Disproportionality and racial disparities in child welfare (2006-current)
Dissemination and implementation of evidence-based interventions for youth and families of color in the child welfare system (2010-current)
Providers and system leaders’ acquisition, interpretation, and use of research evidence (2011-current)
Development and implementation of effective practices and resources for youth of color aging out of foster care (2008-current)
Intersection of immigration and foster care involvement among Latino youth and families (2008-current)
Dr. Antonio Garcia joined the School of Social Policy and Practice at the University of Pennsylvania as an Assistant Professor in 2012. His research trajectory is informed and enriched by his wealth of experience as a former Child Protective Services Worker and Supervisor in Washington State. Since earning his doctoral degree in Social Welfare at the University of Washington in 2010, his research and publication record to date has focused on understanding epidemiological trends related to children of color’s experiences in foster care; and etiological explanations for their increased risk of out-of-home displacement, and lack of access to and use of effective mental health interventions as compared to their Caucasian counterparts. Grounded in a transdisciplinary context, his post-doc training at the Child and Adolescent Services Research Center in San Diego, CA between 2010-2012 focused on identifying how to shrink the research to practice gap to ameliorate these disparities.
His rigorous training has provided Dr. Garcia with the ability and motivation to develop and implement a research agenda that is locally grounded and contextually driven. While efficacy is well documented for several evidence-supported interventions, it is not clear what strategies will address contextual and organizational system-level barriers to implementing them, or what implementation conditions will ameliorate the gap between need for and use of interventions for the disproportionate number of African American and Latino children in foster care. Several of Dr. Garcia’s projects aim to address these gaps, with a particular focus on ensuring leaders and caseworkers are equipped with the capacities, resources, and skills to prevent trauma and address the impact of adverse childhood experiences.
Dr. Garcia’s research interests also involve addressing the complexities of immigration and child welfare system involvement among Latino youth and families; and understanding how and under what conditions providers and system leaders in child-serving agencies gather, interpret, and use research to scale-up evidence-based practices. His long-term career goal is to rely on science and community stakeholder input to develop effective dissemination and implementation strategies to promote the use of evidence-based or promising practices and policies for the racially/ethnically diverse pool of youth and families involved in multiple systems of care. In the future, Dr. Garcia will examine whether and how safety, permanency, and well-being are achieved by agencies that rely upon effective strategies to successfully implement evidence-based practices. As co-director of the Child Well-being & Child Welfare (CW2) Specialization, Dr. Garcia is equally passionate to bring his evolving knowledge and expertise to the classroom, having taught direct practice, child welfare micro practice and policy, and direct practice research in the past.
“Mitigating barriers to implementing evidence-based interventions: Lessons learned from scholars and agency directors”
Garcia, A.R., DeNard, C., Morones, S., & Eldeeb, N.
Garcia, A.R., DeNard, C., Morones, S., & Eldeeb, N. (2019). Mitigating barriers to implementing evidence-based interventions: Lessons learned from scholars and agency directors. Children and Youth Services Review, 100, 313-331.
