Where is the exit? Intergenerational ambivalence and relationship quality in high contact ties

We challenge the common idea that solidarity has positive, whereas conflict has negative implications, by investigating intergenerational ambivalence – defined as the co-occurrence of solidarity and conflict – and relationship quality. We use representative data on non-coresident adult children and parents with high levels of contact (weekly or more; N = 2,694 dyads). Results show that over half of high contact parent–child ties can be characterized as ambivalent and of high-quality. The likelihood of negative instead of positive ambivalent ties is greater if adult children have few exit options because they are socially isolated or have a small number of siblings. Ties between fathers and sons, and those between caring daughters and aging parents also have a high probability of belonging to the negative ambivalent type.     

Programmatic effects to modify sources of financial support among Hispanic teenage mothers

This study evaluates whether a randomized school-based intervention for adolescent teenage mothers successfully helped participants achieve better financial independence and economic prospects. Project Mothers and Schools (PMAS) is an initiative intended to modify attitudes and beliefs related to self-sufficiency, parenting, educational goals and achievement, career goals, health behaviors, and interpersonal relationships with family members. PMAS participants were surveyed at baseline and 12 months after intervention enrollment to evaluate the receipt of financial support from 11 sources. The 48 “core group” participants received a basic level of services, whereas the 43 “core-plus group” participants received the same basic services and additional enhanced services. Wilcoxon signed-rank tests were used to identify statistically significant changes in participant responses from baseline to 12 months post-intervention. Both groups reported higher levels of employment 12 months post-intervention compared to baseline (z = − 3.162, p = 0.002 and z = − 2.646, p = 0.008, respectively). The core-plus group used more Food Stamps (z = − 2.673, p = 0.008) and reported receiving more child support (z = 2.236, p = 0.025) 12 months post-intervention versus baseline. PMAS benefited all participants by promoting employment 12 months post-intervention versus baseline. The enhanced services offered to the core-plus group appeared to also increase participant access to Food Stamps and child support, sources which assist participants down the path toward eventual financial independence.     

Looking for sufficient change: Evaluation of counsellor training for STI syndromic management in India

In India, public health care of Sexually Transmitted Infections is delivered through Designated STI/RTI Clinics (DSRCs) using syndromic management. This paper describes efforts, over three years, to improve in-service training for counsellors positioned at DSRCs—using a data approach. The programme managers realised, through rigorous monitoring of initial induction training reports that, while knowledge and attitudes of most trainees had improved as evident from t-tests, at least one-quarter scored worse on post-training assessments (n = 859). Therefore, they undertook a survey using a competency approach to diagnose what critical competencies are influenced through training: counselling skills, risk reduction suggestions, labelling male and female anatomy, record-keeping and STI patient education (n = 132). Survey results demonstrated that trainees failed to pass a two-thirds cutoff score in most competencies. These findings led the programme managers to modify training and implement tighter quality measures. In the second round of training – refresher training – outcomes on competency assessments before and after training showed more acceptable performance (n = 833). The paper describes how programme managers, after an acceptance of such initial short-comings, developed customized assessments when literature provided limited guidance and how they worked to achieve change that was acceptable for programme needs.     

Staff and youth views on autonomy and emancipation from residential care: A participatory research study

The use of participatory approaches in designing services is still relatively uncommon. In this study, we helped design a service to support the transition of youth from residential care to independent living by exploring the perspectives of staff and of youth regarding: (a) the concept and development of autonomy; and (b) key factors in developing this type of service. We gathered the data through 10 interviews with staff (n = 10) and 4 focus groups with youth (n = 21), and subjected the data to a thematic content analysis. Staff defined autonomy as self-regulation and self-care, and identified three paths to foster autonomy – a sense of normality, meaningful relationships, and planning for emancipation. The staff and youth identified the following important aspects in designing the service: achieving normality (e.g. limited number of residents), promoting youth capacity (e.g. skill-building activities), providing social support (e.g. trust and respect between residents), and assuring guidance and boundaries (e.g. supervision of youth).     

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.     

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.     

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.     

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.     

Cooks training for Faith,Activity, and Nutrition project with AME churches in SC

PurposeThis study describes the development and evaluation of a participatory training for cooks in African American churches.The 8-h training focused on providing healthy meals within the church food program. It enlisted cooks in hands-on “cooking with the chef” training and menu building exercises, and demonstrated development of flavor in foods through healthy ingredients. Cook ratings from pre- to post-training (possible range: 1–10) were evaluated with the Wilcoxon signed rank test.Results114 cooks from 57 churches over the period from 7/21/07 to 3/21/11 participated in trainings. Self-rated cooking skill increased from pre- (6.5 ± SD) to post-training (7.9 ± SD), p = 0.0001. Self-rated confidence in preparing meals also increased significantly (pre: 7.3 ± SD; post: 8.3 ± SD), p = 0001.Qualitative feedback from the cooks’ training has been positive. Two of the more frequently stated changes cooks report are using less salt and using more vegetables and fruits in menus. Lessons learned include: choosing the right church to host the training, teamwork as a key component, need for support system for church cooks, allocation of time for planning as well as shopping for healthy ingredients, and incorporation of flexibility into the training plan.     

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.     

Measuring social networks cross-culturally

This paper explores the reliability and validity of a cross-cultural survey approach to network measurement using data from two ethnic groups in rural West Africa. Over a 2-week test-retest period, no significant differences in network size were detected. Network composition was less stable over the same period, particularly among peripheral versus core network members. Comparisons with support networks identified through lifecycle interviews and 24 h recall support the construct validity of the survey approach in both ethnic groups.     

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.     

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.     

‘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.     

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.     

Statistical power of the social network autocorrelation model

The network autocorrelation model has become an increasingly popular tool for conducting social network analysis. More and more researchers, however, have documented evidence of a systematic negative bias in the estimation of the network effect (ρ). In this paper, we take a different approach to the problem by investigating conditions under which, despite the underestimation bias, a network effect can still be detected by the network autocorrelation model. Using simulations, we find that moderately-sized network effects (e.g., ρ = .3) are still often detectable in modest-sized networks (i.e., 40 or more nodes). Analyses reveal that statistical power is primarily a nonlinear function of network effect size (ρ) and network size (N), although both of these factors can interact with network density and network structure to impair power under certain rare conditions. We conclude by discussing implications of these findings and guidelines for users of the autocorrelation model.     

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.     

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.     

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.