The Assessment Checklist for Adolescents — ACA: A scale for measuring the mental health of young people in foster,kinship, residential and adoptive care

The Assessment Checklist for Adolescents — ACA is a 105-item carer-report mental health rating scale, measuring behaviours, emotional states, traits, and manners of relating to others, as manifested by adolescents (ages 12 to 17) residing in various types of alternate care, as well as those adopted from care. The ACA was designed for population and clinical research with these young people, and for use as a clinical assessment measure. The ACA's content was largely derived from the Assessment Checklist for Children (ACC). Fifteen ACC items were modified to better reflect adolescent difficulties, and 25 additional items were derived using a combination of inductive and deductive strategies. Item and factor analyses were carried out on scores from a 136-item research instrument, obtained for 230 young people residing in long-term care (as part of the NSW Children in Care study). These data were supplemented by ACC scores obtained for 142 adolescents residing in treatment foster care in Ontario, Canada. A robust 7-factor model was identified among a core of 73 clinical item scores, accounting for 51% of score variance. Four of the factors replicate ACC clinical scales (non-reciprocal interpersonal behaviour; sexual behaviour problems; food maintenance behaviour; and suicide discourse), and three are unique to the ACA (social instability/behavioural dysregulation; emotional dysregulation/distorted social cognition; and dissociation/trauma symptoms). The ACA also contains two empirically-derived low self-esteem scales (low confidence; negative self-image) that are shared with the ACC. Initial data indicate that the ACA has good content, construct and criterion-related validity, as well as high internal reliability.     

Assessing behavior in children aged 12–24 months using the Strengths and Difficulties Questionnaire

Behavioral and emotional problems in infants and toddlers are common, often persist and put children at risk of later mental health problems. Reliable, efficient, and sensitive tools are needed to identify young children who may benefit from further assessment and support. The Strengths and Difficulties Questionnaire (SDQ), offers a brief, convenient means of screening for early problems, however, it lacks psychometric validation in infants. The aim of this study was to assess the validity and reliability of the SDQ in children aged 12–24 months. Ninety-three participants, with children aged 12–24 months, completed the SDQ and Child Behavior Checklist (CBCL) online. Concurrent validity of the SDQ was assessed through comparison with the CBCL. The results demonstrated that key subscales of the SDQ and CBCL were significantly correlated (r range= −.19 to –.57). Key SDQ subscales showed moderate reliability (Cronbach's alpha range = .38–.79, mean inter-item correlation range = .06–.43). The SDQ shows promising reliability and validity as a measure for rating the behavior of 12–24-months-old children, particularly for externalizing symptoms. Further research is needed to assess its predictive utility.     

The ethics of participatory research with children

This paper argues that ethical problems in research involving direct contact with children can be overcome by using a participatory approach. A study of children's participation in decisions when they are looked after is described in terms of how a view of the ‘social child’ (James, 1995) shaped the approach to establishing contact with children, the choice of topics and methods of communication which were used, and the way in which children were given opportunities to interpret the data for themselves. The paper concludes with the suggestion that a participatory approach can also assist with reliability and validity.     

Medical complexity and placement outcomes for children in foster care

ObjectiveMedical complexity threatens placement stability and permanency outcomes for children in foster care (FC). This study aimed to characterize for US children in FC: 1) medical complexity, using number of diagnosed types of disability as a proxy; 2) demographic and removal characteristics based on level of complexity; and 3) whether increasing levels of complexity were associated with foster care placement outcomes.MethodsThe analysis included children in FC, ages 0–21 whose disability status was clinically assessed and documented (n = 538,695). Using data from the FY 2014 Adoption and Foster Care Analysis and Reporting System, medical complexity was categorized (0–4 +) based on 5 disability types: emotional, hearing/vision, intellectual, physical, and other. Bivariate analyses (χ² tests, Kruskall-Wallis) compared the distribution of demographic and removal characteristics among complexity groups. Multiple logistic regression evaluated relationships between medical complexity and placement outcomes, including length of stay in FC, placement stability, and permanency.ResultsTwenty-three percent of the sample had 1 disability type, 7% had 2, 3% had 3, 1% had 4 +, and 67% had no disability. Children with increasing complexity were more likely to be older, older on FC entry, male, Black, non-Hispanic, placed in a group home or institution, have abuse, neglect, and/or child disability/behavior as reason for removal, and have poor placement outcomes.ConclusionChildren in FC with greater medical complexity are at risk for undesirable placement outcomes. By recognizing and addressing the unique needs of this vulnerable population, pediatric providers and child welfare staff may identify strategies to improve placement outcomes.     