Casework services are ineffective in (1) reducing risk factors associated with child welfare system (CWS) involvement and negative child psychosocial outcomes, and (2) reducing racial disproportionality and racial disparities in utilization of effective child welfare services. Although child welfare leaders recognize the impetus to implement evidence-based practice (EBP) to address these challenges, they aren’t privy to how to optimize provider, organizational, and political contexts to promote their implementation. Implementation barriers are also likely to linger if workers and leaders have ongoing doubts about the effectiveness and applicability of EBPs for diverse populations in child welfare (Axford & Morpeth 2013). While some child welfare supervisors and leaders collaborated with researchers to identify and address barriers to implementing EBPs for the disproportionate number of youth of color they serve (HHS 2017), their experiences are rarely disseminated. Thus, the current study aimed to understand how they: (1) experience the implementation process in child welfare agencies, (2) explain how various inner (provider and organizational characteristics) and outer (funding, mandates, and inter-organizational networks) contextual factors might be linked or related to one another, and (3) illuminate what strategies they rely upon to mitigate contextual implementation barriers. Selection criteria included (1) EBPs classified as targeting “behavior management including parent training” on the California Evidence-Based Clearinghouse (CEBC) website, (2) EBPs rated as “1” for effectiveness and ranked “medium” or “high” relevance in the CWS by the CEBC, and (3) tested for effectiveness by RCTs or quasi-experimental designs, and (4) research studies that meet a “diversity” threshold, by which at least 25% of the study sample identifies as African American and/or Latino. Using these criteria, the interventions included Parent-Child Interaction Therapy (PCIT), Trauma-Focused Cognitive Behavioral Therapy, Level 4 TripleP (Pathways Positive Parenting Program), and Multi-Systemic Therapy. Scholars who originally tested the effectiveness of each EBP were invited to participate in semi-structured interviews via telephone during the spring and summer of 2014. If they declined to participate, the investigators of the earliest published effectiveness studies were contacted. Directors of child welfare agencies implementing TripleP (Levels 3 and 4) and PCIT in a large mid-Atlantic city were interviewed in-person in 2017. In sum, four agency directors and seven scholars participated in the study. A directed content analyses approach was used to develop an initial set of codes among the scholar data. Then, Grounded Theory Methods (Strauss & Corbin, 1990) were used to generate themes from the directors’ experiences. Lastly, the themes from the scholar and director analyses were integrated to provide a more holistic understanding of EBPs implementation in the CWS. Findings illuminate six major themes. The first theme, the outer context, affects implementation climate (Theme 2), defined as the extent to which employees perceive that innovation is expected and supported (Powell et al. 2017). Due to lack of readiness, the nature of crisis-oriented work in child welfare practice, and intermittent dissemination of knowledge about EBPs, the climate is not always conducive to the implementation process. However, cultural exchanges (Theme 3), when encouraged and precipitated by leaders, may address barriers that interfere with cultivating an optimal implementation climate. According to both scholars and leaders, cultural exchanges, defined as exchanges of knowledge, attitudes, and practices that occur when two actors representing diverse perspectives or identities engage in a process of debate and compromise (Palinkas, et al., 2005), likely increase awareness of EBPs. In turn, increased awareness due to exchanges may modify negative perceptions and beliefs about EBPs (Theme 4). At this stage, leaders and workers garner knowledge to identify barriers clients often grapple with during the implementation process. With perception established, practices are subsequently implemented (Theme 5). These practices include whether and how evidence is disseminated by directors, and if caseworkers decide to refer parents to an EBP. Finally, these conditions influence whether intended outcomes (safety, permanency, and well-being) are achieved (Theme 6). This is the first study to draw from the experiences of scholars and directors who have implemented EBPs that meet our stringent selection criteria in the CWS. Child welfare agency leaders and scholars can rely upon findings to inform efforts to implement EBPs. The finding that the efficacy and relevancy of cultural exchanges are contingent upon an optimal implementation climate influenced by outer contexts and cultivated by transformational leadership is novel. However, future research is needed to validate it in other agency contexts and by larger samples. What is clear, however, is that cultural exchanges are sporadic; and thus results suggest efforts to develop strategies to increase them are warranted.
“I am more than my past”: Parents’ attitudes and perceptions of the Positive Parenting Program in Child Welfare”
Garcia, A.R., Ohene, S., DeNard, C., Morones, S., Connaughton, C.
Garcia, A.R., Ohene, S., DeNard, C., Morones, S., Connaughton, C. (2018). “I am more than my past”: Parents’ attitudes and perceptions of the Positive Parenting Program in Child Welfare. Children and Youth Services Review, 88, 286-297.
Child welfare workers are challenged on a daily basis to achieve the goals of promoting child safety, permanency, and well-being. To achieve these goals, system leaders in two child welfare agencies in a large-Mid-Atlantic City received external funding to implement the Positive Parenting Program (Triple-P), an evidence-supported parenting intervention (ESPI). While contextual and organizational barriers have been illuminated among clinicians and child welfare workers and leaders, less is known about the attitudes and perceptions of ESPIs among parents involved in the child welfare system. Thirty-five parents who graduated from or who were near completing Triple-P participated in one of four focus groups. Grounded Theory methods illuminated three core themes. Categories within the first theme “barriers of engagement” included lack of immediate acceptability, multiple demands, limited time and visitation privileges to practice new skills, and biased assessments by caseworkers. However, the parents overcame barriers (theme two) due to Triple-P providers’ ability to cultivate positive therapeutic alliances by praising and recognizing progress, adapting case studies for increasing applicability, and facilitating bonds between peers. Consequently, the parents illuminated the impacts of engagement (theme three), which included: confidence to engage in positive talk with children, increased insight of previous negative parenting practices, and recognition of positive and prosocial child behaviors. Findings underscore the salience of providing support and resources for clinicians and child welfare workers to effectively engage parents in ESPIs. Future research is needed to validate these findings in other agency contexts, and with attention to other ESPIs implemented in child welfare agencies.
