“At the Mercy of our System”: Structural and programmatic changes for supporting parents with children in out-of-home care

Abstract

System reforms are needed to better support families and prevent child welfare system (CWS) involvement. For parents with children in out-of-home care, it is critical that CWS required programs meet their unique needs and minimize the harm of separation. Yet, few programs have been developed for this population of parents. This study sought to understand important factors to consider when developing responsive programming within the unique parenting context of supervised visitation. Data were collected through semi-structured interviews and focus groups with 107 individuals. Two focus groups included parents with lived expertise whose children were returned to their care after being removed. Interviewees included service providers from state CWS, legal, nursing, and Court Appointed Special Advocate (CASA) programs, child welfare researchers, and racial equity experts. Qualitative thematic analysis involved coding, code grouping, and theme development using ATLAS.ti. Findings indicate the need for broad systems attention to marginalization, separation trauma, and preparing workers for the context of supervised visitation Programs and requirements for parents should attend to self-identified needs, be trauma-informed, and needs-matched. Implications for child welfare programming are addressed, emphasizing community-based programming and family supports aimed at preventing removal, alongside systems-based efforts to minimize harm and meet families’ unique needs when separation cannot be avoided.

1. Introduction

Parenting programs are a nearly ubiquitous intervention strategy for parents engaged with the United States (U.S.) child welfare system (CWS), reflecting an assumption that all CWS-involved parents have parenting deficits in need of remediation. In fact, CWS assessment rarely evaluates individual parenting skills or capacities and their potential connection to the presence of, or risk for, child abuse and neglect (CAN) (Berliner et al., 2015; Smith et al., 2014). This assumption is particularly detrimental for parents whose children have been removed from their care and must regain the right to parent by complying with mandated services meant to address individual deficits. Parenting skills are often the target of services despite neglect being the most common allegation type, and the type most often associated with substantiation and child removal. Using a decade of NCANDS data (2008–2018), Nadon et al. (2023) found neglect was associated with the highest odds of both substantiation (OR = 1.91) and out-of-home placement (OR 2.64) compared with no maltreatment allegations and other maltreatment types. Without a direct link between the content of parenting programs and the risk of CAN, parents with children in out-of-home care may be mandated to complete time-consuming, and logistically difficult interventions that reinforce a message that they are “bad parents”. At the same time, the constrained and scrutinized environment of supervised visitation may impede their ability to demonstrate their parenting abilities while their children are in out-of-home care.

For those CWS-involved parents who may need parenting supports, there are few programs that have been designed specifically for a CWS population. Moreover, existing programs, even when adapted to the CWS context, rarely attend to differences in need based on whether children are in home or placed in out-of-home care, lack cultural specificity, and operate with little evidence of effectiveness regarding the aim of ensuring child safety and wellbeing (Berliner et al., 2015; Casanueva et al., 2008; Estefan et al., 2013; Landers et al., 2018; McWey, et al., 2015; Pinna, et al., 2015). Out-of-home placement is an important distinguishing factor among CWS-involved families. In addition to logistical challenges and heightened vulnerabilities experienced by families with children in out-of-home care, the trauma caused by child removal makes these families distinct from others who are CWS involved (e.g., Marcenko et al., 2011; Testa & Smith, 2009). Furthermore, parent–child contact during out-of-home placement occurs primarily in the context of periodic, scheduled visits, supervised by a third party. In addition to being supervised, these visits often occur in unnatural settings for parenting such as social service agencies and are largely unstructured with limited resources or activities for engaging children. For all these reasons, and due to the oversight of the CWS, these visits are often a source of stress, entered into with little guidance or preparation for parents or visit supervisors. Supervised visitation is an underutilized opportunity to support the maintenance and development of parent–child connections and mitigate the trauma of separation. Yet, few interventions are aimed at supporting parents in the unique context of supervised visitation visits (Fischer et al., 2020; Smith et al., 2014). Also lacking are training, guidance, and support for visit supervisors charged with monitoring and reporting on these visits (Zilberstein, 2023). Consequently, the present study sought to increase understanding of the unique context of parenting while children are in out-of-home care, build empirical evidence regarding how programming during supervised visits can support parent–child relationships, inform the development of supervised visitation interventions, and help prepare visit supervisors to support parents in this context.

2. Background

2.1. Scope of child welfare system involvement

In the U.S. in 2022, of the more than 4 million referrals to the CWS, approximately 3 million children were subject to an investigated report; of these, more than 550,000 were “confirmed victims”, of whom almost 300,000 received post-response services (U.S. Department of Health & Human Services (U.S. DHHS), 2024). Among those receiving post-response services through the CWS, approximately 105,000 were placed in out-of-home care in FY 2022 (U.S. DHHS, 2024). Furthermore, the U.S. Children’s Bureau takes a yearly snapshot of the number of children in out-of-home care on a given day; in 2022 that was more than 368,000 children across the country (U.S. DHHS, 2024).

2.2. Families with children in out-of-home care

Parents with children in out-of-home care have some of the most intensive case plans, outlining service requirements they must complete before regaining custody of their children (D’Andrade & Chambers, 2012). Failure to meet these requirements risks permanent termination of parental rights. These requirements and expectations can include accessing services such as substance abuse and mental health treatment, parenting interventions, attending case management meetings, and supervised visitation with their child(ren) (Stromwall et al., 2008). Most parents are referred to a variety of services to address several system-identified concerns relating to, for example, substance use, mental health, parenting skills, intimate partner violence (IPV), and unsafe/unstable housing (D’Andrade, 2015; D’Andrade & Chambers, 2012). However, there is often a lack of explicit connection between identified concerns and the CAN found to have put their child(ren) at risk (Berliner et al., 2015).

