The Brief Assessment Checklists (BAC-C,BAC-A): Mental health screening measures for school-aged children and adolescents in foster,kinship, residential and adoptive care

More than half of children and young people in foster, kinship, and residential care, as well as those subsequently adopted from care, have mental health difficulties that require clinical formulation and intervention. While an increasing number of alternate care jurisdictions are instituting universal mental health screening, existing measures may not adequately screen for a range of attachment- and trauma-related mental health difficulties observed among these populations. The Brief Assessment Checklist for Children (BAC-C), and the Brief Assessment Checklist for Adolescents (BAC-A) are 20-item caregiver-report psychiatric rating scales designed to: 1. screen for and monitor clinically-meaningful mental health difficulties experienced by children and adolescents in various types of care; and 2. be safely administered and interpreted by health and social care professionals other than child and adolescent mental health clinicians. The BAC-C/A were also designed to be used as brief casework monitoring tools by foster care and adoption agencies, and for treatment monitoring in CAMHS. The BAC-C and BAC-A were derived from the Assessment Checklist for Children (ACC, 120 items) and Assessment Checklist for Adolescents (ACA, 105 items) respectively. Internal consistency of BAC-C (N = 347) and BAC-A (N = 230) scores were 0.89 and 0.87 respectively. The BAC-C/A were highly accurate in screening for clinical range ACC and ACA scores (area under the curve (AUC) ranging from 0.96 to 0.99), as well as for CBCL clinical range scores (AUCs: BAC-C = 0.89 to 0.92; BAC-A = 0.93 to 0.94). They were moderately accurate in screening for children that caregivers reported had been referred to mental health services (AUCs: BAC-C = 0.74; BAC-A = 0.79). Initial BAC-C/A psychometric properties compare favourably with that of existing screening instruments, including the Strengths and Difficulties Questionnaire and the Brief Problem Monitor (CBCL short form).     

A Short Form of the Trauma Symptom Checklist for Young Children

A short form of the Trauma Symptom Checklist for Young Children was derived from the original 90 items. An exploratory factor analysis of each factor identified the four items from each of the original factors with the highest eigenvalues. These items were subjected to confirmatory factor analysis. The best fit was obtained for an 8-factor, 32-item model. The short form evidenced good convergent validity with parent ratings obtained from the Child Behavior Checklist, the Child Sexual Behavior Inventory, and the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD RI). Norms (t-scores and percentiles based on raw scores) were calculated by age and by gender. The short form has promise as a screening measure with parents in settings like a child advocacy center.     

The Clinical Relevance of Divergence in Adolescent–Parent Reports of Adolescent Depression and Anxiety

This study examines associations between adolescent problem behaviors and adolescent–parent disagreement in ratings of adolescent depression and anxiety symptoms. Adolescent–parent dyads (N?=?463; mean age?=?12.68 years; 48.5% female; 78.2% White and 21.8% non-White) reported on adolescent depression and anxiety using parallel scales from the Youth Self Report (Achenbach et al., J Emot Behav Disord 10:194–203, 2002) and the Child Behavior Checklist (Achenbach and Rescorla, The manual for the ASEBA school-age forms & profiles, University of Vermont, Research Center for Children, Youth, and Families, Burlington, 2001) across four waves. Generalized estimating equations were used to examine the relationship between discrepancy scores and adolescent behavioral outcomes: incidence of adolescent past-year substance use (alcohol use, binge drinking, marijuana use, and nonmedical use of controlled medications), delinquency, self-harm behavior, and aggression. Findings showed that larger adolescent–parent divergence scores of depression were associated with higher odds of marijuana use, non-medical use of controlled medications, alcohol use, binge drinking, in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Results further revealed that larger divergence scores on anxiety were associated with higher odds of in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Adolescent–parent reporting discrepancy on adolescent’s depression and anxiety symptoms may be indicative of adolescent’s social, emotional, and behavioral problems, and the disagreement may signal further need for assessment of the adolescent.     

