Benefit-cost analysis of residential and outpatient addiction treatment in the State of Washington

A benefit-cost analysis of full continuum (FC) and partial continuum (PC) care was conducted on a sample of substance abusers from the State of Washington. Economic benefits were derived from client self-reported information at treatment entry and at 9 months postadmission using an augmented version of the Addiction Severity Index (ASI). Average (i.e., per client) economic benefits of treatment from baseline to follow-up for both FC and PC were statistically significant for most variables and in the aggregate. The overall difference in average economic benefit between FC and PC was positive ($8,053) and statistically significant, favoring FC over PC. The average cost of treatment amounted to $2,530 for FC and $1,138 for PC (p < .01). Average net benefits were estimated to be $17,833 (9.70) for FC and $11,173 (23.33) for PC, with values showing statistical significance (p < .05). Results strongly indicate that both treatment options generated positive and significant net benefits to society.     

Proposed bill for HEROES Act would give $1.5 billion to SAPT block grant

With the House of Representatives planning to vote last Friday on the fourth COVID‐19 stimulus package, substance use treatment stands a chance of being included — if the Senate, which at press time was still opposing the measure, as was the White House, goes ahead to approve it as well. The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, for about $2 trillion, would finally give some money to states, counties and health care. So far, more than $2 trillion has been spent on stimulus funding, with the field trying hard to be included in each bill (see “NASADAD requests $250 million for Phase 4 stimulus,” ADAW April 13, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32688 ).     

Typologies of substance use and illegal behaviors: A comparison of emerging adults with histories of foster care and the general population

This study used latent class analysis (LCA) to explore whether patterns of substance use and illegal behaviors among emerging adults, 18 to 28 years old, differ depending on whether they have a prior history in foster care. The study sample, consisting of 316 respondents who had previously been in foster care and 14,301 respondents without a foster care history, was drawn from the third wave of the National Longitudinal Study of Adolescent Health. A multiple-group LCA compared former foster youth to their peers in the general population. The following four classes were identified: illegal behaviors, substance use, illegal behaviors with problematic substance use and normative behaviors. Most of the differences between the groups were not statistically significant. However, within the illegal behavior class former foster youth were less likely to have bought, sold, or held stolen goods; injured someone in a fight so that she or he needed medical attention; to have sold drugs; and to have been drunk at school or work. Additionally, in the illegal behaviors with problematic substance use class emerging adults in the general population were more likely to have used cocaine. Within the normative behaviors class, former foster youth were more likely to be current smokers, and to have injured someone in a fight so that he or she required medical attention. Within the substance use class, emerging adults from the general population were more likely to have taken place in a fight where one group fought another. Additional statistically significant, but very small differences were also identified.     

Youth Substance Use in a Context of Family Homelessness

Objective

This study examines the relationship between family processes and youth substance use debuts among a sample of youth residing in urban family homeless shelters.

Method

Data regarding shelter experiences, youth and family characteristics, and the use of three substances (i.e., cigarettes, alcohol, and marijuana) were gathered from a sample of youth (11-14 years) and their respective parents residing in an urban family homeless shelter system. Multinomial logistic regression analysis was used to examine the influences on youth substance use.

Results

Of the 198 youth included in the statistical analysis, 72% (n = 143) reported no substance use debuts, while 18% (n = 35) indicated one and 10% (n = 20) indicated two to three substance use debuts. Within the final model, greater substance use debut was associated with being older (13-14 vs. 11-12; OR = 7.5; 95% CI = 1.8-30.9) and stressors exposure (OR = 4.8; 95% CI = 1.5-14.7). Furthermore, youth of adult caretakers that reported low levels of the three family processes considered were almost four and a half more likely (OR = 4.4; 95% CI = 1.2-16.5) to have made two to three substance use debuts.

Conclusions

Family processes may be a particularly important intervention target toward reducing the rate of substance use among youth residing in urban family homeless shelters.     

