Risk and protective factors for problem behaviors among youth in residential care

In accordance with problem behavior theory (PBT), the study examined the contribution of risk and protective factors among high-risk adolescents living in residential care settings (RCSs) to their delinquency, substance abuse, and risky sexual behavior, as well as the inter-correlations between these problem behaviors. The specific study variables were chosen to represent the personal and environmental factors operating on the adolescent. It was hypothesized that higher levels of problem behaviors would be associated with higher levels of sensation-seeking and deviant peer associations (risk factors), and lower levels of future orientation and parental support (protective factors).One hundred and forty seven adolescents (M = 16.03) from seven residential facilities for children with severe emotional and behavioral problems in Israel responded to structured self-report questionnaires.The powerful associations found between the abovementioned risk behaviors suggested a problem behavior syndrome among this group. The risk factors of sensation-seeking and deviant peer associations made the largest contribution to the prediction of problem behaviors beyond any background or protective factors examined. Of the protective factors, only future orientation was found to be significantly associated with problem behaviors: i.e., a more positive future orientation correlated with lower engagement in problem behaviors, an association that increased in strength with age.The apparent existence of a single behavioral syndrome among youth in RCSs and the central contribution to the syndrome of risk factors – in particular, deviant peer associations – points to the need for holistic group interventions addressing multiple risk factors.     

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.     

Heterogeneity among adolescent mothers and home visiting program outcomes

Despite the challenges of early parenting, many adolescents navigate motherhood successfully, underscoring an overlooked heterogeneity among adolescent mothers. The present study used Latent Class Analysis (LCA) to identify subgroups of adolescent mothers (n = 704) enrolled in a randomized controlled trial (RCT) evaluation of a home visiting program for young parents. The model incorporated demographic and background characteristics, as well as indicators of psychological vulnerability. Analyses revealed four distinct subgroups: (a) non-Hispanic high vulnerability (n = 209, 30%); (b) Hispanic high vulnerability (n = 98, 14%); (c) non-Hispanic moderate vulnerability (n = 241, 34%); and (d) Hispanic moderate vulnerability (n = 156, 22%). Mothers in the two high vulnerability subgroups exhibited the poorest personal and parenting functioning outcomes measured approximately two years postpartum, particularly in terms of child maltreatment (non-Hispanic high vulnerability) and depressive symptoms (Hispanic high vulnerability). Analyses revealed positive effects of the home visiting program within specific latent classes on such outcomes as healthy baby at birth, high school or GED attainment, and repeat birth.     

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

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

Empowering children with safety-skills: An evaluation of the Kidpower Everyday Safety-Skills Program

Changes in child safety knowledge concerning bullying, boundary-setting, and help-seeking were evaluated after participation in the Kidpower Everyday Safety Skills Program (ESSP), a workshop designed to increase children's knowledge of safe choices. The program consisted of an in-school workshop, weekly follow-up sessions, and homework assignments over 10 weeks and included skills-training, parental involvement, and opportunities to practice safety skills. Third-grade students (n = 128) participated in pre- and post-tests of safety skills, and were compared to a comparison group (n = 110) that did not participate in the program. Findings indicate that students who participated had increases in safety knowledge (maintained over 3 months) greater than the comparison group. Additional assessments indicate that the program was implemented with high fidelity and both teachers and students found the program successful. Children's understanding of the competency areas boundary-setting, stranger safety, help-seeking, and maintaining calmness and confidence improved.     

Criminal conduct subgroups of “aging out” foster youth

Subgroups of adolescents drawn from the Midwest Study of the Adult Functioning of Former Foster Youth were identified on the basis of cluster analysis of self-reported criminal behavior: Cluster 1: No Criminal Activity (n = 204), Cluster 2: Moderate Criminal Conduct (n = 300), Cluster 3: Extensive Criminal Involvement (n = 87), and Cluster 4: Group Fighting (n = 139). Logistic regression analysis revealed higher proportions of foster youth with alcohol and drug diagnoses, male gender, out of school status, and limited caregiver closeness in each of the groups in which there was evidence of significant criminal conduct (Clusters 2, 3, & 4) in comparison to the no criminal activity group (Cluster 1). The same variables contributed to discrimination between the cluster subgroup with the most serious and pervasive pattern of criminal conduct (Cluster 3) and the two with less extensive criminal involvement (Clusters 2 & 4). Current findings and those of G. R. Cusick, M. E. Courtney, J. Havlicek & N. Hess (2010), help in identifying the differing needs of youth aging out of the child welfare system and should be useful in informing development of targeted interventions.     

