The Interaction of Structural Variables and Discretion in Individual Outcomes: The Case of Length of Stay for Mental Patients

There is a long history or debate concerning the relative effects of external variables and individual discretion on individual outcomes. Yet, few attempts have been made to specify their cumulative effects on individual outcomes. Using length of stay in mental hospitals as our outcome measure, and type of commitment as our discretion measure, results from regression analyses indicate that discretionary and external variables (i.e., positions in the social structure) interact. Under conditions of low discretion, status resources have much stronger effects on length of stay than they do under conditions of high discretion. We conclude that external factors and discretionary variables can and should be included in the analysis of social action.     

Client retention in residential drug treatment for Latinos

Client drop out from treatment is of great concern to the substance abuse field. Completion rates across modalities vary from low to moderate, not ideal since length of stay has been positively and consistently associated with better client outcomes. The study explored whether client characteristics shown to be related to retention were associated with treatment completion and treatment duration for a sample of 164 Latino substance users who entered a culturally focused residential program. In-person client interviews were conducted within a week of program admission. Logistic regression analysis was used to examine research questions. Clients most likely to drop out had self-reported co-occurring psychiatric diagnoses; they were 81% less likely to complete the program, suggesting that clients with mental health problems have a more difficult time remaining in residential treatment. Clients using drugs in the three months prior to entry were three and a half times more likely to be in the shorter stay group, and clients who lived in institutions prior to program entry were three times more likely to be in the longer-stay group. Factors contributing to drop out for this Latino sample were similar to those identified in the literature for non-Latino samples. Methods for addressing the needs of clients with co-occurring disorders are discussed.     

Family reunification efforts that work: A three year follow-up study of children in residential treatment

A three year follow-up study of children discharged from a residential treatment program was conducted to determine long-term family reunification rates. The primary interest was a comparison of families which had received different types of parent involvement programs during their child's placement. Results indicated that families which had received a combination of experiential and didactic involvement programs reunified at a significantly higher rate than did those receiving either program separately. Results are discussed with regard to the difficulties of achieving successful reunification for families with children in placement.     

Juvenile offender recidivism: an examination of risk factors

One hundred and seventy three male juvenile offenders were followed two years postrelease from a residential treatment facility to assess recidivism and factors related to recidivism. The overall recidivism rate was 23.9%. Logistic regression with stepwise and backward variable selection methods was used to examine the relationship between recidivism and nine specific variables: offense type, age at initial involvement in juvenile justice, child welfare system involvement, termination of parental rights, parental criminal history, family support, program completion status, length of treatment stay, and discharge placement. Offender type was the only factor found to have a significant impact on recidivism with general and substance-involved offenders more likely to recidivate than sex offenders. Implications for future research are discussed.     

Juvenile Offender Recidivism: An Examination of Risk Factors

One hundred and seventy three male juvenile offenders were followed two years postrelease from a residential treatment facility to assess recidivism and factors related to recidivism. The overall recidivism rate was 23.9%. Logistic regression with stepwise and backward variable selection methods was used to examine the relationship between recidivism and nine specific variables: offense type, age at initial involvement in juvenile justice, child welfare system involvement, termination of parental rights, parental criminal history, family support, program completion status, length of treatment stay, and discharge placement. Offender type was the only factor found to have a significant impact on recidivism with general and substance-involved offenders more likely to recidivate than sex offenders. Implications for future research are discussed.     

Vicarious trauma: an exploratory study of the impact of providing sexual abuse treatment on clinicians' trust and intimacy

This study examined vicarious trauma effects in male and female clinicians who treat sexual abuse survivors (n = 111) and sexual offenders (n = 272). The national survey was conducted using a random sample of clinical members of two professional organizations. Analyses tested the relationships between demographic variables, maltreatment history, client population served, and cognitions about trust of and intimacy with others, using the Trauma Stress Institute Belief Scale (TSIBS-R-L, Pearlman 2003), the Childhood Trauma Questionnaire (CTQ, Bernstein & Fink, 1998), and author-generated questions. Respondents reported high rates of multiple forms of childhood maltreatment; however there was no relationship between history of child sexual abuse and vicarious trauma effects. Scores for self-reported disruption in cognitions about intimacy with others exceeded norms for mental health professionals. Sequential regression analyses were used to examine theoretically-derived variables. Implications for practice and research are detailed.     

