Multiple Service Use: The impact of consistency in service quality for vulnerable youth

doi:10.1016/j.chiabu.2013.10.024

Child Abuse & Neglect

Volume 38, Issue 4, April 2014, Pages 687-697

https://doi.org/10.1016/j.chiabu.2013.10.024 Get rights and content

Abstract

Little is known about the way in which variations in service quality influence outcomes when youth are clients of more than one service system. This article reports on a study of 1,210 adolescents (aged 13–17 years), half were concurrent clients of two or more services and half were not involved in two or more services. Youth completed a self-report questionnaire administered by a trained interviewer. It was hypothesized that youth reporting two positive service experiences would report lower risks, higher resilience, and better outcomes than youth reporting inconsistent or two negative service experiences and that their resilience, risks, and outcomes would be similar to those of youth not involved in two or more services. MANCOVA was used to determine the relationship among service quality and resilience, risk, and outcomes with four covariates that assessed family and neighborhood environments, history of abuse and neglect, and chronic need. Results indicate that service quality had an effect on resilience, risks, and outcomes. These relationships were mediated quite strongly by the influence of the risks youth faced in their neighborhoods and to a lesser extent by the other three covariates. Of the three dependent variables, risk appeared to be the most consistently influenced by all the covariates, and it also differentiated service experience groups. Results point to the importance of services developing strategies to effectively address risks confronted by youth and also to ensure that when more than one service is involved with youth, consistency in service delivery is achieved.

Introduction

Little attention has been given to the combined impact of interventions from multiple service systems (e.g., child welfare, mental health, special education, juvenile corrections) on vulnerable youth despite the fact that youth with the most complex needs and the highest risks are typically clients of more than one service system (Ungar, Liebenberg, Dudding, Armstrong, & Van de Vijver, 2013). Berzin (2010) makes a case for more attention to be paid to the complex nature of the transition through adolescence for youth who are clients in multiple service systems. She also argues for research that reaches “beyond system classifications toward broader definitions of risk that more adequately portray youth experience” (p. 487). Others have drawn attention to the fact that youth concurrently involved in more than one service system face heightened risks across a broad spectrum of developmental outcomes and generally do not achieve better outcomes despite the larger volume of services they receive (Garland et al., 2003, Haapasalo, 2000, Harpaz-Rotem et al., 2008, Hazen et al., 2004, Kroll et al., 2002, Loeber et al., 1998).

It is not clear whether multiple system involvement enhances outcomes for youth who face significant levels of risk or makes it more difficult for them to chart a safe course through adolescence and into adulthood. The present study investigates the connection between the quality of service experiences within and across service systems and levels of risk, resilience, and outcomes taking account of the role of ecological variables (such as the neighborhood and family environment), history of abuse and neglect, and chronic need.

Section snippets

Ecological theory and service delivery

Ecological theories posit that protective resources in one area can offset the impact of risks in other areas (Bronfenbrenner, 1977). In this regard, service involvement is potentially a developmental asset available to vulnerable youth, possibly mitigating these risks and enhancing youth capacity to achieve good outcomes (Gilligan, 2004, Mitchell, 2011). It could be argued that the greater the number of services involved in vulnerable lives, the better the outcomes are likely to be. However,

Sample

This analysis focuses upon youth recruited into an international study of risk, resilience, and service utilization. The research was approved by the University Ethics Review Board prior to data collection. Data were gathered during 2009 and 2010 (n = 1,494). Six hundred and five youth included in this analysis were purposefully selected through referrals from service providers who knew youth to be concurrent clients of two or more service systems (child welfare, juvenile corrections, education

Results

As can be seen from Table 4a, Table 4b, the four service experience groups were similar to each other on demographic characteristics (age, gender, and ethnicity) but differed in terms of their living arrangements. Youth in the negative service experience group reported higher than expected rates of living in either residential care settings (27% compared with 7.7% overall) or independently (6.2% compared with 3.6% overall), while youth in the MCG reported higher rates of living with family,

Discussion

Consistency in service quality measured the extent to which two service providers worked in empowering and respectful ways with youth, taking active account of cultural identity, family circumstances and values, and encouraging active involvement of youth in solving the issues or challenges they were confronting (i.e., encouraging youth agency). The measure was based on the theoretical position that when youth are actively involved in service delivery, able to form positive relationships with

Conclusion

Youth with complex needs and who face high levels of risk typically have many service providers involved in their lives (Garland et al., 2003, Hazen et al., 2004, Loeber et al., 1998, Haapasalo, 2000, Harpaz-Rotem et al., 2008, Kroll et al., 2002). The nature of contemporary service delivery means that providers usually focus on a relatively narrow scope of practice defined by their organizational and professional mandate (Berzin, 2010). In this way, each provider targets a particular aspect of

Acknowledgements

The authors thank The Ministry of Business, Innovation and Employment for funding this research programme. They also gratefully thank all the young people and their supporters who participated in the research. Finally they acknowledge the contribution of The Donald Beasley Institute, The Victoria University Research Trust and its staff, Youthline Auckland and all the other researchers who helped with the research.

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Multiple Service Use: The impact of consistency in service quality for vulnerable youth

Abstract

Introduction

Section snippets

Ecological theory and service delivery

Sample

Results

Discussion

Conclusion

Acknowledgements

Sierra Leone's former child soldiers: A follow-up study of psychosocial adjustment and community reintegration

Child Development

Vulnerability in the transition to adulthood: Defining risk based on youth profiles

Children and Youth Services Review

Toward an experimental ecology of human development

American Psychologist

The costs and effects of addressing the needs of vulnerable populations: Results of 10 years of research

Canadian Journal of Nursing Research

A developmental psychopathology perspective on bipolar disorder

The Satisfaction with Life Scale

Journal of Personality Assessment

Community-level prevention of child maltreatment: The Durham Family Initiative

Predictors of resilience in abused and neglected children grown-up: The role of individual and neighborhood characteristics