Parents,friends, and depression: A multi-country study of adolescents in South Asia

PurposeThis study investigates the association between social support networks, as measured by parental involvement and close friendships, and depression among adolescents in South Asia.MethodsNationally representative samples of adolescents between the ages of 12 and 16 + years (n = 16,592) from the Global School Based Health Surveys from India, Sri Lanka, Pakistan, and Myanmar were analyzed to provide prevalence rates of depression. Additionally, differences in past year depressive symptoms were compared cross-sectionally by social support from parents and friends, separately. This was done by computing prevalence ratios adjusting for potential confounders and demographic factors.ResultsOf all adolescent respondents in the study, 14.5% met the criteria to be screened for depression, while 50% reported having three or more close friends, and 80% reported having very involved parents. Adjusted prevalence ratios indicated that those with close friendships were much less likely to be screened for depressive symptoms compared to their counterparts, as were adolescents with very involved parents. However, low and moderate levels of parent involvement were not found to be significantly associated with adolescents' propensity for being screened for depressive.ConclusionSocial support is a social determinant of adolescent mental health in South Asia that has received little scholarly attention to date. This study highlights the importance of research and interventions involving parents and close friends in building programs for adolescents that target mental health.     

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.     

A cross-lagged model of the relationship between violent video game exposure and moral disengagement in middle school and high school students

Previous studies have proved that violent video game exposure might have an association with moral disengagement; however, the directionality of this correlation remains unclear. Therefore, we examined the reciprocal effects between violent video game exposure and moral disengagement in a longitudinal study. The sample included 1393 adolescents (48.7% boys) in the seventh (middle school students, n = 694, M_age = 13.15 years) and tenth (high school students, n = 699, M_age = 15.93 years) grades at six Chinese secondary schools. The results showed that high school students' levels of moral disengagement were higher than those of middle school students, and violent video game exposure was positively associated with moral disengagement. The cross-lagged panel model suggested that violent video game exposure predicted moral disengagement (six months later) in all participants, with a slightly stronger effect in middle school students. The finding also indicated differences in the development of perspective regarding the association between violent video game exposure and moral disengagement, which observed a predictive effect for middle school students but a lagged effect for high school students. Thus, different preventions and interventions should be distinguished for middle school and high school students.     

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.     

Measurement and evaluation practices of factors that contribute to effective health promotion collaboration functioning: A scoping review

The purpose of this scoping review was to identify promising factors that underpin effective health promotion collaborations, measurement approaches, and evaluation practices. Measurement approaches and evaluation practices employed in 14 English-language articles published between January 2001 and October 2015 were considered. Data extraction included research design, health focus of the collaboration, factors being evaluated, how factors were conceptualized and measured, and outcome measures. Studies were methodologically diverse employing either quantitative methods (n = 9), mixed methods (n = 4), or qualitative methods (n = 1).In total, these 14 studies examined 113 factors, 88 of which were only measured once. Leadership was the most commonly studied factor but was conceptualized differently across studies. Six factors were significantly associated with outcome measures across studies; leadership (n = 3), gender (n = 2), trust (n = 2), length of the collaboration (n = 2), budget (n = 2) and changes in organizational model (n = 2). Since factors were often conceptualized differently, drawing conclusions about their impact on collaborative functioning remains difficult. The use of reliable and validated tools would strengthen evaluation of health promotion collaborations and would support and enhance the effectiveness of collaboration.     

