate their projects. Under contract with the Children's Bureau of the U.S. Department of Health and Human Services, James Bell Associates developed a compendium of standardized instruments used by discretionary grantees in order to help future grantees or evaluators of other child welfare-related initiatives. It includes common instruments that measure outcomes at the child, caregiver, family, or organization levels.

    The compendium is available at (870 KB).

  • Commissioner's Page

    Commissioner's Page

    The following is the monthly message from Rafael López, the Commissioner of the Administration on Children, Youth and Families. Each message focuses on the current Children's Bureau Express Spotlight theme and highlights the Bureau's work on the topic.

    Children and youth in foster care often enter care with significant health challenges. Child abuse and neglect, poverty, parental substance abuse or mental illness, and disruption caused by removal from the home can all contribute to health and mental health issues. Therefore, ensuring that children and youth in foster care receive the medical and mental health services they need is of paramount importance to their overall well-being.

    Recent mandates stipulated in the Patient Protection and Affordable Care Act (ACA) aim to facilitate access to health and mental health services for this population, and especially for older youth in or formerly in care. However, youth may need guidance to understand the benefits they are eligible for and how to access them. Below, two young adults formerly in foster care, Emmie and Desiree, share their experiences with receiving health-care services during and after care and words of wisdom for youth and for the professionals who serve them.1

    How did you come into contact with foster care, and what was your experience like?

    Emmie: I sought out foster care around the age of 15 when I realized the home I was living in was not anything like my peers, but much worse. Foster care is not perfect, but it seemed like a refuge in comparison to the conditions of my family's home. I only moved a few times and was fortunate to find one placement with my foster mom, Paula, who ended up being a home to me for nearly 3 years. To this day, Paula is a mom to me. I transitioned out of foster care on my 19th birthday straight into my freshman year of college and lived on campus independently.

    Desiree: I entered foster care at the age of 4 with my three siblings (two older brothers and a younger sister) due to abuse and neglect. Placement was difficult for our large sibling group. We were able to be with one another in our first placement. However, my brothers were eventually placed in a different home and my sister and I were also sent to a different home in the same school district as our older brothers, which allowed us to remain close and form healthy relationships. We had weekend visits with one another, with our grandparents, and with our father, when he was able to visit. Our mother's whereabouts were unknown and would remain so until I was 18. As a sibling group, foster care allowed us to experience both joys and sorrows. I stayed in my third placement for the last 11 years of my time in care. There, I received the nurturing and support needed to ensure that I would have a successful future.

    Have you ever had trouble accessing health care while you were in foster care or after?

    Emmie: Just before moving to Portland, OR, to continue my bachelor's degree, I discovered that I wouldn't be covered by my same insurance while I was out of State and that Oregon wouldn't cover me even though I had been in foster care in another State [Wyoming]. This was just after the ACA had taken effect and States had the option to choose who they covered.2 I was one of the people that decision directly affected, and one of the people who they decided not to cover. Luckily, my scholarship covered my junior year of student health insurance, but this year they changed their terms and wanted us to use the ACA to cover our own health insurance. I was back to square one, but fortunately my partner offered to include me in her health insurance and I'm covered again in a great insurance plan that includes dental.

    Other difficulties were largely due to the limited providers who accept Medicaid. In Wyoming, I skipped dentist appointments from the age of 16 until just recently as I could not find a dentist who would take my insurance. I had no dental coverage under my student insurance in Oregon, and the cost of student dental services on campus felt like spending food and school money. Prioritizing what is most important in life is a constant battle [for youth in care]. Seeing a dentist or doctor regularly seems like a luxury to me, not a necessity. I feel like this is probably the mindset of other youth in care, too.

    Desiree: While in care [in Wisconsin], I was a fairly healthy child, so I accessed health care minimally and with ease. However, accessing dental care was always difficult. Due to low Medicaid reimbursement rates, many dentists in my area were unwilling to accept State insurance. [After foster care], I experienced difficulty accessing health care through coverage I had purchased through my employer. I no longer qualified for State insurance [the ACA provision expanding Medicaid coverage to youth formerly in foster care until age 26 had not yet become effective]. This proved to be costly due to increased charges for out-of-network providers and traveling for [the care I needed], which was not available in my community.