Comparing developmental outcomes for children in care with those for other children in Canada

This study assessed the test–retest reliability and convergent validity of single items from the Assessment and Action Record (AAR), from Looking After Children (Ward, 1995). It also compared developmental outcomes of 43 children cared for by a Canadian child welfare agency and those of an approximate comparison group of 1,600 children from the National Longitudinal Survey of Children and Youth (Statistics Canada, 1995). High and low reliability and validity were found for different AAR items. The children in care had worse outcomes than the comparison children on indicators of educational success and negative behaviour, but not on measures of identity, social and family relationships, or prosocial behaviour.     

Profiles of the parents of adolescent CSA perpetrators attending a voluntary outpatient treatment programme in Ireland

A group of 22 parents of adolescent sexual offenders (PASO) was compared with a group of 19 normal controls (NC) and 10 clinical controls (CC) on demographic, developmental, personal adjustment and family environment variables. The assessment protocol included the General Health Questionnaire‐12, the Culture‐Free Self‐Esteem Inventory, the Child Behaviour Checklist, the Family Assessment Device, the Parent Satisfaction Scale and the Multidimensional Scale of Perceived Social Support. Compared with clinical and normal controls, more parents in the PASO group reported that they had been arrested or charged for a criminal offence; had personally experienced child abuse; and more of their adolescents had experienced child abuse, with emotional abuse being the most common form of abuse for both parents and adolescents. Compared with clinical and normal controls, more adolescents of parents in the PASO group had witnessed parental drug or alcohol abuse and had been placed in care outside their home. While parents in the PASO group did not differ from clinical or normal controls in terms of personal adjustment, their adolescents had significantly more internalizing behaviour problems than normal controls, whereas adolescents of parents in the clinical control group had significantly more externalizing behaviour problems than normal controls. Compared with normal controls, parents in both the PASO and clinical control groups reported more difficulties with general family functioning, roles, affective responsiveness, affective involvement and behaviour control and lower levels of parental satisfaction. However, the groups did not differ significantly in their levels of perceived social support. Copyright © 2003 John Wiley & Sons, Ltd.     

A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

This study aimed to evaluate the comparative effectiveness of individual therapy and combined individual and group therapy in the treatment of the psychological sequelae of child sexual abuse. The Child Behaviour Checklist (CBCL), the Youth Self Report form (YSR), the Children's Depression Inventory (CDI) and the Trauma Symptom Checklist for Children (TSCC) were administered before treatment and 6 months later to a group of 20 young people who participated in individual therapy (IT) programmes and to a group of 18 young people who participated in programmes that involved combined individual and group therapy (IGT). For both types of programmes, statistically significant improvement occurred on the following scales: the total problems, internalizing problems, externalizing problems, withdrawn, somatic complaints, anxious/depressed, social problems, attention problems and aggressive behaviour problems CBCL scales; the total depression, interpersonal problems and anhedonia CDI scales; and the depression and anger TSCC scales. The only scale for which one therapy programme led to greater improvement than another was the CDI ineffectiveness scale. The IGT programme led to a reduction in the mean CDI ineffectiveness score, whereas a slight increase in the mean ineffectiveness score occurred in the IT group. There were no significant differences in the rates of clinically significant improvement associated with the two treatments and no major differences between cases who improved and those that did not improve over the course of therapy. From this study, it may be concluded that after 6 months, individual therapy and combined individual and group therapy were equally effective in the treatment of the psychological sequelae of child sexual abuse. Copyright © 2002 John Wiley & Sons, Ltd.     

Child global rating scales: Selecting a measure of client functioning in a large mental health system

The Global Assessment Scale for Children (GAS-Children) and the Children's Impairment Scale (CIS) were examined for inter-rater reliability, discrimination of outpatients from inpatients, and clinician acceptance. Forty-four clinicians used the two scales to rate 146 recently admitted children and adolescents in eight mental health programs. An additional study assessed the inter-rater reliability of the two scales compared with the Connors Parent-Teacher Questionnaire and the correlation of the GAS-Children with both the Connors Parents Questionnaire and Achenbach's Child Behavior Checklist. The GAS-Children showed better interrater agreement than any of the four subscales of the CIS, although the sum of the CIS subscales also showed adequate inter-rater reliability. Among adolescents, the GAS-Children correlated highly with the adult GAS, but the scales showed different mean values. Clinicians slightly preferred the GAS-Children over the CIS. To assess comparability of scale usage across sites, clinicians rated six case vignettes. Inpatient clinicians rated the vignettes as more dysfunctional than did their outpatient counterparts. Bias-adjusted scores still discriminated outpatient from inpatient children. Nevertheless, these rater biases should make evaluators cautious about comparing functioning scores across programs, even when the rating scale is ostensibly the same.     

