The elementary-school functioning of children with maltreatment histories and mild cognitive or behavioral disabilities: A mixed methods inquiry

Children and Youth Services Review 35 (2013) 420–428

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Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth

The elementary-school functioning of children with maltreatment histories and mild cognitive or behavioral disabilities: A mixed methods inquiry Wendy Haight a,⁎, Misa Kayama a, Tamara Kincaid b, Kelly Evans a, Nam Keol Kim c a b c

School of Social Work, University of Minnesota — Twin Cities, 1404 Gortner Ave., St. Paul, MN 55108, USA Social Work, University of Wisconsin-River Falls, 229 Wyman Education Bldg., River Falls, WI 54022-5001, USA Department of Educational Psychology, University of Minnesota — Twin Cities, 56 East River Road, Minneapolis, MN 55455, USA

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Article history: Received 19 September 2012 Received in revised form 15 December 2012 Accepted 15 December 2012 Available online 5 January 2013 Keywords: Child maltreatment Cognitive and behavioral disabilities School functioning Mixed methods Cross-systems collaboration

a b s t r a c t This mixed methods inquiry examined the school functioning of elementary school-aged children with maltreatment histories and mild cognitive or behavioral disabilities. Quantitative analyses of linked social service and education administrative data bases of 10,394 children in Minnesota with maltreatment histories indicated that 32% were eligible for special education services. Of those children with maltreatment histories and identified disabilities, 73% had mild cognitive or behavioral disabilities. The most frequent primary disabilities categories were specific learning disabilities (33%) and emotional/behavioral disabilities (27%). Children with maltreatment histories and mild cognitive or behavioral disabilities scored significantly below children with maltreatment histories and no identified disabilities on standardized assessments of math and reading, and this gap increased with grade level for math. Qualitative interviews with 22 child welfare professionals and 15 educators suggested why some children with maltreatment histories, especially those with mild cognitive or behavioral disabilities, struggle in school. Risks to school functioning included children's and families' multiple unmet basic and mental health needs which can mask or overshadow children's mild disabilities; poor cross systems collaboration between child welfare, education and mental health systems; and inadequate funding, especially for mental health services. Protective factors included child engagement in school, parent engagement with child welfare services and a professional culture of cross-systems collaboration. Implications are discussed for holistic child, family and system-level interventions. © 2013 Elsevier Ltd. All rights reserved.

1. Introduction In this study, we examine the school functioning 1 of elementary school-aged children receiving child protection services who have mild cognitive or behavioral disabilities such as specific learning disabilities, emotional/behavioral disorders and Attention Deficit Hyperactivity disorder (ADHD). Decades of research indicate that many children with maltreatment histories struggle in school (e.g., see Stone, 2007). As a group, children with maltreatment histories show more externalizing and internalizing problems, and less academic engagement than children who have not been maltreated (e.g., Shonk & Cicchetti, 2001). Children involved in child welfare have relatively high rates of placement in special education programs (e.g., Goerge, Van Voorhis, Grant, Casey & Robinson, 1992; Jonson-Reid, Drake, Kim, Porterfield & Han, 2004; Scherr, 2007; Zetlin, 2006), and poor

performance on standardized tests (e.g., Sullivan & Knutson, 2000). They also have more suspensions and expulsions than other students (Kortenkamp & Ehrle, 2002) and are more likely to repeat a grade (see Eckenrode, Laird, & Doris, 1993). Supporting the school functioning of children with maltreatment histories may be critical not only to their immediate well-being, but to their long term development. Indeed, the adult functioning of former foster children, in terms of employment, self-sufficiency and self-esteem generally is linked to their academic achievement (see Altshuler, 2003). Understanding the challenges and sources of support influencing the school functioning of children with maltreatment histories is necessary for the design of effective interventions to support their academic success.

1.1. Co-occurrence of disability and maltreatment ⁎ Corresponding author. Tel.: +1 612 624 4721; fax: +1 612 624 3744. E-mail addresses: [email protected] (W. Haight), [email protected] (M. Kayama), [email protected] (T. Kincaid), [email protected] (K. Evans), [email protected] (N.K. Kim). 1 We use the term “school functioning” to refer broadly to children's social and emotional adjustment to school, as well as their academic achievement. 0190-7409/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.childyouth.2012.12.010

Disabilities can present additional challenges to the school functioning of children with maltreatment histories. They are more likely to have disabilities than their non-maltreated peers. Nationally, 11.2% of all children from ages 6 to 17 received special education in 2008 (Data Accountability Center, 2012). In contrast, Scherr's (2007) meta-analysis

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of 24 studies indicated that about 31% of foster youth qualified for special education services.2 Lightfoot, Hill and LaLiberte (2011) examined the prevalence of disabilities among children in Minnesota's child welfare system. They found that 28% of school-aged children with substantiated cases of maltreatment had identified disabilities. Most studies also indicate that children with disabilities are more likely to have experienced maltreatment than their typically-developing peers (e.g., American Academy of Pediatrics, 2001; Crosse, Kaye & Ratnofsky, 1992; Stalker & McArthur, 2012; Sullivan & Knutson, 1998, 2000; Westcott & Jones, 1999). Sullivan and Knutson (2000), for instance, found that 31% of children with identified disabilities for which they were receiving special education services had maltreatment histories. In comparison to their peers, children with disabilities were 3.79 times more likely to have been physically abused, 3.76 times more likely to have been neglected, and 3.14 times more likely to have been sexually abused. They also were at higher risk of suffering from multiple types and episodes of maltreatment (Sullivan & Knutson, 2000). Sedlak et al. (2010) reported some mixed results regarding elevated risk of maltreatment for children with disabilities, but did find that children with disabilities experienced more serious maltreatment than children without disabilities.