    How familiar are you with ACA provisions affecting older youth in or formerly in foster care? Did your caseworker talk to you about your health-care options while in foster care and/or after you transitioned out of care?

    Emmie: I'm more familiar now than when I moved to Oregon or when I was in Wyoming getting ready to start college. I know that I'm not covered by Medicaid until 26, unlike my peers who can stay on their parents' insurance until that age or other foster youth who either live in the State [where they were in foster care] or in a State that accepts out-of-State foster youth into their health-care programs. There was not much discussion with my caseworker about health-care options as I was transitioning because I was planning to stay in Wyoming at the time.

    Desiree: As a former special needs adoption social worker, I am aware of these ACA provisions. In 2008, State health-care options were less beneficial for youth. At that time, wards of the State [of Wisconsin] were able to maintain State coverage if they were full-time students or employed. Fortunately, I was a full-time student. In 2011, when I turned 21 and was no longer eligible for State care based on my foster care status, I paid for insurance through my place of employment. [In 2014, the ACA provision extending Medicaid coverage to youth formerly in foster care until age 26 became effective.]  My caseworker had little to do with my knowledge of medical benefits during care and after. Most of my knowledge came from foster parents, former youth, and trial and error.

    Overall, how do you feel about the health care you have received while in foster care and after? Do you feel your concerns and wishes regarding your own health care have been heard? Is there anything you think would have made it easier for you to access health care?

    Emmie: The health-care providers I found on my college campus have been amazing, and I'm so glad I stumbled upon them. While in care, [I never consistently saw] one primary doctor, which added to the anxiety of finding a primary care physician when I left care and moved out of State. I was not [provided with my full medical records]. I'm happy that is behind me, but I hope that youth in care now do not have to struggle so long to have their basic health needs met. They have so much going on already—their physical and mental health should be a top priority, not a burden.

    Desiree: I think I was provided accurate and timely health care, disregarding dental, while in care. I never experienced stigma or discrimination due to my State health insurance coverage. After care, I have continued to receive excellent [health] care. Increasing the reimbursement rate or providing incentives to dental clinics would improve access to health care. There are few dental offices that accept Medicaid, and the ones that do have waitlists that are months out.

    Do you have any advice for older youth in foster care about accessing health care?

    Emmie: Know your resources and don't be afraid to ask, research, and explore. Find out who is in your area, what has worked and what has not worked, look online at reviews, and do not expect anyone to do it for you. If you need something, do anything you can to get to it. Also, read carefully if you sign up for anything relating to health care. If you can't receive health care for free as a youth because you are not in the State in which you spent time in care, use caution when getting a plan through the health-care exchange so you get the best deal for your money and needs.

    Desiree: Know your benefits and stay informed. If you are up for the renewal process and need to provide documentation for continued insurance, do not wait—be proactive. Once coverage is ended, it is more difficult to sign up for coverage, as all documentation is once again needed. Keep copies of your medical records and immunization records. If a medical facility sends you a balance statement requesting you pay, call your State Medicaid office to clarify. Always advocate and protect your rights and benefits as a former or current foster youth!

    Do you have any advice for caseworkers about the health care of the youth with whom they work?

    Emmie: Take the time to truly help [youth] understand what they may come up against after leaving care. Don't let moving out of State and losing health insurance come as a surprise. Inform [youth] of their options and make them aware of plan B's and C's if things were to go differently than expected.

    Desiree: Ensure that youth are well informed of their benefits for health care and that they complete necessary documentation prior to discharge from care. Enable them to be successful in the future by teaching them how to complete needed paperwork, instead of completing it for them.

    Do you have any advice for medical professionals who work with youth in foster care?

    Emmie: Going to a doctor is not always a normal experience for youth in or from foster care, for various reasons. Many haven't been to doctors regularly growing up; they don't want to have to tell their life story over and over again to new doctors and for some, a doctor's office is where foster care may have started for them. Take the time to treat them like any other patient while hearing them out for their individual needs through an unbiased lens. It can be scary enough coming to you for help, but once we are there, help us know we made the right choice by coming to you.

    Desiree: Be trauma informed!