Parents with CWS involvement – - including those whose children are in out-of-home care – - are overwhelmingly female, living in poverty, and disproportionately people of color (Saldana, et al., 2021). As they work towards reunification, these parents often manage many significant stressors some of which may have contributed to their child(ren)’s removal (Saldana et al., 2021; Zilberstein, 2016). In fact, some argue that parents with children in out-of-home care are a distinct subset of parents in the CWS (Testa & Smith, 2009). Indeed, these parents face higher rates of poverty, mental health and substance use challenges, housing instability, and IPV compared to the broader CWS population, which may impact their ability to access and utilize ordered services (Courtney et al., 2004; D’Andrade, 2015; Marcenko et al., 2011; Saldana, et al., 2021). Despite these challenges, a greater number of needs may result in a heavier burden for parents both in terms of the number of services ordered and number of required appointments per week (D’Andrade & Chambers, 2012). The lack of instrumental support and unattainable expectations can present barriers to engagement, and many parents fail to complete all required services (D’Andrade, 2015; Landers et al., 2018). These barriers are compounded for those from racially and economically marginalized communities, who face disproportionate surveillance, reporting, and involvement with the CWS and systematic disinvestment and unfair individual expectations (Dettlaff & Boyd, 2020). Furthermore, these disadvantages and barriers ultimately impact who regains custody of their children. D’Andrade (2015) found service use patterns among parents with children in out-of-home care were lower for Black, Latinx, and American Indian/Alaska Native (AI/AN) parents, noncustodial parents, fathers, and younger parents. Barriers to service access are important given that successful completion of ordered services is associated with a greater likelihood of reunification (D’Andrade, 2015; Horwitz & Marshall, 2015).

2.3. Parenting programs for CWS-involved parents

There is little research on what services are ordered for parents, and how well they align with identified needs (service matching/targeting) (D’Andrade & Chambers, 2012). Among several requirements for CWS-involved parents, one of the most ordered services is parenting intervention (D’Andrade & Chambers, 2012; Stromwall et al., 2008). Yet, these parenting programs vary widely in terms of content and structure, often fail to include important features associated with lasting behavior change, and lack evidence of overall effectiveness (Casanueva et al., 2008; Estefan et al., 2013; McWey, et al., 2015; Pinna, et al., 2015). Furthermore, even those studies of intervention effectiveness tend to measure parent skills or child behavior and provide little explanation as to how these account for CAN risk, which is the target of CWS intervention (Berliner et al., 2015). Few parenting programs have been developed to specifically address CAN or to be implemented specifically with a CWS population, although many EBIs have been adapted for use within the CWS context (Berliner et al., 2015). Even when adapted to the CWS context, EBIs – - which are rarely culturally specific – - need added adaptation to meet the needs of diverse families; an important consideration given the disproportionate representation of racial and ethnic minoritized groups in the CWS.

2.4. The need for tailored parenting interventions

Experiences of marginalization, a multitude of stressors, and significant barriers to service access and engagement make parents with children in out-of-home care a distinct subpopulation in the CWS in need of targeted and relevant programming (Akin, Brook et al., 2018; Landers et al., 2018; Testa & Smith, 2009). These parents have little choice but to accept offered services, and many do so with distrust toward service providers who are often culturally, racially, and/or socioeconomically different from them (Akin, Brook et al., 2018; Mirick, 2012; Rooney, 2009). Facing logistical and material limitations and numerous requirements, parents with children in out-of-home care may have difficulty engaging in and completing compulsory services, compared with voluntary parents (Faver et al., 1999; Sotero et al., 2016). The involuntary nature and resulting power imbalance of CWS services create an environment in which parents often feel stressed, intimidated, fearful, and powerless (Akin & Gomi, 2017; Ayón & Eisenberg, 2010; Buckley et al., 2011; Dumbrill, 2006; Gopalan et al., 2023). Yet, overcoming these structural obstacles is critical given the connection between successful service completion and reunification with their children (D’Andrade, 2015; Horwitz & Marshall, 2015).

2.5. The need to address trauma in supervised visitation

Programming for parents with children in out-of-home care should also consider that these parents have limited access to their children and added barriers to engagement (Estefan et al., 2013; Landers et al., 2018; McWey, et al., 2015; Pinna, et al., 2015). The sudden separation associated with placement in out-of-home care can disrupt bonds and limits parents’ access to their children. The resulting trauma experienced by parents and children requires specific redress that frequently must occur in clinical environments in which parenting is supervised. Parents must manage existing stressors, along with additional demands from the CWS, and parent their potentially traumatized child within the constrained context of supervised visitation. Yet, parents often come into these high-stakes settings with little preparation and support and are supervised by providers unlikely to have been trained in culturally specific, trauma-informed approaches.

2.6. Few existing Models of parenting programs in the context of supervised visitation

In recent years, a small number of parenting interventions have been developed for use with parents involved in supervised visitation. The empirical literature on the effectiveness of supervised visitation in the context of child welfare is particularly limited. The Family Visit Coaching (FVC) model developed by Marty Beyer (Fischer et al., 2020) aims to improve parenting skill through interactive sessions with professionally trained and supervised coaches. Fischer et al, (2020) evaluated FVC with 106 non-randomly selected parents and found improved parenting skills for participating parents compared to controls, though skill acquisition was not evaluated in relationship to CAN or reunification / re-entry outcomes. The ‘Sherman’ model was developed through participatory processes as a strengths-based practice model for use in supervised visitation (Smith et al., 2014). The model faced implementation challenges and to date, published research focuses on formative evaluation measures of participant satisfaction, not model testing. Designed with a more narrowly focused goal of easing tensions between parents and foster caregivers regarding supervised visitation, the Fostering Relationships intervention (Burtch et al, 2024) has been piloted comparing 7 intervention and 4 control dyads of parents and foster caregivers on a limited single outcome measure: whether the parent followed the child’s lead during the supervised visit. Burtch et al. indicated that parents participating in the program more often followed their child’s lead compared to parents in the control group. However, the sample size (N = 11) was too small for statistical analysis. A last intervention developed for use in the context of visitation described by Nese and colleagues (2016) “Filming Interactions to Nurture Development” (FIND), is a video coaching program designed to increase supportive parenting behaviors in the context of supervised visitation in child welfare. Implemented with only 4 dyads of parents and children in out-of-home care, and evaluated using single subject methods, Nese et al., (2016) reported mixed evaluation results, finding increases in several targeted parenting behaviors, although not all were maintained at the post-test just one week after the intervention.