Group Therapy for Emotional Dysregulation: Treatment for Adolescents and Their Parents

A dialectical behaviour therapy (DBT) group has been conducted for a number of years at a public outpatient clinic for adolescents suffering with emotional regulation difficulties and their families. A detailed account of the rationale, design, and content of both the adolescent and parent groups are provided. Data from these groups adds to the limited evidence regarding the efficacy of such groups. A retrospective analysis of changes in the adolescent participants’ emotional dysregulation, depression, anxiety and stress, following their participation in the group (N?=?12) was conducted. Several substantial improvements were noted across the measures of psychopathology, following the completion of the group. These findings support the teaching of DBT skills to adolescents and their families, with some modifications being appropriate for their application to this population. Future avenues for research stemming from the group program are also discussed.     

Correlates of the Randolph Attachment Disorder Questionnaire (RADQ) in a Sample of Children in Foster Placement

This study examined mental health and attachment problems in children in foster care. This study also obtained data concerning the validity of the Randolph Attachment Disorder Questionnaire (RADQ). Children were selected according to length of time in placement and age and screened for mental health symptoms using the Child Behavior Checklist and the RADQ. The findings showed that children in foster care have reported symptoms within the range typical of children not involved in foster care. The conclusion is that the RADQ has limited usefulness due to its lack of specificity with implications for treatment of children in foster care.     

Health care innovations for homeless families: Emerging opportunities under Medicaid and the Affordable Care Act

Prior to the Patient Protection and Affordable Care Act of 2010 (the ACA), the US health care system left many low-income families facing limited access to medical care, struggling with high-health costs, or lacking health insurance altogether. The ACA aims to increase access to care, improve the quality of care, and lower total health care costs. While the ACA can benefit all individuals and families, it has significant potential for expanding and improving services for those experiencing homelessness. This paper describes specific opportunities under the ACA and Medicaid that can be used to strengthen services for homeless families and provides examples of efforts under way. It also offers guidance for how homeless service agencies can effect change in their respective states. The examples described here are promising approaches to strengthening homeless services. Pursuing these ideas for homeless families will require initiative, creativity, and perseverance, but recent progress is encouraging.     

Child Care as a Relational Context for Early Development: Research in Neurobiology and Emerging Roles for Social Work

The quality of child care in the United States is an important social problem, particularly for economically vulnerable families. This is highlighted by multidisciplinary research on the importance of early caregiving as a determinant of child health and wellbeing. This article examines center-based child care as an important relational and developmental context for infants and young children. Through an integration of psychosocial studies and emerging research in the cognitive neurosciences, this paper describes how developmental research on early emotional development can be utilized to inform our understanding of child care as a critical social and interpersonal context for infants and young children. In particular, this paper examines research on early interpersonal experience as a determinant of the capacity for affect regulation. Focusing on the application of theory to practice, this paper discusses the relevance of this research to informed direct practice, advocacy and program development.     

Trauma specific versus generic measurement of distress and the validity of self-reported symptoms in sexually abused children

This study examined two issues in the assessment of child sexual abuse victims: sensitivity to trauma-related symptoms and validity of self-reports. The Trauma Symptom Checklist for Children (TSCC) and Personality Inventory for Youth (PIY) were completed by 41 sexually abused children. Parents and children completed diagnostic interviews for PTSD. We predicted that TSCC validity scales would be moderately correlated with PIY scales measuring similar constructs, and that TSCC clinical scales would be more sensitive to PTSD status than the PIY clinical scales. Results supported both hypotheses. TSCC validity scales appeared to be less likely to identify clinical cases, however. Clinical and research implications are discussed.     

