Programmatic effects to modify sources of financial support among Hispanic teenage mothers

This study evaluates whether a randomized school-based intervention for adolescent teenage mothers successfully helped participants achieve better financial independence and economic prospects. Project Mothers and Schools (PMAS) is an initiative intended to modify attitudes and beliefs related to self-sufficiency, parenting, educational goals and achievement, career goals, health behaviors, and interpersonal relationships with family members. PMAS participants were surveyed at baseline and 12 months after intervention enrollment to evaluate the receipt of financial support from 11 sources. The 48 “core group” participants received a basic level of services, whereas the 43 “core-plus group” participants received the same basic services and additional enhanced services. Wilcoxon signed-rank tests were used to identify statistically significant changes in participant responses from baseline to 12 months post-intervention. Both groups reported higher levels of employment 12 months post-intervention compared to baseline (z = − 3.162, p = 0.002 and z = − 2.646, p = 0.008, respectively). The core-plus group used more Food Stamps (z = − 2.673, p = 0.008) and reported receiving more child support (z = 2.236, p = 0.025) 12 months post-intervention versus baseline. PMAS benefited all participants by promoting employment 12 months post-intervention versus baseline. The enhanced services offered to the core-plus group appeared to also increase participant access to Food Stamps and child support, sources which assist participants down the path toward eventual financial independence.     

‘Reach Out,Rise Up’: The efficacy of text messaging in an intervention package for anxiety and depression severity in young people

BackgroundDepression and anxiety are among the most commonly experienced mental health issues faced by young people in Aotearoa, New Zealand. Considerable barriers exist that prevent young people from engaging with face-to-face mental health services. Young people's preference for technology-based counselling mediums such as text messaging opens up new pathways for intervention.ObjectiveA pilot text message-based intervention package was trialled for use by young people to evaluate the potential efficacy of the text package as an intervention for depression and anxiety symptoms.MethodThe text package was piloted using a 10-week longitudinal cohort pilot with 21 young participants (12–24 years) who demonstrated mild to moderate anxiety and/or depression symptoms.ResultsParticipants' post-package scores were significantly lower than their pre-package scores for both anxiety (Z = − 2.83, p = .005, r = − 0.65) and depression (Z = − 2.49, p = .013, r = −.056). ‘Feeling encouraged and supported’ increased as a result of receiving support from a trained supporter (Z = − 2.06, p = .039, r = − 0.45), but not from friends/family (Z = − 1.72, p = .130, r = − 0.37). Anxiety and depression scores did not change as a result of support from either trained supporters or friends/family.ConclusionsFindings support the potential efficacy of the text package, justify wider trials of the text package, and support the use of text message-based interventions as potentially effective therapies for young people.     

Factors associated with treatment attrition for Medicaid-enrolled youth with serious emotional disturbances

Premature discontinuation from treatment is a significant problem that undermines the delivery of effective mental health services and increases the risk for relapse and poor outcomes. However, factors associated with treatment attrition in children and adolescents are not well understood. This retrospective longitudinal cohort study examines factors associated with attrition for Medicaid-enrolled youth, aged 5 to 17 with “new episodes” of ICD-9-CM diagnosed serious emotional disturbance (N = 43,122). Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Multilevel modeling was used to assess the association between individual and contextual-level variables and attrition. Of the 43,122 youth in the study sample, 4056 (9.4%) discontinued treatment. The odds of treatment attrition were significantly higher for youth who were male (OR = 1.16, p < 0.001), black compared to white (OR = 1.19, p < 0.001), had a co-occurring substance abuse disorder (OR = 1.35, p = 0.01), and lived in a county with a larger percentage of minorities (OR = 1.02, p = 0.01). In contrast, youth diagnosed with bipolar and depressive disorders compared to ADHD (OR = 0.78, p < 0.001 and OR = 0.87, p = 0.01, respectively), with comorbid psychiatric (OR = 0.74, p < 0.001) and medical disorders (OR = 0.82, p < 0.001), and a prior history of two or more psychotropic medications compared to no medications (OR = 0.76, p < 0.001) had lower odds of attrition. Residence in a county with a larger number of pediatricians and psychologists also reduced the odds of attrition (OR = 0.97, p = 0.05 and OR = 0.99, p = 0.03 respectively). Overall, this study suggests that a combination of individual factors, demographic and clinical, and contextual factors impact attrition in children's mental health outpatient treatment.     