1.2. Risks to children's school functioning due to maltreatment and disability Children with disabilities and maltreatment histories may experience an escalation of risk to their school functioning due to the complex, bidirectional relationship of disability and maltreatment. Disabilities can increase children's risk of maltreatment (e.g., Sobsey, 2002), for example, due to their physical vulnerabilities or difficult behaviors. Maltreatment also can increase children's risk of disabilities, for example, through direct trauma to the brain as in Abusive Head Trauma (shaken-baby-syndrome) (Sobsey, 2002) and the adverse effects on brain development caused by exposure to interpersonal violence (e.g., De Bellis, 2001) and neglect (e.g., Strathearn, Gray, O'Callaghan, & Wood, 2001). Maltreatment also may result in problems with affect regulation, forming attachments to adults, peer relationships, and mental health disorders that make it difficult for children to achieve in school (e.g., Cicchetti & Toth, 1995). Further, maltreatment may lead to children's out-of-home placements which can pose additional risks to their school functioning due to disruptions in their caregiver and family relationships (see Coohey, Renner, Hua, Zhang & Whitney, 2011). 3 Additional risks accrue if they experience gaps in instruction due to school moves (Altshuler, 2003; Scherr, 2007). Children with disabilities may be especially vulnerable if school moves result in the disruption of special education services (Altshuler, 1997; Zetlin, 2006). Yet school-aged children receiving child protection services who have disabilities are more than twice as likely to be placed in out-of-home care as children with maltreatment histories who do not have disabilities (Lightfoot, Hill & LaLiberte, 2011). Older youth with disabilities spend more time in out-of-home placements, and have higher rates of placement instability than their child welfare-involved peers without disabilities (Hill, 2012). In addition, children with maltreatment histories and disabilities may experience delays in their access to appropriate services (e.g., Casanueva, Cross, & Ringeisen, 2008; Rosenberg & Smith, 2008). Yet timely access to services may not only improve children's immediate functioning, it also

2 This figure is similar to those reported in studies reviewed by Scherr (2007) examining the percentage of foster youth who actually received special education services. 3 This risk may be lessened in states such as Minnesota, the site of the current research, which have seen a reduction in the number of children in foster care placements (Child Welfare League of America, 2012) following the implementation of a differential response model for responding to reports of child maltreatment (Institute of Applied Research, 2006).

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may prevent the development of emotional and behavioral problems resulting from frustration, school failure and negative social interactions. There are a variety of possible reasons for delays in services to children with maltreatment histories and disabilities. For instance, some parents involved in child protection are struggling to meet their families' basic needs, and may not follow through with the process required for their children to receive disability services (Shannon & Tappan, 2011). In addition, collaboration between educators and child welfare professionals can be problematic if communication across systems is inadequate, and professionals working within various systems do not share a common understanding of children's disabilities (e.g., Altshuler, 2003; Shannon & Tappan, 2011). In this study, we focus on the school functioning of children with maltreatment histories and mild disabilities of cognition or behavior. In some cases, these children can be at increased risk relative to children with more apparent disabilities. Unlike challenges faced by children with disabilities involving vision, hearing, mobility, and global cognitive deficits, for instance, those experienced by children with relatively “hidden” disabilities can be difficult for the children and others to interpret. Their difficulties can even be misinterpreted as disobedience, disrespect or laziness (e.g., McNulty, 2003; Portway & Johnson, 2005). In many respects, they appear to be typically developing children and function competently. Yet they struggle to interact with others; learn to read, write or calculate; or control their emotions and behaviors. Misinterpretations of the source of children's difficulties can delay their access to the support necessary for their development, including special education services. These misinterpretations also may leave children with these hidden disabilities vulnerable to maltreatment. Indeed, Helton and Cross (2011) found that among a U.S. national probability sample of families investigated for maltreatment, children with minor language deficits were at greater risk for physical abuse by parents than those with severe language impairments. 1.3. Present study In this mixed method inquiry, we use administrative data analyses and qualitative interviews with child welfare professionals and educators to address four research questions. Our initial questions are: 1) To what extent are school-aged children with mild cognitive or behavioral disabilities represented in the Minnesota child protection population? 2) What is the academic achievement of these children compared to children with maltreatment histories who do not have identified disabilities? To interpret general trends and individual variation in children's school functioning, we next consider: 3) What strengths and challenges to school functioning do professionals describe for children with maltreatment histories and mild cognitive or behavioral disabilities and their families? and 4) How do professionals describe cross system collaborations in supporting these children and their families? 2. Methods 2.1. Design We examine children's school functioning through a mixed methods design with an emphasis on the qualitative component (Creswell, Plano Clark, Gutmann & Hanson, 2003). The purpose of our design primarily is expansion; that is, we use quantitative and qualitative methods to study different phenomenon (e.g., demographic patterns, and professionals' perspectives) to increase the breadth and depth of our understanding (Greene, Sommerfeld & Haight, 2010). For our quantitative analyses (research questions 1 and 2), we access both child welfare and education administrative data bases. The education data base includes the standard disability categories under which children receive special education services. Disability categories for each child are based on medical diagnoses, psychological and academic testing and social developmental studies. Following Coohey et al. (2011), we use two key areas of academic skill as a