    1 These interviews express the personal opinions and experiences of two youth formerly in foster care and include information about how certain laws and policies were applied to their individual cases. This information is not intended to represent a review of Federal or State laws and policies.

    2 The Centers for Medicare and Medicaid Services interprets the ACA as giving States the option to cover youth who were formerly in foster care in another State. For more information, see here (PDF - 106 KB).

  • CB Website Updates

    CB Website Updates

    The Children's Bureau website carries information on child welfare programs, funding, monitoring, training and technical assistance, laws, statistics, research, Federal reporting, and much more.

    Recent additions to the site include:

    Visit the Children's Bureau website often to see what's new at

Child Welfare Research

This month, CBX features a two-volume special issue of the Child Welfare journal dedicated to families in child welfare affected by substance use, a report on the importance of using baseline equivalence in measuring a program's effectiveness, and more.

  • Annual Report Highlights Global Family Health Indicators

    Annual Report Highlights Global Family Health Indicators

    Child Trends recently released the new World Family Map report, which monitors the global health of the family by tracking 16 indicators in 32 countries. The annual report shares data on these indicators—covering family structure, socioeconomics, processes, and culture—and also includes a detailed essay that focuses on a single aspect of family life. The focus of this year's report is how couples divide work and family responsibilities and its relationship to levels of happiness. In addition to examining how married and cohabitating couples with children split paid and domestic labor and their resulting happiness levels, it also explores whether factors like age, education, and religiosity affect how labor is divided and if the influence of these factors is region-specific.

    Overall, findings show that there is no dominant pattern for labor division among couples and that no approach is consistently linked to higher levels of happiness; however, parents who have a partner to divide the labor with report more happiness than parents who do not have a partner. Other trends included the overall positive effect of women's education, a decreased gender gap in domestic work than was originally anticipated, and that domestic work is divided more traditionally in richer countries. In addition, the report describes findings in poverty levels; hunger and undernutrition; and the prevalence of marriage, cohabitation, and nonmarital childbearing in different regions.

    World Family Map 2015: Mapping Family Change and Child-Well Being Outcomes is available at (10 MB).

  • Using Baseline Equivalence to Measure Program Effectiveness

    Using Baseline Equivalence to Measure Program Effectiveness

    Programs for children and families have a vested interest in demonstrating the effectiveness of their services. In order to do this, researchers conducting program evaluation must show that an identified person or group of people has benefited from the interventions. The Office of Planning, Research and Evaluation (OPRE) released a report in 2014 on the importance of using baseline equivalence in measuring a program's effectiveness. The report defines baseline equivalence as the compared similarities between two groups before program service begins so as to measure the effects caused by a program from effects caused by other factors.

    The report cites the Home Visiting Evidence of Effectiveness (HomVEE) review, which provides conditions upon which it accurately measures exceptional effectiveness in home-visiting programs by asking the following questions:

    • Why is baseline equivalence important for program evaluation?
    • How can researchers be sure that study groups are equivalent at baseline?
    • What is the HomVEE standard for baseline equivalence? How can researchers meet that standard?

    The HomVEE review also provides recommendations to researchers regarding approaches that should be avoided when attempting to achieve baseline equivalency.

    On Equal Footing: The Importance of Baseline Equivalence in Measuring Program Effectiveness is available at (149 KB).

  • Journal Issue Focuses on Child Welfare and Substance Use

    Journal Issue Focuses on Child Welfare and Substance Use

    In October 2015, the Child Welfare League of America (CWLA) released a two-volume special issue of Child Welfare dedicated to families in child welfare affected by substance use. Article topics include cross-system collaboration, family drug court program compliance, peer mentoring, intensive family preservation services, and others. This new issue is an update from the 2001 special issue that focused on parental substance use disorders among families in child welfare. The 2015 special issue of Child Welfare, Vol. 94, Nos. 4 and 5, can be purchased at

    CWLA's 2016 national conference is also dedicated to the confluence of child welfare and substance use. For more information about the conference, which will be held August 1–3 in Orange County, CA, visit the CWLA website at

  • Disparities in Access to Postadoption Services

    Disparities in Access to Postadoption Services

    Research has shown that in families that receive postadoption services, children who were adopted from foster care are more likely to thrive and adoption disruption or dissolution is less likely to occur. A recent article in the Journal of Family Strengths explores specific barriers experienced by families, referred to as underserved adoptive families, in accessing postadoption services.

