Childhood behavioral and emotional disorders

We reviewed the literature on family treatment for childhood behavioral and emotional disorders and found an increase in the number of studies since 1995; however there was significant variation by disorder and therapy model. There is substantially more research on externalizing disorders (i.e., conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder) then internalizing disorders, depression and anxiety disorders. The data support the conclusion that family-based interventions produce results comparable to individually oriented interventions, and in some cases family-based interventions are superior to individual treatments. To date, cognitive behavioral family therapy and parent management have been the two models studied, almost exclusively. Implications for family therapy and future research are considered.     

Reporting suspected child maltreatment: Managing the emotional and relational aftermath

Social workers who report suspected child maltreatment often struggle with the potential consequences to the client–worker relationship. Families who are reported may have intense feelings and reactions that can lead to premature termination or a compromised relationship that interferes with optimal treatment. This article explores Ontario social workers’ retrospective evaluations of the impact of reporting suspected child maltreatment. Participants described a range of feelings, reactions, and impacts to the therapeutic relationship and clinical work. The subjective appraisals, obtained through an online survey, lead to practice recommendations.     

Examining the relationship between child maltreatment and severity of attachment difficulties among children five years of age and older

The target population in this study were foster or adoptive parents who were caring for a child who had experienced CM and/or disruptions in a primary caregiver. Participants (N = 223) were categorized as caring for a child who had a history of CM and/or disruptions in a primary caregiver before/by age 5 or as caring for a child who had a history of CM and/or disruptions in a primary caregiver after age 5. Participants were administered the Attachment Disorder Assessment Scale-revised to assess for the presence of AD among the children that they were caring for. Two separate between groups ANOVAs were conducted to examine the differences between the scores on the ADAS-R (dependent variable) for those participants caring for a child who had 1) a history of CM before/by age 5 vs. after age 5 and/or 2) disruptions in a primary caregiver before/by age 5 vs. after age 5 (independent variable). Results indicated that those children who were older than 5 when they experienced CM and/or disruptions in a primary caregiver actually had more substantial AD than those children who had these experiences by/before age 5.     

Serving families with child maltreatment and substance use disorders: A decade of learning

ABSTRACT

An increase in parental substance use disorders (SUD) and the number of infants and toddlers entering foster care has prompted federal and state efforts to change the treatment paradigm toward more integrated and family-centered strategies. The Regional Partnership Grant (RPG) program demonstrated that family-centered strategies can improve child and parent outcomes. The current challenge is to bring effective strategies to scale. This conceptual article highlights the lessons learned from 10 years of implementing and evaluating programs to meet the needs of families affected by parental SUD and child maltreatment. Effective family-centered strategies identified by the RPG program are illustrated with specifics from the Sobriety Treatment and Recovery Team program. These effective strategies could be implemented in any jurisdiction and include (1) collaboration toward integrated services between child welfare and SUD treatment, (2) timely access to SUDS treatment, (3) recovery management and support, (4) tailored family services, and (5) adaptation to local jurisdiction needs. When these strategies are operational, children are more likely to be safe and remain in parent custody, and parents are more likely to achieve sobriety and improve their parental capacity. Future research might examine the unique impact of each of the five strategies independently.     

Examining the need for cultural adaptations to an evidence-based parent training program targeting the prevention of child maltreatment

Evidence-based behavioral parent training programs (BPTs) have been recommended as a primary prevention strategy for child maltreatment, and use of BPTs is increasing. As these programs are implemented in new contexts and among new populations, the cultural relevance of these programs and need for adaptations or modifications must be considered. The purpose of this study was to assess the types of cultural adaptations that are being made to a widely implemented BPT, SafeCare, by providers working with families involved in the child welfare system, and to explore the need for more systematic adaptations. Eleven SafeCare providers, from six states, participated in individual, semi-structured interviews. Overall, the providers did not recommend systematic adaptations of the model for specific ethnic groups. However, they provided general and specific information regarding SafeCare components that require adaptation on a case-by-case basis, which is likely to be applicable to many BPTs. More research is needed to develop clear guidance about when and how to assess the need for cultural adaptations and how to institute adaptations that improve rather than weaken evidence-based programs. By sharing data and experiences, purveyors can contribute to the body of knowledge about adaptation.     