2.7. The need for accessible and affordable parenting programs in the context of supervised visitation

In addition to the effectiveness of parenting interventions for supervised visitation, are implementation and accessibility considerations. Researchers have demonstrated the importance of gaining perspectives from both parents receiving the services and workers providing the services, when developing and implementing interventions in the CWS context (Ayón & Eisenberg, 2010). CWS providers’ perceptions of a parenting program’s feasibility within a CWS setting are important for program success – - costly and time-consuming evidence-based programs can prove incompatible (Gopalan et al., 2015; 2023). In service systems already lacking resources and providers, it is critical that parenting interventions for supervised visitation requiring additional skills and supports are affordable and accessible to lay supervisors tasked with meeting a high need. Lack of resources, few providers, and long waitlists are structural issues in general parenting programming, and especially problematic within the CWS where services are often mandated (Ayón & Eisenberg, 2010; Tilbury & Ramsay, 2018). These factors significantly limit accessibility for low-income families (Gopalan et al., 2015). For CWS-involved parents, these structural limits set them up for failure, contribute to dissatisfaction with the system, and pose barriers to engagement that may not be surmountable by individual worker efforts such as fostering relationships and buy-in (Ayón & Eisenberg, 2010; Tilbury & Ramsay, 2018). Therefore, it is important to design parenting interventions that directly meet the needs of parents with children in out-of-home care, advance understanding of what factors might help service providers support parent–child connection during supervised visitation, and which are cost-effective and widely available to implement (Orlando et al., 2019). The findings from the current study can help increase understanding of parenting in the context of child welfare and offer perspectives to inform and shape future intervention programming for parents involved in supervised visitation. Parenting interventions in the context of supervised visitation remain few and those researchers and professionals developing and reforming such programs can benefit from the insights of practitioners and parents with lived experience.

2.7.1. Development of an Evidence-Informed parenting intervention specifically for CWS-involved parents during supervised visitation

Considering the CWS-specific gaps in programming for parents involved in supervised visitation, a team of researchers from a university-affiliated research and evaluation organization with collaborative ties to agency partners in the CWS of one state, and community stakeholders invested in family well-being, including parents with lived expertise in CWS, sought to collect data to inform the development of one such program. Beginning in 2014 this team engaged in a three-stage plan to inform, design, and develop a parent intervention with high CWS relevance that would also be broadly accessible and cost-effective (Orlando et al., 2019). This endeavor combined current research evidence, and broad stakeholder perspectives and input via interviews and focus groups, to inform the design and development of the program. Given the limited existing attention to supervised visitation as an opportunity to engage parents, the team focused on the need for a parenting program specific to the time when children are in out-of-home care, that considers the unique circumstances of the CWS and CWS-involved parents navigating supervised visits.

2.8. The current study

The current study analyzes the qualitative stakeholder interview and focus group data collected to inform the development of this CWS specific intervention to: 1) document the empirically based thematic content that informed its development (Orlando et al., 2019), and 2) provide a rich and detailed discussion of thematic results to inform our knowledge of the unique context of parenting while children are in out-of-home care and how intervention programming during supervised visits can support and enhance parent–child relationships during separation. Research questions guiding the qualitative analysis included:

1. What unique factors in the parenting context do key stakeholders identify for CWS-involved parents with children in out-of-home care?

2. What components and approaches do key stakeholders identify as important when designing a CWS specific parenting program for supervised visitation?

3. Methods

3.1. Sample and Recruitment

Participants included 107 key stakeholders and content experts associated with the CWS of one state. As described in more detail below, the study team was especially interested in hearing from parents with lived expertise and experience with the CWS. Two focus groups were held with Parent Allies (n = 11), parents with prior experience in the CWS who had successfully navigated child removal and reunification. Other key stakeholders included: service providers contracted by the state CWS (n = 10), CWS management level staff (n = 13), representatives of the legal community (n = 9), child welfare research and “best practice” experts (n = 14), and public health nurses (n = 3). Given the disproportionate representation of Black and AI/AN individuals in the CWS both nationally and in this state, diversity, and racial equity experts advising the state’s CWS (n = 7) were included. A focus group was also held with Court Appointed Special Advocate (CASA) program managers (n = 40). Demographic information was not collected from participants.

3.1.1. Perspectives of parents with lived expertise

The inclusion of Parent Allies in the study was undertaken intentionally to inform the design and content of the parenting program. Incorporating the voices and lived expertise of those directly affected by the CWS can illuminate factors that would otherwise be missed (Whelan, 2023). Furthermore, amplifying marginalized voices of those with lived expertise is an application of social work values of social justice and belief in the dignity and worth of all people. It is particularly important to include those most affected by the findings when developing mandated interventions such as those within the CWS.

3.2. Interview guide development

A semi-structured interview guide was used to facilitate discussions with stakeholders. The focus of the open-ended interview questions drew from other phases of the intervention development process such as literature review and early discussions with stakeholders. The guiding questions shifted over time, as information from other interviews and sources was continuously incorporated, guiding the direction of the project (Orlando et al., 2019). General topics discussed in interviews and focus groups included: 1) What areas of need do key stakeholders identify for child welfare specific parenting programs? 2) What are the gaps in current evidence-based parenting programs available to these parents? 3) What components and approaches do key stakeholders identify as important when designing a CWS specific parenting program? 4) What additional factors related to racial and ethnic disproportionality in the CWS should be considered?

3.3. Data collection

Interview data were collected via phone interviews in which the interviewer took detailed notes. The three focus groups were conducted in person. The first was held during a statewide CASA program manager’s meeting. All 40 managers in attendance participated and did not receive compensation. In person parent focus groups occurred in a private room in the county courthouse and were digitally recorded and professionally transcribed. Two focus groups were conducted with Parent Allies now working to support parents with children currently in out-of-home care. Parents were identified and invited to participate by a statewide service organization that supported the peer-led program. The first of these two parent focus groups included 3 fathers, and the second included 6 individuals, both mothers and fathers. In each of the two parent focus groups, there was one parent who was unable to attend and was subsequently interviewed over the phone. All parents received compensation for their time. Institutional Review was sought, and the interview data collection and analyses were considered exempt by the [blinded] State Institutional Review Board.

