Does what happens in group care stay in group care? The relationship between problem behaviour trajectories during care and post‐placement functioning

Residential programmes for youth may improve youth behaviour during placement, but it is not clear whether there is an association between a youth's behaviour pattern during placement and post‐placement outcomes. Life course perspective has been used to understand longitudinal patterns and pathways, and new statistical methods have been developed to identify latent trajectory groups. This study used administrative data from a family‐style group care programme to assess whether a youth's externalizing behaviour trajectory while in placement can significantly predict delinquency and adjustment outcomes at discharge and 6‐month follow‐up. Findings from multinomial logistic regression revealed a statistically significant relationship between a youth's behaviour trajectory class and outcomes. Behaviour pattern during care was a stronger predictor of outcome than cross‐sectional measures such as other demographic factors, placement history or mental‐health need indicators.     

Relations Among Gender Typicality,Peer Relations,and Mental Health During Early Adolescence

The current study examines whether being high in gender typicality is associated with popularity, whether being low in gender typicality is associated with rejection/teasing, and whether teasing due to low gender typicality mediates the association with negative mental health. Middle school children (34 boys and 50 girls) described hypothetical popular and rejected/teased peers, and completed self‐report measures about their own gender typicality, experiences with gender‐based teasing, depressive symptoms, anxiety, self‐esteem, and body image. Participants also completed measures about their peers' gender typicality, popularity, and likeability. Results indicated that popular youth were described as more gender typical than rejected/teased youth. Further, being typical for one's gender significantly predicted being rated as popular by peers, and this relationship was moderated by gender. Finally, low gender typicality predicted more negative mental health outcomes for boys. These relationships were, at times, mediated by experiences with gender‐based teasing, suggesting that negative mental health outcomes may be a result of the social repercussions of being low in gender typicality rather than a direct result of low typicality.     

Building home on a fault line: Aging out of child welfare with a serious mental health diagnosis

Youth aging out of foster care are at high risk for homelessness. This research explains how and why homelessness occurs among youth with serious mental health struggles after aging out of residential and transitional living programmes. Using a longitudinal constructivist grounded theory design, we analyse 20 in‐depth interviews exploring youth's transition experiences and perceptions of transition success within 4 months of emancipation and at 6 and 12 months postemancipation. Monthly 15‐min check‐ins prevented attrition. A three‐phase transition process was observed driven by participant desires and actions to cultivate psychological home through establishing physical home alone away from social networks. Pre‐emancipation, the promise of home was privacy and opportunity for self‐redefinition. Shortly after emancipation, home became a physical and social space to be, a valuable resource to share and a demonstration of personal transition success. However, later in the year postemancipation, maintaining physical home proves nearly impossible given the risk context. Findings speak to how and why youth aging out appear overly self‐reliant upon emancipation. Cultivating a psychological sense of home has practice implications for child welfare providers who aim to prepare youth to live independently postemancipation.     

Examining Protective Factors for Dysthymia Among Individuals Attending Substance Abuse Treatment

ABSTRACT

Dysthymia affects millions of people and has been associated with impaired psychosocial and occupational functioning and poor clinical treatment outcomes. Yet few studies have examined protective factors that can be utilized to help individuals with dysthymia in clinical settings, particularly among individuals with comorbid substance use disorders. The purpose of this study was to examine the potential protective quality of adult attachment dimensions, spirituality, and meaning in life among clients with and without dysthymia in treatment for addiction. Data were obtained from 305 self-report questionnaires administered to clients attending a residential substance abuse treatment center. Approximately 25% of the sample met criteria for dysthymia. Results from logistic regression analyses indicated that purpose and meaning in life and attachment anxiety were the most important protective factors against having dysthymia. These results suggest that mental health professionals may need to integrate these protective factors into the treatment of individuals with dysthymia and substance use disorders, which may enhance treatment outcomes and maximize treatment effectiveness. Future studies should continue to explore protective factors that can assist individuals who experience these comorbid conditions and consider replicating this study using an ethnically diverse sample and other clinical settings to determine the generalizability of the findings.     