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proxy for school achievement: standardized reading and math test scores. Higher scores on reading and math usually indicate a mastery of grade level material, and a greater likelihood of graduating from high school (see Coohey et al., 2011). We use qualitative strategies of in-depth interviews to interpret the school functioning of children with maltreatment histories and mild cognitive or behavioral disabilities from the perspectives of expert educators and child welfare professionals (research questions 3 and 4). Relatively few studies have considered the perspectives of these front line professionals involved in providing services for children with maltreatment histories and disabilities. Their perspectives can help us to understand the challenges and sources of support experienced by these children and their families. 2.2. Quantitative methods We linked the Minnesota Child Protection Administrative Data (the Social Service Information System, or SSIS) with the Minnesota Automated Report Student System (MARSS) of the Minnesota Department of Education to identify children with maltreatment histories including those with disabilities, and describe their academic achievement. Link Plus, a program developed by the Center for Disease Control and Prevention was used to match each child's SSIS record with his/her MARSS record by date of birth; and first, middle and last names. The match rate was 91%. We sampled 10,394 children enrolled in Minnesota public schools in third through sixth grades in 2009–2010 who: 1) were involved with Minnesota Child Protection due to substantiated allegations of abuse or neglect anytime between 2008 and 2010, and 2) who took the Minnesota Comprehensive Assessment (MCA).4 Only 5.6% of these children were in out of home placements. Fifty-two percent were male. Fiftyfour percent were white, 25% were African American, 10% were Hispanic, 8% were Native American and 3% were Asian or Pacific Islander. Children's mean age was 10.5 (SD = 1.1), ranging from 9 to 13. Children were considered to have mild cognitive or behavioral disabilities if they: a) had Individual Education Plans (IEPs) (or had been evaluated as eligible for special education services but were not currently receiving them), and b) received the majority of their special education services in their general education classrooms, or part time in a special education room. Children were excluded if they were receiving special education services primarily for vision, hearing, mobility, or physical impairment.5 Of the children with maltreatment histories and mild cognitive or behavioral disabilities, and children with maltreatment histories and no identified disabilities; 67% and 44%, respectively, were male (χ2 1 = 375.40, p b .001, ϕ = 0.20); and 59% and 53%, respectively, were white (χ2 1 =30.07, p b .001, ϕ = 0.06) (note that these ϕ values reflect small effect sizes). 2.3. Qualitative methods 2.3.1. County sites Adult participants practiced in two counties in Minnesota. We sampled counties in two different parts of Minnesota in order to increase the range of issues addressed by participants. Directors of the Departments of Human Services in Maple and Birch Counties 6 responded to an invitation sent to Minnesota county directors to participate in the research. Maple County is located in southern Minnesota. According to

4 108 children were excluded because they did not take the MCA. Children do not take the MCA for a variety of reasons including severity of disability. Children with severe cognitive disabilities take a modified or alternative standardized achievement test. 5 A total of 1.9% of children with maltreatment histories and disabilities were excluded because of these disabilities. 6 All names of places and participants are pseudonyms.

the 2011 census, it is home to around 150,000 people spread over approximately 700 mile2. Approximately 70% of the population resides in an urban area and surrounding suburbs. Maple County is predominately White (87%), with Asians (6%) and Blacks (5%) comprising the largest minority groups. About 40% of the population holds bachelor's degrees or higher, and the median household income is $64,000 per year. Birch County is located in northern Minnesota. It is more rural and its residents on average are of lower socioeconomic status than Maple County. It is home to approximately 35,000 people spread over about 860 mile 2 with no urban areas. The majority of residents identify as White (90%). The largest minority group in Birch County is Native American (6% of the population). About 20% of the population has a bachelor's degree or higher, and the average household income is approximately $53,000 per year. 2.3.2. Participants Professional participants were purposely sampled because of their experience with elementary school-aged children with maltreatment histories including those with disabilities. They included 22 child welfare professionals and 15 educators referred by county directors of human services. They had a mean of 16 years of experience in child welfare or education (SD = 8) ranging from 3 to 35 years. Their positions included elementary school principals, special education teachers, general education teachers, school social workers, child protection investigators and other child welfare workers. 73% were female. 7 2.3.3. Procedures Professionals participated in individual, audio taped, semi-structured telephone or face-to-face interviews lasting approximately 30 to 60 min. They were asked to describe any risks or protective factors they have observed in children with maltreatment histories and mild cognitive or behavioral disabilities, and the extent to which these factors are similar or different than those of children with maltreatment histories and no disabilities. They also were asked to describe one or two illustrative cases. Finally, they were asked to comment on collaboration between child welfare professionals, educators and other social service providers in cases of children with maltreatment histories and mild cognitive or behavioral disabilities. 2.3.4. Qualitative data analysis Interviews of child welfare professionals and educators were transcribed verbatim. Emic codes focusing on the meanings ascribed by the participants to their experiences were induced through repeated readings of the transcripts (see Schwandt, 2003) by two independent researchers. The final coding scheme was finalized through discussion. All interviews were then coded by two independent coders who resolved any disagreements through discussion. Member checking and peer debriefing further enhanced the validity of our interpretations. 3. Results 3.1. To what extent are children with mild cognitive or behavioral disabilities represented in the Minnesota child protection population? The administrative data analysis showed that of the 10,394 children with maltreatment histories, 3309 (32%) received, or were eligible for, special education services. Of those children, 2410 (73%) had mild cognitive or behavioral disabilities. Of those children with maltreatment histories and mild cognitive or behavioral disabilities, their primary disability category was specific learning disabilities (33%

7 There were no significant differences in the years of experience or gender of educators and child welfare professionals.

