The impact of para-professional social workers and community health care workers in Côte d'Ivoire: Contributions to the protection and social support of vulnerable children in a resource poor country

BackgroundResearch indicates a disproportionate impact of HIV and AIDS in sub-Saharan African countries, leading to many vulnerable families and children. Many of these communities have limited resources to support these vulnerable families, especially orphans and vulnerable children (OVC).Study aims and objectiveThis study set out to investigate how para-professional social workers and community health workers (PSWCHW) impact the provision of services and the psychosocial wellbeing and protection of vulnerable children in the community.MethodsThis quasi-experimental research study used data from an independent Save the Children program evaluation study in Côte d'Ivoire. We compared the health and psychosocial wellbeing of identified vulnerable children supported by para-professionals (n = 334) and children not receiving para-professional support (n = 213).FindingsSupport services and activities provided by PSWCHW included encouraging the children to be part of psychosocial support groups. Many of the children reported legal issues that ranged from getting a birth certificate issued to fighting or quarrelling with adults, disputes, public insults, beatings, and refusing to go to school. We found that the engagement of PSWCHW helped three out of four children go to school (compared to only one in four of the children without PSWCHW). PSWCHW also helped the children improve access to health care services.ConclusionsCommunities in sub-Saharan Africa should continue to consider the integrated utilization of para-professional social workers and community health care workers to support and improve psychosocial wellbeing of orphaned and vulnerable children which, in turn, enhances child protection services and access to healthcare.     

The characteristics of delinquent behavior and predictive factors in Japanese children's homes

The purpose of this study was to examine the risk factors of delinquent behavior in children's homes in Japan and the co-occurrence of externalizing problem behavior and internalizing problem behavior. Eight hundred and nine children (436 boys, 373 girls were recruited from such homes. Childcare workers from these homes completed sets of questionnaires. Our results found significant relationships between delinquent behavior and gender [odds ratio (OR) = 1.66; 95% confidence interval (CI), 1.16–2.38], age (OR = 1.25; 95% CI, 1.16–1.35), parent–child conflict (OR = 2.79; 95% CI, 1.45–5.36), neglect (OR = 1.43; 95% CI, 1.03–2.11), and aggressive behavior (OR = 1.10; 95% CI, 1.08–1.12). Results also showed externalizing problem behaviors and internalizing problem behaviors were associated with age (OR = 1.23; 95% CI, 1.08–1.41), thought problems (OR = 1.37; 95% CI, 1.17–1.59), attention problems (OR = 1.12; 95% CI, 1.02–1.23), and physical abuse (OR = 3.09; 95% CI, 1.64–5.83). Our study clarifies the predictive factors for delinquency and related internalizing behavior symptoms and externalizing behavior problems. These results indicate that children in children's homes have various problems and require multilevel intervention. Our findings may be used to improve current policies governing children's homes.     

The relationship between parent immigration status and concrete support service use among Latinos in child welfare: Findings using the National Survey of Child and Adolescent Well-being (NSCAWII)

The underutilization of concrete services by immigrants is widely documented across several service sectors, yet evidence is lacking on the use of such services among immigrants reported to child welfare for the purposes of reducing maltreatment. It has been suggested that Latino immigrants involved with the child welfare system may face steep challenges to receiving needed services due to issues surrounding legal status, language and cultural barriers. The purpose of this study was to determine whether referral to and receipt of concrete services by Latino families reported to child welfare agencies, was associated with legal immigration status. The sample included children of Latino parents who participated in the second National Survey of Child and Adolescent Well-being (NSCAWII), who remained in the home following a child welfare investigation (n = 561). Over a third (37%) of Latino families were referred for at least one concrete service, yet only 17% received any. Weighted logistic regression models showed that families in which the primary caregiver was undocumented had significantly lower odds (OR = .24) of receiving services once referred. Families who had trouble paying for basic necessities (OR = 7.52), those with active domestic violence in the home (OR = 4.98), and those receiving ongoing child welfare services (OR = 4.52) had increased odds of referral for services by the caseworker. The odds of receiving services increased when the primary caregiver was unemployed (OR = 5.24), when there was domestic violence in the home (OR = 4.59), and with the receipt of child welfare agency services (OR = 8.83). There appears to be an unmet need for concrete services among Latinos investigated by child welfare, as demonstrated in the gap between overall service referral and receipt. A parent's legal status may be one reason for that unmet need, implying that children of undocumented parents are less likely to have basic needs met to mitigate economic stress and reduce maltreatment risk upon contact with child welfare. Policy recommendations and implications for child welfare practice are discussed.     