The role of religion in mediating the transition to residential care

PurposeThe move from independent domicile to residential care can be a traumatic experience for the elderly. This study investigated the mediatory role of the individual's religious and spiritual beliefs on coping with this transition.Design and methodsA self-report survey design was used, and questionnaires were administered to 50 individuals who had entered residential care within the previous 12 months.ResultsThe analyses showed that scores on a life satisfaction scale were significantly and positively correlated with those from a spirituality measure (p = .033), from a faith in nature and humanity scale (p = .001), and from an instrument to measure the use of religion as a coping measure (p = .004). Contrary to the hypotheses, there were no such significant relationships with measures of either organised or non-organised religion. The relationships between variables were further explored through a path analysis.ImplicationsThe findings pointed to the benefits of a more personal and subjective belief system than a formal one. We concluded that it is important for all those who work with the elderly to acknowledge and recognise the role that religious and spiritual beliefs may have as a coping mechanism during stressful times.     

An investigation of problematic internet use among adolescents in terms of self-injurious and risk-taking behavior

The purpose of this study was to examine problematic internet use in terms of self-injurious behavior and risk-taking behavior. This study was performed with 736 high school students, 328 females and 408 males studying at various high schools in Trabzon (in Turkey). The Problematic Internet Use Scale was used to measure students' problematic internet use levels, the inventory of statements about self injury to measure self-injurious behavior and the Adolescent Risk-Taking Questionnaire to measure risk-taking behavior. According to the results of the study, a positive and significant relationship was found between risk-taking behavior and problematic internet use (r = .39, p < 0.01), and it was determined that self-injurious behavior and risk-taking behavior significantly predict problematic internet use (F = 86.94, p < 0.01). Furthermore, it was found that problematic internet use displays variation according to self-injurious behavior (F_{(1, 732)} = 32.32, p < 0.01). The findings have been discussed in relation to the existing literature.     

Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents

This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure.ResultsAttendance records (0 = absent, 1 = present, criteria = ≥70%) indicated that 71.5% of families attended each session. The survey (1 = false, 6 = true, criteria = ≥4.5) indicated that participants perceived a positive group climate (M = 5.16, SD = 0.69). A trained evaluator reported that facilitator dose delivered (0 = no, 1 = yes, criteria = ≥75%) was high (99.6%), and fidelity (1 = none to 4 = all, criteria = ≥3) was adequate at facilitator (M = 3.63, SD = 0.41) and group levels (M = 3.35, SD = 0.49). Five cultural topics were raised by participants related to eating (n = 3) and physical activity (n = 2) behaviors and were integrated as part of the final curriculum.DiscussionResults identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.     

Gang involvement moderates the effectiveness of evidence-based intervention for justice-involved youth

There are no validated, evidence-based intervention approaches to helping youth who are involved in gang activity. The goal of this study was to evaluate the impact of gang involvement on the effectiveness of evidence-based intervention services for problem behavior delivered to youth referred by the justice system. We analyzed data drawn from 421 youth (69% male; M age = 15.08 years, SD = 1.32; 38% Black/African-American, 18% Latino/a, 34% White, 10% other) referred consecutively over a 13-month period for Multisystemic Therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009) across clinical service sites in 7 different Eastern states of the US. Outcomes were indicated by successful or unsuccessful case closures, and gang involvement was indicated by a validated multi-factored classification scheme. We conducted analyses of outcomes related to gang involvement for the whole sample as well as a propensity score-matched (PSM) reduced sample. Analyses of treatment success rates indicate that gang involvement significantly and substantially reduces the effectiveness of MST in this population.     

Expanding the conceptualization of re-entry: The inter-play between child welfare and juvenile services

Re-entry in child welfare is traditionally viewed as a child exiting to permanency and then reentering the child welfare system. Using this approach is effective for understanding child welfare practice from a single-system lens, but gives an incomplete picture of how children may move between related child serving systems. The present study expands the definition of re-entry by examining re-entry for 2259 children who either return to the child welfare system or move into the juvenile justice system after reunification from foster care. When measuring a broader concept of re-entry (into either system) the rate of re-entry went from 18% to 25% - a 33% increase. Regression analyses further suggested that many of the risk and protective factors associated with standard child welfare reentry were also predictive of multisystem re-entry such as having previous child welfare experience (OR = 1.79, p < 0.000), and child behavior as a factor at removal (OR = 1.75, p < 0.000). Findings of this study support the need to continue increasing the conceptualization of re-entry to be more inclusive of related systems as well as continuing to focus research efforts on understanding effective practices within child serving systems so that re-entry into either system is mitigated.     