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of children), emotional/behavioral disorders (27%), other health impairments, including ADHD (16%), speech and language impairments (11%), Autism Spectrum Disorders, high functioning (7%), and mild cognitive disabilities (7%).

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Mean Reading Score

The mean reading score (Minnesota Comprehensive Achievement tests) for children with maltreatment histories and mild cognitive or behavioral disabilities was 41.15 (SD=16.72), and for children with maltreatment histories and no identified disabilities the mean score was 52.30 (SD=14.93) (note that the mean reading score for all Minnesota children in the third through sixth grades was 58.96 (SD=16.458)). A grade level (3–6) by group (children with maltreatment histories and mild cognitive or behavioral disabilities by children with maltreatment histories and no identified disabilities) ANOVA on reading scores indicated significant main effects of group (F1,8790 =778.15, pb .001, η2 =.081) and grade (F3,8790 =6.39, pb .001, η2 =.002), and an interaction (F3,8790 =14.37, pb .001, η2 =.005). Overall, reading scores declined as grade level increased but η2 values indicate that this effect size was small. Children with maltreatment histories and mild cognitive or behavioral disabilities scored lower than children with maltreatment histories and no identified disabilities, and this effect size was medium. The achievement gap decreased with grade level, but the effect size was small (see Fig. 1). The mean math score (Minnesota Comprehensive Achievement tests) for children with maltreatment histories and mild cognitive or behavioral disabilities was 41.81 (SD = 14.28), and for children with maltreatment histories and no identified disabilities the mean score was 50.58 (SD = 12.65) (note that the mean math score for all Minnesota children in the third through sixth grades was 57.48 (SD = 13.86)). A grade (3–6) by group (children with maltreatment histories and mild cognitive or behavioral disabilities by children with maltreatment histories and no identified disabilities) ANOVA on math scores indicated significant main effects of group (F1,8380 =694.60, pb .001, η2 =.077) and grade (F1,8380 =101.14, pb .001, η2 =.035), and an interaction (F3,8380 =2.87, p=.035, η2 =.001). Overall, the math scores of children with maltreatment histories declined as grade level increased, but η2 values indicate that the effect size was small. Children with maltreatment histories and mild cognitive or behavioral disabilities scored lower than children with maltreatment histories and no identified disabilities, and the effect size was medium. The achievement gap in math scores increased with grade level, but the effect size was small (see Fig. 2). One significant challenge to the academic achievement of all children with maltreatment histories is the significant amount of school they missed. As a group, they were absent or tardy for a mean of approximately 20 days a year. 9 Children with maltreatment histories and mild cognitive or behavioral disabilities, however, missed even more school, approximately 4.4 more days of school per year than children with maltreatment histories and no disabilities. They attended and attended on time 87% (SD = 22%) of school days, and children with maltreatment histories and no identified disabilities attended and attended on time a mean of 90% (SD = 17%) of school days (t1 = 6.11, p b .001, Cohen's d = 0.125). This effect size, however, was small. The qualitative interviews of professionals suggest other possible contributors to children's relatively low academic performance, as well as sources of individual variation.

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40

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20 General population 10

Maltreatment with no identified disability Maltreatment with mild disabilities 3

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Fig. 1. Children's mean reading scores by grade level.

3.3. What challenges and supports for children's school functioning do professionals describe for children with maltreatment histories and mild cognitive or behavioral disabilities and their families? Some professionals noted that it is difficult to identify challenges and sources of support unique to children with maltreatment histories and disabilities. They speculated that many children with maltreatment histories have undiagnosed, mild cognitive or behavioral disabilities. In addition, fewer Minnesota children with maltreatment histories are being placed in foster care since the adoption of a differential response model for child maltreatment reports. Thus, educators interact primarily with biological parents and may not be aware that a family is even receiving child protection services. Finally, some professionals considered mild cognitive or behavioral disabilities not as uniquely contributing to a child's risk, but as “compounding” and “magnifying” the diverse challenges experienced by many children with maltreatment histories. Nevertheless, professionals did describe a range of potential challenges and sources of support to the school functioning of children with

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Maltreatment with no identified disability Maltreatment with mild disabilities

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Mean math and reading scores for all children (third to sixth grades) were calculated using raw test scores reported in the MARSS database. 9 Calculated based on the length of school year required in Minnesota (935 h for 1–6 grades, equivalent to 170 school days; Minnesota Department of Education, 2011). This is the minimum requirement, and school districts may lengthen the school year by several days.

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Grade

Mean Math Score

3.2. What is the academic achievement of children with maltreatment histories and mild cognitive or behavioral disabilities compared to children with maltreatment histories and no disabilities?

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3

4

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Grade Fig. 2. Children's mean math scores by grade level.

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maltreatment histories and mild cognitive or behavioral disabilities, some of which are unique to those with disabilities and others of which are experienced by many children with maltreatment histories.

needs for income, shelter, safety, etc. are prioritized over children's school struggles including those related to relatively mild cognitive or behavioral disabilities. These priorities can result in delays in children's receipt of services. One child welfare professional observed:

3.3.1. Children have unmet basic and mental health needs that undermine school functioning Professionals described the school functioning of children with maltreatment histories and mild cognitive or behavioral disabilities as hampered by multiple, complex, unmet basic and mental health needs. As one educator commented on unmet basic needs,

The other piece that I think is so hard to determine, especially if they are involved in the child welfare system, is there's a lot of traumatic events … creating a lot of chaos right now for that family and that child … so there's so many things that take priority that especially with mild disabilities some of these are going to be overlooked.