Cultural diversity competencies in child and youth care services in Portugal: Development of two measures and a brief training program

Few researchers have examined the training of child care workers in cultural diversity competencies, despite the growing number of ethnic minority children and youth in residential care. The present paper reports two studies. In study 1, we aimed to adapt and develop two measures of cultural diversity competencies—a self-report questionnaire and an objective measure based on a case vignette (n = 51). In study 2, we proposed a brief training program. A quasi-experimental design (n = 30) was used, with cultural competencies being evaluated before and after the training. Results revealed that (1) child care workers tended to over-estimate their self-perceived competence and that (2) the experimental group was more capable of including cultural elements in their definition of strategies and relational aspects of intervention after a brief training than the group that received no training (control). Implications of this study are discussed for further development of cultural diversity competencies in professionals working in residential child care.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

Long-Term Implications of Welfare Reform for the Development of Adolescents and Young Adults

We draw upon the 3-wave longitudinal dataset called Welfare Children and Families: A Three-City Study to examine the long-term implications for adolescents and young adults (N = 783) of mothers' welfare receipt and labor force participation from 1999 to 2005. In general, changes in mothers' work and welfare patterns were not associated with deterioration or improvement in youth development (ages 16 to 20 years at Wave 3). The few significant associations suggested that youth whose mothers increased employment (net of welfare participation) were less likely to show increases in serious behavior problems and delinquency compared to youth whose mothers were unemployed or employed part-time during the study period. Welfare roll exits (controlling for employment experiences) were unrelated to adolescent and young adult outcomes. Mothers' employment transitions were linked to improvements in household income and mothers' self esteem in addition to reductions in financial strain and their own illegal activities. However, these associations did not explain the relation between maternal employment and youths' improved behavior. These results do not support the predictions of either the supporters or the opponents of welfare reform, an outcome we discuss.     

A latent class analysis of resilient development among early adolescents living in public housing

The aim of this study was to identify types of early adolescents living in public housing neighborhoods based on patterns of resilient development. Informed by ecological-transactional theory, we evaluated a broad range of individual, relational, and contextual influences on resilient development among an ethnically diverse sample of 315 early adolescents (M_age = 12; 51% female) living in public housing neighborhoods. Results of a latent class analysis of 11 indicators and 2 outcome variables suggest three empirically derived classes representing overall patterns of favorable and unfavorable behavior. Daily hassles, low neighborhood cohesion, and a relaxed attitude towards substance use corresponded with a higher probability of substance use and delinquency. Significant differences in favorable behavior patterns reflecting resilient development between classes were found in attitudes towards substance use, academic efficacy, and school commitment. Results suggest important implications for preventive interventions for early adolescents living in public housing neighborhoods that are discussed.     

The Brief Assessment Checklists (BAC-C,BAC-A): Mental health screening measures for school-aged children and adolescents in foster,kinship, residential and adoptive care

More than half of children and young people in foster, kinship, and residential care, as well as those subsequently adopted from care, have mental health difficulties that require clinical formulation and intervention. While an increasing number of alternate care jurisdictions are instituting universal mental health screening, existing measures may not adequately screen for a range of attachment- and trauma-related mental health difficulties observed among these populations. The Brief Assessment Checklist for Children (BAC-C), and the Brief Assessment Checklist for Adolescents (BAC-A) are 20-item caregiver-report psychiatric rating scales designed to: 1. screen for and monitor clinically-meaningful mental health difficulties experienced by children and adolescents in various types of care; and 2. be safely administered and interpreted by health and social care professionals other than child and adolescent mental health clinicians. The BAC-C/A were also designed to be used as brief casework monitoring tools by foster care and adoption agencies, and for treatment monitoring in CAMHS. The BAC-C and BAC-A were derived from the Assessment Checklist for Children (ACC, 120 items) and Assessment Checklist for Adolescents (ACA, 105 items) respectively. Internal consistency of BAC-C (N = 347) and BAC-A (N = 230) scores were 0.89 and 0.87 respectively. The BAC-C/A were highly accurate in screening for clinical range ACC and ACA scores (area under the curve (AUC) ranging from 0.96 to 0.99), as well as for CBCL clinical range scores (AUCs: BAC-C = 0.89 to 0.92; BAC-A = 0.93 to 0.94). They were moderately accurate in screening for children that caregivers reported had been referred to mental health services (AUCs: BAC-C = 0.74; BAC-A = 0.79). Initial BAC-C/A psychometric properties compare favourably with that of existing screening instruments, including the Strengths and Difficulties Questionnaire and the Brief Problem Monitor (CBCL short form).     