Program records as a source for program implementation assessment and youth outcomes predictors during residential care

This study used point card information from a residential program to generate treatment fidelity metrics and determine if the metrics predicted youth outcomes after six months in care. Youth outcomes included staff (n = 52) and youth (n = 143) ratings, youth conduct records kept by the residential program's teaching-family homes and school records. Treatment fidelity metrics included the program components: (a) percentage of positive interactions, (b) number of privileges earned, and (c) a skills taught to interactions ratio. The percentage of positive interactions averaged 90% per youth; 76% of the point cards indicated that privileges were earned; and a variety of life skills were typically taught to the youth (skills ratio = .61). The data from the treatment fidelity metrics supported that the program was implemented consistent with program expectations. The range of implementation quality for each measured component was then used to predict youth outcomes. Increased percent of positive interactions predicted significantly decreased externalizing behaviors as reported by staff (β = − 0.31, p < .001) and youth (β = − 0.30, p < .001), and significantly fewer incidents of non-compliance (Exp(b) = 0.93, p < .001) and school problems (Exp(b) = 0.91, p < .001) as indicated on the program records. The skills ratio indicated similar trends across outcomes, although non-significant at the p < .01 level. Permanent products may be helpful to develop program treatment fidelity metrics, which may be useful for monitoring implementation and may be associated with improved youth outcomes.     

Diabetes education program for people with type 2 diabetes: An international perspective

BackgroundIn the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range.ObjectiveThis study aimed at measuring the effect of diabetes educational intervention program for patients suffering from type 2 diabetes attending the Diabetes Clinic in Tulkarim Directorate of Health.MethodsA short duration observational study involving pre- and post-test educational intervention program was carried out on a relatively small number of type 2 diabetes patients at the Diabetes Clinic in Tulkarim Directorate of Health. In total, 215 patients attended a group-based 4 h educational intervention session about diabetes. The program included explaining diabetes mellitus-symptoms, risk factors, types, treatment and complications and main aspects of self-care of the disease (foot care, eye care, and blood glucose monitoring), main aspects of dietary management, weight reduction, blood pressure, smoking cessation, periodic investigations, home monitoring and importance of physical activity. Knowledge evaluation questionnaire were evaluated pre- and post-study. Anthropometric measurements such as body weight (WT), body mass index (BMI) and laboratory tests such as fasting blood glucose (FBG), hemoglobin A1C (HbA1c), cholesterol (Chol), and triglycerides (TG) were measured both at the beginning and at the end of the study. Significance of the results was assessed by paired t-test at 95% confidence interval.ResultsThe participant’s mean age was 51.07 that ranged between 31 and 70 years. For a total of 215 participants, 41.4% were males and 58.6% were females. The mean weight before educational intervention was 80.81 ± 14.95 kg (82.6 kg for males and 79.5 kg for females) that decreased to 78.9 ± 14.33 kg (81.1 kg for males and 77.3 kg for females) after educational intervention program. The BMI also decreased significantly after educational intervention. The mean fasting blood sugar was 188.65 ± 71.45 mg/dL before educational intervention that decreased to 177.7 ± 66.11 mg/dL after the educational intervention (p = 0.049). The mean glycosylated hemoglobin was 8.57 ± 1.21 before educational intervention that decreased to 7.95 ± 1.42 after educational intervention. The mean value of cholesterol before educational intervention was 183.27 ± 37.74 mg/dL that decreased to 169.57 ± 34.23 mg/dL after educational intervention. The mean triglycerides value decreased after educational intervention from 209.85 ± 171.04 mg/dL to 183.28 ± 152.4 mg/dL (p = 0.025). The mean score of knowledge questionnaire before educational intervention was 60.6 ± 20.65 that increased to 78.1 ± 13.4 after conducting educational intervention.ConclusionsDiabetes education was found to be effective on BMI, FBG, HbA1c, Chol, TG, and knowledge.RecommendationsDiabetes education is a cornerstone in the management and care of diabetes and should be an integral part of health planning involving patient’s family, diabetes care team, community, and decision makers in the education process.     

Mortality among a national population sentenced to compulsory care for substance use disorders in Sweden: Descriptive study

Sweden's compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n = 4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR = 1.28, narcotic users OR = 1.16), gender [males were nearly 3 times more likely to die among narcotics users (p < .000) and 1.6 times more likely to die among alcohol users (p < .01)] and reporting serious health problems (for alcohol users p < .000, for narcotics users p < .05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users.     

