Improving student knowledge and perceptions of primary care providers at campus health centers

ABSTRACT

Objective: To examine current knowledge and perceptions toward primary care providers commonly staffed at student health centers (PAs and NPs), and also assess the effectiveness of information-rich provider biographies to improve knowledge and perceptions. Participants: One thousand six hundred forty six students from 2 universities in 2 states participated in this study from February to November, 2016. Methods: An online survey. Students were exposed to an improved biography of an NP discussing how she can perform many of the same duties as primary care physicians. Changes in knowledge and perceptions were assessed pre- and post-biography exposure. Results: More than half of students are unaware NPs and PAs can prescribe medications and diagnose illnesses. Students exposed to the biography increased their knowledge of NPs, and perceptions of their expertise. Conclusions: Results suggest improved provider biographies on student health centers' websites can help reduce the knowledge deficit that exists among students regarding common primary care providers.     

Can Machine Learning Create an Advocate for Foster Youth?

ABSTRACT

Statistics are bleak for youth aging out of the United States foster care system. They are often left with few resources, are likely to experience homelessness, and are at increased risk of incarceration and exploitation. The Think of Us platform is a service for foster youth and their advocates to create personalized goals and access curated content specific to aging out of the foster care system. In this article, we propose the use of a machine learning algorithm within the Think of Us platform to better serve youth transitioning to life outside of foster care. The algorithm collects and collates publicly available figures and data to inform caseworkers and other mentors chosen by the youth on how to best assist foster youth. It can then provide valuable resources for the youth and their advocates targeted directly toward their specific needs. Finally, we examine machine learning as a support system and aid for caseworkers to buttress and protect vulnerable young adults during their transition to adulthood.     

Personal control and service connection as paths to improved mental health and exiting homelessness among severely marginalized homeless youth

ObjectiveNon-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes.MethodSeventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline.ResultsPersonal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health.ConclusionsThis study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.     

The Use of Online Social Support by Foster Families

ABSTRACT

The extent to which foster families utilize social support on the Internet is examined in a sample of 34 foster families in a digital divide intervention program and a comparison sample of 30 foster families who were not part of the program. In spite of increased Internet access, the frequency of using online social support is low. A minority of parents and children increased their use of the Internet to give and receive help, communicate with other foster families and e-mail with their foster care worker. More than half of foster youth have used the Internet to stay in touch with friends and relatives and have “made a new friend” over the Internet. Implications for child welfare practice and for further research are discussed.     

Social and psychological resources among homeless youth: protection against risk for physical victimization?

ABSTRACT

This study examines child physical abuse, social and psychological resources, and street physical victimization among 150 homeless youth from the Midwest. Path analyses results show that males have higher self-efficacy than females, while older youth and those who experienced less child physical abuse reported higher self-esteem. Self-efficacy and self-esteem were positively associated with social support as was being younger and having experienced less child physical abuse. Younger respondents reported fewer difficulties obtaining basic necessities, and those who had less trouble finding these necessities experienced less street physical victimization. Females, younger youth, and those who experienced less child physical abuse reported lower rates of physical victimization. Agencies should be aware that many youth experiencing homelessness have trouble obtaining basic necessities, which increases risk for victimization. Moreover, the ability to obtain necessities appears to override the influential role of social support, further affirming the foundational importance of agencies helping youth meet their basic needs.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

Qualitative evaluation of historical and relational factors influencing pregnancy and sexually transmitted infection risks in foster youth

