‘Youth are not something to check off your to do list’: Poetic inquiry into the symbols youth,parents and professionals use to reimagine supports for youth in foster care

The child welfare system is characterized by fixed power structures, coercion and hierarchies that privilege the perspectives of a select few. These oppressive aspects of the system quelch youth voice and others' voices, especially those with lived experience, frequently omitting them from case- and system-level decisions. Acknowledging the empowering potential of creative and arts-based research, this study used poetic inquiry with youth in or formerly in foster care, parent partners and professionals working in child welfare, inviting them to reimagine how the system could support youth in foster care towards thriving. Through seven poetry focus groups, 41 participants wrote individual and relational poems. Analyses focused on how symbols were used and their suggestions for revisioning child welfare. Seven themes identified the types of symbols used in poems: 1) Nature/Natural Phenomena, 2) Human Body/Senses, 3) Actions, 4) Physical Objects, 5) Paperwork, Cases, Bureaucracy, 6) Connectedness/Family and 7) Strong Emotions. Beyond demonstrating a novel arts-based method, findings offer a new, creative space for understanding the foster care system. Symbols were powerful and cut across life experiences and identities. A key implication pointed to using symbolic language to aid the work of revisioning child welfare towards humanistic and embodied approaches, social justice and well-being.     

Should responder analyses be conducted on continuous outcomes?

Continuous outcomes are often dichotomized to classify trial subjects as responders or nonresponders, with the difference in rates of response between treatment and control defined as the “responder effect.” In this article, we caution that dichotomization of continuous interval outcomes may not be best practice. Defining clinical benefit or harm for continuous interval outcomes as the difference between the means of treatment and control, that is, the “continuous treatment effect,” we examine the case where treatment and control outcomes are normally distributed and differ only in location. For this case, continuous treatment effects may be considered clinically relevant if they exceed a prespecified minimum clinically important difference. In contrast, using minimum clinically important differences as dichotomization thresholds will not ensure clinically relevant responder effects. For example, in some situations, increasing the threshold may actually relax the criterion for effectiveness by increasing the calculated responder effect. Using responder effects to quantitatively assess benefit or risk of investigational drugs for continuous interval outcomes presents interpretational challenges. In particular, when the dichotomization threshold is halfway between the treatment and control outcome means, the responder effect is at a maximum with a magnitude monotonically related to the number of standard deviations between the mean outcomes of treatment and control. Large responder effect benefits may therefore reflect clinically unimportant continuous treatment effects amplified by small standard deviations, and small responder effect risks may reflect either clinically important continuous treatment effects minimized by large standard deviations, or selection of a dichotomization threshold not providing maximum responder effect.