Future orientation climate in the school class: Relations to adolescent delinquency,heavy alcohol use,and internalizing problems

It is well known, based on previous research, that adolescents' thoughts and feelings about their future are related to the risk of delinquency, alcohol use as well as health. However, other well-known facts are that adolescents' actions are substantially shaped in interaction with peers and that, during adolescence, individuals spend a considerable amount of the day at school, in interaction with classmates. Despite this, there is an almost complete lack of studies exploring to what extent the school climate, as measured by thoughts and feelings about the future, can influence individual adolescents. The aim of the current study is to investigate whether the future orientation (FO) climate, measured at the school class level, is related to delinquency, alcohol use and internalizing problems at the individual level, among a sample of Swedish students 14–15 years of age. The data used come from the Swedish part of the Youth in Europe (YES!) study, which is part of the larger project Children of Immigrants - Longitudinal Survey in Four European Countries (CILS4EU). In the present paper, we use data from the first wave, collected among 8th grade students in 2010/11 (n = 4119–4364). The method used was multilevel modeling (linear probability models (LPM) and linear regression analysis). The results showed that, in school classes where a high proportion of students had a positive future orientation, the risk of heavy alcohol use at the individual level was lower, also after adjusting for individual FO and for individual- and class-level socioeconomic conditions. A similar, but not statistically significant, tendency was found for delinquency. In addition, having a high proportion of students with a positive FO in a school class was associated with fewer internalizing problems, also after controlling for individual FO and socioeconomic conditions at the individual and school class level. We conclude that the surrounding school class, in terms of its general future orientation climate, may play a role for individual outcomes in the form of problem behaviors and mental health.     

The reasons why children work on the streets: A sample from Turkey

The phenomenon of children working on the streets is a societal issue in all underdeveloped or developing countries just as it is in Turkey. The purpose of this research was to examine the reasons that children work on the street by conducting individual in-depth interviews with working children and their mothers, choosing individuals from similar socioeconomic demographic backgrounds and making a comparison of their acceptance or rejection of working, the perception of social support received by the mothers, and their problem-solving skills. The research was a mixed study that used both qualitative and quantitative techniques. The research was conducted in two stages. In the first stage, quantitative comparisons were made of the problem-solving skills of and social support received by the mothers of children working on the streets (n = 37) and non-working children (n = 35) and of the parental acceptance or rejection/control status of working children (n = 41) and non-working children (n = 41). In the second stage, the reasons children were working on the streets were evaluated qualitatively with seven children who were working on the streets and nine mothers. The Child/Adolescent Parental Acceptance–Rejection/Control Questionnaire, the Multidimensional Scale of Perceived Social Support, the Problem-Solving Inventory, and individual interview questionnaires were used as data collection tools. The social support and problem solving skills of the mothers with children working on the streets were lower than those of the mothers whose children were not working. The main themes and sub-themes that stood out at the end of the research were socioeconomic and political factors, environmental factors, cultural factors and family factors.     

Cigarette,alcohol, and marijuana use among adolescents in foster family homes

Data from a cross-sectional study conducted in a random sample of children who were placed in foster family homes were used to examine the prevalence and associated factors of substance use (i.e., cigarette, alcohol, and marijuana), and to explore if adolescents in foster family homes had different rates of substance use than those in the general population matched on age, gender and race/ethnicity. Logistic regression models were used to determine factors associated with substance use and McNemar tests were used to compare prevalence rates of substance use. Substance use was common among adolescents in foster family homes. A higher number of placement settings were significantly associated with current cigarette use (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09–1.60), and being placed in special study homes (i.e., fictive kin) was significantly associated with current marijuana use (OR, 6.43; 95% CI, 1.40–29.52). Compared to adolescents in the general population, those in foster family homes had lower rates of current alcohol (9.1% vs. 38.3%, p < 0.0001) and marijuana (13.6% vs. 29.7%, p = 0.005) use. No significant difference was observed for current cigarette use (18.2% vs. 11.5%, p = 0.08). More research is needed to confirm the lower rate of current substance use in foster family homes than those matched in the general population, and to explore why adolescents in special study homes were more vulnerable to marijuana use.     