3.4. Thematic analysis

We used methods described by Braun & Clarke (2021) and Brooks et al. (2015) for conducting ‘codebook’ thematic analysis of qualitative interview and focus group transcripts. Our methods most closely resembled a style of thematic analysis called Template Analysis, which uses hierarchical coding within a highly structured yet flexible analytic process (Brooks et al., 2015), wherein codes are used to develop themes that can be both descriptive and interpretive (King, 2004, as cited in Braun and Clarke, 2021). Template Analysis can be well suited to team-based research that includes members with diverse qualitative analysis skills, including beginning researchers, and applied across several theoretical approaches (Braun and Clarke, 2021; Brooks et al., 2015). The analytic steps we undertook are detailed below.

Five researchers, including two who conducted the interviews and focus groups, were involved in the initial analytic discussions and decisions. These researchers generated initial codes using both inductive and deductive approaches, from a subset of the data. Two researchers per interview created and applied initial codes to each of seven interviews, selected for length and richness and inclusive of each stakeholder group. Analysis focused on identifying and applying descriptive codes to data excerpts identified as relevant to the two primary research questions. Code review and comparison assisted researchers in refining the scope, focus, and depth of analysis. The codes from all interviews were collated into a coding template spreadsheet. The five researchers then convened to review the codebook, remove, or collapse any redundant codes, and confirm structure and process for coding.

The next steps involved several qualitative coders/analysts. First, analysts coded each interview transcript, using the established template. Analysts read each interview, identified pertinent quotations related to the research questions of interest, and applied relevant codes. Review, and coding was completed in ATLAS.ti for Windows version 22 (ATLAS. ti Scientific Software Development GmbH, 2022). This allowed for easy organization and review of codes and corresponding quotations. Analysts then reviewed the developing coding template, comparing codes against interview excerpts to ensure confirmability (Drisko, 1997). Initial themes were then generated via review and condensing of codes into code groups. Several iterations of review, condensing, and theme development were undertaken. The final step was writing up the findings (Braun & Clarke, 2021). All researchers reviewed and provided input on the final results and manuscript. Findings are presented in narrative form in the following section and include direct quotes from transcripts to illustrate and support findings (Elo & Kyngäs, 2008).

4. Results

Analyses resulted in the development of three overarching themes organizing several multi-layered subthemes: 1) Continuous systems change alongside flexible and responsive programming, 2) Contextually situated and needs-matched support and services to bolster parent–child relationships, and 3) Elements important to mandated parenting programs for families with children in out-of-home care.

4.1. Continuous systems change alongside flexible and responsive programming

Key to responsive, flexible, and adaptable programming for parents with children in out-of-home care is recognition of structural and systemic factors outside of, and within, the CWS impacting CWS-involved parents, the scope of which go beyond any one individual parenting intervention. In many instances, interviewees turned the focus back on the CWS, and those working within it, suggesting the need for attention beyond just individual parents. The following subthemes outline important considerations and “best practices” for anyone developing or implementing a parenting program for CWS-involved parents. Subthemes include: 1) Increasing awareness of historical and contemporary contexts of marginalization, and culturally situated parenting practices, 2) Recognizing the “unnatural environment” of the CWS, 3) Prioritizing engaging diverse providers and culturally responsive programming, and 4) Targeted training and skill development for providers.

4.1.1. Increasing awareness of historical and contemporary contexts of marginalization, and culturally situated parenting practices

Interviewees noted that programs serving CWS-involved families often lack awareness of cultural context and culturally relevant parenting practices. Lack of attention to historic and current experiences of racism and marginalization also inhibit programs from serving the needs of racially and ethnically diverse families. Providers working within the CWS should be supported to consider the history and context of all families. As one interviewee stated, “[providers] need to understand historical trauma and the long intergenerational trauma that has gone on/is going on in these families”. Another individual suggested using a Race Equity Lens tool to intentionally bring issues of race and indigeneity to light.

“It’s VERY IMPORTANT to look at parenting through a cultural and racial lens. […] I have heard a lot of complaints over the years by parents involved with the CWS that their culture or race was not taken into account when involved with the CWS system. Often there is a lack of awareness of the historical issues related to race or Tribe. ANY work done needs to take that into consideration. Using a Race Equity Lens tool will be helpful in identifying what is needed for parenting programs.”

4.1.2. Recognizing the “unnatural environment” of the CWS

Many individuals expressed understanding of the difficult nature of interacting and engaging with the CWS for parents who have children in out-of-home care. They noted things like lack of trust, feelings of anger, competing stressors, and lack of instrumental supports. Others noted the cultural incongruence and alluded to experiences of being misunderstood by, or facing bias from, providers. In one evocative example, an interviewee describes the difficult context of the environment in which parents are trying to parent:

“When they are visiting children, it’s very hard, they have no control. They are at the mercy of our system. They don’t know. They want to appear good. They are being watched. It’s an unnatural environment.”

This interviewee’s comment, combined with others’ observations highlight the systemic and structural factors playing a role in parents’ experiences.

4.1.3. Prioritizing engaging diverse providers and culturally responsive programming

One way to increase racial equity and culturally relevant services is to provide interventions targeted to a specific culture or group and/or engage providers who are racially/ethnically similar to the parents being served. One tribal service provider illustrated how interwoven history, culture, and parenting practices are:

“We had our own parenting programs. They were culturally based. A lot of traditions were missing and [parents] needed to know how they got where they are. We used [a] holistic approach. Intakes were thorough and comprehensive. You are here for parenting, but what got you here? We asked all kinds of questions“.

Furthermore, culturally specific interventions may help increase the sense of relevancy and engagement and help counter cultural isolation when children are placed with caregivers with different racial and/or cultural backgrounds. One interviewee gave an example from an existing program for Native families:

“One of the things I really appreciated with one of our Native providers is that they had a cradleboard class and talked about tradition and history and wove that into their parenting support with urban Indians who were away from their Tribes. Also, the families with older kids took a dance class and made traditional costumes which reinforced the values of their culture and history.”

