Child Well-being and "Whole Child" Representation

Stoneleigh Fellow: Christine Trinkl Dougherty, 2008-2010

The 1997 Adoption and Safe Families Act (ASFA) established goals of "safety, permanency and well-being" for children in the dependency system. "Well-being" is difficult to define and to measure, yet it is a crucial element because children involved in the dependency system often suffer from emotional and behavioral health issues as well as physical and chronic health problems. If undiagnosed or untreated, these problems make it less likely for children to succeed in school, find stability in placement, and acquire important life skills. Inadequate assessments and insufficient services are two failures of the child welfare system that contribute to the unmet health needs of children. More difficult to measure but similarly compelling is the apparent failure of the justice system to deliver substantive and procedural entitlements that could remedy or ameliorate barriers to well-being. Moreover, failure to address these issues often place children and youth at risk for ending up in the juvenile justice system.

This fellowship focuses on the "well-being" portion of ASFA; namely, improving the well-being of children in the dependency system. This focus is due, in part, because the concepts of safety and permanency are well defined and accordingly have clearer implications.

Through her fellowship project (January 2008-December 2009), Child Well-Being and "Whole Child" Representation, Christine sought to develop an advocacy model that focuses on the well-being of children involved with the Philadelphia Dependency Court system and singles out two critical components of well-being: physical and behavioral health. 

Project Goals

On both the individual case level and at the level of public systems, Christine's project sought to make child well-being a component of system concern and court review for every child in every case. In collaboration with the Support Center for Child Advocates, Christine worked to create a case-planning method for internal multidisciplinary (lawyer-social worker team) strategy setting and external consultation across disciplines and systems. Advancing a model of child advocacy that seeks to integrate representation and services for the "whole child," Christine's project sought to bring form, method, and study to this emerging approach.

Project Method

Christine's research plan was to study 100 dependent, court-involved children and youth ages 10-13, who have been placed in out-of-home care, identifying their physical and behavioral health needs, and ensuring that the child receives the needed services. In addition to this child-specific advocacy, she sought to create a method by which the courts and child advocates can integrate measures of well-being into their everyday practice.

Other project methods included:

  • Create a measurement and evaluation tool to assess outcomes achieved for the sample of clients
  • Multi-disciplinary identification of individual, child-specific case goals and strategies, and tracking case outcomes
  • Develop a written tool for the volunteer attorney and social workers to use in guiding and evaluating appropriate physical and behavioral health services and assessment for the child
  • Consult with the Support Center for Child Advocates (Child Advocates) team (Child Advocates uses a client representation model that partners a child advocate social worker with a pro bono attorney to serve as the child's advocate in every case) to select the more appropriate remedy or to eliminate the barriers to receiving intervention
  • Involve the youth in service planning
  • Provide training sessions to segments of the child welfare community on the integration of well-being into the court's jurisprudence
  • Creation of a "medical passport," which will contain an abbreviated medical history to be shared with the youth and her health providers. (This is necessary since many children in the system lack a comprehensive health history, due in part to multiple placements, uncertain health histories upon entering out-of-home care and a lack of communication among health providers.)

Use of the Results

Upon completion of the project, Christine sought to open the door for changes in local child welfare policy and practice and therefore, enhance the methods used by children's lawyers, social workers and judges in the dependency system. 

The results of this project could influence service delivery for this vulnerable population of young people.  Through local and national training, Christine hopes to make child well-being a matter of court concern in all cases. The project will impact practice in part by teaching others how to do it. Model court orders developed during the project could be used in dependency hearings, and policy recommendations generated by the results will assist the Pennsylvania Departments of Human Services and Public Welfare in developing and implementing policy issues.