A reciprocal relationship between parental maltreatment and child bullying perpetration in China

This study aimed to examine the longitudinal reciprocal relationship between parental maltreatment and child bullying perpetration from middle childhood to early adolescence in China and the associated gender differences. Eight hundred ninety-one children completed a battery of questionnaires at four time points. A random-intercept cross-lagged model was established. The results indicated that at the between-person level, child bullying perpetration was positively associated with physical and psychological maltreatment. At the within-person level, there was a significant association between an increase in bullying perpetration and an increase in parental psychological and physical maltreatment across the four time points. Conversely, an increase in physical maltreatment led to an increase in child bullying perpetration from T1 to T2, while an increase in psychological maltreatment resulted in an increase in child bullying perpetration from T1 to T2 and T2 to T3. Furthermore, an increase in physical maltreatment increased boys' bullying perpetration but decreased that in girls from T2 to T3. These findings provide inspiration for future family education and anti-bullying interventions in schools.     

Use of parent education to improve self-efficacy in parents of students with emotional and behavioral disorders

The results of a practice-based research project are described, in which parents of students with emotional and behavioral disorders (EBD) participated in a parent education presentation aimed at increasing parental self-efficacy. Results indicated that parents who participated did increase both their parental self-efficacy in regard to influencing their child’s school-related performance and helping their child succeed in school. Qualitatively, parents also reported the parent education was helpful and that they had tried suggested interventions at home. Though a small-scale pilot project, results are promising and suggest parent education is a feasible technique school districts can use to reach parents of students with EBD. Limitations and future directions are discussed.     

Contextual moderators of the link between national and European identity among European youth

Identification with Europe can constitute an important part of psychological citizenship for European citizens. From a self-categorization perspective, higher-order (e.g. with Europe) and lower order subgroup identities (e.g. with the nation) may interfere with each other if they are seen as incompatible. We were interested in contextual moderators at school and country level of youth’ national identity on identification with Europe. We used multi-level regression analyses based on data from the International Civic and Citizenship Education Study, collected from 14-year old students (n?=?71,282) from 22 European countries. Results showed strong positive effects of national identity at the individual, and classroom-level on European identity. However, main effects of national identity at the individual level were qualified by a number of interactions with contextual-level moderators. The relationship between national and European identity was weaker for adolescents attending classrooms or living in countries with lower average levels of trust in EU institutions. Living in countries with higher gender and income inequalities, less friendly immigration policies, and a communist past lessened the association between national and European identity. Results point to the powerful effects of context in shaping the relationship between national and European identity.     

Differences in drinking expectancies and motives for regular education and special education high school students with emotional/behavioral disorders

Alcohol expectancies and drinking motives were compared for regular education students (n=159) and students with emotional/behavioral disorders (EBD) receiving special education services (n=51). Differences existed between groups with respect to expected negative social consequences and emotional and physical outcomes associated with drinking. Across groups, drinkers reported more positive alcohol expectancies than non-drinkers, while non-drinkers reported more negative alcohol expectancies than drinkers. Differences also existed between the regular education and EBD students who drank with respect to coping, conformity, and social motives. Accounting for sample sizes differences, the relationship between alcohol use and negative physical effect was stronger for regular education students, while the relationship between alcohol use and conformity motives was stronger for the EBD group.     

The role of interagency collaboration in facilitating receipt of behavioral health services for youth involved with child welfare and juvenile justice

Unmet need for behavioral health care is a serious problem for crossover youth, or those simultaneously involved with the child welfare and juvenile justice systems. Although a large percentage of crossover youth are serious emotionally disturbed, relatively few receive necessary behavioral health services. Few studies have examined the role of interagency collaboration in facilitating behavioral health service access for crossover youth. This study examined associations for three dimensions of collaboration between local child welfare and juvenile justice agencies - jurisdiction, shared information systems, and overall connectivity - and youths' odds of receiving behavioral health services. Data were drawn from the National Survey of Child and Adolescent Well-Being, a national survey of families engaged with the child welfare system. Having a single agency accountable for youth care increased youth odds of receiving outpatient and inpatient behavioral health services. Inter-agency sharing of administrative data increased youth odds of inpatient behavioral health service receipt. Clarifying agency accountability and linking databases across sectors may improve service access for youth involved with both the child welfare and juvenile justice systems.     

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 relationship between unemployment and child maltreatment: A county-level perspective in California

The conventional logic supported by research and statistics suggests that there will be more child maltreatment as the economy becomes worse and less child maltreatment as the economy becomes better. However, in some local jurisdictions in California, statistics indicate the opposite. A closer examination of one county, San Mateo, suggests that this may be due to the fact that the County has a very high Self-Sufficiency Standard in which people get jobs with incomes that do not exceed the Standard, but in fact disqualifies them from the safety net of Federal benefits. Further, children born around the time of the last recession have a higher chance of adverse mental health issues and are now entering schools with issues that may reflect child abuse and neglect.     