Recovery coaches and the stability of reunification for substance abusing families in child welfare

Substance abuse is a long-standing challenge for child welfare systems. Parental substance abuse disrupts family stability, family cohesion, and jeopardizes the well-being of children. In the current study we test an intervention to improve child welfare outcomes for substance abusing families, specifically the probability of families achieving a stable (at least 12 months) reunification. The intervention was an integrated case management model where recovery coaches were appointed to substance abusing parents associated with an open foster care placement. A diverse group of families (n = 1623) were randomly assigned to either a control group (services as usual) or an experimental group (services as usual plus a recovery coach). Multinomial logistic regression indicated that substance abusing parents associated with a recovery coach were significantly more likely to achieve a stable reunification as compared with similar families in the control group.     

A randomized controlled trial of the effectiveness of the youth crime prevention program ‘New Perspectives’ (NP): Post-treatment changes and moderator effects

ObjectivesNew Perspectives (NP) aims to prevent that youth at onset of a criminal career will develop a more persistent criminal behavior pattern. The study aim was to examine whether NP was effective relative to care as usual in preventing and reducing (persistent) delinquency. Moreover, we examined improvements in secondary outcomes (e.g., peer and parent relationships and cognitive distortions) and other outcomes (e.g., substance use and self-esteem).MethodsAt-risk youth (N = 101) aged 12 to 19 years were randomly assigned to the intervention group (NP, n = 47) or control group (‘care as usual’, n = 54). The effects of the NP intensive phase (3 months after program start) and aftercare phase (6 months after program start) were analyzed.ResultsNP and care as usual did not differ on any of the outcome measures at both post-test occasions. The effects of NP were the same for boys and girls, different age groups, and ethnic groups.ConclusionsThe overall null-effects are discussed, including implications for further research, policy, and practice.     

It takes a team: Improving placement stability among children and youth with Fetal Alcohol Spectrum Disorder in care in Canada

Concerted efforts have been devoted to improving placement stability for children in care. These efforts have been driven by evidence of negative outcomes for foster children who experience frequent placement changes. Of particular concern are significantly higher rates of placement disruptions among children in care who experience Fetal Alcohol Spectrum Disorder (FASD). This mixed methods study examines the impact of enhanced child welfare practice interventions on placement stability for 182 children in care who experience FASD. A quasi-experimental matched comparison group design was employed, where rates of placement change were compared between children in the Project Regions who received enhanced practice standards to those in the Comparison Regions who did not. The sample included 182 participants including 98 children and youth in care from the Project Region and 84 cases from the Comparison Region. The Project Regions reported considerably lower placement changes (M = .33) than the Comparison Region (M = .98). Logistic regression analysis revealed that worker contact was found to be predictive of placement stability. Specifically, as worker contact increased, the likelihood of placement change decreased [B = − .28, W (5.35, p = .02)]. In keeping with the adage that it takes a village to raise a child, one could add for children affected by FASD, that it takes a dedicated team to promote placement stability and better life trajectories.     

Adolescent Problem Behavior in Toronto,Canada

The purpose of this study was to evaluate the relative association of unique aspects of social capital at the level of families, schools, and neighborhoods on adolescent self‐reported violence, property crimes, and substance use. Data come from the 2006 Canadian International Youth Survey that asked adolescents between the ages of 12 and 15 in the metropolitan city of Toronto (N = 3, 101) about their problem behavior. Poisson regression models revealed that parental monitoring, school performance, peer approval of illegal activities, and neighborhood social disorder were consistently associated with all three adolescent problem behaviors, net of controls. Results were more mixed for remaining measures of social capital on adolescent problem behavior. Interestingly, neighborhood cohesion was a significant predictor of adolescent substance use, but operated in a direction that was contrary to the proposed hypotheses. These findings highlight the importance of teasing out how different facets of social capital in different environments are linked to adolescent problem behavior.     

