‘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.     

Predicting illegal income generation among homeless male and female young adults: Understanding strains and responses to strains

This study examined gender differences among homeless young adults' engagement in illegal economic activity (i.e., panhandling, selling drugs, survival sex, gambling, theft). A purposive sample of 601 homeless young adults (ages 18–24) was recruited from three U.S. cities (Los Angeles, CA [n = 200], Austin, TX [n = 200], and Denver, CO [n = 201]) to participate in semi-structured interviews. General strain theory was used to identify predictors of illegal economic activity, including strains (childhood abuse, street victimization, length of homelessness, transience) and responses to strain (deviant peer associations, substance use, post-traumatic stress disorder, arrest history). The full hypothesized path models for males and females separately were tested using observed-variable path analysis. Among females, a greater variety of illegal income sources was reported by those who had experienced greater street victimization and who had used a greater number of substances in the past year. Among males, a greater variety of illegal income sources was reported by those who had more deviant peer associations, experienced greater street victimization, and used a greater number of substances in the past year. Findings have implications for research and preventive interventions to address engagement in illegal economic activity among male and female homeless young adults.     

Keeping it in the family: The impact of a Family Finding intervention on placement,permanency, and well-being outcomes

Child-centered recruitment via Family Finding has gained national attention as an approach to search, discover, and engage kin and fictive kin to support the attachment and permanency needs of children in foster care. However, despite its promise it has received scant attention in the empirical literature. The current study compared the outcomes of a front-end Family Finding intervention (n = 196) and a comparison group (n = 262) among children in foster care in Cook County Illinois between the ages of 6 and 13. Results showed that there were no differences between the intervention and comparison group on reunification rates, placement stability, or on longitudinal externalizing behavior and internalizing symptoms. However, the intervention found close to 75% more relatives than the control group, and many of these relatives were significant figures in the children's lives. The intervention was also associated with a higher proportion of relative placements to total placements for a subgroup of children with five or more placements. Further, the effect of the intervention on this proportion (relative placements to total placements) was mediated by the greater number of relatives found in the intervention. Finally, the intervention was associated with relatively better Concurrent Planning. These results suggest that Family Finding has the potential to impact proximal outcomes related to discovery, engagement and planning but is currently not impacting more distal outcomes such as permanency and well-being. Family Finding approaches should continue to innovate, possibly through integration with psychosocial interventions, to affect more distal variables such as well-being outcomes.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

To be or not to be a rights holder: Direct and indirect effects of perceived rights on psychological adjustment through group identification in care

This study explores how young people in residential care perceive their rights and the relationship with their adjustment, through the role of group identification. Data from a non-random sample of young people (N = 356; aged 11–18 years) in Portuguese residential settings was analysed and a set of mediation effects was found. Findings revealed a set of mediation effects on the relationship between Participation and Protection and Positive Self and between Respectful system practices and behaviours and Emotional Distress, Anger Control and Antisocial Behaviour. Higher scores of these rights perceptions were associated with lower psychological problems, through the indirect effect of group identification (i.e., the sense of belonging to the group in residential care). These findings are discussed based on social and developmental insights together with empirical evidence on residential care. These results provided important practical implications in residential care, namely, assuring the young people's participation, the promotion of professional practices based on the respect for young people and their families, non-discriminatory behaviours and equal opportunities.     

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.     

Effects of vocational training on unemployed youths' work motivation and work engagement: Mediating roles of training adequacy and self-actualization

This study investigated work motivation and work engagement, along with their associated factors, among unemployed young people participating in vocational training schemes in Tianjin, China. Derived from a sample of 209 young trainees (mean age = 22.67, SD = 1.93), the results supported the hypotheses that training adequacy and self-actualization showed positive effects on work motivation and work engagement. Furthermore, training variables (the number of training courses attended and duration of workplace training) did not present any significant direct effect on either work motivation or work engagement; however, they predicted the two outcome variables indirectly through the mediating effects of training adequacy and self-actualization. The study implied that power, skills, and other resources gained during the training provided fuel for motivation and performance. The study also advanced the human capital development approach by unraveling the mechanism through which hard skills and soft skills contribute to youth empowerment and employment. The implications of these present findings for theory, practice, and policy were also 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.     

Finish what you start: A study of Design Team change initiatives' impact on agency climate

This study employs a multi-site longitudinal design to examine the effect of a Design Team intervention on organizational climate. Thirteen private, not-for-profit child welfare agencies from one state participated in a Design Team intervention to address workforce needs. A total of 407 workers from those agencies responded pre and post intervention to a survey that measures worker perceptions of the psychological climate of their organization using the Parker Psychological Climate Survey. Workers in organizations that completed the Design Team intervention had statistically significant increases in three of the four dimensions of the Parker scale. On the role dimension, significant change was noted on all three subscales on the interaction between Time 1 and Time 2 (ambiguity: p = 0.012; conflict: p = 0.04; overload: p = 0.05). On the organization dimension, the justice and support subscales had significant differences in the desired direction (justice: p = 0.05; support: p = 0.03). On the supervisor dimension, significant change was observed in the desired direction for both the goal emphasis and work facilitation subscales (goal emphasis: p = 0.02; work facilitation: p = 0.00). Statistically significant improvements in the organizational climates of child welfare agencies suggest the benefit of future research to test the effectiveness of Design Team interventions in other service areas. These findings build on intervention research with organizations by linking the ability of an organization to fully implement a change initiative to their capacity to improve the workplace climate for employees.     