    Data for the study came from an online survey of adoptive parents who have adopted at least one child from the U.S. foster care system. The data indicate that 60 percent of surveyed families are considered "underserved," and certain demographic groups are disproportionately represented among this population, specifically non-White families. Findings also showed that certain postadoption services are more likely than others to be classified as an unmet need, including respite care. The survey results also suggest that particular State practices and policies systematically lead to higher rates of underserved adoptive families.

    The article highlights the historical purpose of postadoption services and resources within each State. Implications for practice, specialized services needed, and barriers to access are also discussed. Child welfare agencies are encouraged to reevaluate their postadoption services and establish a proactive service delivery model.

    "Underserved Adoptive Families: Disparities in Postadoption Access to Information, Resources, and Services," Journal of Family Strengths, 15(1), 2015, is available at

Strategies and Tools for Practice

This section of CBX offers publications, articles, reports, toolkits, and other instruments that provide either evidence-based strategies or other concrete help to child welfare and related professionals.

  • The Intersection of Domestic Violence and Human Trafficking

    The Intersection of Domestic Violence and Human Trafficking

    As part of the Human Trafficking and the State Courts Collaborative, the Center for Court Innovation recently published a factsheet for professionals in the justice system. This publication outlines the connection and overlap between intimate partner abuse—such as domestic violence and sexual assault—and human trafficking, aiming to provide information and support to jurisdictions interested in implementing or improving their court-based response.

    This publication walks readers through recognizing potential situations of human trafficking through domestic abuse and sexual assault; to understanding the complexity of abuse, specifically through coercion, isolation and intimidation, and obstacles; to using system resources. Professionals are also provided with a five-step strategy on how they can put practices in place to improve outcomes for victims of human trafficking.

    The factsheet, The Intersection of Domestic Violence, Sexual Assault, and Human Trafficking, is available on the Human Trafficking and the State Courts Collaborative website at

  • December Special Initiatives: Focus on National Health

    December Special Initiatives: Focus on National Health

    Being healthy is an important part of maintaining one's well-being. This December, there are three national initiatives that highlight important issues related to health: World AIDS Day (December 1), National Influenza Vaccination Week (December 4–10), and National Handwashing Awareness Week (December 6–12).

    Since 1988, World AIDS Day has been held on December 1, providing people around the world with an opportunity to unite in the fight against HIV, show their support for people living with HIV, and commemorate those who have passed.1 More information about this observance day and ways to get involved can be found on the World AIDS day website at

    National Influenza Vaccination Week is a chance to feature the importance of everyone, especially young children, getting vaccinated for the flu. After November, the number of administered flu vaccinations drops, even though flu season peaks between December and February.2 Resources and facts about vaccinations and the flu are available at In addition to getting vaccinated against the flu, washing your hands is an easy and effective way to prevent getting sick. The Henry the Hand Foundation provides four easy-to-remember principles of hand awareness, programs, and other materials to help spread the word about hand hygiene. Check them out at

    The first step to improving the health care of children in foster care is making sure they have access to health-care coverage. The Patient Protection and Affordable Care Act (ACA), which expanded Medicaid to cover youth formerly in foster care until age 26, provides youth and families involved in child welfare and youth who have aged out of foster care with opportunities to get the coverage they need. Below are a few resources for youth, families, and professionals that can help:

    Related Items

    For more resources on the ACA and its effect on youth in foster care, see this month's Children's Bureau Express (CBX) Spotlight section.

    The May 2014 issue of CBX also highlighted "Former Foster Care Youth and the Affordable Care Act (ACA) Toolkit," which presents an array of resources for service providers related to the new health-care provisions.

    1 World AIDS Day. (2015). About World AIDS Day. Retrieved from
    2 Center for Disease Control. (2014). 2014 National Influenza Vaccination Week (NIVW) Key Points. Retrieved from (90 KB).