I come from the basic premise that if a kid is worried about what they're gonna wear or what they're gonna eat, or what they're gonna go home to, they're not going to be able to learn… you [teachers] are not gonna get what you want … if basic needs are not being met.

Twenty-seven percent of professionals also discussed parents' own unmet mental health or disability needs as impeding their ability to provide help for their children's school learning. One child welfare professional observed: “… a lot of times parents have the same disabilities that either were identified or were not identified and they're not able to help them [children] with … things that are going on in school. ….” Families' unmet needs also may result in family contexts which undermine children's school functioning. Indeed, 19% of professionals discussed lack of structure and adult supervision in the home as impediments to children's school functioning. As one educator generalized:

More commonly, 76% of professionals discussed children's unmet mental health and behavior needs, including trauma and loss, as impediments to learning. Children struggling with unmet mental health needs may be distracted from learning academic content and have fewer emotional resources and less motivation for tackling their learning challenges. One teacher described: “… if they have a bad day … sometimes they are not even there with you. They're in a memory …” Children's mental health issues resulting from trauma, abuse or chronic neglect also may manifest as difficulties in developing and maintaining relationships. Indeed, 73% of professionals discussed children's relationship problems at school as impediments to their learning. For example, children's problematic relationship histories with adults can make it harder for them to establish relationships with teachers. … they're also dealing with the loss of a critical element that I believe professionally and personally goes into education which is having that [interpersonal] connection… And if you have a child who has unrest and uncertainty in a home environment or … lack of trust or uncertainty with adults, now you throw them into the school setting where there's a lot of adults, a lot of uncertainty, and on top of that, have a disability. Frequent school moves can further impede relationship building with educators. One child welfare professional observed: “Sometimes… families, they move from school to school. They're [children are] not in one school long enough to develop a supportive relationship.” Children also may become socially isolated from peers due to behavior or hygiene which can lead to their disengagement from school. One teacher explained: Because of their behavior they often end up eliminated from their [sports] teams… They have no friends… somehow we have to find a place for them because we tend to remove them [from social and educational contexts] and it doesn't work…. It doesn't teach them anything, and… then they're isolated… In addition to mental health needs resulting from trauma, many children suffering from chronic neglect or whose families live in poverty may not have the life experiences teachers expect of them when entering a classroom. Indeed, 30% of professionals noted a general lack of school readiness in many children with maltreatment histories entering school. 3.3.2. Families have unmet needs that overshadow or undermine children's school functioning Professionals also recognized that the multiple, complex, unmet needs of families can impede children's school functioning. Thirty-eight percent of professionals indicated that when families are in crisis, other basic

…they're on their own a lot. They have a lot more unstructured time after school, or they tend to not have as many rules at home, so they're tired when they come to school. A lot of them don't have bedtimes, or there's no real routine to their life. Fifty-four percent of professionals perceived an ongoing lack of parental support and encouragement for children's school functioning at home. This lack of support was reflected in children's incomplete homework, tardiness or truancy, and parents' lack of involvement in school. For example, one educator described: He's been diagnosed with ASD [autism spectrum disorder] and it's tough for him socially, it's tough for him academically, it's just been tough. And that's just worsened by this lack of support at home, the lack of support for anything that we do here [at school]. Professionals suggested that parents' lack of support for their children's school functioning may result, in part, from their own negative experiences at school. Twenty-seven percent of professionals discussed some parents' attitudes towards school based on their own experiences as negatively impacting their children's school learning. One child welfare professional discussed: It kinda depends on what the parents' experience was with school. I've seen parents who basically have posttraumatic stress, you know going back into the first school meeting for their own child, it's like, “Holy crap,… this is a repeat of what happened to me as a kid and I didn't think I got a fair shot in school, hated school, dropped out…” …Or, “I was misdiagnosed, and now they're trying to do that same thing to my kid and I don't see it [child's problem].” Some parents' disengagement from school may extend to disability services. Twenty two percent of professionals described cases in which parents did not recognize their children's disability needs. A child welfare professional described: …the parent [is] not recognizing that [the child has a disability] … for whatever reason … they [are] not willing or not able to recognize that the child, especially with the more mild disabilities, has a disability.

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3.3.3. Children's challenges are masked by their own and their families' unmet needs Fifty-seven percent of professionals described challenges in understanding children's difficulties as an obstacle in providing timely, appropriate interventions. One educator observed that children's challenges resulting primarily from their cognitive disabilities can be misattributed to mental health issues stemming from stress, upheaval and lack of support in the home. A general lack of school readiness also may mask mild cognitive or behavioral disabilities. The challenges of understanding children's problems can be even greater when environmental risks are serious and cognitive or behavioral disabilities are mild. Regardless of the particular configuration of children's multiple challenges the result is the same: children may remain undiagnosed longer and miss out on timely intervention. Fifty one percent of professionals expressed concern about children's undiagnosed disabilities. One child welfare professional described the consequences of undiagnosed dyslexia:

3.4. How do professionals describe cross system collaborations in supporting children with maltreatment histories and mild cognitive or behavioral disabilities and their families?