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.     

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.     

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.     

Exploration of factors predictive of at-risk fathers' participation in a pilot study of an augmented evidence-based parent training program: A mixed methods approach

There has been burgeoning parenting intervention research specifically addressing fathers in recent decades. Corresponding research examining their participation and engagement in evidence-based parent training programs, which have almost exclusively targeted mothers, is just emerging. The current study used mixed methods to examine factors that influenced completion of an augmented version of an evidence-based child maltreatment prevention program developed for male caregivers called SafeCare Dad to Kids (Dad2K) in a pilot study. The current sample comprised 50 male caregivers (M_age = 29.42 years, SD = 8.18) of a child between the ages of 2 and 5 years. Fathers participated in a baseline assessment and were considered program completers (n = 27) if they participated in the program's six home visiting sessions. A subsample of completers (n = 11) was recruited to participate in qualitative interviews that provided in-depth information about fathers' experiences in Dad2K. Logistic regression indicated that, in the context of other demographic predictors, fathers with an education beyond high school were over 5 times more likely to complete Dad2K program compared to fathers with a high school education or less. Qualitative analyses revealed that interviewed father completers were motivated to enroll and participate in a fathering program because of an interest to learn and obtain skills to make them a better parent. Fathers with a high school education or less may require additional engagement strategies to help proactively encourage their enrollment and completion of parent training 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.     

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.     

Participation,empowerment and capacity building: Exploring young people's perspectives on the services provided to them by a grassroots NGO in sub-Saharan Africa

This paper explores young people's perspectives on the services that were provided to them by one NGO in sub-Saharan Africa. Semi-structured interviews and discussion groups were carried out with 71 young people, aged between 10 and 18 years old, who lived and worked on the street. Volunteer facilitators (n = 26) who run the groups and who had either previously lived on their street themselves or who lived in the ‘informal slum areas’ also took part in the discussions. A number of challenges and tensions became apparent from discussions including issues around capacity building, empowerment, participation and the depoliticised nature of social action.     

Risky sexual behavior and substance use among adolescents: A meta-analysis

This study presents the results of a meta-analysis of the association between substance use and risky sexual behavior among adolescents. 87 studies fit the inclusion criteria, containing a total of 104 independent effect sizes that incorporated more than 120,000 participants. The overall effect size for the relationship between substance use and risky sexual behavior was in the small to moderate range (r = .22, CI = .18, .26). Further analyses indicated that the effect sizes did not substantially vary across the type of substance use, but did substantially vary across the type of risky sexual behavior being assessed. Specifically, mean effect sizes were the smallest for studies examining unprotected sex (r = .15, CI = .10, .20), followed by studies examining number of sexual partners (r = .25, CI = .21, .30), those examining composite measures of risky sexual behavior (r = .38, CI = .27, .48), and those examining sex with an intravenous drug user (r = .53, CI = .45, .60). Furthermore, our results revealed that the relationship between drug use and risky sexual behavior is moderated by several variables, including sex, ethnicity, sexuality, age, sample type, and level of measurement. Implications and future directions are discussed.     

The effectiveness of a parenting education program based on respected parents & respected children for mothers of preschool-aged children

The purpose of this study was to evaluate the effectiveness of the Respected Parents & Respected Children (RPRC) parenting education program for mothers of preschool-aged children in South Korea. A total of 99 mothers were assigned to an intervention group (n = 54) or a control group (n = 45). Mothers in the intervention group received 16 weekly sessions of the parenting education program and then were compared with mothers who did not take part in the program. Questionnaires were used to assess parenting characteristics (i.e., maternal depression and anger, parenting behavior, co-parenting, parenting efficacy, and parenting stress) at baseline (pre-test), immediately after the termination of the program (post-test), and 8 months after the end of the program (follow-up test). Maternal rejection/restrictions, dissatisfaction, and parental distress of the intervention group decreased and efficacy as parents improved after taking part in the program, and these effects were sustained at follow-up. Our findings support the effectiveness of the RPRC parenting education program in changing parenting strategies and satisfaction and emphasize the need for preventive interventions for parents with young children.     

How an intervention project contributes to social inclusion of adolescents and young people of foreign origin

This article presents the results of the impact study of the Nightingale Project, a social mentoring project, whose aim is to support the welcoming and social inclusion processes of adolescent students of foreign origin who recently arrived in Catalonia and who are currently enrolled in the country's schools. The more than one hundred mentoring pairs (mentor and mentee) that took part in the intervention project were administered a questionnaire (N = 58). This same questionnaire was also given to a group of adolescents with the same profile but who did not participate in the project (N = 128) and who were treated as a control group.After six months of intervention (which corresponds to the duration of the Nightingale Project), results show that students who participate in mentoring learn the language faster, create broader and more diverse networks of friends in school, develop higher educational aspirations and expectations, are better acquainted with the reception context (municipality they live in), and improve standards of self-confidence and self-esteem, among other characteristics. The research also demonstrates that mentoring aimed at adolescents, as is the case of the Nightingale Project, plays a key role in avoiding development of an oppositional identity and, conversely, helps facilitate a process of resilience in adolescents in the new context of reception.