  • New Blog Series Raises Awareness About Girls' Aggression

    New Blog Series Raises Awareness About Girls' Aggression

    The Center for Advanced Studies in Child Welfare launched a new blog series to raise awareness about issues related to and interventions for addressing aggression in girls involved with child welfare. The Girls Aggression and Child Welfare Social Work Blog Series aims to build child welfare workers' capacity to provide leadership in working with these young people; however, the information provided is also helpful to other service providers, teachers, and parents.

    Aggression is a well-documented byproduct of complex trauma experienced by children and youth involved in the approximately 1 million substantiated cases of child abuse and neglect each year. The accompanying abandonment and loss that comes with complex trauma, in combination with physical and verbal abuse, puts these young people at risk for behaving aggressively. The blog series suggests that the aggression shown by young girls needs to be addressed effectively at a younger age. If aggressive behavior receives little or no corrective attention, and it travels with girls into adulthood, they may harm their children, other family members, and people in their neighborhoods and communities.

    The blog series focuses on girls' aggression because, previously, the national spotlight had been focused on boys, and public policies and programs have been developed to address boys' aggression. The blogs are based on building trust and supportive communities that create conditions where girls feel respected and understood. Topics explored in the 13-part series include the following:

    • Blog 1: Worthlessness and Self-Compassion
    • Blog 2: Girls' Aggression: An Overview
    • Blog 3: Types of Aggression: Instrumental and Reactive
    • Blog 4: Types of Aggression: Non-Contact and Contact Aggression
    • Blog 5: Girls' Relational Aggression: Targets of the Aggression
    • Blog 6: Relational Aggression: Girls Who Perpetrate
    • Blog 7: Girls' Aggression, Executive Function, and Self-Regulation
    • Blog 8: Antonia: A Case Study That Illustrates Executive Function and Self-Regulation
    • Blog 9: Differential Assessment
    • Blog 10: Relational Interviews and Relationship-Based Interventions
    • Blog 11: Group Work Based on Relationship-Based Practice
    • Blog 12: Relationship-Based Intervention Programs
    • Blog 13: Systems Change Through Relational Interviews

    Each blog in the series is available on the Center for Advanced Studies in Child Welfare at


This CBX section provides a quick list of interesting resources, such as websites, videos, journals, funding or scholarship opportunities, or other materials that can be used in the field or with families.

  • Differential Diagnosis: Trauma and ADHD

    Differential Diagnosis: Trauma and ADHD

    Many children who exhibit clinical symptoms of attention deficit and hyperactivity disorder (ADHD) and have been diagnosed often exhibit symptoms that may resemble symptoms of children who have experienced or been exposed to trauma. Symptoms of trauma and ADHD manifest with conditions affecting the child's behavioral, mental, physical, and/or emotional health. As a consequence of the overlapping symptoms and lack of trauma-informed training, medical and educational professionals are sometimes unable to distinguish the cause of problematic behaviors, resulting in an unfitting diagnosis. To help separate the behavioral commonalities of ADHD and trauma, the National Child Traumatic Stress Network (NCTSN) published a podcast that features an interview with Dr. Heather Forkey, a pediatrician at the University of Massachusetts Memorial Medical Center.

    During her interview, Dr. Forkey highlights similarities in how trauma and ADHD impact the brain at different stages of a child's cognitive development. She also explains how the cognitive impact from exposure to trauma impacts the same part of the brain as ADHD. Because the impact is identical, the resulting behaviors can be identical. Therefore, when medical and educational professionals witness behaviors such as the inability to control impulses, difficulty focusing, problematic behaviors at school or at home, aggression, or difficulty acquiring developmental milestones, they commonly assume the child has ADHD.

    To support the progress of a trauma-informed child welfare system, Dr. Forkey suggests that parents and medical and educational professionals continuously communicate about any traumatic experience(s) encountered by the child. Furthermore, she suggests continuous reassessment of the child's behaviors to help identify any progress.

    In addition to the podcast interview with Dr. Forkey, the NCTSN provides a family handout guide for foster and adoptive parents who are raising children exposed to trauma. Produced by the American Academy of Pediatrics in collaboration with the Dave Thomas Foundation for Adoption, the guide begins with an explanation of what trauma is, the effects, and triggers that compound the existing symptoms. It also mentions the importance of trust in relation to the healthy development of a child, particularly one who has been affected by trauma. In its conclusion, the guide provides suggestions for parents to help better understand their child's needs after trauma.