… often times we don't see. … [the] invisible disabilities a lot of the kids have. And I think that's frustrating… the kid's not able to do …[what] you ask him to do… which …[can] cause him to act out. And so sometimes there's a delay in testing these kids…

Collaboration is key, because each of those groups brings different resources to the table, and if we can work together and we share in education, social services and child welfare what we're doing and they share with us, we become a really powerful team. We're all moving in the same direction for the child rather than working in isolation.

Thirty percent of professionals discussed that even when adults recognize children's struggles and refer them to special education and other services, their disabilities may not be “severe” enough to be eligible for services. One child welfare professional noted, “I think that sometimes they can fall through the cracks…” 3.3.4. Some children and parents are positively engaged in school and child welfare Professionals also described child and family strengths that may account for some individual variation in the school functioning of children with mild cognitive or behavioral disabilities. The primary protective factor identified by professionals for children was engagement in school. Sixty-five percent of professionals described children with maltreatment histories who were positively engaged in school. One child welfare professional indicated that “school is kind of a safe haven for them [children with maltreatment histories].” Another noted: “many of them [children with maltreatment histories] do think of school as a kind of refuge … a good place, a happy place.” Educators' comments included: “They feel like school is a safe place they really want to come,” “They really enjoyed the routine of coming to school — it was important to them that they were there and that we had a firm routine that we would follow,” and “They love school, they enjoy being here… they thrive here because it's safe and nurturing.” Twenty-seven percent of professionals specifically described some children with maltreatment histories as eager to engage in relationships with supportive adults. One educator commented “[Children] want to talk with you. They need the relationship with you… so there's an openness that you don't have with kids that already have that need met…” Another potential protective factor described by professionals was parents' willingness to engage with professionals. Sixty percent of professionals described parents receiving child protection services who did work collaboratively with educators and child welfare professionals. As one child welfare worker explained, … families really do want more and better for their kids than what they have. I mean I truly believe that and I get that from most families …also families that can identify early enough that they need help and they're willing to ask for and get it… I think all those things are really impacting [children].

3.4.1. Culture of collaboration Educators and child welfare professionals generally recognized that their collaboration provides opportunities to better understand and intervene in problems families are facing. Some professionals mentioned a professional culture of cross systems collaborations as strengths within their counties. As one child welfare professional observed: My experience with the kids is that they can do much better when you get more collaboration around the schools. Basically we're all on the same page, we're coordinating services. The right hand knows what the left hand is doing — more of a smooth process than the adversarial type of relationship. Educators also underscored the importance of cross-systems collaboration:

3.4.2. Inadequate communication and collaboration across multiple systems Yet 73% of professionals spoke of inadequate communication and collaboration across multiple systems involved with the child, for example, the school, child mental health and child protection. A child welfare professional described the need for closer collaboration: And certainly one of those challenges is … not everybody is collaborative… some people feel like that's not their job, or they can't afford to give that much time to one kid… it just comes … with the territory when you're working between agencies. Another child welfare professional articulated the need for better cross system collaboration: “…it doesn't do any good if we all just stay in our silos…” An educator expressed frustration: I don't have a whole lot of things positively to say regarding the help and assistance in working with parents that we've gotten at the county level…It just seems like they [child welfare professionals] will often come to us with open hand, but when we have questions in return its: ‘Nope, wait. That's not what we're going to do here.’ … it's a two way street that often only runs one way.

3.4.3. Systems are not parent friendly Thirty eight percent of professionals noted that systems are not always parent-friendly. For example, multidisciplinary team meetings may be intimidating or uninviting for parents. As described by one child welfare professional: I think maybe people forget that in the end the parents still get to have a voice or still get to have a say. It's not the child protection worker, or the guardian, or the foster parents, it's the parents and I think people leave them out and don't talk to them or give them the information. In addition, multiple and large systems may be difficult for parents to navigate. Another child welfare professional noted:

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I don't think that some of the families that we work with could access some of those extra resources if we weren't there to help advocate for them and help them navigate through the system because it can be so overwhelming and so confusing.

3.4.4. Inadequate funding In a time of tight budgets, 32% of professionals described inadequate funding for services, especially mental health services. One child welfare professional described: Our programs and funding … are continually being chipped away at, you know. They're continually being cut and I mean the legislative session in 2011 was … very hard on us, and … ultimately it affects the quality of life of the people that we serve. And so, I think that needs to be addressed. I think that they need to quit chippin' away at services for people with disabilities and chip away somewhere else. They're killing us…!