Can Psychosocial Intervention Improve Peer and Sibling Relations Among War‐affected Children? Impact and Mediating Analyses in a Randomized Controlled Trial

Social resources are considered important protectors in traumatic conditions, but few studies have analyzed their role in psychosocial interventions among war‐affected children. We examined (1) whether a psychosocial intervention (teaching recovery techniques, TRT) is effective in improving peer and sibling relations, and (2) whether these potentially improved relations mediate the intervention's impacts on children's mental health. Participants were 428 Palestinian children [10–13 (mean = 11.29, standard deviation SD = .68)‐year‐old girls (49.4 percent) and boys (50.6 percent)], who were cluster‐randomized into the TRT and wait‐list control groups. They reported the quality of peer (friendship and loneliness) and sibling (intimacy, warmth, conflict, and rivalry) relations, and posttraumatic stress, depressive and psychological distress symptoms, as well as psychosocial well‐being at baseline (T1), postintervention (T2), and six month follow‐up (T3). Results showed gender‐specific TRT intervention effects: Loneliness in peer relations reduced among boys and sibling rivalry reduced among girls. The TRT prevented the increase in sibling conflict that happened in the control group. The mediating hypothesis was partially substantiated for improved peer relations, and beneficial changes in sibling relations were generally associated with improved mental health.     

Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

ABSTRACT

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.     

Comfort and Confidence Levels of Health Care Professionals Providing Pediatric Palliative Care in the Intensive Care Unit

ABSTRACT

Most childhood deaths that occur in the hospital happen in the pediatric intensive care unit. Providing pediatric palliative care in the intensive care unit comes with unique challenges due to the acute care, curative and often medically aggressive focus of these settings. In this study, 190 PICU health care professionals reported on their comfort and confidence in providing palliative care. Findings indicate that professionals report only a moderate level of comfort and confidence in this type of care in the pediatric ICU. For physicians and nurses, comfort and confidence was significantly higher for those who had practiced 8 years or more. Practitioners reported less comfort in providing psychosocial care. Implications for the social work role on the interdisciplinary team and suggestions for future research are discussed.     

The contribution of mentoring to the life skills of youth leaving care in Israel

The goal of this study was to examine the contribution of natural mentoring to the improvement of life skills among youth in care in core areas of education, employment, and avoidance of risk behaviours while controlling for personal characteristics and placement history. The sample includes 174 adolescents in residential care in Israel. Results showed that mentoring duration and mentoring functions including mentor as “role model,” “parental figure,” and “independence promoter” significantly contributed to the prediction of the three life skills above and beyond control variables. This study highlights both the array of meaningful roles mentors play in youth's development of life skills and identifies important practice implications regarding the mechanism by which mentoring relationships contribute to the resilience of adolescents.     

The effect of services coordination teams on outcomes for children in state custody

The author describes the results of a quasi-experimental study of the effects of interorganizational services coordination teams on the quality and outcomes of services to children in state custody. The findings suggest that services coordination teams improve access to services and enhance service outcomes. Children served by services coordination teams were more likely to be placed in less restrictive residential settings, more like to be placed in settings appropriate to their levels of psycho-social functioning, and more likely to receive needed services from the state's mental health system. Moreover, those children with the most serious externalizing problem (i.e., aggressive, antisocial) behavior made more progress when served by services coordination teams.     

Youth and parent perceptions of aftercare supports at discharge from residential care

While much is known about youth struggles after reintegration into the home and community settings following stays in out‐of‐home care, little is known about appropriate supports for aftercare, or parent (see Note ¹ ) and youth perceptions during this critical transition period. This study seeks to begin to address these questions through surveys evaluating youth (n = 48) and parent (n = 48) perceptions of (i) transition planning, family preparedness and aftercare; (ii) youth preparedness for the transition period across major life domains (e.g. education, health care, relationships); and (iii) the importance of specific aftercare supports and services. Results indicate differences between youth and parents on perceptions of need for continued supports, likelihood of participation in aftercare programs; and youth preparedness for success in relationships, family and independent living domains. In contrast, similarities were found on youth and parent ratings regarding the importance of specific services and supports, with both groups indicating supports in education as most important and supports in mental health as least. Study limitations, future research and implications are provided.     