4.1.4. Targeted training and skill development for providers

Interviewees emphasized the need for providers of parent interventions to have a broad range of skills, including interpersonal skills such as empathy, knowledge of trauma-informed, anti-racist, and culturally responsive approaches, child development, and CWS processes and procedures. They also noted the need for support, training, and guidance for providers to develop needed skills, and increase their ability to be creative and flexible to address client needs and circumstances. As with parents, providers have different strengths and areas for growth, and these should be assessed, and training specifically targeted. One worker discussed this saying it is important to focus on provider:

“Attitudes – a long list – [need] creativity and flexibility […] People have different strengths – some [are] very skilled in child dev [elopment] but need work in clinical awareness or engagement skills. Others fabulous [at] engagement but need child development [skills].”

Across these subthemes, interviewees recognized it may not be possible for a parenting program to make meaningful changes to these structural and systemic factors. However, they emphasized that these factors should be considered when developing, implementing, and delivering parent programs. Furthermore, strategies that can be implemented by those working directly with families should be supported and incorporated.

4.2. Contextually situated and needs-matched support and services to bolster parent–child relationships

Parenting programs for CWS-involved parents with children in out-of-home care must address systemic and structural barriers to engaging in and completing mandated requirements, the trauma of separation and support to maintain parent–child relationships, and when appropriate access to needs-matched intervention services. The related subthemes include: 1) Increasing accessibility to mandated services, 2) Support for addressing separation trauma and building, strengthening, and maintaining parent–child relationships, and 3) Assessment and needs-matched supportive interventions.

4.2.1. Increasing accessibility to mandated services

Case plans and required parenting interventions fail to account for structural and systemic barriers such as economic marginalization, limited access to housing, transportation, and food, education and employment opportunities which impact parents’ ability to engage in services required by the CWS to reunify with their child(ren). Commenting on the common expectation that parents establish stable housing, one interviewee stated, “I continue to hear issues related to housing needs pop up from parents. They don’t have their child and they need housing in order to get their child back.” Parents’ ability to attend parent–child visits routinely and establish financial stability, other common expectations, can be hindered by current programs’ inflexibility to accommodate work schedules. As one stakeholder indicated:

“We hear from parents (who are barely getting by financially) that you want me to do all these services but they are only offered during work time and not available other times. They have to take time off work to participate. We talked about whether other modes of accessing program[s] (online, interactive) might work.”

Thinking of ways to address concrete needs among families, one intervention provider suggested:

“what [the CWS] could really use is an evidence based family preservation program. Something that would include parent mentors that would help parents get connected to services, stay connected to services and get on lists for things like housing”.

4.2.2. Support for addressing separation trauma and Building, Strengthening, and maintaining parent-child relationships

Interviewees indicated the need for parent programming that bolsters parent–child relationships during separation and addresses the trauma of out-of-home placement and supervised visitation. An essential part of helping parents to maintain and strengthen relationships with their child(ren) during separation is addressing and helping parents navigate their own and their child’s CWS-involvement related trauma. One parent noted, “[We] need boundary setting. Giving us words for what we are experiencing and what kids are experiencing – needs to be trauma-informed”. A provider explained, “The first visit needs to address trauma for the birth parent and the child. Some parents do not engage in visits due to emotional blockage. Some need to either create or re-establish a bond so that they can move forward and regain custody.” Many advise the need for programming that addresses child relational needs and trauma early in the life of the case. Such programming should address and provide guidance regarding the complex emotions associated with children being in out-of-home care and resulting supervised visitation.

Relatedly, providers of parenting interventions or supervised visitation need to, “understand the complex emotions experienced by children and parents prior to, during, and after parent–child visitation”. Parents need support to process their emotions, as well as the emotions and reactions of their child(ren) from the beginning of CWS-involvement. One parent interviewee touched on the complex emotional environment of the supervised visit, suggesting parents need guidance regarding:

“How to deal with grief, loss, guilt and fears in the initial visits – trauma, separation and anxiety – helping parents cope with the child’s trauma – [we] need language for the trauma.”

4.2.3. Assessment and needs-matched supportive interventions

Many interviewees emphasized the importance of assessment, suggesting parenting interventions are often ordered “as a matter of rote” whereby, “almost every parent is referred”. One parent attorney put it this way: “I do not think every parent needs a parenting class. Too often [this] service [is] provided […] without real assessment about what parenting [capacity] is […] and assumptions about what [their] deficits are”. Interviewees emphasized taking a balanced approach, suggesting assessments should focus on “assess[ing] [parent] strengths and what they are struggling with so they can provide a more tailored approach that is matched to the parents’ needs“. Workers can play a role in determining whether these assessments are accurate and have some power to advocate for appropriate interventions and supports. For example, one worker stated, ”It is also important to sometimes push back on the dept[artment’s] services plan and assessments and tell them what strengths I see in the client.“ A clear understanding of a family’s needs and connection between ordered services and decisions about the case are critical when parents and children are living apart.

These assessments should be collaborative and incorporate parents’ own identification of needs related to parenting support. One interviewee stated, “It’s more respectful to ask parents to rate their own skills even if they differ from our opinions.“ Another suggested including parents in this process because, “Parents have good insight into what they need to work on”.

Interviewees’ discussion of assessment called back to issues of understanding the history and context of families’ CWS involvement. For example, one individual suggested using a questionnaire in the initial family interview “that allows for active listening and provides context behind the situation”. They further suggested these practices should be institutionalized stating, “[some] social workers are doing this, but it can be helpful to have this really spelled out“.

When identified, addressing substance misuse, mental health needs, and trauma with CWS-involved parents is important, especially if these experiences create barriers to engagement with, or access to, services that are tied to successful reunification with their children. In addition to impacting service engagement, interviewees discussed these challenges as impeding parents’ capacity to care for and successfully parent their children. Many stressed that needs related to substance use and mental health should be addressed through uniquely tailored and trauma-informed programs to support their capacity to parent, which for some has little to do with lacking parenting skills. As one interviewee shared:

“Lots of our parents are depressed…they are overwhelmed with life and they have become depressed. Most of cases are neglect […] Most parenting programs do not address the core of why they are neglecting their kids…the depression and how they manage life. The moment we only focus on parenting, life continues to happen and they are back in pattern of being overwhelmed. We have a lot of really good parents […] I would love to see a program that addressed healthy living and life skills.”