PurposeTo explore how attitudes, norms, behaviors, responses to early life experiences, and protective factors influence pregnancy and sexually transmitted infection risks from the perspectives of current and former foster youth to inform the development of prevention strategies.MethodsWe conducted semi-structured individual qualitative interviews with a diverse sample of 22 current/former foster youth aged 15–21 years (63% female; average age = 18.6 years). We then used Theoretical Thematic Analysis to systematically analyze the data for key themes related to sexual health in four categories: 1) norms and attitudes, 2) responses to early life experiences, 3) protective factors, and 4) youth-driven intervention ideas.ResultsParticipants reported a range of sexual experience levels, varied sexual orientations, and also reported varied life experiences prior to and during foster care. We detected several norms and attitudes that likely contribute to risks of early pregnancies and sexually transmitted infections. These included that one can tell by looking whether a partner is trustworthy or has a sexually transmitted infection, that condoms aren't necessary with long-term or infrequent partners or if birth control is used, and that teen pregnancy is an inevitable event. With respect to responses to early life experiences, youth frequently described difficulties dealing with strong emotions in the context of romantic and/or sexual relationships; many attributed these difficulties to early experiences with biological family members or in foster care. Participants linked emotion regulation difficulties with struggles in trust appraisal, effective communication, and impulsive behaviors. Youth also described a variety of protective factors that they felt helped them prevent sexual risk behaviors or improved their lives in other respects. Finally, participants endorsed factors likely to improve intervention acceptability and efficacy, including an open, non-judgmental group-based environment, involvement of peer mentors, and inclusion of caregiver and caseworker training components.ConclusionsTrauma-informed, tailored intervention strategies which address key norms and attitudes and provide broad-based assertiveness and emotion regulation skills are likely to be the most effective strategies to reduce risks of teen pregnancies and sexually transmitted infections among teens in foster care. Group-based interventions that involve peer mentors and caregiver and caseworker components may be especially acceptable and effective for teens in foster and/or kinship care.     

Factors driving Salvadoran youth migration: A formative assessment focused on Salvadoran repatriation facilities

BackgroundBeginning in early 2014, the United States' southern border was flooded with an unprecedented number of Central American migrant youth attempting to enter the United States. In response to the influx of immigrants, the Obama administration requested $3.7 billion in emergency funding to be allocated to border security, detention, removal, immigration courts, and care for children. We conducted this research with the aims of identifying and understanding push factors for Salvadoran youth migration and of raising awareness of the need for services among recently deported youths.MethodsData for this mixed-methods study are drawn from field research conducted in El Salvador between 2014 and 2015. We conducted direct observation and 14 in-depth semi-structured interviews with case workers. We analyzed quantitative data from the Salvadoran respondents to the Latin American Public Opinion Project (LAPOP) and data from the Dirección General de Migración y Extranjería (DGME).ResultsIn the context of an intergenerational culture of migration, case workers describe how family reunification, security, coyote payment, and socioeconomic factors contribute as push factors for Salvadoran youth migration. Quantitative data illustrate a spike in youth repatriated by land in July 2014, and family reunification, insecurity, and economic factors were primary push factors reported for youths repatriated to El Salvador via land.ConclusionsThis assessment of Salvadoran youth migration push factors relied on interview data provided by case workers who have processed the multiple complex stories of youths at risk for migration. Quantitative data triangulated findings that show how family reunification, violence, and socioeconomic factors act within an intergenerational culture of migration to push Salvadoran youths into a dangerous migration attempt. Our findings can be used to inform the development of strategies to provide services to Salvadoran youths at risk for future migration and to generate mechanisms for providing those services.     

Comorbid Substance Use and Mental Disorders Among Offending Youth

ABSTRACT

This study examines the offense, substance use, and mental illness characteristics for a subset of adolescent juvenile detainees receiving services through a federally funded system of care initiative. Findings indicate that 65% of these youth were comorbid for both mental and substance use disorders. Female detainees were at greater risk on almost every measure of mental health impairment and dual substance use and mental disorders. Study results highlight the need for effective, integrated treatment models that can serve youth involved in multiple child-serving systems, and address the challenging constellation of comorbid conditions faced by many juvenile offenders.     

The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis

ObjectiveThe outcome of institutional youth care for children is heavily debated. This multilevel meta-analysis aims to address the outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence in economically developed countries. A gain of knowledge in this area may help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care.MethodsOf 19 controlled studies (15.526 participants), 63 effect sizes of behaviour problems (externalizing, internalizing, and total), skills (social and cognitive) and delinquency were computed based on comparisons between institutional Evidence-Based Treatment (EBT), institutional Care As Usual (CAU), non-institutional EBT, and non-institutional CAU.ResultsInstitutional CAU showed a small-to-medium negative significant effect compared to non-institutional CAU (d = − 0.342). Furthermore, children in institutional care showed slightly more delinquent behaviour compared to children in non-institutional care (d = − 0.329). Significant moderating effects were also found for study design, year of publication and sex of the child.ConclusionsChildren receiving non-institutional CAU (mostly foster care) had slightly better outcomes than children in institutional CAU (regular group care). No differences were found between institutional and non-institutional care when institutional treatment was evidence-based. More research is needed on the conditions that make established treatment methods work in institutional care for (young) children.     