Sleep among youths in foster care: Associations with potentially traumatic events,PTSD and mental health

Among maltreated youth in foster care, little is known about frequency of sleep problems and its association to potential traumatic events (PTEs) and mental health. Among youths in foster care, we examined: (1) sleep patterns, difficulties initiating and maintaining sleep (DIMS) and related functional impairment; (2) whether exposure to PTEs, symptoms of post‐traumatic stress disorder (PTSD) and general mental health problems are associated with DIMS and related functional impairment, controlling for age, gender and time in foster care; and (3) whether PTSD and general mental health problems mediate the association between PTEs and DIMS. Foster youths in Norway (n = 299) completed a survey on sleep behaviour, the Child and Adolescent Trauma Screen, and the Strengths and Difficulties Questionnaire. Overall, 53.2% reported DIMS. For 82.1%, these sleep problems had lasted 3 months plus. Increased PTEs, PTSD and general mental health problems were all associated with increased DIMS score. Increased rate of PTEs was associated with decreased sleep duration. PTSD and general mental health problems partially mediated the association between PTEs and DIMS. Youth in foster care are at high risk of sleep problems, related to traumatic experiences and mental health problems. Treatment of PTSD may improve sleep problems among maltreated youth.     

Correlates of Treatment Retention Among Persons with Serious Mental Illness Receiving Integrated Care in a Community Mental Health Setting

ABSTRACT

Knowledge about methods to retain community mental health (CMH) clients in integrated primary and behavioral health care (PBHC) programs is needed to address longstanding health disparities. A preexisting data set that contained the clinical records of 446 PBHC program participants was used to examine whether baseline sociodemographic, health, and psychosocial characteristics predicted retention in care at 6 months post-enrollment. Results indicated that less than half of PBHC participants (43.7%) were retained in care, and approximately 17% of the variance in retention was explained by the inclusion of seven predictors in the model (overall health, medications, laboratory data, primary care provider, disorder type, transportation, and living arrangement). Clients with thought disorders were almost twice as likely as those with mood disorders to be retained in care, and greater frequency of prescribed medications also increased the likelihood of treatment continuation (ORs = 1.99 and 1.20, respectively). Future research should identify factors that improve retention in integrated PBHC programs overall, and among persons with mood disorders, in particular.     

Intergenerational pathways leading to foster care placement of foster care alumni's children

This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between poorer father's functioning to greater alumni depression, which was in turn associated with negative social support, and then a greater likelihood of child out‐of‐home placement. Other parent to alumni paths were that poorer father functioning was associated with alumni anxiety and post‐traumatic stress disorder (PTSD), and poorer mother's mental health was associated with PTSD; however, anxiety and PTSD were not implicated as precursors of foster care placement of the child. Findings support the need for increased practice and policy support to address the mental health needs of parents of children in or at risk of foster care, as well as the children themselves, as family history may have a lasting influence on quality of life, even when children are raised apart from biological parents.     

Applying a Positive Youth Development Perspective to Observation of Bereavement Camps for Children and Adolescents

A positive youth development perspective focuses on recognizing psychosocial strengths and providing social environments that contribute to the development of these in children and adolescents. Bereavement camps can provide such an environment as they help children cope with the death of someone close. The purpose of this study was to observe bereavement camps through the lens of positive youth development to determine the applicability of the eight features of positive developmental settings for describing bereavement camps (safety, appropriate structure, supportive relationships, opportunities to belong, positive norms, support for efficacy, skill building opportunities, integration of family and community). Observational notes were recorded by researchers during on-site visits to three different weekend bereavement camps. Results identified how each element of positive developmental settings was exemplified in either typical camp activities or bereavement-focused activities. For example, assigning campers to cabin groups based on age and gender provided opportunities to belong, and giving campers a comfort object and a big buddy provided supportive relationships. Findings were used to create a positive developmental settings observation checklist for use by bereavement camp practitioners to assess the extent to which each camp provides the requisite elements for promoting positive youth development.     

Do Marginalized Youth Experience Strengths in Strengths-Based Interventions? Unpacking Program Acceptability through Two Interventions for Sexual and Gender Minority Youth

ABSTRACT

Strengths-based interventions have potential to improve the wellbeing of sexual and gender minority youth (SGMY). This study examined the youth program acceptability of two strengths-based programs tailored for SGMY: ASSET (group counseling), and strengths first (SF) (care coordination). A mixed-methods approach was applied to secondary data extracted from client files (n = 247). Most participants were aged 15–18 (89%). Gender identities included woman (66%), man (30%), and transgender (<1%). Sexual orientations included bisexual (32%), lesbian (26%), gay (23%), and queer/pansexual (14%). Most participants identified as White, Hispanic (47%), Black, Non-Hispanic (17%), and Hispanic, No other race (19%). Program acceptability was measured using the 11-item Youth Acceptability and Strengths Scale. Quantitative analyses indicate program acceptability was high for SGMY participants and did not significantly differ across program type, gender identity, sexual orientation, or ethnoracial identity. There were no differences between strengths enhancement or client satisfaction between intervention types. Compared to group counseling, care coordination significantly increased problem-solving skills. Qualitative analysis identified that strengths-based interventions provided: (a) social support; (b) community; (c) confidence; and (d) positive mentors. Findings demonstrate the acceptability of strengths-based programming for SGMY. Strategies are provided to incorporate intervention program acceptability, yet future research is needed to explore youth acceptability.     