Profile of children placed in out-of-home care: Association with permanency outcomes

The goals of this study were to explore characteristics and profiles of children who received out-of-home care services and to examine the relationship between their profiles and permanency outcomes. Results of latent class analysis suggest that there are three distinct subgroups of children served in out-of-home care (N = 33,092): Children with Complex Needs (6%), Children in Families with Complex Needs (64%), and Older Abused Children (30%). Of the three identified subgroups Children with Complex Needs consisted of youth who were at greater risk for adverse outcomes. These children were less likely to experience timely adoption, had the longest length of stay in out-of-home care, and were least likely to experience timely reunification. Although permanency outcomes for Older Abused Children are somewhat better than for Children with Complex Needs, they represent a vulnerable population of youth in out-of-home care who have a very low chance of being adopted. Overall, this study suggests that service provision by itself may not improve permanency outcomes for children unless both prevention and intervention efforts address co-occurring family needs and are tailored to specific characteristics of the children being served.     

Understanding contextual effects on externalizing behaviors in children in out-of-home care: Influence of workers and foster families

The expression of externalizing behaviors of children in-care can be influenced by a multitude of factors. The current study examined the simultaneous levels of influence of workers and foster families on children's externalizing behaviors in those receiving out-of-home care. A cross-classified multilevel model was used to partition variance in children in-care's externalizing scores into worker, foster family and child-specific levels of influence. The extent to which processes are explained by worker and foster-family level predictors was examined. Assessment and Action Record (AAR) data from the Ontario Looking after Children (OnLAC) project were analyzed. The sample included data from 1063 children between 10 and 17 years of age (M age = 13 years, 6 months, SD = 2.08 years). While individual differences in children's externalizing behaviors were primarily attributable to child-specific effects (72%), 10% and 18% of the variance can be explained by worker and foster family influences respectively. Worker education accounted for substantial differences seen between workers where more difficult children were monitored by workers with less educational attainment. Furthermore, foster-family level predictors also explained variance in children's externalizing behaviors. Relative to children in foster care, those in kinship care displayed significantly lower levels of problem behaviors while children in group care displayed significantly higher levels. Higher levels of parental negativity within the foster family and the experience of more differential parental negativity relative to siblings were significantly associated with more externalizing behaviors. Lastly, children who were more satisfied with their placement displayed significantly lower levels of problematic behaviors. These results suggest that children in-care can be conceptualized within a multilevel framework.     

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.     

Child Advocacy Center Based Group Treatment for Child Sexual Abuse

The present study examines initial symptom presentation among participants, outcomes, and social validity for a group treatment for child sexual abuse delivered at a child advocacy center. Participants were 97 children and their nonoffending caregivers who were referred to Project SAFE (Sexual Abuse Family Education), a standardized, 12-week cognitive-behavioral group treatment for families who have experienced child sexual abuse. Sixty-four percent of children presented with clinically significant symptoms on at least one measure with established clinical cutoffs. Caregivers of children who presented with clinically significant symptoms reported more distress about their competence as caregivers. Children who presented as subclinical were more likely to have experienced intrafamilial sexual abuse. Posttreatment results indicated significant improvements in functioning for all children who participated in treatment, with greater improvements reported for children who initially presented with clinically significant symptoms. Overall, the program was rated favorably on the posttreatment evaluation of social validity.     

The psychological and behavioral outcomes of migrant and left-behind children in China

With China's urbanization and its development in market economy, mass rural-to-urban migration greatly expanded over the past decades. Consequently, migrant and left-behind children have greatly increased in number. Using data from the 2011 Survey on Social Integration of Migrant Children in Wuhan, China, this study examined psychological and behavioral problems of migrant and left-behind children. Results showed that left-behind and migrant children had poorer psychological and behavioral outcomes than local children. However, the difference disappeared after controlling for family and school characteristics. The findings provided implications on improving psychological and behavioral outcomes of migrant and left-behind children through family intervention and education policy reform.     