Agency among young people in marginalised positions: towards a better understanding of mental health problems

ABSTRACT

Agency in marginalised youth has been studied from various perspectives, yet the challenges that mental health problems pose for their agency remain poorly understood. Drawing on data from a study on youth transitions fractured by mental health problems, this study sheds light on this important issue. The data consists of 49 life story interviews with young adults. Using Ruth Lister’s four-dimensional taxonomy of agency, the analysis shows how everyday struggles with mental distress are entangled with the practices of the social security system, medical care, education, labour markets, and work life. It also reveals how emerging attempts at strategic agency can fail or flourish depending on the response of the social and structural context. If strategic agency is restricted by institutional practices, it will soon return to day-to-day struggling or become everyday resistance and cynicism towards the system. However, if the strategic agency is supported by institutional practices, a genuine path out of distress emerges. The paper suggests that taking seriously the experiences of mental distress and situating them in a specific socio-political context is essential for understanding youth agency today.     

Examining risk,strengths, and functioning of foster families: Implications for strengths-based practice

ABSTRACT

Foster families provide safe and stable homes for children and youth who are removed from their homes due to maltreatment. Despite the stressors associated with bringing children in and out of a family’s home, many maintain healthy family functioning and continue fostering for many years serving an essential function in the child welfare system. This study sought to understand the factors that explained higher levels of family functioning within foster families. Collaborating with one statewide public child welfare agency, 681 licensed foster parents participated in an online survey that examined the association between family functioning with family strengths and risk factors. Findings from this study can inform strengths-based practice including training, assessment, and interventions for new and existing foster families to strengthen families and improve the well-being of children and youth in their care.     

Internal and External Stress Factors Associated with the Identity Development of Transgendered Youth

Abstract

The goal of this paper is to present an alternative to a traditionally-held view that transgendered youth suffer from some sort of disorder, and instead shed light on the internal and external stress factors that may lead the young person to seek help. Social service professionals need to be aware of such factors in order to make a full assessment of what a potential transgendered adolescent client's issues are, and in order to work at changing some of these external pressures societally so that more transgendered youth can attain peaceful identity integration.     

Challenges,pride, and connection: A qualitative exploration of advice transgender youth have for other transgender youth

Abstract

Transgender youth experience a variety of risk and resilience factors that impact their wellbeing. However, the research on these factors rarely includes the personal perspectives or authority of transgender youth. To address this gap, we collaborated with a transgender youth advisory board to conduct qualitative interviews with 19 transgender youth (15–22?years-old). Participants lived in two Midwestern states to provide the perspective of transgender youth often missed by research. Data were analyzed using thematic analysis and resulted in three categories of advice: challenges are real, have pride, and you are not alone. Participants acknowledged that challenges are a salient aspect of growing up as a person who is transgender but provided advice for their peers to persevere, feel proud of their identities, and support development and wellbeing through connections to others. Findings provide important implications for practitioners working with transgender youth and researchers aiming to promote resilience and reduce risk. Additionally, providing opportunities for transgender youth to participate in research as the experts and share their perspectives may also help promote resilience.     

Hispanic and African American Youth

SUMMARY

This exploratory, qualitative study of 28 (10 Hispanic and 18 African American) former foster care youth attempts to capture the essence of their quest for self-sufficiency. While research on former foster care youth continues to highlight the problems confronting them after they emancipate from care, the depth of their struggles is often lost in the aggregation of statistics. The numbers themselves often fail to capture the hardships, isolation, hope, and despair many of them may face as they attempt to adjust to life after foster care. Furthermore, existing research often regards emancipated youth as a homogeneous population. Interviews with these respondents of color were coded to determine the themes and stories they held. The themes emergent from these interviews were: the importance of people in the independent living programs; vagueness in recalling the content of the independent living programs; family conflict; housing instability; regrets, fears, and lessons learned; and future goals. Implications for culturally sensitive practice and research are drawn from these data.     