4.3. Elements important to mandated parenting programs for families with children in out-of-home care

Systems changes in child welfare can help shift services towards preventive interventions which keep children in their homes and towards voluntary and community-based services rather than out-of-home care and mandated parenting programs. However, in cases in which children cannot safely remain in their home, out-of-home placement remains the practice and parents are expected to participate in mandated services. CWS-involved families with children in out-of-home care have varying needs and also the common need for support regarding the impacts of child removal and the unique context of supervised visitation. Whether programming is developed specifically for this population and/or tailored to their specific context, interviewees outlined several important strategies for supporting parents. The fundamental components of such programming would include:

1) Using trauma-informed approaches, 2) Strategies for fostering, building, and strengthening relationships, and 3) Strategies to successfully engage parents.

4.3.1. Using trauma-informed approaches

Individuals emphasized the need for programs that are trauma-informed and tailored to parents’ and families’ unique needs. One interviewee clearly stated, “We should ask parents “what do you need?” and then individualize the intervention to meet the need.” Recognizing the complex context of mandated services and navigating the CWS, another stated, “I like the idea of thinking about the first five things every parent needs to be able to do.” Ultimately, interviewees rejected one-size-fits-all approaches and suggested there likely needs to be a variety of flexible and responsive interventions and supports. Some emphasized the need to keep the child’s needs at the forefront, ensuring that targets of parenting intervention are specific to the family and connected to child wellbeing. One parent described a deep desire for the type of parenting support she needed during supervised visits:

“what to look for in our kids…trauma and how that might show up in visits. Our children’s emotions start to get lost. We need to watch for depression and angry episodes. How can we show them appropriate feelings to help them get through their day[?] Modeling by parents. Our sponges already know how to be aggressive, angry, and hurt.”

4.3.2. Strategies for Fostering, Building, and strengthening relationships

CWS interventions must balance parent engagement and autonomy, and child safety. This inherently creates tension between parents and workers who hold power over them. For parents, the very nature of CWS involvement is harmful, adversarial, and punitive and workers can better acknowledge and provide understanding and support within this context. As one worker noted, “Trust and confidentiality are big issues. You have to elicit the trust of the [client] so they can feel safe divulging information.” Interviewees recognized the importance of relationship building for the worker-client dynamic and the need to take time to build rapport. Despite an emphasis on the value of investing time in strengthening relationships, many noted structural constraints, such as high caseloads and limited resources. Nevertheless, many workers found ways to focus on building rapport, highlighting the importance of approaching parents with warmth and a positive regard. Describing the complex and delicate balance of building relationships within a mandated and coercive context, one service provider stated,

“It is really difficult for [parents] to get started. I think it is important to gauge a parent’s commitment to change and I don’t think the system does enough to recognize that it will come in time. I try to create a therapeutic environment to allow them to be heard and also to set up clear goals and standards for what will be expected”.

In terms of workers’ roles in supporting parent–child relationships, interviewees emphasized the importance of meeting parents’ and child (ren)’s needs throughout the length of the case, with a goal of promoting long-term success. Parent Allies, in particular, expressed the difficulty that can come with reunification and the many transitions inherent to the process. In addition to the support needed during supervised visitation, interviewees emphasized the need for support prior to, during, and after reunification; particularly concrete and material supports. One parent stated:

“You know how they support you with all these classes? When he came home, they pretty much shut me off of everything. They don’t really steer you in the direction of where you – to get the help. They were paying for my daycare and now all of sudden I have to pay for a big chunk…[need] some kind of transition plan with paying for this. I have a car now, but I was riding the bus doing my case, before the case was even closed they shut it off. It would [be] helpful if the services they provided could taper off, not shut off over night.”

4.3.3. Strategies to successfully engage parents

Many interviewees discussed the trauma and barriers created by child removal, impacting workers’ ability to engage parents with children in out-of-home care. They noted that parents’ visitation with their children can be traumatic, adding to logistical barriers that make it difficult for them to attend consistently. Taking these factors into account, interviewees shared successful strategies for engaging these parents.

4.3.3.1. Celebrate, motivate, incentivize.

Interviewees emphasized the importance of implementing programs that are strengths-based and focus on positive reinforcement. Leading with praise, encouragement, and warmth can make parents feel comfortable and seen in these spaces, encouraging their continued engagement. Interviewees suggested facilitating engagement in required services by assisting with material supports necessary to meet their own basic needs and to complete required objectives.

4.3.3.2. Integrate coaching and supervision.

For individuals who would benefit from additional parenting skills and strategies, interviewees indicated a need for programs that integrate opportunities for hands-on coaching and application of acquired skills. These opportunities can help solidify skills, and can be motivating when successes are reflected on, reviewed on video, or praised by a facilitator. One parent commented on their positive experience with coaching for skill-building: “They took videos and we went over them…extremely helpful…I didn’t know I was doing a lot of things until I saw them on tape. They were teaching me to be aware and he [my baby] can’t speak and so he couldn’t tell me what he needed or wanted […].”.

3. Discussion

This qualitative thematic analysis of interviews and focus groups with CWS-involved stakeholders resulted in several important take-aways regarding CWS programs for parents with children in out-of-home care. Parent programming requires broad shifts in thinking about the underlying causes of CWS involvement, consequences of child removal, and associated attitudes and perceptions of parents and families. Service requirements should include parent-identified and needs-based supports, including material needs. The current assumption of parenting interventions for all CWS involved parents can result in piling on time consuming and logistically difficult service requirements not directly connected to child risk and removal, and which add stress and fear, impacting the most marginalized of CWS involved parents.