Sexual Abuse Prevention Concept Knowledge: Low Income Children Are Learning but Still Lagging

School-based child sexual abuse (CSA) prevention programs have proliferated since beginning over 30 years ago. Research on program effectiveness has emphasized summative outcomes while under-reporting implementation and process fidelity, limiting reliable comparisons across programs and populations. External validity is further limited by racially and economically homogenous samples, or a failure to report such demographics. This article presents data from a CSA prevention program delivered to 2nd and 3rd grade public school children. A formative concept and item level analysis on the Children’s Knowledge of Abuse Questionnaire at baseline and four week follow-up, as well as fidelity and implementation data, are reported. Results show that children learn and retain certain concepts, but vary widely in knowledge across items. This sample of low-income, minority children also show lower baseline and “learned” abuse prevention knowledge compared to published norms, which is not attributed to implementation variability. These data give critical insight into workshop effectiveness that is masked in summative reporting, yet essential to adapting and strengthening school-based CSA programs. Knowing the long-term consequences of adverse childhood experiences and disparate health outcomes linked to race and socioeconomic status, it is imperative to adequately assess CSA prevention program impact across diverse populations.     

Measuring the willingness to foster children with emotional and behavioral problems

Many children in foster care have emotional or behavioral problems or are at risk for these problems. It is important to identify parents willing to foster children with these problems in order to ensure placement, care, stability and well-being of such children. This study presents a new 40-item self-report measure of the willingness of parents to foster children with emotional and behavioral problems, and two 20-item parallel forms of this measure. In addition, this study presents evidence of reliability and validity of scores derived from these measures with a national sample of 297 foster mothers. Coefficient alpha for these measures was .92 or greater, indicating excellent internal consistency reliability. Scores from these measures were unrelated to demographic characteristics, providing evidence of discriminant validity. In addition, scores from these measures were higher for foster mothers licensed to provide treatment foster care than for mothers only licensed to provide regular foster care, providing support for known groups validity. Finally, support for construct validity is provided by the fact that foster mothers with higher scores on these measures had fostered longer, were fostering more children at the time of this study, and had fewer children removed from their home at their request.     

An evaluation of the effects of an integrated services program for multi-service use families on child welfare and educational outcomes of children

The purpose of the study was to evaluate a program that provides integrative case management for families dependent on at least two government services (e.g., child welfare, disability, chemical dependency, vocational rehabilitation). In the current study, we focused on effects of services on children's educational and child welfare outcomes two years after program exit. Children enrolled in the program were compared to a community comparison sample through propensity score matching. None of the group differences was significant. However, outcomes related to child maltreatment (number of child maltreatment reports accepted by Child Protective Services and out-of-home placements) improved dramatically within two years after exit. Outcomes in the education area were less uniformly positive. On the one hand, children's attendance was high and school mobility was low. In addition, there was a significant reduction in the number of children receiving special education services two years after exit. Nevertheless, a third of the children were still receiving special education services two years after exit, and their academic performance on standardized reading and math tests was quite poor. Thus, the intensive case management model was related to successful outcomes in an area directly targeted by the program (child maltreatment), but the gains did not generalize to another domain that was not an explicit focus of the program (academic achievement).     

Outcomes of a randomized trial of continuum of care services for children in a child welfare system

The Connecticut Department of Children and Families Title IV-E waiver demonstration evaluated whether the well-being of children approved for residential mental health services could be improved, and lengths of stay in restrictive placements reduced, by providing case rate payments to community agencies to provide continuum of care services. Children between ages 7 and 15 were randomly assigned to either the demonstration group (n = 78) or to usual state-supported services (n = 79). One-year outcome results indicated that in a situation that is less costly, improvement in outcomes occurred in less restrictive settings. Continuum of care services were more effective in 1) returning children to in-home placements, 2) reducing the length of stay in restrictive placements, and (3) utilizing higher levels of case management through coordination among agencies and family support services.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

The early home environment and developmental outcomes for young children in the child welfare system

The quality of the early home environment is predictive of young children's subsequent cognitive, academic, and behavioral functioning. Limited research has focused on the effects of the early caregiving environment on the functioning of young children involved with the child welfare system. This study investigated the influence of children's home environments (i.e., number of children in the home, number of moves the child experienced, level of cognitive stimulation, and level of emotional support) during the first 2 years of life on their preschool developmental outcomes (i.e., cognition, language, social skills, and behavior problems).As anticipated, a high-quality early home environment promoted the well-being of preschool children who had entered the child welfare system as infants. Children who lived with greater numbers of children incurred more compromised cognitive, language, behavioral, and social outcomes. No significant associations emerged between the total number of placements and developmental outcomes; children who remained in the same home during infancy (typically the birth family home) had more compromised developmental outcomes in every domain except behavioral problems.Both cognitive stimulation and emotional support in the home predicted higher cognitive and language scores, decreased behavioral problems, and increased social skills. Early out-of-home placement and lack of emotional support interacted to predict children's behavioral problems. These findings are considered in the context of extant research and policy relevant to young children in the child welfare system.     