From foster care to juvenile justice: Exploring characteristics of youth in three cities

Children placed in foster care are at risk for becoming involved with the juvenile justice system. This study documents the rates at which children involved with foster care enter the juvenile justice system (crossover or dually involved), and the factors associated with this risk. We utilize multiple birth cohorts and prospective, longitudinal data from birth to maturity separately in three major American cities. Analyses consider integrated administrative records from multiple birth cohorts representing populations in Cook County (Chicago; N = 26,003), Cuyahoga County (Cleveland; N = 10,284), and New York City (N = 13,065). Crossover rates ranged from 7 to 24%. African American males, and children who experienced congregate care were at highest risk for juvenile justice involvement. Older age at first foster care placement signaled progressively greater risk, as did more foster care spells for those first placed as infants. We discuss findings in terms of developmental theory, and as actionable intelligence to inform prevention, practice, and policy.     

Using a community-based participatory research approach to evaluate resident predictors of involuntary exit from permanent supportive housing

ObjectiveThe aim of this study was to determine an association between resident characteristics at time of entry to permanent supportive housing and exit status.MethodsA community-based participatory research (CBPR) approach was the guiding framework for the design, implementation and evaluation of this project. This retrospective observational study used an administrative data source from a local permanent supportive housing provider to compare resident characteristics among those who left housing voluntarily or involuntarily.ResultsThe population based sample (n = 407) was comprised of 51% males and 47% African-Americans with a mean age of 40 years (SD = 11.8). Involuntary exits (IEs) occurred in 40% of the sample (n = 166). IE was less likely with receipt of mainstream benefits, compared to employment income (O.R. = .546, p = .032). IE was more likely for residents self-identifying as African-American (O.R. = 1.56, p = .037) and when children resided in the household (O.R. = 2.03, p = .013).ConclusionsDespite limitations of community-derived data, findings suggest that supportive housing providers consider income source and family status when designing interventions to decrease IEs. A CBPR approach is a promising framework to guide evaluation efforts for supportive housing programs.     

Is child protective services effective?

A number of studies have concluded that there is little observable connection between CPS involvement and improved outcomes for children and families. Evidence of CPS effectiveness is complicated by the presence of selection bias and difficulty controlling for confounding. To understand outcomes by group and intervention effects, comparable groups are necessary and difficult to ascertain using CPS administrative case record data. This study examines the causal effect of CPS involvement on the likelihood of future maltreatment using administrative case management records from July 1, 2010 and June 30, 2011. The current study accounts for differences in pre-existing condition between groups to establish sound estimates of CPS involvement effects. Logistic regression models were used to examine the difference in subsequent substantiated investigation between families with comparable risk and differing service recommendation (p = 0.83), recurrence among families with comparable risk, the same service recommendation that did or did not receive services (p = 0.83). Hazard models were used to explore risk of substantiated investigation among families with comparable risk and differing service recommendation (p = 0.77). Results indicate receipt of CPS services had no observable effect on recurrence of maltreatment overall and among families with similar levels of risk of recurrence. Further inquiry into worker attributes, decision-making, types of and quality of services offered to families could help explain the effective, or ineffectiveness, or services.     

Organizational climate and child welfare workers' degree of intent to leave the job: Evidence from New York

With increasingly unstable workforce in child welfare agencies, it is critical to understand what organizational factors lead to intent to leave the job based on job search behaviors. Using recent survey data collected among 359 child welfare workers from eight agencies in New York State during 2009–2011 and a Structural Equation Model (SEM) method, this study examines the relationship between employee perceptions of organizational climate and the degree of intent to leave the job (thinking, looking and taking actions related to a new job). Fifty-seven percent (n = 205) reported that they had considered looking for a new job in the past year. Bivariate analyses indicated that there were significant differences between those who looked for a job and those who did not look for a job in the past year. SEM analysis revealed that four organizational climate factors were predictive of decreasing the degree of intent to leave the job: Perceptions on organizational justice was most predictive factor for thinking of a new job followed by organizational support, work overload and job importance. The findings of this study help us understand the employee perceptions of different organizational factors that impact employee turnover especially from the time an employee thinks of leaving the job to actually taking concrete actions related to a new job.     

The characteristics of delinquent behavior and predictive factors in Japanese children's homes

The purpose of this study was to examine the risk factors of delinquent behavior in children's homes in Japan and the co-occurrence of externalizing problem behavior and internalizing problem behavior. Eight hundred and nine children (436 boys, 373 girls were recruited from such homes. Childcare workers from these homes completed sets of questionnaires. Our results found significant relationships between delinquent behavior and gender [odds ratio (OR) = 1.66; 95% confidence interval (CI), 1.16–2.38], age (OR = 1.25; 95% CI, 1.16–1.35), parent–child conflict (OR = 2.79; 95% CI, 1.45–5.36), neglect (OR = 1.43; 95% CI, 1.03–2.11), and aggressive behavior (OR = 1.10; 95% CI, 1.08–1.12). Results also showed externalizing problem behaviors and internalizing problem behaviors were associated with age (OR = 1.23; 95% CI, 1.08–1.41), thought problems (OR = 1.37; 95% CI, 1.17–1.59), attention problems (OR = 1.12; 95% CI, 1.02–1.23), and physical abuse (OR = 3.09; 95% CI, 1.64–5.83). Our study clarifies the predictive factors for delinquency and related internalizing behavior symptoms and externalizing behavior problems. These results indicate that children in children's homes have various problems and require multilevel intervention. Our findings may be used to improve current policies governing children's homes.     