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.     

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.     

‘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.     

From assessing needs to designing and evaluating programs: Case study of a family support program in Portugal

In the last years, researchers have been emphasizing the importance of promoting needs-led, context-specific, user-centered services in the context of child protection. However, policy-makers and service planners around the world largely depend on US-based research evidence of what is effective in the domain of family support. This work presents, in two studies, the process of design and evaluation of a targeted family support intervention that was developed and implemented in Portugal.Following the Common Language Approach to needs assessment (Dartington Social Research Unit, 2001), in study 1 we screened 100 children and their families attending a generalist child care service for risk and protective factors. Four different clusters of needs were identified. One cluster was selected as target-group for the design of a service to match their needs. Results indicated that families in this cluster had socioeconomical disadvantages, a challenging family environment and inadequate parenting practices. Children were showing signs of problematic social behaviors.In study 2 we describe the theoretical process model and the logic model for the intervention, and experimentally evaluate the program's efficacy. Results from pre–post assessments indicate improvements in the intervention group (N = 20) in several areas of parental empowerment and family relations, comparing with the control group (N = 20).This approach to need-service matching seems to be a viable pathway to design needs-led, context-specific, and user-centered services, and to assess their efficacy, thereby informing policy makers and service planners.     

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

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

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.     

Unmet legal and social advocacy needs of children with sickle cell disease: Implications for health care payer costs

Previous studies of advocacy needs faced by children and families have not differentiated needs that require attorney involvement (“legal advocacy needs”) from needs best addressed by social workers or lay advocates (“social advocacy needs”). Studies have also not examined the relationship between either type of need and health care costs. We developed a novel, replicable process to differentiate between legal advocacy needs and social advocacy needs. We then collected cross-sectional data from a sample of 52 children with sickle cell disease who were at least 1 year of age, a population with high advocacy needs and high health care costs. Mean annual health care costs to payers for children whose families had a least one legal advocacy need were $16,314, compared to $5552 for children in families with no legal advocacy needs (P = 0.007). After adjusting for covariates, the presence of a legal advocacy need was associated with $12,040 more in health care costs to payers (P = 0.02). Whether interventions to prevent and resolve legal advocacy needs can reduce health care costs by addressing the social determinants of health warrants future study.     

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.     

Intersection of homelessness and mental health: A mixed methods study of young adults who accessed psychiatric emergency services

Young adults who experience homelessness have high rates of mental disorders, yet low rates of outpatient mental health service use. This mixed methods study examined the intersection of homelessness and mental health in a sample of 54 young adults (ages 18–25) who were hospitalized on a short-term, inpatient psychiatric unit. Nearly half (n = 26) reported being homeless in the prior year and more than a quarter were homeless at the time of admission (n = 15). Qualitative analyses identified key factors that contributed to both mental health problems and homelessness including disrupted support networks, fragile family relationships, foster care involvement, substance use and traumatic events. Homelessness was both a facilitator and a barrier to successfully accessing mental health services to manage mental health symptoms. Findings highlight the interconnection of homelessness and mental health and their common relationship with additional underlying risk factors. Providers across service settings need to recognize the overlap of client populations and provide integrated, trauma informed care to address housing instability, mental health, and substance use together.     

Contact with birth family in intercountry adoptions: Comparing families headed by sexual minority and heterosexual parents

Contact between adoptive families and birth families in the context of intercountry adoption, as well as adoption by sexual minorities (e.g., lesbians and gay men), represent understudied topics. In the current study, we examine the extent and type of contact with birth family in intercountry adoptive families headed by heterosexual and sexual minority parents. Data were drawn from the Modern Adoptive Families project, a nationwide, non-random survey of adoptive parents' beliefs and experiences that was conducted from 2012 to 2013. The current sample consisted of 479 families headed by heterosexual parents (H) and 38 families headed by sexual minority women (SM) whose oldest adopted child was younger than 18 years of age and who had been placed from another country. Although no family type difference was found in contact with birth family prior to or at the time of placement (H = 9.6%; SM = 13.2%), sexual minority respondents reported a higher level of contact with one or more members of their children”s birth families following adoptive placement than did heterosexual respondents (SM = 28.9%; H = 14.4%), as well as currently (SM = 21.1%; H 9.8%). They also reported more contact with their children”s birth mothers than did heterosexual parents, although no family type differences were found for contact with other birth family members. Policy and practice implications are discussed.     