"Measuring racial/ethnic disparities in mental health service use among children referred to the child welfare system"
Kim, M., & Garcia, A.R.
Kim, M. & Garcia, A. R. (2016). Measuring racial/ethnic disparities in mental health service use among children referred to the child welfare system. Child Maltreatment, DOI 1077559516656397.
Relying upon nationally representative longitudinal data of children referred to the CWS due to reports of maltreatment, findings show that racial and ethnic mental health service disparities increased between 1999 and 2009, regardless of which metrics were used to measure them. Even more alarming is that the estimated increases in racial disparity were even greater among the subset of youth who met criteria for clinically pervasive externalizing and internalizing problems.
"Context matters: The state of racial disparities in mental health services among youth reported to child welfare in 1999 and 2009"
Garcia, A. R., Kim, M., & DeNard, C.
Garcia, A. R., Kim, M., & DeNard, C. (2016). Context matters: The state of racial disparities in mental health services among youth reported to child welfare in 1999 and 2009. Children and Youth Services Review, 66, 101-108.
Relying upon nationally representative longitudinal data of children referred to the CWS due to reports of maltreatment, findings showed that disparities in utilization of mental health services are no longer detected after taking into account poverty and organizational climate, suggesting indeed that context plays a fundamental role in reducing disparities.
"Barriers and facilitators to delivering effective mental health practice strategies for youth and families served by the child welfare system"
Garcia, A.R., Circo, E., DeNard, C., & Hernandez, N.
Garcia, A.R., Circo, E., DeNard, C., & Hernandez, N. (2015). Barriers and facilitators to delivering effective mental health practice strategies for youth and families served by the child welfare system. Children and Youth Services Review, 52, 110-122.
Findings from focus groups illuminated that caseworkers are likely to experience barriers and facilitators in delivering services to children and families of color at the micro, mezzo, and macro practice levels. At the macro level, “dissemination” of effective practice was emphasized. “Awareness” of effective practices was identified at the mezzo- level; and “implementation” was the focus at the micro-level. At the macro-level, funding, development of effective practice strategies, and proximity to effective services are likely to influence “dissemination”. Secondly, caseworkers agreed that at the mezzo-level, job support is needed to facilitate “awareness”, but to feel supported, they need effective training and opportunities to engage in interagency collaboration. Finally, at the micro-level, they suggested that cultural competence influences “implementation” of effective services. However, increased awareness around the social ills of stigma and the salience of “insider work” (i.e., engaging in reflexive practice) are needed to increase cultural competence. Emphasis on securing resources to promote (1) positive organizational culture and climate, and (2) communication and collaboration between mental health and child welfare agency providers will likely play a role in ameliorating racial service disparities.
"Socio-contextual determinants of Research Evidence Use in Public-Youth Systems of Care"
Garcia, A.R., Kim, M., Palinkas, L.A., Snowden, L., & Landsverk, J.
Garcia, A. R., Kim, M., Palinkas, L. A., Snowden, L., & Landsverk, J. (2015). Socio-contextual determinants of Research Evidence Use in Public-Youth Systems of Care. Administration and Policy in Mental Health and Mental Health Services Research, 1-10.
Socio-contextual drivers for 37 counties in California were gathered from public records in 2008; and public youth system leaders’ (n=96) perceptions of REU were measured via the Structured Interview of Evidence Use (SIEU) between 2008 and 2012. On average, leaders reported a SIEU score of 3.37 (SD = .33) on a five-point scale. Higher educational attainment increased the likelihood of REU. Positive relationships between scores on the “input” subscale and racial minority concentration and poverty were detected. Results suggest leaders gather evidence to work effectively within poor and minority communities, but may decide to not rely upon the evidence to inform practice. Findings underscore the need to understand these relationships and hire leaders who are trained to use evidence.
"The influence of caregiver depression on children in non-relative foster care versus kinship care placements."