Broad systems efforts needed include greater attention to the historic and contemporary experiences of marginalization that contribute to CWS involvement and that can impede parents’ ability to meet the mandated requirements to regain custody. Parents need support navigating CWS requirements, and in the unique context of supervised visits, programming to address the trauma of separation and help parents and children navigate this trauma and maintain or (re)build connection. Our study points specifically to the need to prepare workers, including the often-third-party providers supervising visits, for how to deliver such services to families. For those parents who could benefit from additional parenting support, recommendations should be rooted in assessment of factors contributing to CAN risk, trauma-informed, relationship supportive, and responsive to their unique and self-identified needs. Efforts to recognize culturally specific parenting practices and provide culturally relevant support and intervention are also needed.

Additionally, our findings extend the literature regarding the specific needs of, and approaches to engaging, parents with children in out-of-home care. Most specifically, these findings add to our knowledge of programming developed explicitly for this population and relevant to supervised visitation and undergird the development of one such program (Orlando et al., 2019). This program aimed to create a free and easily accessible intervention to help workers support parent–child connection during supervised visits. This is important given that costs and burdensome implementation factors have been identified in the literature as impeding accessibility and uptake of EBIs in the CWS (Gopalan et al., 2023).

5.1. Attention to issues of marginalization

Parents with children in out-of-home care are a particularly vulnerable CWS-involved population, with distinct needs and barriers to successfully engaging in services required to reunify with their children. Evidence suggests the need for attention to issues of historic and contemporary marginalization related to race, indigeneity, and poverty across all stages of the CWS, and their role in the overrepresentation of, and disparate outcomes for these groups in the CWS (Sedlak et al., 2022). Our study helps contextualize research suggesting experiences of marginalization contribute to CWS involvement, the risk for child removal, and can impede individuals’ ability to meet CWS mandates (D’Andrade, 2015). For example, stakeholders within the CWS and formerly involved parents in our study highlight the difficulty parents face attending to service demands without access to transportation, and while seeking or maintaining employment, and locating housing.

5.2. Needs-matched and culturally relevant services

For these families, there are several considerations for CWS programming, from broad shifts in perspective of the CWS and those within it, and related shifts in approaches to working with parents within this context. A shift in how the broader CWS frames the needs of families with children in out-of-home care will likely impact the services imposed on families. Our findings emphasize the importance of attention to the historical and contextual factors of a family’s experience with the CWS. This view can help providers understand and determine the needs of each family including parents’ self-identified needs.

For example, while substance misuse, mental health concerns, and poverty represent common issues faced by parents with children in-out-of-home care (Courtney et al., 2004; D’Andrade, 2015; Marcenko et al., 2011; Saldana, et al., 2021), they may not be a significant or primary contributing factor to CAN (Berliner et al., 2015). Therefore, it is important to engage parents in identifying what their needs are, and what might be getting in the way of providing a safe environment for their children. Identifying benefits and services to address parent needs should include assessment of whether these issues are relevant to CAN risk and in what ways required services and community-based supports will help to mitigate that risk.

Our findings support prior research reflecting frequent receipt of irrelevant services and limited access to needed services among CWS-involved parents (Lee & Logan-Greene, 2017). For example, interviewees suggested parents are often required to attend parenting programs without a clear need, and struggle to access housing resources and information. Rather than assuming a parenting intervention is needed, such interventions should be considered following an assessment suggesting the need for specific interventions or parenting skills. For example, assessment for developmental delays and subsequent provision of early intervention services for parents and children (Zimmer & Panko, 2006). Within such an approach, CWS policies and practices should allow consideration of culturally specific parenting practices. Furthermore, perhaps such assessment follows efforts to aid parents in meeting their most pressing needs such as those for housing and financial resources.

5.3. Trauma-informed supports during supervised visitation

Issues of trauma are highly relevant given the presence of CAN, and the trauma of separation for both parents and children. Our findings suggest the specific need for trauma-informed approaches to supervised visitation programming and recognizing the unique experience of separation trauma for families whose children have been placed in out-of-home care. Importantly, the impacts of traumatic separation combined with the unnatural and constrained context of supervised visits make this an important time for supportive interventions to sustain and grow parent–child relationships. These interventions require explicit acknowledgment of, and strategies to address, trauma in visit settings. Additionally, visit settings should consider trauma-related needs and the impact environments can have on children and parents, and limitations created by unconducive environments. Lack of attention to supervised visitation interventions and limited training and targeted skill development for visit supervisors mean missed opportunities to engage parents and support parent–child relationships while children are in out-of-home care. Further, they are needed to address the specific harms resulting from child removal.

5.4. Worker training and support for engaging families

The constrained and coercive context of the CWS strains relationships between parents and caseworkers who oversee their completion of the requirements imposed to regain custody of their children. Others have suggested the relevance of ordered services and the worker-parent relationship both play a role in workers’ ability to engage parents (e.g., Akin & Gomi, 2017; Tilbury & Ramsay, 2018). Consistent with prior research, our findings suggest competing stressors, the perceived demands and relevance of the intervention, and provider-related obstacles (e.g., mistrust) are important to consider regarding CWS parenting interventions (Ayón & Eisenberg, 2010; Buckley et al., 2011; Garcia et al., 2018; López-Zerón et al., 2021). Awareness of these factors and attempts to mitigate barriers may help child welfare workers struggling to engage parents. As with barriers to engagement, some of the strategies in our study aimed at helping workers to engage parents — focusing on building relationships, using good communication, incentivizing interventions, and increasing accessibility – are also found in the literature regarding CWS-involved parents (Ayón & Eisenberg, 2010; Buckley et al., 2011; Gopalan et al., 2015; 2023).

Relatedly, increasing the relevance of interventions to meet the needs of parents also came up in our study to address barriers and boost engagement (Akin & Gomi, 2017; Domenech Rodríguez et al., 2011). Providing for self-identified needs such as accessing housing, financial assistance, or childcare may increase engagement and build relationships wherein parents are more open to ask for or receive help regarding parenting skills should they be needed or helpful. These strategies provide targets for workers looking to increase engagement among parents with children in out-of-home care on their caseload, including better preparation for supporting and engaging parents during supervised visitation.