Multi-system factors impacting youth justice involvement of children in residential out-of-home care

Children placed in residential care are significantly over-represented in youth justice systems. Drawing on interviews and focus groups with service providers, this exploratory study examines practice factors that impact on the criminalization of this group of children across multiple services and systems, including in the residential care environment, police, lawyers, courts and youth justice systems, as well as multi-systems practice with this group in one Australian state. Positive outcomes were observed for children in residential care where well-functioning care teams existed, as well as for children in therapeutic residential care settings. However, clear limitations were identified across all phases of children's youth justice system involvement, including placement with offending peers, the criminalization of behaviours of concern, greater use of remand and detention, limited support to navigate legal and youth justice processes, challenges to service collaboration, and limited applicability of sentencing considerations. The findings indicate a pervasive level of systemic disadvantage for this group of children, and imply that a holistic strategy underpinned by affirmative action across several systems will be necessary to address the ongoing criminalization of children in residential care.     

The relationship between adverse childhood experiences,health and life satisfaction in adults with care experience: The mediating role of attachment

Adverse childhood experiences (ACEs) are associated with a plethora of negative outcomes. Research has also found that adults who were separated from parental care and lived in alternative care settings during childhood have high levels of ACEs and are more likely to have poor outcomes. A growing body of research has supported the importance of attachment as a mechanism underlying the relationship between ACEs and adult wellbeing. However, little work has examined the role that attachment may play in the outcomes of adults who resided in residential and foster care during childhood. The current study examined the role of attachment avoidance and anxiety in the associations between ACEs and mental health, physical health, and life satisfaction in a sample of 529 adults with alternative care experience from 11 nations. Attachment avoidance partially mediated the relationship between ACEs and life satisfaction, mental health, and physical health. Attachment anxiety partially mediated the relationship between ACEs and life satisfaction and mental health, but not physical health. Taken together, the present study suggests that both attachment anxiety and avoidance play important, but unique, roles in understanding the relationship between ACEs and health and wellbeing for adults with care experience. Implications and limitations are discussed.     

Self-reported mental health problems and post-traumatic growth among children in Pakistan care homes

ABSTRACT

Children in care experience multiple risk factors, particularly in low-income countries such as Pakistan. The aim was to establish rates of mental health problems and their relationship with posttraumatic growth, as reported by 132 children aged 9–19 years, living in three care homes in Pakistan. Children reported high rates of posttraumatic stress (70.45%) and common mental health symptoms (43.94%) within the clinical range, but also high levels of posttraumatic growth. These findings highlight the high levels of mental health needs among children in residential care, as well as the importance of understanding factors that promote their posttraumatic growth and resilience.     

The Senior Outreach Program of Park Ridge Mental Health

Abstract

Availability and accessibility of mental health services for the elderly is woefully inadequate, failing to recognize the diversity of needs in the older adult population. Stigma, confusing and exclusionary insurance regulations and restrictive mental health center policies have both limited and discouraged treatment interventions. Through innovative case finding, programming and funding arrangements, the Senior Outreach program of Park Ridge Mental Health in Rochester, New York, has proven effective in identifying and providing outreach mental health services to elderly individuals. The program utilizes a human services agency model, yet operates within a large heath care system as part of a continuum of psycho-geriatric services.     

Adventure therapy and its impact on the functioning of youth in a community setting

The purpose of this article is to explore the impact of one type of activity-based group work, adventure therapy (AT) group practice, on youth in a community-based mental health setting. Using data collected from Adventure Works, a nonprofit outdoor behavioral healthcare and adventure therapy counseling center, this article explores treatment outcomes to identify the effectiveness of adventure therapy group interventions. AT has been identified as an effective intervention within wilderness and residential settings, but little research exists focusing on adventure therapy in a community setting. Data collected shows positive outcomes for youth participating in adventure-based group therapy. Research and practice implications are discussed.