4. Discussion Our mixed method inquiry combined administrative data and in-depth interviews with experts to explore the school functioning of children with maltreatment histories and mild cognitive and behavioral disabilities. Attention to these relatively “hidden” disabilities is important because they may place children at increased risk for maltreatment (Helton & Cross, 2011) and delay their access to timely, appropriate services. Consistent with previous research (Lightfoot, Hill & LaLiberte, 2011; Scherr, 2007), our quantitative analyses indicated that approximately one-third of children involved in child protection had identified disabilities, but nearly three-quarters of these children had mild cognitive or behavior disabilities. Also, children with maltreatment histories as a group scored low on math and reading, increasingly so at higher grade levels. Children with maltreatment histories and mild cognitive or behavior disabilities performed lower in math and reading than children with maltreatment histories and no identified disabilities, increasingly so at higher grade levels in math. These finding are of concern in our society where – quite aside from the numerous benefits of education to emotional and social development – success in school is necessary for adult economic well-being, and where math skills are especially important to employment in well-paying technological, medical and scientific fields. There are a variety of reasons why children with maltreatment histories and mild cognitive and behavioral disabilities struggle in school. Consistent with previous research (see Larson, 2010; Larson, Zuel, & Swanson, 2011),10 children with maltreatment histories missed a substantial amount of school. Children with maltreatment histories and mild cognitive or behavioral disabilities missed somewhat more school. In addition, professionals viewed children's and families' unmet basic and mental health needs as impeding children's learning and engagement in school, and overshadowing or masking their mild cognitive or behavioral disabilities. Children's experiences of neglect, trauma and ongoing family upheaval can impact their abilities to attend to school work, control their behavior and emotions and form positive relationships with educators and peers. The consequences to the child of the constellation of unmet individual and family needs can make it very difficult for educators to recognize when children also have disability needs. Furthermore, professionals observed that when families are in crisis, children's relatively mild disabilities, even when identified, may not be prioritized for action. In addition, parents may not support children's school functioning at home, or provide a structured, adult supervised environment. Parental support of 10 Of course, in some cases, such as educational neglect, and in some contexts such as group care, children's school attendance can improve once they are placed in out of home care.

children's school functioning may be further eroded if they have unmet mental health or disability needs, or if their own school experiences were negative. Professionals also observed that inadequate collaboration across school and child welfare systems and the failure to design parent-friendly systems and procedures can present additional challenges. Of course, the longer children with disabilities go without appropriate services, the farther they may fall behind their peers academically, and the more likely they may be to act out in frustration, or withdraw from school. Our quantitative analyses also revealed variation in the school functioning of children with maltreatment histories with mild cognitive or behavioral disabilities. Professionals' reflections suggested child and family engagement as possible sources of protection. Some children with maltreatment histories view school as a safe and supportive haven, and seek out educators to form relationships. Some families do engage with professionals in child welfare and education services to support their children. Although professionals viewed family engagement as protective, engaging families involved with child welfare services can be a significant challenge. Upon contact with the child welfare system, many families experience deep fear, suspicion, anger and resentment. In addition, these parents often have goals and services selected and imposed on them by the child welfare system. Professionals must engage these involuntary clients at a time when they may feel least like developing a working relationship (see Altman, 2008). 4.1. Implications for holistic approaches The broad implications of our pattern of findings point to the need for a holistic approach to understanding and then addressing children's and families' complex, multiple needs. 4.1.1. Assessments and screening First, it is critical that children with maltreatment histories and mild cognitive and behavioral disabilities are identified to address their challenges in a timely and effective manner, and to avoid the development of more serious behavioral and academic problems. For example, early intervention with children at-risk of reading due to limited preparation, economic disadvantage, or possible learning disorders can significantly decrease the incidence of reading disorders (Fletcher, Lyon, Fuchs, & Barnes, 2007). Our participants suggested that attending to mental and behavioral health is especially important as these unmet needs can mask mild cognitive and behavioral disabilities and undermine school functioning. Indeed, our quantitative analyses revealed a relatively high incidence of emotional and behavioral disorders relative to the general population. Approximately 5% of children who receive special education services, nationally, do so because of emotional–behavioral disabilities (Data Accountability Center, 2012), in contrast to 27% of children with disabilities in our sample. Professionals from education, child welfare and mental health systems can advocate for the integration of mental and behavioral health with academic screening. They also can utilize the opportunity provided by their interventions to actively seek out and identify children who could benefit from a range of specialized services. For example, student assistance and problem solving pre-referral teams (e.g., Truscott, Cohen, Sams, Sanborn, & Frank, 2005), and school-wide Positive Behavioral Interventions and Support (PBIS) programs (Minnesota Department of Education, 2012) can be resources for the early identification of children who may be struggling with disabilities. 4.1.2. Engagement of adults involved with children, especially parents Developing relationships and working with children's caretakers as partners can facilitate the implementation of services that address families' and children's challenges and reduce the impact of children's disability on their school functioning. Professionals in our study observed that children with maltreatment histories and disabilities are more successful when their caregivers are engaged