A Short Form of the Trauma Symptom Checklist for Young Children

A short form of the Trauma Symptom Checklist for Young Children was derived from the original 90 items. An exploratory factor analysis of each factor identified the four items from each of the original factors with the highest eigenvalues. These items were subjected to confirmatory factor analysis. The best fit was obtained for an 8-factor, 32-item model. The short form evidenced good convergent validity with parent ratings obtained from the Child Behavior Checklist, the Child Sexual Behavior Inventory, and the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD RI). Norms (t-scores and percentiles based on raw scores) were calculated by age and by gender. The short form has promise as a screening measure with parents in settings like a child advocacy center.     

The Convergent Validity of the Trauma Symptom Checklist for Young Children for a Sample of Sexually Abused Outpatients

ABSTRACT

The convergent validity of the Trauma Symptom Checklist for Young Children (TSCYC) was examined with a sample of 172 sexually abused outpatient treatment-seeking children and their caregivers. The TSCYC evidenced good convergent validity with other parent ratings (e.g., the Child Behavior Checklist, Child Sexual Behavior Inventory, and the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index [UCLA PTSD Index]). The convergent validity of the TSCYC and the Trauma Symptom Checklist for Children was weak, perhaps illustrating the lack of agreement often found between children and caregivers and illustrating the need for a multi-informant approach to screening and assessment of sexually abused children. The TSCYC seems to hold promise based on the emerging evidence for its convergent validity.     

Involving children in conciliation

SUMMARY. The question of involving children themselves in conciliation, when their parents are being divorced., has been considered and debated over the ten years since conciliation services began in this country as described in two articles in the last issue of Children & Society. This article describes how children are involved in one service — the Lothian Family Conciliation Service. The author followed up a sample of children who had been involved in conciliation., to ask their views on the service. While the findings point to positive outcomes for many of the children., some safeguards and conditions are needed to improve the service when conciliators see children as well as their parents     

What are the factors associated with educational achievement for children in kinship or foster care: A systematic review

Children in care lag behind their peers on a number of outcome measures, including education. Interventions have been developed to help them close the gap with their peers but these have had limited success to date. One possible reason for this may stem from our lack of understanding about underlying processes and mechanisms.This paper presents the findings of a systematic review of the factors associated with educational outcomes for children in foster and kinship care. It aims to inform the literature on risk and protective factors and inform the development of future interventions.Eight major databases and websites were searched between 1990 and 2016 using a combination of mesh terms. Studies were included if they tested the statistical association between any variable and educational outcomes for school age children in foster or kinship care in high-income countries. Children in other placement types were excluded. Titles and abstracts were screened for 7135 studies identified through searches. Full texts were obtained for 298 and 39 were retained for inclusion.Over 70 factors were identified. For the purposes of the narrative synthesis, factors were categorised into spheres of influence adapted from Bronfennbrenner's (1979) ecological framework. The findings reveal significant heterogeneity. Male gender, ethnic minority status and special educational needs were consistent predictors of poor educational outcomes, while carers' and young people's aspirations appeared to predict greater success. The findings are discussed with implications for future research and practice.     

Wie valide sind Selbsteinschätzungen der Empathie?

Despite the relevance of the empathy-construct with regard to social behaviour, only some of the items, which are supposed to assess empathy, are theoretically useful according to Holz-Ebeling and Steinmetz (1995). This study investigates the empirical validity of the theoretically estimated useful items. As validity aspects, connections of the self-estimation with the estimation of empathy by others, with the “objective” measure of the perspective coordination, as well as connections with the self-estimated social competence, uncertainty orientation and the mental health, are investigated. Results show that different dimensions of self-estimation empathy correlate differently with other-estimation and “objective” indicators of perspective-coordination and thereby affirm the multidimensionality of the empathy-construct. As conclusion, the need to validate empathy self-reports using objective measurements is emphasised and possibilities to promote the relevant dimensions of empathy which are important to solve conflicts are developed.