Psychotherapeutic care for sexually-victimized children – Do service providers meet the need? Multilevel analysis

ObjectivesSurprisingly little is known on the decision to refer sexually-victimized children to psychotherapy. Previous research on service provisions for victims of child maltreatment has analyzed the impact of case characteristics, like child or caregiver functional levels, lack of social support, and socioeconomic status. Findings, however, show that the decision to provide services is not only needs-driven, but also affected by external factors like provincial legislation, institutional policies, and the availability and accessibility of services. By analyzing characteristics behind the decision to refer sexually-victimized children to psychotherapy at the case and institutional level, we aimed to disentangle the complex interplay of factors driving this decision.MethodsThe data for this analysis were drawn from the first nationally-representative agency survey on reported child sexual victimization (CSV) in Switzerland. Over a 6-month data-collection period, 165 child protective services, 87 penal authorities and 98 agencies in the health and social sector documented a total of 911 incidents of CSV. Multilevel logistic regression was applied to analyze factors at both the case and contextual level.ResultsThe main finding was that the severity of consequences was strongly associated with the probability of psychotherapeutic service referrals (OR = 10.4; p < 0.001). However, one bias was identified at the individual level: sexually-victimized children born in Switzerland were more likely to be referred to psychotherapy than immigrant children. Institutional disparities in the decision to refer a sexually-victimized child to psychotherapy were large (median OR = 3.83), with penal authorities referring significantly fewer cases to psychotherapy than specialized agencies in the health and social sector. What exactly was driving the difference between psychotherapy referral in different types of agency remains largely unexplained.ConclusionsFuture research should invest in scrutinizing contextual factors of child protective service decisions. As we operationalize the need for psychotherapy as proxy-rated consequences of victimization, routine screening for mental health needs using standardized measures for children in contact with child protection agencies should be implemented, to help frontline workers to identify the psychotherapeutic needs of victimized children.     

An intensive mental health home visiting model for two at-risk early childhood populations

This study examined proximal outcomes of a mental health home visiting model for two populations at risk for child maltreatment: families with young children referred by child protective services (CPS) and at-risk pregnant women (Prenatal) referred by community agencies. Family- and caregiver-level outcomes were measured using the Family Assessment Form (FAF). Families (n = 215) showed significant improvement in all eight family functioning factors over the course of their participation in mental health home visiting services. Initially, CPS-referred families (n = 84) scored higher on the FAF measure of Interactions between Caregivers, indicating greater conflict between caregivers in the family. Prenatal referred families (n = 131) were at greater risk initially on Housing. Prenatal-referred families demonstrated greater risk reduction on measures of Supports to Caregivers, Developmental Stimulation, Caregiver Personal Characteristics and Housing. In addition, all families demonstrated significant improvements in functioning on 11 of 12 items comprising the Caregiver Personal Characteristics factor. Overall, CPS-referred families scored at higher risk on items reflecting externalizing problems, while Prenatal-referred families showed greater improvement on items reflecting internalizing problems. This model was successful in reducing risk factors and promoting protective factors for CPS-referred and Prenatal at-risk families. Implications and future directions are discussed.     

Parental emotional warmth and psychological Suzhi as mediators between socioeconomic status and problem behaviours in Chinese children

ObjectiveThis study investigated psychological mechanisms underlying the relationship between family socioeconomic status (SES) and problem behaviours in Chinese children.MethodsParticipants were 1128 children (556 females) from two Chinese elementary schools, aged 8–13 years (M = 10.82, SD = 1.26), attending the 3rd–6th grades. Children provided self-report on parental emotional warmth and psychological suzhi, whereas parents reported on SES and problem behaviours.ResultsData analyses, including structural equation modelling (SEM)—employed to test a three-path mediation effect of parental emotional warmth and psychological suzhi after controlling for gender and grade—revealed that: (1) SES, parental emotional warmth, and psychological suzhi were negatively correlated with children's problem behaviours; (2) SES indirectly affected children's psychological suzhi through parental emotional warmth; (3) psychological suzhi mediated the relation between parental emotional warmth and problem behaviours; and (4) children belonging to families with low SES were less likely to receive emotional support from their parents. This significantly predicted low psychological suzhi levels, which in turn negatively affected problem behaviours.ConclusionsStrategies that help parents provide warmth and support and those that help children improve psychological suzhi may help reduce problem behaviours in vulnerable groups.     

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.     

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.     

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.