An intensive mental health home visiting model for two at-risk early childhood populations

This study examined proximal outcomes of a mental health home visiting model for two populations at risk for child maltreatment: families with young children referred by child protective services (CPS) and at-risk pregnant women (Prenatal) referred by community agencies. Family- and caregiver-level outcomes were measured using the Family Assessment Form (FAF). Families (n = 215) showed significant improvement in all eight family functioning factors over the course of their participation in mental health home visiting services. Initially, CPS-referred families (n = 84) scored higher on the FAF measure of Interactions between Caregivers, indicating greater conflict between caregivers in the family. Prenatal referred families (n = 131) were at greater risk initially on Housing. Prenatal-referred families demonstrated greater risk reduction on measures of Supports to Caregivers, Developmental Stimulation, Caregiver Personal Characteristics and Housing. In addition, all families demonstrated significant improvements in functioning on 11 of 12 items comprising the Caregiver Personal Characteristics factor. Overall, CPS-referred families scored at higher risk on items reflecting externalizing problems, while Prenatal-referred families showed greater improvement on items reflecting internalizing problems. This model was successful in reducing risk factors and promoting protective factors for CPS-referred and Prenatal at-risk families. Implications and future directions are discussed.     

Cooks training for Faith,Activity, and Nutrition project with AME churches in SC

PurposeThis study describes the development and evaluation of a participatory training for cooks in African American churches.The 8-h training focused on providing healthy meals within the church food program. It enlisted cooks in hands-on “cooking with the chef” training and menu building exercises, and demonstrated development of flavor in foods through healthy ingredients. Cook ratings from pre- to post-training (possible range: 1–10) were evaluated with the Wilcoxon signed rank test.Results114 cooks from 57 churches over the period from 7/21/07 to 3/21/11 participated in trainings. Self-rated cooking skill increased from pre- (6.5 ± SD) to post-training (7.9 ± SD), p = 0.0001. Self-rated confidence in preparing meals also increased significantly (pre: 7.3 ± SD; post: 8.3 ± SD), p = 0001.Qualitative feedback from the cooks’ training has been positive. Two of the more frequently stated changes cooks report are using less salt and using more vegetables and fruits in menus. Lessons learned include: choosing the right church to host the training, teamwork as a key component, need for support system for church cooks, allocation of time for planning as well as shopping for healthy ingredients, and incorporation of flexibility into the training plan.     

Assessment of the complex effects of trauma across child serving settings: Measurement properties of the CANS-Trauma Comprehensive

This study examined the measurement properties of the Child and Adolescent Needs and Strengths-Trauma Comprehensive Version (CANS-Trauma). This comprehensive, trauma-focused, and strengths-based assessment strategy is designed to assess the complex needs of traumatized children and adolescents across child-serving settings and support the treatment/service delivery process. The current study assessed 257 children and adolescents from three mental health agencies across the country that were partners in the National Child Traumatic Stress Network (NCTSN). Internal consistency and inter-rater reliability, convergent and discriminant validity, and scale properties of the CANS-Trauma were examined. Overall, measurement properties of the CANS-Trauma showed promising results. Internal consistency varied from marginally acceptable to excellent across most domain scores (α = 0.62–0.90); the traumatic stress symptoms domain demonstrated very good internal consistency (α = 0.82). Inter-rater reliability for the CANS-Trauma was good overall, while the traumatic stress symptoms domain had marginally acceptable reliability. There was evidence for convergent validity with more limited evidence for discriminant validity, based on the association between domains on the CANS-Trauma and subscales of the Trauma Symptom Checklist for Children-Alternate (TSCC-A) and the Child Behavioral Checklist for Children (CBCL). Rasch modeling analyses indicated that the CANS-Trauma had good scale properties overall, including item fit within each of the domains. These preliminary results also suggested that the various mental health and trauma symptom domains on the CANS-Trauma were more sensitive to populations with significant trauma symptoms and mental health difficulties compared to populations with lower to moderate difficulties in these areas. Implications of these findings are discussed in terms of the utility of a comprehensive, trauma-informed assessment strategy in practice settings.