Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

Living arrangements and level of care among clients discharged from a scattered-site housing-based independent living program

There is little recent research in the field of adolescent independent living that looks at the specific living arrangements of youth, who at the point of discharge from the child welfare system, had experienced living independently and had access to a choice of housing options. Administrative data and reviews of client records were used in this study to look at the choice of housing option and the change in level of care of 367 young adults who emancipated from the Lighthouse Youth Services Independent Living Program in Cincinnati, Ohio, during the five-year period 2001-2006. Given a range of housing options at the time of discharge, over half (55%) chose an independent living arrangement, including 41% who lived in their own place, either alone (28%) or with a roommate (13%). Only 21% decided to live in someone else's home, including just 7% with one or both birth parents, 10% with some other relative, and 4% with a non-relative. The remaining 24% of youth were discharged from independent living to a more restrictive living arrangement (a.k.a., higher “level of care”, including a residential treatment program, group home, foster care, or supervised independent living program) (11%) or whose whereabouts were unknown (13%). The outcomes of this study suggest that, when presented with a choice of housing options, most of this county's emancipating foster youth would prefer to live on their own, rather than to return to live with their families of origin. The study also suggests that many youth who participate in a scattered-site housing-based independent living program can succeed in leaving care with affordable housing in place and avoid immediate homelessness.     

Race,Substance Abuse,and Mental Health Disorders as Predictors of Juvenile Court Outcomes: Do They Vary By Gender?

Predicting juvenile court outcomes based on youthful offenders’ delinquency risk factors is important for the adolescent social work field as well as the juvenile justice system. Using a random sample of 341 delinquent youth from one Midwestern urban county, this study extends previous research by examining if race, substance abuse, and mental health disorders influence important delinquency outcomes (number of court offenses, felony conviction(s), probation supervision length, detention length, and number of probation services) differently for male and female juvenile offenders. Multivariate analysis findings revealed that race was significant only for males, and having a substance use disorder was a stronger predictor of delinquency outcomes for males; whereas, having a mental health disorder was a stronger predictor of delinquency outcomes for females. Implications for this research include the importance of early disorder identification and subsequent availability of gender-focused treatment.     

Peer contagion among youth in Medicaid-funded residential mental health treatment programs

This paper examined juvenile justice encounters among youth with mental health needs who received care in residential treatment settings. The focus is on peer effects, and whether delinquent peers negatively affected youth. Matched data from Florida Medicaid and Juvenile Justice were used to examine the association between peer delinquency in a residential treatment setting and juvenile justice encounters during and after the treatment episode. Fifteen percent of youth had justice encounters during residential out-of-home treatment, while the rate was lower in the six months after (23.0%) treatment than the six months before (33%). Support for peer contagion was found as youth treated in Medicaid-funded residential mental health treatment programs were more likely to have JJ encounters when the other youth in the facility had histories of delinquency.     

Client retention in residential drug treatment for Latinos

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

The journey of dually-involved youth: The description and prediction of rereporting and recidivism

Dually-involved youth refers to youth that are simultaneously receiving services from both the child welfare and juvenile justice systems. The current study focused on a sample of dually-involved youth (N = 1148). The study examined the characteristics of dually-involved youth and reported and predicted the incidence of subsequent maltreatment and re-offending. We found that 8% of dually-involved youth had at least one arrest before entering child welfare system, 32% experienced new reports of maltreatment referrals subsequent to arrest, and 56% were charged with a second offense (i.e., recidivated). The court outcomes received in delinquency court were associated with both rereporting and recidivism. These findings support the development of a shared services model for child welfare and juvenile justice systems.     

The effects of adoption openness and type on the mental health,delinquency, and family relationships of adopted youth

ABSTRACT

Analyzing the 2007 National Survey of Adoptive Parents, this study examines the impact of open adoption, demographics, and other factors on adopted children’s mental health, delinquent behavior, and family relationships. Specifically, we compare findings for youth in private and public (i.e., foster care) adoptions and identify key similarities and differences between predictors of children’s well-being across these two types of adoption. We find that youth in open foster care adoptions are more likely to receive an attachment disorder diagnosis than those in closed foster care adoptions but are also more likely to have family relationships characterized by trust and adoptive parents’ willingness to recommend adoption to others. Further, we find children in both public and private adoptions who are older at placement are more likely to have posttraumatic stress disorder diagnoses. For children in private adoptions, no statistically significant predictors affected youths’ delinquency outcomes or family relationships, with the exception of parents of private adoptees in households characterized by lower levels of poverty indicating they would be more likely to recommend adoption to others. The implications of the key findings are discussed with regard to service provision for multiple types of adoptive families.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

What does self-esteem have to do with behavioral health among low-income youth in Chicago?