Where can I mourn? Psychodynamic contributions to working in residential child care

ABSTRACT

Loss permeates the experience of being placed in residential child care, yet residential workers are rarely trained to work with young people who are grieving the loss of family and home. This article will provide an overview of psychodynamic theories of mourning, and will discuss how grief work can be facilitated for children and youth in residential child care.     

Sexual health programming for vulnerable youth: Improving knowledge,attitudes, and behaviors

PurposeAmong girls in foster care, 48% become pregnant at least once by age 19 (Dworsky & Courtney, 2010). Youth in or at-risk for foster care (YFC) report limited knowledge about, access to, and use of condoms; ambivalent attitudes towards teen parenting; and participation in other risky behaviors. For the current study, we adapted and supplemented an evidence-based sexual health program called SiHLE, using a systematic adaptation framework (ADAPT-ITT, Wingood & DiClemete, 2008), to address the unique and targeted needs of youth living in a temporary shelter due to lack of housing. Youth in this study were either in foster care and awaiting placement, or having serious family problems and were at-risk of entering the foster care system.MethodsThirty-six youth participated in SiHLE-YFC during their stay at a temporary shelter. Four 90-minute sessions focused on increasing sexual health knowledge, improving attitudes towards and self-efficacy of condom use, and developing core skills such as problem-solving and communication.ResultsAs hypothesized, youth showed high satisfaction with the intervention and significant improvement in sexual health knowledge from pre to post. At one-month follow-up, youth continued to show significant improvement in sexual health knowledge, along with a significant reduction in risky sexual behaviors. Though not significant, there were moderate effect sizes for changes in attitudes towards teen pregnancy and condoms. There were no changes in attitudes towards teen parenting.ConclusionTaken together, findings suggest that sexual health education directly targeting the unique needs of YFC may improve sexual health knowledge and behavior, and are discussed in the context of challenges associated with intervention and research with this population.     

Foster care,geographic neighborhood change,and the risk of delinquency

Background and purposePrevious studies report that foster care placement is associated with an increased risk of delinquency. Yet it remains unclear which aspects of the placement experience increase the risk of delinquency. The current study addresses this knowledge gap. This study investigates the relationship between geographic neighborhood change and the risk of delinquency for adolescents in foster care settings. Based on findings from the neighborhood effects literatures, we hypothesize that moving to a neighborhood characterized by concentrated disadvantage and residential instability is associated with increased risk of delinquency.MethodsThe design for the current study is longitudinal. The sample is comprised of 145 foster youth from two birth cohorts, one born in 1983 and one in 1984, in Chicago, Illinois. The sample was 92% African American and 52% male. Overall, 11% had an official juvenile arrest. We used data from multiple sources, including the 1990 census data and administrative data from the Illinois Department of Children and Family Services and the Cook County Juvenile Court. To measure neighborhood change, we calculated a difference between children's home and placement neighborhoods on ten census variables: percentages of households in a given neighborhood that were below the poverty line, neighborhood households on public assistance, female-headed households, unemployed population, and persons < 18 years old, African American, Latino, foreign-born, residents living in the same house as five years earlier, and owner-occupied homes, all of which are commonly used in neighborhood studies. We identified two factors within the neighborhood variables—concentrated disadvantage and residential instability,—and used the two-factor scores in the following analysis. We conducted a Cox regression to model time to first arrest.ResultsThe results indicate that moving to a neighborhood with high residential instability significantly increases an individual's risk of juvenile delinquency. In addition, two subgroups—male foster youth; and all foster youth with an experience of neglect—are significantly more likely to be associated with a formal delinquency petition.Conclusions and implicationsThe current study is unique and builds the knowledge base with regard to the placement of children and adolescents in substitute care settings. The findings indicate that the neighborhoods in which children are placed do matter in terms of their outcomes, and thus they should be considered in the placement decision process. This finding is consistent with the “person-in-environment” concept advanced by social work professionals.