The Recalled Childhood Gender Questionnaire-Revised: a psychometric analysis in a sample of women with congenital adrenal hyperplasia

We administered the 18-item Recalled Childhood Gender Questionnaire-Revised (RCGQ-R), female version, to 147 adult women with congenital adrenal hyperplasia (CAH) representing three different degrees of prenatal androgenization due to 21-hydroxylase deficiency and to non-CAH controls. A principal components analysis generated three components accounting for 46%, 9%, and 6% of the variance, respectively. Corresponding unit-weighted scales (high scores = feminine) were labeled Gender Role (13 items; Cronbach alpha = .91), Physical Activity (3 items; alpha = .64), and Cross-Gender Desire (2 items; alpha = .47). Discriminant validity was demonstrated in terms of highly significant comparisons across the four groups. We conclude that the first 2 RCGQ-R scales show good psychometric qualities, but that the third scale needs to be further evaluated in a sample that includes women with gender identity disorder.     

“Adding Their Flavour to the Mix”: Involving Children and Young People in Care in Research Design

Abstract

Children and young people are often the subjects of research but are not usually thought of as codesigners of research projects contributing to the development of tools and resources so that research about them and their peers is more likely to be appropriate and effective. This paper describes and analyses the involvement of a group of 14 children and young people who have been in out-of-home care. They assisted in the design of a research project that sought their views on what makes a “good” foster carer. The impetus for this study arose from a desire to include children and young people as stakeholders in improving the foster care system and a long-held belief that they could and should be active partners in creating change. The study demonstrated how children and young people could be engaged creatively in individual and group conversations and activities in relation to potential research questions and research methods and tools. The paper concluded that capturing their views will ensure that research will be of benefit to other children and young people and to policy makers and practitioners working in the field.     

Not Always ‘Left-Behind’: Indonesian Adolescent Women Negotiating Transnational Mobility,Filial Piety and Care

In contrast to current research focusing on how migrant parents provide care for their ‘left-behind’ children, this article highlights how Indonesian adolescent women also migrate (or stay) in order to provide care for their families. Drawing from ethnographic research conducted mainly between 2014 and 2015 in Central Javanese migrant-origin villages, this article discusses how opportunities for transnational labour migration affect young unmarried women’s roles as ‘dutiful daughters’ in diverse ways. By analysing how the (im)mobilities of three young women are mutually shaped by diverse expectations to care for their families, I highlight that care is always relational, showing that the distinction between care-givers and care-receivers is less evident than currently assumed in migration studies. Closer examination of how young persons mutually negotiate mobility and parent–child care expectations brings into focus the new forms of agency, power and vulnerability that they encounter in migration and migrant-origin contexts.     

Foster parents' emotional investment and their young foster children's socio-emotional functioning

Emotional investment may be defined as a willingness to accept and become committed to a child, and being aware of influencing the child's development. Research in this field is limited, and has shown that commitment in particular is associated with foster children's socio-emotional functioning. Our aim was therefore to investigate 60 foster parents' acceptance, commitment and awareness of influence to their early placed foster children at 2 years, as well as to investigate the association between these three concepts and the foster children's social-emotional functioning (externalizing, internalizing, dysregulation and competence) at 2 (T1) and 3 (T2) years of age. The caregivers were interviewed with “This is My Baby”, and completed the questionnaire “Infant-Toddler Social and Emotional Assessment”. Results showed that on average the foster parents were rated quite high on emotional investment. Linear regressions, including one predictor and one outcome variable, revealed associations between emotional investment and foster children's socio-emotional functioning. Moreover, in regressions including all three predictors, commitment significantly negatively predicted externalizing behavior in the foster children at T1, while acceptance significantly negatively predicted dysregulation at T2. Lastly, among others for externalizing, the coefficient of commitment was significantly higher at T1 than at T2. Our results indicate a possible short-term influence of commitment on externalizing- and a possible long-term influence of acceptance on dysregulation behavior in foster children. We will therefore highlight the clinical importance of emotional investment in foster care, in order to help the young foster child towards a healthy social-emotional functioning.     

