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.     

The effects of organizational context on autonomy-enhancing policies in assisted living

This study examines the effects of facility size, ownership, chain membership, and residents' characteristics on autonomy-enhancing policies in assisted living. The theoretical framework for the study is based on the open systems perspective, which views organizations as being influenced by environmental context (e.g., ownership and chain membership). Data were collected from interviews with administrators of 60 facilities in Maryland. Autonomy-enhancing policies were assessed with the MEAP Policy Choice and Resident Control scales. Facility size and residents' disability were strong predictors of autonomy-enhancing policies (R² = .39, p < .001). Higher levels of policies that foster resident autonomy were associated with larger facility size (β = .54, p < .001) and lower residents' disability (β = .23, p < .05). Chain membership had an indirect influence on autonomy-enhancing via facility size and residents' disability. Chain-related facilities were larger, and their residents were less disabled. The study contributes to a better understanding of the mechanism through which organizational factors influence resident-oriented policies.     

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.     

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.     

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

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

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.     

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

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

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.     

‘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.     

The role of religion in mediating the transition to residential care

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

Mental health outcomes among child welfare investigated children: In-home versus out-of-home care

BackgroundChild welfare has increasingly focused on alternatives to out-of-home (OOH) placement. In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.ObjectiveTo evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methodsWe examined a cohort of children (aged 1.5–18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.ResultsAmong the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).ConclusionsFor school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families.     

The relationship between the type of smartphone use and smartphone dependence of Korean adolescents: National survey study

The purpose of this study is to verify the relationship between the type of smartphone use and smartphone dependence. We analyzed 2212 data of middle and high school students of the survey on internet addiction by the Korea Information Society Agency in 2016. We conducted a hierarchical multiple regression analysis to examine the effects of smartphone use for information seeking, entertainment seeking, gaming, mobile SNS, and mobile instant messenger on smartphone dependence after controlling smartphone usage frequency, and smartphone usage time. As a result of the analysis, the frequency of smartphone use of weekday (p < 0.001) and weekend (p < 0.001) was related to the dependence on smartphones. In addition, the amount of smartphone use for information seeking (p < 0.01), entertainment seeking (p < 0.05), and gaming (p < 0.001) were associated with the dependence of smartphone. The amount of smartphone use for mobile SNS and mobile instant messenger are not related to smartphone dependence. The results suggest that different strategies need for the psychological intervention of smartphone dependence according to the main type of smartphone use of adolescents.     

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.     

Concurrent alcohol and cigarette use among school-going adolescents in Korea

BackgroundConrurrent alcohol and tobacco use may increase the risk for substance abuse in adolescents. The aim of this study was to investigate concurrent alcohol and cigarette use and the co-occurrence risks of each substance in school-going adolescents in Korea.MethodsIn a cross-sectional nationally representative survey in 2016, 65,528 students (Mean age = 15.1 years, SE = 0.02) responded to a questionnaire that included measures of substance use and substance use exposure.ResultsIn all, 13.3% of the students were concurrent lifetime smokers and drinkers (19.3% among boys and 6.7% among girls), 25.5% lifetime alcohol users only (24.2% among boys and 26.9% among girls), 3.0% lifetime smokers only (4.7% among boys and 1.1% among girls) and 58.3% never smoked and never used alcohol (52.2% among boys and 47.8% among girls). All measures of more intensive smoking pattern and smoking exposure and more intensive drinking pattern and drinking exposures, respectively, were associated with consistently increased risk of lifetime alcohol use and lifetime smoking, respectively, compared to lifetime never smokers and abstainers. In multinomial logistic regression, compared to students who neither had used alcohol nor tobacco, concurrent lifetime smokers and drinkers were more likely to be male, mixed or boys school, higher school grade, lower paternal and maternal educational level, perceived lower socio-economic status, ever drug user, perceived stress above average, depressive mood, experience of violence victimization, and living in a rural area or medium sized city.ConclusionPrevention and treatment strategies should better incorporate the comorbidity of cigarette smoking and alcohol use in their intervention programmes.     