When Home Is Still Unsafe: From Family Reunification to Foster Care Reentry

Reuniting children with their families is the preferred outcome of foster care, yet many children reunited with their families reenter foster care. This study examined how parental substance abuse and mental health problems, and the time allotted for reunification, are associated with reentry risk. We used a complete cohort of children who entered the Texas foster care system in fiscal years 2008 and 2009 to identify the risk of foster care reentry within 5 years of reunification using selection‐adjusted multilevel survival analysis. Approximately 16% of reunified children reentered care within 5 years. Substance abuse and mental health problems predicted higher rates of reentry. Reunification after 12 months was associated with increased reentry risk overall, but not among children commonly exempted from federal permanency timelines. Permanency guidelines that restrict the length of time to achieve reunification may have the unintended consequence of pushing reunification before maltreatment risks have been resolved.     

The effect of menstruation on psychiatric hospitalization

This study evaluated the effect of menstruation on psychiatric hospitalization. We conducted a retrospective chart review of the medical records of 177 women who met the eligibility criteria. Data collected included demographic details, primary and secondary diagnoses, date of last menstrual period (LMP), medication adherence, psychiatric hospitalization length of stay, previous psychiatric admissions (including those related to menstruation), discharge referrals, and readmissions. The majority of women were admitted for major depression, were single, Caucasian, and had a mean age of 34. A disproportionate percentage (37%) of women had their LMP within 5 days of psychiatric hospitalization (p = 0.0006). The overall average length of stay was 4.37 days, and 48.3% had a previous psychiatric admission. Medication adherence was routinely not documented (77.4%). Psychiatric hospitalizations for women are significantly greater within 5 days of their LMP. Nursing education and improved documentation are warranted to decrease the potential for readmission.     

Predictors of treatment outcome in a child and adolescent psychiatry clinic: A naturalistic exploration

We present data on predictors of treatment outcome for 3200 consecutive referrals to a child and adolescent psychiatry clinic. Using Reliable Change Index (RCI) methodology, we divided children into those who, between intake and discharge, improved, stayed the same, or got worse according to clinician-rated impairment. Most predictors of improvement were related to parent variables (marital status, maternal anxiety, and ethnicity), while those associated with deterioration were tied to child status (extent of psychiatric comorbidity, history of placement in a self-contained classroom, and a prior trial of psychotropic medications). The implications of these findings for data-driven program development, clinic management, treatment planning, and systems of care are discussed.     

Commitment of Juveniles to Training Schools

The study analyzes commitment rates to training schools, average length of stay and the facility utilization in the various states over the period 1979–1990. Based on a regression analysis of the data, we found that only the bed ratio, which is the number of beds per 100,000 eligible population, and average length of stay in training schools are significant in explaining the changes of commitment rate over the years. The paper focuses on the meaning of the variation between states on the commitment rate, the average length of stay and facility utilization might have in terms of correctional policy. There is also a discussion of our findings that the only significant variables in explaining commitment rate change were institutional variables that influence correctional policy.     

Latinas in Treatment

Abstract

This study analyzed secondary data collected from a recovery home specifically for Hispanic female substance abusers, and from four other recovery homes. Demographics, drug use history, and length of stay were compared to determine if participants of the culturally specific home remained in the program longer, and the reasons why. Results indicated that the women in the Hispanic recovery home stayed over a month longer and were more likely to be poor, unemployed, and methamphetamine or heroin addicts. Regression analysis was used to determine how these and other characteristics predicted length of stay, a variable that has been found to correlate with successful outcomes. Length of stay was associated with the culturally specific program, prior arrests, and years of problem drug usage. Implications for program design and treatment are discussed.     