Many studies have examined risk factors associated with poorer behavioral health among low-income African American youth, such as low school engagement, delinquency, mental health problems, drug use, and risky sex. However, fewer studies have examined protective factors for such behavioral health risk behaviors. This study sought to address this gap by examining whether high levels of self-esteem were associated with better behavioral health factors for this population. A survey was administered to a sample of 638 low-income African American adolescents in Chicago to examine the degree to which high self-esteem was associated with less delinquency, substance use, and sexual risk behaviors, and more school engagement, and whether such associations varied by gender. Stepwise linear and logistic regression models were estimated to assess the influence of self-esteem. Higher self-esteem for this sample of low-income African American adolescents was associated with lower rates of delinquency, drug use, and risky sexual behaviors and increased rates of school engagement. Gender moderated only a few of these relationships. These findings suggest that programs that promote high self–esteem alone or in combination with other resilience factors may promote better behavioral health factors for African American adolescents.     

Internalizing symptoms linking youths' maltreatment and delinquent behavior

This study examines internalizing mental health symptoms (depression and posttraumatic stress disorder) as potential intervening factors in the relationship between maltreatment and delinquency using data from the National Survey for Child and Adolescent Well-Being (N = 1179). Significant mediating effects indicated that youth at greater risk of maltreatment experienced higher levels of internalizing symptoms that result in increased risk for delinquent behavior, although longitudinal effects were not supported. These findings highlight internalizing mental health symptoms as an important factor to address in treating victimized children at risk of future delinquency. Implications for child welfare service provision are discussed.     

Outcomes for a transitional living program serving LGBTQ youth in New York City

Providing stable housing for runaway and homeless youth is a major function of a transitional living program. This article introduces the focus of one program working with LGBTQ youth in New York City and discusses some issues to consider when working with this population. The article also presents data associated with young people's lives after discharge. In any discussion of outcomes, both reason for discharge and length of stay play important roles in whether or not an exit is safe. Regardless of these two elements, the places youth move to when leaving programs are crucial to their safety and well-being. The exit can be safe even when a young person is discharged early from a program. This article presents types of exits, as well as status of employment and school enrollment at exit. Some youth and staff-identified lessons gained in the program also are discussed in detail. Types of aftercare services sought by discharged youth are specified. This article also describes any differences in outcomes for youth with and without foster care experience.     

Long-Term Implications of Welfare Reform for the Development of Adolescents and Young Adults

We draw upon the 3-wave longitudinal dataset called Welfare Children and Families: A Three-City Study to examine the long-term implications for adolescents and young adults (N = 783) of mothers' welfare receipt and labor force participation from 1999 to 2005. In general, changes in mothers' work and welfare patterns were not associated with deterioration or improvement in youth development (ages 16 to 20 years at Wave 3). The few significant associations suggested that youth whose mothers increased employment (net of welfare participation) were less likely to show increases in serious behavior problems and delinquency compared to youth whose mothers were unemployed or employed part-time during the study period. Welfare roll exits (controlling for employment experiences) were unrelated to adolescent and young adult outcomes. Mothers' employment transitions were linked to improvements in household income and mothers' self esteem in addition to reductions in financial strain and their own illegal activities. However, these associations did not explain the relation between maternal employment and youths' improved behavior. These results do not support the predictions of either the supporters or the opponents of welfare reform, an outcome we discuss.     

Parental Divorce: A Protection from Later Delinquency for Maltreated Children

Family structure and maltreatment (abuse and neglect) have been identified as predictors of youth delinquency, although the relationship is not clear. This article furthers this research by studying a sample of maltreated children (n = 250) in one Midwest county, and through a multiple regression analysis of many risk factors, the study identified only one significant delinquency variable that made delinquency less likely—children who experience parental divorce. Some established risk factors were surprisingly found not to be predictive of later delinquency: minority race, one-parent families, youth substance abuse, recurrent maltreatment, and youth behind in academic grade level. Implications for the family studies and juvenile justice fields are set forth.     

African American males in foster care and the risk of delinquency: the value of social bonds and permanence

Juvenile delinquency remains a significant problem for child welfare systems throughout the United States. Victims of child abuse and neglect are more likely relative to children in the general population to engage in delinquency (Ryan & Testa, 2005; Widom, 1989). Although the magnitude of this relationship is not fully understood (Zingraff, Leiter, Myers, & Johnsen, 1993), the risk of delinquency is particularly high for African American males, adolescents, and children in substitute care settings. Unfortunately little is known about the factors that connect the experiences of maltreatment and delinquency. This lack of knowledge makes it nearly impossible to decrease the risk of delinquency for children in foster care. To improve the understanding of juvenile delinquency in the child welfare system, the current study tests aspects of social control theory within the context of foster care. We focus specifically on the effects of foster parent-foster child attachment, commitment, and permanence. The results indicate that strong levels of attachment decrease the risk of delinquency for youth in foster care. Involvement with religious organizations also decreases the risk of delinquency. In contrast, perceptions of placement instability, placement with relatives, and school suspensions are associated with an increased risk of delinquency.     