Our findings emphasized that interventions should be tailored, adaptable, and strengths based. Indeed, responsive, supportive, and highly relevant services can increase parent engagement and positive perceptions of CWS interventions (Akin & Gomi, 2017; Buckley et al., 2011; Darlington et al., 2012; Garcia et al., 2018; Gopalan et al., 2015; Kemp et al., 2014; Schreiber et al., 2013; Tilbury & Ramsay, 2018), which are crucial components in retention, completion, and ultimately reunification outcomes (D’Andrade, 2015; Horwitz & Marshall, 2015).

Workers’ capacity to build relationships and engage parents depends on individual (e.g., supervision) and structural (e.g., time, intervention priorities) supports enabling this. As systems stakeholders, child welfare staff at all levels must be engaged and consulted regarding effective and sustainable approaches to intervening with families, the necessary structural supports to realize these interventions, and needs and barriers to their successful implementation. However, successful and equitable CWS interventions require more than engagement and buy-in of staff. They require systems-wide approaches, including child welfare agencies regarding supervised visitation as an opportunity for practice engagement, and supporting individual workers to prioritize relationship-building to engage and support families. As our study highlights, assessment and needs-matched supports for families, especially concrete and other self-identified needs, are essential, as is ensuring workers ability to understand and respond to culturally specific parenting approaches and the need for culturally relevant supports.

Importantly, understanding effective elements of interventions for parents with specific needs (e.g., instrumental and material supports), has the potential to inform interventions to address such needs outside of the CWS. If community-based interventions can incorporate effective strategies to address families’ needs, this potentially reduces the need for CWS-involvement and child removal.

5.5. Prevention and concrete supports

Preventive interventions targeting fundamental drivers of CWS involvement, such as economic insecurity, should also be pursued alongside more immediate intervention strategies. Social and economic instability in the 21st century has become more pronounced in the U.S. and in Blinded state, with income inequalities at record highs (Blanchet et al., 2022; Sommeiller & Price, 2018). Further exacerbated by the economic recession and Covid-19 pandemic, income and wealth inequalities have deepened, particularly across race, ethnicity, and indigeneity. Parents need flexible basic needs support to meet a range of pressing economic needs, including housing and food costs, and parents themselves are best positioned to know what their household’s priorities are.

Prevention policies focused on the economic stability of families may help prevent CWS involvement for many families. For example, research indicates that statewide increases in Earned Income Tax Credit and Child Tax Credits are associated with significant decreases in CPS child maltreatment reports (Kovski et al., 2022). Similarly, Guaranteed Basic Income (GBI) policies which provide unconditional cash transfers can help alleviate the immediate stressors of poverty, reduce the risk of child neglect, and can protect families’ right to self-determination. A growing body of evidence points to GBI as being associated with reduced child maltreatment, lower infant mortality, and improved infant brain development (Perigee fund, 2020; Biehl & Hill, 2018; Troller-Renfree et al., 2022). Further, GBI initiatives are anti-racist in that they help address root causes of the racial disproportionality observed in the CWS (Farooqui, 2021).

Additionally, some research suggests provision of housing resources plays a unique role in predicting both decreased risk of child removal and increased likelihood of reunification (LaBrenz et al., 2022; Rog et al., 2017), though more research is needed to understand the complex interplay between housing insecurity and CWS involvement (Bai et al., 2020). Included in future research could be both qualitative and quantitative exploration of parents’ self-identified needs compared to ordered services, their congruence and impacts on reunification outcomes for families with children in out-of-home care. Additionally, person-centered studies examining differences in ordered services and their relationship to reunification outcomes could help our understanding of who is ordered to what services, and with what effect, among families with children in out-of-home care.

5.6. Limitations

It is a limitation of this study that the interview questions were narrowly focused on service needs and therefore participant responses were similarly focused. Consequently, there was little discussion of how issues such as poverty, substance misuse, and racism (both within the CWS and the broader society) are inextricably intertwined – both in terms of how they are experienced by individuals and how they are responded to by systems and individuals working within systems. Further, these findings do not fully capture the unique experiences of racially and ethnically diverse populations. More research focused on Native, Black, and other families of Color, and historically and continually overrepresented and marginalized groups is needed to better capture the needs and unique experiences of these individuals.

5.7. Conclusions and implications for community-based prevention efforts

Researchers, policy makers, and practitioners concerned with child wellbeing must be concerned with two parallel processes. First, investing in needs-matched family supports and instrumental resources delivered via community-based programs, rather than via state surveillance that increases the likelihood of CWS involvement. Second, working to critically examine and reform policies, practices, and interventions within the CWS for families who currently have children removed from their care. Our findings highlight the significant and multifaceted vulnerabilities of families facing CWS-involvement and out-of-home placement of their children – vulnerabilities that often stem from historical and contemporary marginalization and disinvestment. Often, families’ needs are best addressed via preventive policies and community-based programs aimed at increasing supports and shoring up parents’ ability to care for their children. Investments in such resources would, at least in some cases, prevent CWS-involvement, traumatic separation of children and families, and reduce burdens on the CWS. This is critical to consider, given the limits of systems’ ability to provide relevant, responsive, and effective intervention for diverse families, many of whom face additional traumas and impossible mandates once they become involved in the CWS. Our and others’ findings suggest some common barriers to service access (e.g., competing demands) among overwhelmed and impoverished families, suggesting the need for improved access both within and outside the CWS. As with CWS-based interventions, attention to preventing the disparate evaluation and treatment of marginalized groups, should be a central feature of these expanded services.

In time, increased investment in, and access to, community-based supports should lessen the reliance on the CWS for addressing families’ basic needs for material and parenting supports. Supporting this shift requires important changes within the CWS including assessing the unique contributors to CAN risk for each family. Resulting policies and required services and supports should be responsive to these specific needs, recognizing that for many, deficiencies in parenting are not the reason for CWS involvement. In the meantime, intervention with families who already have children in out-of-home care should center their increased vulnerability and the unique parenting context of supervised visitation after traumatic separation. This requires creating environments, including during supervised visitation, where it is possible to build relationships and buy-in with parents that allow for increased engagement to complete services, and facilitate continued connection between parent(s) and child(ren). Furthermore, it requires recognizing and attempting to mitigate the harms of CWS-involvement and traumatic separation that create additional barriers to these goals.

Data availability

The authors do not have permission to share data.