Does family reunification from residential care facilities serve children's best interest? A propensity-score matching approach in Ghana

The U.N. Convention on the Rights of the Child declares that children are entitled to grow up in a family environment with love, happiness and understanding. Governments and international child welfare agencies have promoted the reintegration of children currently in residential care facilities with family or other caregivers. We assess whether 157 children who spent time in a Ghanaian residential care facility but who have been reunified with their families scored differently on a battery of standardized child wellbeing measures than 204 children still living in residential care facilities using propensity score matching models. Results suggest that outcomes, including overall hope (as well as hope pathways and hope agency) and access to basic resources as measured on the Child Status Index, differ between children who were and were not reunified. These results underline the importance of supporting children's physical and psychosocial developmental needs. Children who were reunified with family members or other kin may require additional support regarding access to basic resources whereas interventions designed to increase hope in the future may benefit children in residential care. We urge a redoubling of efforts to care for children under carefully designed national schemes providing resources, trained personnel, and sustained case management.     

The experiences and outcomes of children in foster care who were removed because of a parental disability

The purpose of this study is to examine the experiences and outcomes of children in the foster care system in the United States who were removed from their homes at least partially in relation to their parent's or caretaker's disability. This study uses administrative data from the 2012 year of the Adoption and Foster Care Reporting System (AFCARS), the federal reporting system that collects case-level data on all children in foster care through state and tribal IV-E agencies. While this administrative dataset doesn't collect data on parental disability, it does collect data on parental disability as a removal reason for children in foster care. In 2012, 19.0% of children in foster care had parental disability indicated as at least one removal reason, and 5.18% had parental disability indicated as their sole removal reason. Logistic regression was used to explore how a removal reason of parental disability correlated with removal manner, type of placement, location of placement, current case plans, discharge reasons and termination of parental rights. T-tests were used to compare children with and without parental disability as a removal reason in regards to number of placements, age at removal, length of time since last removal, length of stay in current placement, and total days in foster care. As foster children could have multiple removal reasons, analyses were conducted separately for children with parental disability as at least one removal reason, and those with parental disability as their sole removal reason. Findings indicate that children who have parental disability as a removal reason have different experiences in child welfare and different child welfare outcomes than those without parental disability as a removal reason. While the AFCARS removal reason of parental disability is not a proxy for parental disability, the study points to a need for closer attention to parental disability within the child welfare system to ensure appropriate services and supports, as well as fair treatment.     

Exploratory analysis of child protection mediation permanency placement outcomes

Using a merged data set constructed from empirical data obtained from Child Protective Services (CPS) and a nonprofit agency tasked with conducting an evaluation of a child protection mediation pilot project in the state in which this study was conducted, this study (N = 311) explores how various child and family factors in child protection mediation cases affect placement outcomes for children in care. Results of the multinomial logistic regression (MLR) analyses found that children for whom parent/caregiver substance abuse and/or mental illness was an issue were less likely to be reunified with their parents than remain in care. Those children who experienced a higher number of placements and those who were male were less likely to be placed with relatives. Children whose parents experienced mental health issues were less likely to be placed with a relative. With regard to the permanency outcome of adoption, the findings showed that as the age of the child at time of removal increased, children were less likely to be adopted than remain in care. Additionally, African American children in the sample were less likely to be adopted.     

Homelessness and aging out of foster care: A national comparison of child welfare-involved adolescents

The present study represents the first large-scale, prospective comparison to test whether aging out of foster care contributes to homelessness risk in emerging adulthood. A nationally representative sample of adolescents investigated by the child welfare system in 2008 to 2009 from the second cohort of the National Survey of Child and Adolescent Well-being Study (NSCAW II) reported experiences of housing problems at 18- and 36-month follow-ups. Latent class analyses identified subtypes of housing problems, including literal homelessness, housing instability, and stable housing. Regressions predicted subgroup membership based on aging out experiences, receipt of foster care services, and youth and county characteristics. Youth who reunified after out-of-home placement in adolescence exhibited the lowest probability of literal homelessness, while youth who aged out experienced similar rates of literal homelessness as youth investigated by child welfare but never placed out of home. No differences existed between groups on prevalence of unstable housing. Exposure to independent living services and extended foster care did not relate with homelessness prevention. Findings emphasize the developmental importance of families in promoting housing stability in the transition to adulthood, while questioning child welfare current focus on preparing foster youth to live.     

The relationship of placement experience to school absenteeism and changing schools in young,school-aged children in foster care

Background

Chronic school absenteeism and frequent school changes, particularly among younger children, may be antecedents for the high rates of school failure and subsequent dropout among youth in foster care. However, the relationship of foster care experience to absenteeism and school change has not been well studied.