Programa shortstop: a culturally focused juvenile intervention for Hispanic youth

Culturally sensitive juvenile delinquency and substance abuse interventions are relatively limited and unavailable to many first-time Hispanic juvenile offenders. The purpose of this study was to test the effectiveness of a culturally focused juvenile and substance abuse intervention program for first time Hispanic youth offenders. The intent of the program was to decrease juvenile recidivism and increase substance abuse resistance. Programa Shortstop is a family based intervention designed for Hispanic youth ages 9-17. The intervention was delivered to 352 youth and at least one parent/caregiver over the 5-year study period. For intervention youth, the results of the recidivism study (n = 321) indicated that 89% of youth participating in Programa Shortstop between 1995 to 1997 were not rearrested within one year of completing Programa Shortstop. Additionally, statistical paired t-test analysis found that the intervention model had a positive effect on legal knowledge and school related factors associated with substance abuse and delinquency. Parent participants demonstrated significant increases in knowledge related to substance abuse and the legal system.     

Instability in the lives of foster and nonfoster youth: Mental health impediments and attachment insecurities

Foster youth are at risk for negative mental health and psychosocial outcomes, including when they are on the brink of emancipation from care into self-sustained adulthood. Factors believed to affect outcomes among foster youth include residential and school instability. Although frequent moves to new homes and schools are common for youth living in poverty, instability for foster youth involves not only changing homes and schools but often also changes in caregivers, thus putting foster youth at risk for disrupted attachment relationships. For the current study, structural equation models examined links between instability, mental health problems, and attachment insecurities in foster and at-risk nonfoster youth. A model containing instability provided a better fit to the data than a model containing foster care status only. Group comparisons revealed that instability was associated with posttraumatic stress disorder symptoms for foster but not nonfoster youth. Implications of instability in the lives of foster youth are discussed.     

Do youth with substantiated child maltreatment investigations have distinct patterns of delinquent behaviors?

Delinquency studies often use substantiation as a proxy for child maltreatment, but may underestimate maltreatment involved in unsubstantiated reports. This study assesses whether youth with unsubstantiated investigations have distinct subtypes of delinquency as compared to youth with substantiated reports. We conclude that while the subtypes of delinquency are similar, some differences between the two groups underscore the need to study the larger population of unsubstantiated investigations, which comprise 81.5% of investigations. To compare the groups we used two-group latent class analysis, and then regressed covariates onto the resulting subtypes. The sample consisted of 432 11–17 year old participants in Wave 1 of the second National Survey of Child and Adolescent Well-Being (NSCAW II) with no prior investigations; 191 youth had unsubstantiated investigations and 241 youth had substantiated investigations. We identified three similar subtypes for both groups: delinquency, petty theft, and normative. We found two differences: First, more unsubstantiated youth were normative subtype members and fewer were in the petty theft and delinquency subtypes. Second, delinquency subtype youth with unsubstantiated investigations were more likely to attack with a weapon, steal or try to steal things worth between $50 and $100, and shoplift. In contrast, substantiated youth were more likely to carry a hidden weapon. When covariates were included we found that being male reduced the likelihood of being in the petty theft subtype. For substantiated cases, being older or male increased the likelihood of being in the delinquency subtype. Our findings of high probabilities of marijuana and inhalant use among delinquency subtype youth for both groups is a target for interventions.     

Allegations of maltreatment and delinquency: Does risk of juvenile arrest vary substantiation status?

There exists a healthy debate about the process and value of substantiation in child welfare. Much of this debate focuses on understanding whether substantiated and unsubstantiated allegations of maltreatment share equal risk of recurrence. In the current study we seek to advance this debate by extending the analyses to focus specifically on the risk of juvenile delinquency. We also seek to determine whether the relationship between substantiation and delinquency varies by race and gender. Our sample includes 38,223 youth between 5 and 16 years of age from Los Angeles County. We use propensity score matching to create relatively equivalent groups and use Cox Regression to model the risk of juvenile arrest. The results indicate that the relative risk ratio of arrest is 2.2 times greater for youth associated with a substantiated report of maltreatment as compared with similar youth associated with an unsubstantiated report of maltreatment. Older youth, and African American youth are also at an increased risk of juvenile arrest. These findings indicate that the process of substantiation is not without merit - as investigators and supervisors are clearly able to distinguish cases based on individual risks and strengths.     

The Continued Importance of Quality Parent–Adolescent Relationships During Late Adolescence

The quality of adolescents' relationships with residential parents has been found to predict many different health and behavioral youth outcomes; strong associations have also been found between these outcomes and family processes, and between relationship quality and family processes. Data from Rounds 1–5 of the National Longitudinal Survey of Youth, 1997 were used to examine hypotheses about the influence of the parent–adolescent relationship on subsequent adolescent mental well‐being and delinquency, as mediated by family processes. Using structural equation modeling, we found that the influence of a positive residential parent–adolescent relationship on better mental well‐being and fewer delinquency was entirely mediated by family routines, parental monitoring, and parental supportiveness, net of sociodemographic controls.