Factors that influence parent recruitment into prevention programs in early childhood: A concept map of parents', practitioners', and administrators' points of view

Given that parents are the main carriers of change in their child, their participation in programs for preventing behavior problems in early childhood represents a key element in ensuring the success of the intervention. That said, although at-risk families benefit the most from this type of program, they are identified as being hard to reach. This study aims at identifying the factors that influence parent recruitment based on the points of view of the actors concerned. To this end, a concept mapping operation was performed, which involved parents (n = 19), practitioners (n = 19), and administrators (n = 13) from community and public organizations. The participants generated 131 statements to complete the following sentence: In your opinion, parents would enroll more in prevention activities for their child if…. These 131 statements were classified into 12 groups representing the factors that influence parent recruitment, all of which were considered relatively important (between 3.51 and 4.42 on 5). The participants also agree on an understanding of recruitment that tends toward an ecological model. This study shows that parent recruitment into prevention programs targeting behavior problems in early childhood is complex and multifactorial (including factors that concern parents, practitioners, services, organizations, and policies). Because the map shows that the influencing factors in recruitment appear to be interrelated, they should all be considered to increase the chances of reaching at-risk families.     

A comparison of outcomes for children and youth in foster and residential group care across agencies

Working collaboratively with two state associations and their member (nonprofit) agencies providing out-of-home care to children and youth, University researchers conducted a multi-site project to examine whether there were any differences in individual child-level outcomes between children placed in residential group care and those placed in foster. The study employed a quasi-experimental repeated measures design, with data collected at a minimum of two intervals (at intake and 3-month follow-up) and at subsequent intervals of 6 and 12 months for children remaining in care. Samples for analyses were drawn from 1082 youth in either residential group care (n = 903) or foster care (n = 179), in one of 37 agency sites across two southeastern states, who participated in a broader evaluation project. The average ages of participating youth in residential and foster care were 13.97 (SD = 2.43) and 13.65 (SD = 2.73), respectively. Based on his or her score on the Children's Global Assessment Scale (CGAS) at intake, each participant was also assigned to the low functioning group (n = 526; 53.1%), the borderline group (n = 232; 23.4%), or the high functioning group (n = 232; 23.4%). Analyses confirmed that youth in foster care tended to have higher levels of general functioning at baseline than did youth placed in group care. However, the degree to which youth progressed in care on measures of general functioning and mental and behavioral health problems did not differ based on placement setting; youth in residential group care settings progressed at the same rate as youth in community-based settings, regardless of their level of functioning at intake. The only exception to this pattern was in regard to anxiety; there was an observable, but non-significant trend of youth in foster care reporting decreases in anxiety levels, while those in group care reported increased anxiety.     

Children's subjective well-being in rural communities of South Korea and the United States

The study examined subjective well-being of 10- to 12-year-old children from rural South Korea (n = 489) and rural United States (n = 1286) using the Children's Worlds Survey within the framework of the ecological, relationship-based model of children's subjective well-being. Applying Structural Equation Modeling to the analysis, a large proportion of the variance was explained and children's subjective well-being was predicted in both countries by microsystem factors of family relationships, parent involvement, and school quality, and individual factors of age (younger), and gender (male). Additional microsystem factors predicting subjective well-being were neighborhood quality in South Korea, and peer relationships in the United States, which may reflect contextual influences of collectivistic (South Korea) and individualistic (United States) macrosystems.     

Effectiveness of brief intervention and case management for children and adolescents with mental health difficulties

ObjectiveTo compare the effectiveness of a Brief Intervention (BI) and Treatment As Usual (TAU) in a sample of children and adolescents seeking mental health treatment from a Child and Youth Mental Health Service (CYMHS). BI comprised up to six sessions of psychological therapy from trainee psychologists, and TAU involves case management incorporating assessment and psychological treatment (e.g., individual, parent, family therapy), plus linkage to other services.MethodA matched subjects design was used to evaluate the BI (n = 79) and TAU (n = 79) treatment conditions. Participants were matched according to age, gender, and baseline symptom scores on the Health of the Nations Outcome Scale for Children and Adolescents (HoNOSCA), which was completed at pre- and post-treatment. The HoNOSCA is a clinician-rated measure of symptoms experienced in the previous two weeks.ResultsBI and TAU both significantly reduced mental health symptoms, with no significant difference between treatments overall, on Externalising or Emotional problems subscales, or on the percentage of most problematic items for participants.ConclusionsBI was as effective as TAU in reducing mental health symptoms in some children and adolescents. BI however is briefer, and could form part of a Stepped Care model for CYMHS. Further research is required to establish the most effective elements of BI in reducing mental health symptoms.     

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.     

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.