Objective

This study examined the association of placement experience with absenteeism and changing schools among 209 urban children in foster care enrolled in public elementary schools.

Methods

A cohort of children aged 5 to 8 years who entered non-relative or kinship foster care from 2006–2008 were followed longitudinally for 2 years from entry into foster care. Children residing in foster care were categorized at the end of the study as early stable, late stable, or unstable, if they achieved a permanent placement prior to 45 days, between 45 days and 9 months, or failed to do so within 9 months, respectively. Children who reunified home were classified as a fourth category. Poisson regression, controlling for baseline factors, was used to compare days absent and number of schools attended across categories of placement experience.

Results

Among the 209 children, 51% were male, 79% were African American, and 55% were initially placed with kin. One third of children reunified home; among children who did not reunify, one half was early stable, and a third was unstable. Adjusted rates of school absenteeism increased in stepwise fashion as children's placements became more unstable; children with unstable placements were 37% more likely to be absent than those with early placement stability (p = 0.029). Children who reunified during the study demonstrated the highest rates of absenteeism; however, there was no significant difference in absenteeism before or after reunification. Number of schools attended increased as stability worsened, with the standardized rate of schools attended reaching 3.6 schools (95% CI 3.1–4.1) over a two year period among children in unstable placements.

Conclusions

The relationship between placement experience and school absenteeism and school change illustrates the need to better coordinate the educational experience of high-risk children in foster care. The secondary finding of high absenteeism among children in the process of returning home illustrates that educational challenges for youth may be equally if not more concerning among the greater majority of youth in child welfare who remain home with birth parents.     

Characteristics Predictive of Child Sex Abusers' Response to Treatment:

This was an exploratory study designed to investigate a variety of characteristics of child sex abusers that may bc predictive of treatment response. A total of 122 clients were interviewed prior to their entry into therapy. The majority of thc sample could be classified as intrafamilial abusers. This study focused on Ihree classes of variables: (1) sociodemo ra hic characteristics, (2) molestation history characteristics, an%(3! psychosexual history characteristics. The results indicated that therapy attendance accounted for a significant portion of the treatment variance. Offenders from high socioeconomic classes show better therapy progress than thosc from the lower socioeconomic strata. Denial of abuse was found to be a major impediment to therapy progress. Offenders who have a sexuality conservative orientation also progress more slowly than those whose sexual views are more liberal. Those offenders who had been victimized during their own childhood show more rapid treatment progress than offenders who did not have this history. In general, however, psychosexual history variables accounted for only small portions of treatment progress variance.     

Treatment outcomes among adolescents with substance abuse problems: the relationship between comorbidities and post-treatment substance involvement

This study examines comorbid mental disorders in relation to post-treatment outcomes (12 months post-intake) among adolescents (N=419) who entered three residential drug treatment programs. When contrasted with youths who had no comorbid mental disorders or youths with a single comorbid condition, those with combined internalizing and externalizing disorders (mixed comorbidity) had higher levels of substance-related problems and poly-drug use at entry to treatment, and poorer outcomes, e.g. relapse, particularly evident for drugs other than alcohol or marijuana. A significantly higher proportion of those with mixed comorbidity were admitted to short term residential treatment, as compared to long term residential care. However, the effects of comorbidity were independent of both planned and actual length of stay, suggesting that comorbidities can negatively impact treatment outcome in multiple ways, apart from length of stay. Since co-occurring problems appear to profoundly limit treatment effectiveness, treatment strategies that address comorbidity are needed to improve outcomes.     

The Social and Spatial Stratification of Vaccinal Patterns in Berlin Following Re‐Unification

Efforts by health authorities to stress the importance of herd immunity in the light of a resurgence of seemingly vanquished childhood diseases have frequently met with poor response rates. Investigating whether reunified Berlin can achieve a desirable herd immunity of 80% ‐ 85% against diphtheria, this paper examines the potential influence of socio‐demographic variables (age, gender, social circumstances, migration background) on vaccine‐uptake. Secondly, it investigates historically diverging vaccinal policies in Berlin as well as recent changes to monitoring coverage in their effect on immunisation‐related behaviour.