    Listen to Dr. Heather Forkey's podcast interview, "Is it ADHD or Trauma Symptoms?" on the NCTSN website at

    Access Parenting After Trauma: Understanding Your Child's Needs: A Guide for Foster and Adoptive Parents on the American Academy of Pediatrics website at (2 MB).

    Related Items

    Child Welfare Information Gateway recently published the issue brief Developing a Trauma-Informed Child Welfare System, available at Information Gateway also published a series of factsheets for families about parenting children who have been exposed to trauma, experienced sexual abuse, or experienced abuse or neglect. These publications are available at:


  • Documentary Film Sheds Light on Reunification

    Documentary Film Sheds Light on Reunification

    Tough Love, a new documentary film directed by filmmaker Stephanie Wang-Breal, follows the lives of a single father in Seattle and a Bangladeshi-born mother of two in New York City as they navigate various State systems in an effort to improve their chances of having their children returned home from foster care. The film is meant to highlight the lives of two parents who lost custody of their children after being charged with neglect.

    Confronted with poverty, substance use, gambling, and domestic violence issues, these families are required to acknowledge their mistakes and overcome various obstacles to prove that they can safely care for their children. Tough Love focuses on two parents' love for their children as well as their parallel doubts and struggles to resolve the problems that brought them to the attention of child protection agencies and the courts. The film also intends to raise awareness about the roles that judges, caseworkers, advocates, and other professionals play in order to determine what makes a parent a "good parent."

    The filmmaker offers a compassionate and yet unbiased look into the reality of the child protection, foster care, and court systems, revealing the tireless efforts and dedication of all the professionals involved and the powerful impact of innovative programs and services designed to support and reunify families.

    For more information about the film, to view the trailer, or purchase the DVD, visit the film's website at

  • Utilizing and Creating Adoption Support Groups

    Utilizing and Creating Adoption Support Groups

    Adopting a child can be a very joyous and rewarding experience for both the adoptive child and the adoptive parent(s); however, along with rewarding experiences come various challenges. Adoption support groups can offer an environment for adoptive parents to discuss these challenges and share similar stories.

    A tip sheet developed by the Coalition for Child, Youth and Families and the Wisconsin Department of Children and Families discusses the different types of adoption support groups available to adoptive parents and what they can offer, in addition to providing guidelines on how to begin a support group on your own, either in-person or virtually.

    Somebody to Lean On: Connecting With or Creating a Support Group is available on the Wisconsin Department of Children and Families website at (636 KB).

Training and Conferences

Find trainings, workshops, webinars, and other opportunities for professionals and families to learn about how to improve the lives of children and youth as well as a listing of upcoming events and conferences.

  • On-Demand Father Engagement Training Certificate

    On-Demand Father Engagement Training Certificate

    The National Fatherhood Initiative offers an online certificate titled On-Demand Father Engagement Training. The certificate is designed for professionals and individuals who work with, or plan to work with, communities and organizations in improving their father engagement programs and practices. This certificate is also beneficial to professionals by adding credibility to their work with organizations and grantees. The training focuses on the following five father engagement topics:

    1. Foundational: How to Create a Father-Friendly Organization
    2. Program Design: 7 Best Practices in Designing a Fatherhood Program
    3. Recruitment & Retention: How to Think Like a Marketer When Marketing a Fatherhood Program
    4. Involving Moms: How to Work With Moms to Encourage Father Involvement
    5. Fundraising: How to Develop a Funding Plan for a Fatherhood Program

    For more information, or to purchase the training, visit

  • Conferences


    Upcoming national conferences on child welfare and adoption through March 2016 include:

    January 2016

    • Children's Law Institute
      Southwest Region National Child Protection Training Center at New Mexico State University
      January 6–8, Albuquerque, NM
    • 30th Annual San Diego International Conference on Child and Family Maltreatment
      Chadwick Center for Children and Families, Rady Children's Hospital-San Diego
      January 24–29, San Diego, CA

    March 2016

    Further details about national and regional child welfare and adoption conferences can be found through the Conference Calendar Search feature on the Child Welfare Information Gateway website at