Walk-in clinic counselling for emotional regulation with low-needs youth on the autism spectrum

A single-session consultation model for low-needs youth on the autism spectrum is presented with the mental health concern of emotional self-regulation, a common issue in family psychotherapy. This research is contextualised within the growing field of short-term therapy as it intersects the growing demand to therapeutically address clients on the autism spectrum. The treatment intervention is delineated through five sequential phases within the walk-in clinic setting for the practitioner clinician. A rationale, overview, and instruction for the practitioner clinician utilising this novel model is provided through a case study format. By using a more structured and integrated approach to treatment, organised through an externalised metaphor, it is suggested that the current model will be more effective for this specific clinical population. Additionally, a case illustration is provided that scaffolds the treatment model, which includes table formats and pictures. The case study illustrates the self-regulation map metaphor visually and interactively linking client challenges, strategies, and motivations simultaneously on multiple electronic devices in session. Relevant works were selected to explore the effectiveness of single-session consultation models for those presenting on the autism spectrum. Treatment interventions for specific clinical populations are recommended, especially within walk-in clinic therapy. This clinical research introduces a paradigm shift towards therapeutically addressing emotional self-regulation with low-needs youth on the spectrum through virtual, interactive technology.     

Developing and transferring behavioral technologies for children and youth

Behavioral researchers have developed a variety of technologies for improving the capacities of children and their caregivers. Despite the availability of behavioral technologies for children and youth, their widespread adoption and sustained use has been limited. Characteristics for appropriate (e.g., sustainable, effective) technologies for children and youth are suggested here, and strategies for research and development of these methods are described. This paper outlines the process of transferring behaviorial technologies including the phases of awareness, interest, assessment, trial, implementation, maintenance, and reinvention. Finally, issues implicit in the process of transferring behavioral technologies for children and youth are discussed.     

Speaking up and stepping back: Examining the link between employee voice and job neglect

How does an employee attempts (or lack thereof) to improve or change work related circumstances influence one's ability to do one's job? This longitudinal study sought to examine this question by testing the relationship between employee voice and two distinct forms of job neglect (active and passive neglect) among child welfare workers at baseline (time 1: n = 359) and six month follow-up (time 2: n = 187). Path analysis results revealed significant yet unexpected relationships between employee voice and the forms of job neglect. At time one, results showed that as employees voiced, they engaged in active neglect; yet this relationship shifted over time. In that, employees who exercised voice at time 1 were less likely to engage in active job neglect at time 2. With respect to passive neglect and voice, employees who indirectly limited their work effort at baseline were more likely to speak up at time 2. This study examines this unique finding and the role that both employee voice and job neglect play as workers attempt to manage dissatisfying work conditions or promote positive organizational change.     

Describing the context and nature of emotional maltreatment reports in children

The circumstances leading to reports of emotional maltreatment are potentially unique from those of other abuse types. This study utilized data from the National Child Abuse and Neglect Data System (NCANDS), which is a federally sponsored effort requiring the submission of case-level data on all children who were subject to maltreatment investigations by state child welfare agencies. The central aims of this study were to examine case-level characteristics of sole occurrences of emotional maltreatment Child Protective Service (CPS) reports in an effort to address how caregiver and child risk correlates affect the substantiation of these allegations. A cluster analysis was performed to explore how the risk assessment factors grouped together; secondarily, the cluster groupings were examined in a logistic regression model to measure factors associated with substantiation of these abuse reports. Four unique clusters emerged, with one cluster absent any risk assessment factors entirely and another cluster solely composed of domestic violence. Caregiver risk factors with the highest odds of predicting report substantiation included caregiver substance abuse, domestic violence, and caregiver learning disabilities.     

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.     

Intersections of individual and neighborhood disadvantage: Implications for child maltreatment

Parenting behaviors are influenced by numerous factors, including individual, family, and community contexts. Ecological systems theory suggests that these systems as well as interactions among the systems coalesce to influence the parent/child relationship in multiple ways. When challenges exist within and across these systems, child abuse and neglect can occur. While a significant body of research has delved into parsing the relative importance of neighborhood-level versus individual-level predictors, little is known about the complex ways in which interactions across ecological systems might enhance or hinder parenting behaviors. The current study seeks to fill this gap by answering the following research question: (1) Are there interactive effects of individual and neighborhood poverty on the risk of child maltreatment? Structural equation modeling was used to analyze data from 946 parents at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics in Franklin County, Ohio. Living in higher poverty neighborhoods is associated with higher levels of maltreatment irrespective of individual poverty status, but there is not a corresponding decrease for those living in lower poverty neighborhoods. These findings suggest that both individual poverty status and neighborhood poverty matter for child maltreatment and that there does not appear to be a compounding effect of being both poor and in a poor neighborhood, nor is there a protective effect when poor but living in a nonpoor neighborhood.