Promotive and risk factors as concurrent predictors of educational outcomes in supported transitional living: Extended care and maintenance in Ontario, Canada

We tested selected promotive and risk factors as concurrent predictors of educational attainment, educational aspirations, and participation in education, training, or employment among young people enrolled in extended care and maintenance (ECM) in Ontario, Canada. ECM is a legislatively established transitional living program that provides financial, instrumental, and emotional support to former youths in care in the province who have had their individualized plans for education, training, or work accepted by their local Children's Aid Societies. The 406 participants in the research were 18-20 years of age and included 230 females (56.7%) and 176 males (43.3%). The data were collected by the youths' child welfare workers in interviews conducted by means of the second Canadian adaptation of the Assessment and Action Record from Looking After Children (AAR-C2-2006; Flynn, Vincent, & Legault, 2009). Cross-sectional hierarchical regression and sequential logistic regression analyses showed that the youth's total number of developmental assets was the most consistent promotive factor, predicting more favorable levels of all three educational outcomes. Cognitive impairments and soft-drug use were the most consistent risk factors, each predicting lower levels of two of the three outcomes. The practice and policy implications of the findings, as well as the limitations of the research, were discussed.     

Assessing Posttraumatic Stress Disorder Using the Trauma Symptom Checklist for Young Children∗

ABSTRACT

This pilot study assessed the performance of the Trauma Symptom Checklist for Young Children (TSCYC) in correctly classifying the presence or absence of PTSD, as determined by the Diagnostic Interview for children and Adolescents-Parent (DICA-P). Participants included 34 children, ages 4 to 12, referred for outpatient treatment. The 11 PTSD-positive participants scored significantly higher than the 23 PTSD-negative participants on scales assessing intrusive symptoms, arousal symptoms, and total posttraumatic stress (PTS). A model including the PTS-Intrusion, PTS-Avoidance, and PTS-Arousal scales, and the sexual concerns, dissociation, and anger/aggression scales correctly classified 100% of the PTSD-negative and 72.7% of the PTSD-positive participants. These findings suggest that the TSCYC may be used as an economical and time-efficient screening device for PTSD.     

Measuring the willingness to foster children with emotional and behavioral problems

Many children in foster care have emotional or behavioral problems or are at risk for these problems. It is important to identify parents willing to foster children with these problems in order to ensure placement, care, stability and well-being of such children. This study presents a new 40-item self-report measure of the willingness of parents to foster children with emotional and behavioral problems, and two 20-item parallel forms of this measure. In addition, this study presents evidence of reliability and validity of scores derived from these measures with a national sample of 297 foster mothers. Coefficient alpha for these measures was .92 or greater, indicating excellent internal consistency reliability. Scores from these measures were unrelated to demographic characteristics, providing evidence of discriminant validity. In addition, scores from these measures were higher for foster mothers licensed to provide treatment foster care than for mothers only licensed to provide regular foster care, providing support for known groups validity. Finally, support for construct validity is provided by the fact that foster mothers with higher scores on these measures had fostered longer, were fostering more children at the time of this study, and had fewer children removed from their home at their request.     

A Shelter-Based Stress-Reduction Group Intervention Targeting Self-Esteem, Social Competence, and Behavior Problems Among Homeless Children

It has been estimated that families with children now account for 40% of the population who become homeless. Given the consistency of research showing the potentially damaging effects of homelessness as a stressor upon the social and emotional development of children, the question of importance is how to best intervene to reduce the likelihood or severity of such possible negative consequences. The approach taken here involved the development of a Shelter-Based Stress-Reduction Group Intervention Targeting Self-Esteem and Behavior Problems Among Homeless Children.Data were collected on 52 elementary-school–age children from family-shelter facilities in Central Florida. The child's level of psychosocial functioning was assessed using the Coopersmith Self-Esteem Inventory (CSEI) and Achenbach's Child Behavior Checklist (CBCL). Although the repeated measures ANOVA techniques applied to those subjects were nonsigni-ficant, the relatively small sample size in study conditions led to consideration of the magnitude of effect sizes obtained in treatment and comparison groups. The changes in the intervention group's mean scores on key psychosocial outcome variables of interest were consistent with hypotheses, providing suggestive evidence of the potential utility of stress management training.