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without blame for their children's behaviors or lack of educational progress. Yet both educators and child welfare professionals described situations in which caregivers had not been successfully engaged due to their negative experiences in the child welfare system, their own difficult educational experiences, or their lack of understanding of the special education process. Working with parents and caregivers, especially those who are reluctant to engage with schools, can be facilitated when professionals gain their trust and form relationships with them. For instance, parents of children with disabilities expressed willingness to work with professionals who are reliable, respect them and their children, and treat them as equal partners (Blue-Banning, Summers, Frankland, Nelson, & Beegle, 2004). Similarly, qualitative interviews with parents involved in child welfare suggest that their engagement can be facilitated through professionals' assertive, honest, and clear communications; and caring, firm relationships with clients (Altman, 2008). Professionals also can help parents understand why their children's cognitive and behavioral challenges are a concern, and the various intervention options. They can empower parents to make educated choices about interventions that fit with their children's needs as well as their own ability to meaningfully participate in the intervention. Effectively engaging parents or other caregivers may mean additional time and care must be spent approaching parents about concerns regarding the child's disability at the outset, but can facilitate positive outcomes in the long run. 4.1.3. Implementing services for children and families through crosssystems collaboration In order to design and implement a comprehensive, holistic intervention, collaboration between educators, child welfare and other professionals such as mental health workers are necessary. Yet both educators and child welfare professionals described cross-systems collaboration as inadequate. Some educators reported a lack of communication with child welfare professionals even regarding which children were involved in both systems. Given data that type and severity of maltreatment is related to educational challenges (e.g., Coohey et al., 2011), some sharing of basic information seems relevant to the provision of adequate educational support. One of the barriers to cross-systems collaboration may be a difference between systems in requirements and procedures for providing support. The presence of a professional who has knowledge of both education and child welfare systems can facilitate such collaborative relationships. Other challenges include the importance of confidentiality to both child welfare and education. There are, however, models of other systems in which such concerns have been successfully negotiated to the benefit of vulnerable children and their families. The Crossover Youth Practice Model designed by Georgetown University (Center for Juvenile Justice Reform, 2012), for instance, has been implemented in a number of jurisdictions nationwide to facilitate cross system collaborations to reduce the involvement of children from the child welfare system in the juvenile justice system. Protocols have been put in place to share information across juvenile justice, child welfare and child mental health systems to design and implement integrated interventions for vulnerable youth. Such collaborations may provide useful models for enhancing collaboration between child protection, education and other social service systems. 4.2. Limitations This study has a number of limitations. Administrative data bases used for the quantitative component of the study were not collected for research purposes, but for record keeping and administrative accountability, which may impact their reliability and validity. Due to our concerns about the quality of available administrative data, we did not examine children's school functioning relative to the types of maltreatment they had experienced. Yet the chronicity and type of maltreatment children

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experience, as well as its timing relative to their development, may impact the nature of their educational challenges (e.g., Coohey et al., 2011; Scarborough & McCrae, 2010). Next, we used cross sectional data from the administrative data base. Additional, longitudinal research can enhance our understanding of findings, e.g., the decline in math and reading scores of children with maltreatment histories as grade level increased. Further, some educators' struggles to differentiate those children with disabilities who were and were not receiving child protection services is a qualitative finding relevant to cross systems collaborations, but it also reflects a limitation in their abilities to address any unique challenges and strengths of children with maltreatment histories and mild cognitive or behavioral disabilities. Next, worker bias, burn out or secondary traumatic stress may have influenced some professionals' perspectives of families. For example, children's tardiness, truancy and incomplete homework may result not from lack of parental support for education, but from demands on parents holding multiple, low-wage jobs. Nonetheless, understanding the perspectives of professionals, regardless of their veracity, is useful in shaping interventions which necessarily will involve caregiver–professional collaborations. Finally, this report has focused on the perspectives of adult professionals. Our ongoing research will also consider the perspectives of parents and children. In conclusion, elementary school-aged children with maltreatment histories and mild cognitive and behavioral disabilities are especially vulnerable to academic problems which, if not addressed in a timely and effective manner, can result in disengagement from school and academic failure. Although the implications of our findings may seem to require a larger investment in time and resources than is currently provided by either child welfare or education systems, time spent early on may reduce the long term costs to both systems. Intervening with children who have progressed to the middle and high school years without effective intervention for their disabilities can result in unnecessary human suffering, and more expensive services outside the child's home or school district. Acknowledgments Saahoon Hong, Elizabeth Jerrison Terry, Traci LaLiberte and Laurel Bidwell provided invaluable consultation. This project was funded by the Gamble-Skogmo Endowment at the University of Minnesota. References Altman, J. C. (2008). Engaging families in child welfare services: Worker versus client perspectives. Child Welfare, 87(3), 41–61. Altshuler, S. J. (1997). A reveille for school social workers: Children in foster care need our help! Social Work Education, 19(2), 121–127. Altshuler, S. J. (2003). From barriers to successful collaboration: Public schools and child welfare working together. Social Work, 48(1), 52–63. American Academy of Pediatrics: Committee on Child Abuse and Neglect and Committee on Children with Disabilities (2001). Assessment of maltreatment of children with disabilities. Pediatrics, 108(2), 508–512. Blue-Banning, M., Summers, J. A., Frankland, H. C., Nelson, L. L., & Beegle, G. (2004). Dimensions of family and professional partnerships: Constructive guidelines for collaboration. Exceptional Children, 70(2), 167–184. Casanueva, C. E., Cross, T. P., & Ringeisen, H. (2008). Developmental needs and Individualized Family Services Plans among infants and toddlers in the child welfare system. Child Maltreatment, 13, 245–258. Center for Juvenile Justice Reform (2012). Crossover youth practice model. Retrieved from http://cjjr.georgetown.edu/pm/cypm.html Child Welfare League of America (2012). State fact sheets 2012. Retrieved from http:// www.cwla.org/advocacy/statefactsheets/statefactsheets12.htm Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 541. Coohey, C., Renner, L. M., Hua, L., Zhang, Y. J., & Whitney, S. D. (2011). Academic achievement despite child maltreatment: A longitudinal study. Child Abuse & Neglect, 35(9), 688–699. Creswell, J. W., Plano Clark, V. L., Gutmann, M. L., & Hanson, W. E. (2003). Advanced mixed methods research designs. In A. Tashakkori, & C. Teddlie (Eds.), Handbook of mixed methods in social and behavioral research (pp. 209–240) Thousand Oaks, CA: Sage. Crosse, S. B., Kaye, E., & Ratnofsky, A. C. (1992). A report on the maltreatment of children with disabilities. National Center on Child Abuse and Neglect, Administration of Children, Youth and Families, Administration for Children and Families, US Department of Health and Human Services.

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