Garcia, A.R., O’Reily, A., Matone, M., Kim, M., Long, J., & Rubin, D.
Garcia, A.R., O’Reily, A., Matone, M., Kim, M., Long, J., & Rubin, D. (2014). The influence of caregiver depression on children in non-relative foster care versus kinship care placements. Maternal and Child Health Journal.
Findings show that emotional and behavioral outcomes are more likely to improve among youth in kinship care when caregivers demonstrate a reduction in depression over time or are never depressed. Findings lend to policy relevance for child welfare systems to allocate additional resources to strengthen and support the kinship placement for their sake and for the children they care for.
"Foster youth & social support: The first RCT of independent living programming"
Greeson, J.K. Garcia, A.R., Kim, Minseop, & Courtney, M.
Greeson, J.K., Garcia, A.R., Kim, Minseop, & Courtney, M. (2014). Foster youth & social support: The first RCT of independent living programming. Research on Social Work Practice.
This study evaluates the effectiveness of Massachusetts’ Adolescent Outreach Program for Youths in Intensive Foster Care (Outreach) for increasing social support among enrolled youth. Outreach did not increase foster youth’s social support, compared to services as usual. No racial/ethnic disparities in program effect were detected. Findings underscore the need to develop and implement more intensive services to increase the odds of social support.
"Looking beneath and in-between the hidden surfaces: A critical review of defining, measuring and contextualizing mental health service disparities in the child welfare system"
Garcia, A.R., Palinkas, L.A., Snowden, L., & Landsverk, J..
Garcia, A.R., Palinkas, L.A., Snowden, L., & Landsverk, J. (2013). Looking beneath and in-between the hidden surfaces: A critical review of defining, measuring and contextualizing mental health service disparities in the child welfare system. Children and Youth Services Review, 35(10), 1727–1733.
Based upon a critical review of child welfare and public health research, the authors’ conclude that there remains a lack of clarity and consistency with which to measure, monitor, and contextualize disparities. Recommendations are offered to generate and articulate a clear definition that reveals, rather than conceals, conceptual and methodological innovation. These efforts will bring us closer to understanding and ameliorating racial and ethnic disparities in access to and use of mental health services for youth in foster care.
"Pathways to service inequities among Latinos in the child welfare system"
Garcia, A., Aisenberg, A., & Harachi, T.
Garcia, A., Aisenberg, A., & Harachi, T. (2012). Pathways to service inequities among Latinos in the child welfare system. Children and Youth Services Review, 34(5),1060–1071.
Relying upon Grounded Theory to analyze focus group data collected from caseworkers, the authors’ illuminated factors that contribute to the increasing numbers of Latino children in the foster care system, including acculturative stress; and lack of culturally congruent services, language interpreters, and bilingual foster care providers.
"Institutional predictors of developmental outcomes among racially diverse foster care alumni"
Garcia, A.R., Pecora, P, Harachi, T., & Aisenberg, A.
Garcia, A.R., Pecora, P, Harachi, T., & Aisenberg, A. (2012). Institutional predictors of developmental outcomes among racially diverse foster care alumni. American Journal of Orthopsychiatry, 82(4), 573-584.
Secondary data analyses of retrospective interviews with adults who were formerly placed in foster care (alumni) were conducted to identify predictors of mental health, education, and employment outcomes. Findings show that having access to a wide array of services while placed in foster care and feeling prepared to leave foster care were salient in predicting education and mental health outcomes among African Americans and Caucasians, but not among Latinos. Given that the majority of the alumni left the foster care system living independently, future research should be devoted to understanding how independent living services and resources may be enhanced to promote positive adult developmental outcomes.
"Prevalence and predictors of service utilization among racially and ethnically diverse adolescents in foster care diagnosed with mental health and substance abuse disorders"
Garcia, A. & Courtney, M.
Garcia, A. & Courtney, M. (2011). Prevalence and predictors of service utilization among racially and ethnically diverse adolescents in foster care diagnosed with mental health and substance abuse disorders. Journal of Public Child Welfare, 5 (5), 521-545.
This study identifies predictor of mental health, substance abuse disorders, and service utilization among older youth aging out of foster care. Findings show that African American teens are three times less likely than Caucasian teens in foster care to utilize services, controlling for need, gender, and placement setting.