Behavior problems in children raised by grandmothers: The role of caregiver distress, family resources, and the home environment

Over the past few decades there has been a dramatic increase in children being raised by grandparents due to a variety of factors including child maltreatment, parental abandonment, substance abuse, and incarceration. The purpose of this study is to examine the extent of behavior problems in children being raised by grandmothers and to determine factors in their current environment that are related to child behavior problems. The study draws on McCubbin's resiliency model of family stress, adjustment and adaptation.The sample comprised of 230 children ages 2 to 16 years who were being raised by grandmothers in parent-absent homes. The families were predominantly low income and African American. The grandmothers ranged in age from 37 to 80 years. Grandmothers responded to several self-report measures pertaining to child behavior problems, family resources, social support, and caregiver psychological distress. Trained research assistants completed a standardized observational measure of the home environment.Results indicated that 31.3% of child participants scored in the clinically elevated range for total behavior problems, with 21.3% and 32.6% scoring in the elevated range for internalizing and externalizing behaviors, respectively. Hierarchical regression analyses revealed that of the variables examined, increased psychological distress in grandmothers was most predictive of child behavior problems, followed by less supportive home environments and fewer family resources.Results of the present study underscore the need for interventions that focus on reducing child behavior problems, as well as enhancing the parenting skills of grandmothers raising grandchildren. Findings also support the need for strategies to reduce stress in grandmother caregivers and to improve access to resources needed to provide supportive home environments for their grandchildren.     

Reunification in a complete entry cohort: A longitudinal study of children entering out-of-home care in Tasmania,Australia

The aim of this study was to examine the nature and predictors of family reunification patterns in Australia. Using a large representative sample, this study extends previous studies based on older, often smaller samples and encompasses a period in which kinship care comprised a substantial proportion of out-of-home care placements. Analyses were based on a sample of 468 children who entered care for the first time in the State of Tasmania between January the 1st 2006 and December 31st 2007. Administrative data and case-worker interviews were used to obtain information concerning children's demographics, family backgrounds and placement movements over 2–4 years. The results showed that around 50% of children had gone home after 2 years, but that 79% of returns occurred in the first 6 months. Reunification was slower for younger children, those in kinship care, and amongst children from families affected by poverty, substance abuse and for a cluster children with the highest prevalence family risk factors. The study contributes to international knowledge concerning the importance of assessing the multiplicity of risk factors in family reunification research and the implications of kinship care for the increased stability, but higher retention, of children in out-of-home care.     

Characteristics and factors impacting reunification outcomes among Vietnamese immigrant families in the child welfare system

Using a mixed methods approach, this study examined reunification processes and outcomes among Vietnamese immigrant families involved in the child welfare system. A quantitative design was used to describe characteristics and reunification outcomes of Vietnamese immigrant children and families who are involved in family reunification services. Qualitative methods were used to explore factors that may influence reunification outcomes among Vietnamese families.The quantitative portion of the study included an exploratory design using administrative data from one county in the Northern California. The quantitative sample (N = 32) included children entering the foster care system for 8 or more days between January 1, 2001 and December 31, 2007 from child welfare administrative data (CWS/CMS) which was merged with eligibility data (CalWIN) in order to obtain parent and child place of birth to determine country of origin. The qualitative study included an exploratory design using interview data from child welfare workers (N = 8) and Vietnamese immigrant parents who had successfully reunified (N = 7).Quantitative results indicated that the most common type of maltreatment leading to entry into care was caretaker absence or incapacity, an abuse category that is often used in cases of parental substance abuse. 53.8% of Vietnamese immigrant children in the quantitative sample reunified with their parents, which is close to the national rate of reunification. Qualitative findings pointed to the importance of the following factors within reunification: acculturation-related issues, parental substance abuse, child welfare worker cultural competency and issues related to service availability and effectiveness. Implications for social work practice and policy are discussed.     

Psychopathology,physical complaints and health risk behaviors among youths who were victims of childhood maltreatment: A comparison between home and institutional interventions

Based on investigations of child maltreatment by Child Protective Services (CPS), several children who are identified receive some kind of individual or familial intervention. However, the literature has shown conflicting results in regard to the later functioning of the children who are target of different protective measures in different settings, compared to other youths who receive no intervention. We assessed childhood adversity, psychopathology, physical complaints and health risk behaviors among youths who received one of two different protective interventions during childhood (home vs. institutionalization group), and we compared them with youths who receive no intervention (comparison group). In total, 216 youths participated, with ages ranging from 14 to 23 years (M = 17.05 years, SD = 1.8 years; 105 males, 111 females), including 136 youths that were contacted based on their CPS records completed during their childhood, and 80 youths from the community without CPS identification.