The within poverty differences in the occurrence of physical neglect

This secondary data analysis examined the risk and protective factor(s) associated with physical neglect within a sample of impoverished children. We conducted a multivariate logistic regression analysis to examine the associations among maternal age, child gender, caregiver depression, caregiver history of maltreatment, income-to-needs ratio, number of children in the home, marital status, neighborhood quality, and physical neglect. Social support was explored as a potential moderator. Among this impoverished sample, children whose caregivers had depression were 2.03 times as likely to experience physical neglect as children whose caregivers were not depressed (95% CI 1.25, 3.30; p = 0.004). Children whose caregivers reported experiencing child maltreatment were 1.81 times as likely to experience physical neglect as children whose caregivers did not experience maltreatment as a child (95% CI 1.17, 2.81; p = 0.008). Children who live in higher quality neighborhoods were 0.74 times as likely to experience physical neglect as children who live in lower quality neighborhoods (95% CI 0.57, 0.96; p = 0.03). No other significant relationships were found.     

Association between social support and child abuse potential among Japanese mothers

Child abuse is a global public health problem and a serious social issue in Japan. Social support is beneficial for parents faced with childrearing challenges. The aim of this study was to clarify the association between social support and child abuse potential. A cross-sectional study was conducted using a structured questionnaire. The target population was mothers of children at nine public nursery schools. Bivariate and multiple linear regression analysis were performed to examine the effects of socio-demographic, social support and psychological distress factors on child abuse potential. Among 309 mothers, 29 (9.4%) had a high child abuse potential score. Bivariate analysis indicated that mothers with a higher child abuse potential score were more likely to be divorced or unmarried (P < 0.001); living in single-female-parent households (P < 0.001); have low perceived economic status (P < 0.001); have a low level of child care support (P = 0.01); have a low Multidimensional Scale of Perceived Social Support (MSPSS) score (P < 0.001); and/or a high General Health Questionnaire-12 score (GHQ-12) (P < 0.001). Important predictors of child abuse potential among the mothers surveyed included living in single-female-parent households, having low perceived economic status, low MSPSS score, and high GHQ-12 score. Improving approaches that help mothers build social support relationships and ease them into child rearing in a psychologically healthy condition is recommended to prevent child abuse.     

Societal factors impacting child welfare: Re-validating the Perceptions of Child Welfare Scale

ObjectiveThis research examines the psychometric properties of the Perceptions of Child Welfare Scale (PCWS) by seeking to understand the differences between workers' perceptions of how society views them based upon job title by revalidating the PCWS with a sample of administrators and clinicians.MethodsConfirmatory factor analysis was utilized to analyze data on 165 administrators and 153 clinical child welfare workers.ResultsThe final model consisted of three latent variables with ten indicators related to stigma, value, and respect ([X²] = 167.6, [p] = 0.00; [RMSEA] = 0.07; 90% [CI]: 0.06–0.09; [CFI] = 0.95; [TLI] = 0.95).DiscussionThe factors found in the previous study were confirmed using an entirely different sample of child welfare workers. The factors value, stigma, and respect were confirmed across the sample based upon whether the workers were administrators or clinicians. This provides reassurance that measuring how workers perceive they are viewed by those outside the child welfare system does not vary based upon job title.     

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.     

Cyberbullying victimization and fatalism in adolescence: Resilience as a moderator

The present study used quantitative data to address two gaps in cyberbullying research. First, to examine the relationship between fatalism and cyberbullying victimization in an adolescent sample not previously explored. Second, despite investigating these relationships from a main effects perspective, the present study extended research by examining fatalism from an interaction effects perspective. Specifically, this study examined adolescents' resilience as a moderator of the relationship between cyberbullying victimization and fatalism. A total of 643 adolescents (M_age = 14.56; SD = 1.45) from grades 7 to 10 of compulsory education participated in this study. Cyberbullying was associated with higher levels of fatalism. The key finding was that resilience was a moderator of the relationship between cyberbullying victimization and fatalism. These findings emphasize the importance of the protective function of resilience in cyberbullying victimization outcomes.     

Foster and adoptive parent training: A process and outcome investigation of the preservice PRIDE program

This study investigated the widely-used but under-researched program for training resource parents (i.e., foster, adoptive, or kinship parents) known as preservice PRIDE (Parent Resources for Information, Development and Education). The sample consisted of 174 participants in Ontario, Canada. Examination of the process of training showed that the participants were highly satisfied with the training and rated it as being of high quality. The participants experienced a large pretest-posttest mean gain (d = 1.17, p < 0.001) on the total score of the primary outcome measure, knowledge of the PRIDE competencies taught by the program. Training quality was a positive and statistically significantly predictor of both gains in knowledge of the PRIDE competencies and satisfaction with training. The results were discussed in terms of their implications for research and practice.