The Links Among Perceived Adherence to the System of Care Philosophy,Consumer Satisfaction,and Improvements in Child Functioning

The present study investigated the associations among perceived adherence to the system of care philosophy, changes in internalizing and externalizing behaviors, and consumer satisfaction with services. Participants included 98 families, interviewed at two time points across a one-year period. Hierarchical multiple regressions indicated that the more a child and family perceived services to be consistent with the system of care philosophy, the greater their level of satisfaction with services and the fewer internalizing and externalizing behaviors they reported one year after receiving services (controlling for initial levels of problem behaviors). Implications for children’s mental health service delivery are offered.     

Moving from Principles to Practice: Recommended Policy Changes to Promote Family-Centered Care

This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by siblings of children with severe emotional disturbance and their caregivers. This discussion provides a springboard for policy recommendations to strengthen family support programming and enhance family-centered care, from modifying funding streams such that systems extend their reach beyond children with full-blown, diagnosable problems (those meeting standards of "medical necessity), to supporting prevention and early intervention initiatives that address families as targets for intervention. Recommendations include ensuring that communities with SOC funding address the needs of families; broadening Medicaid rules and definitions; expanding the range of reimbursable activities and services; and increasing funding for evaluating family-centered care models and family support programming.     

Examining Externalizing Behavior Trajectories of Youth in Group Homes: Is there Evidence for Peer Contagion?

Although concerns about peer contagion are often cited in critiques of group treatments for troubled youths, few studies have examined the effects of exposure to deviant peers in residential group care settings. This study used administrative data of youth served at Boys Town, a nationally-known group care provider. Using latent class growth analysis, this study identified the externalizing behavior trajectories of youth in group care as well as the behavior trajectory of the peers with whom they lived, assessed the relationship between youth trajectory classes and individual and peer group characteristics as well as the relationship between an individual youth’s behavior pattern and the behavior pattern of proximal peers. Several results suggested the presence of peer contagion in group care: a trajectory class of gradually increasing externalizing behavior problems, the strength of deviant peer density in predicting an individual youth’s externalizing behavior trajectories and significant associations between behavior patterns of youth and proximal peers. While there is some evidence that suggests an increase in problem behavior during care, results from this study indicated that over 90% of the youth did not have an increase in problem behaviors and that positive peer influences may also be protective and inhibit problem behaviors.     

The Relation of Parental Emotionality and Related Dispositional Traits to Parental Expression of Emotion and Children's Social Functioning

The purpose of this study was to test relations between parental temperamental emotionality and regulation or related personality characteristics and parental behavior, children's regulation, and children's social functioning. Mothers and fathers reported on their own personality and/or temperament and expressivity in the family (mothers only); parents and teachers rated children (71 girls and 99 boys; M age = 73 months) on their temperamental regulation, social competence, and problem behavior. Mothers also were observed interacting with their child, and behavioral measures of children's regulation were obtained. In general, high parental regulation and low negative emotionality were associated with positive developmental outcomes in children and more positive parental behaviors, and mothers' expression of positive emotion in the family mediated some of the relations of their dispositions to children's socioemotional functioning.     

A Longitudinal Analysis of Family Empowerment and Client Outcomes

We examined the relationship between family empowerment, parent satisfaction, and mental health outcome across time. Based on the Vanderbilt Family Empowerment Project Model, increased empowerment should lead to positive changes in client outcomes. Data consisted of the Family Empowerment Scale (FES), which was used to assess the caregiver's perception of empowerment, Child and Adolescent Functional Assessment Scale (CAFAS), which measures the degree of disruption in the youth's current functioning, Client Satisfaction Questionnaire (CSQ), and demographic information gathered from families receiving services from a county mental health service system at intake and discharge. The results showed that the CAFAS and CSQ were related to empowerment at intake and discharge. Results also indicated significant increases in the knowledge subscale of the FES and the CAFAS and moderate increases in the advocacy subscale of the FES and the CSQ. We discuss the implications of these findings for systems of care, such as stronger parent-professional relationships.     

流动儿童的问题行为与人格、家庭功能的关系

以北京市806名流动儿童和319名城市儿童为被试,采用问题行为问卷、小五人格问卷和家庭功能问卷,考察流动儿童问题行为的特点及其与城市儿童的差异,并探讨人格和家庭功能对流动儿童问题行为的影响。结果发现:(1)流动儿童内、外化问题行为的自我报告率分别达到了31.0%2、0.1%,与城市儿童相比,流动儿童的内化问题行为较为突出。(2)人格的情绪性、开放性显著正向预测流动儿童的内化问题题行为,外向性、家庭功能的亲密度显著负向预测其内化问题行为,情绪性、开放性显著正向预测流动儿童的外化问题行为,宜人性、谨慎性、亲密度显著负向预测外化问题行为。(3)人格在家庭功能的亲密度与内化问题行为之间起部分中介作用,在亲密度与外化问题行为之间起完全中介作用。     

Can We Uncouple Neighborhood Disadvantage and Delinquent Behaviors? An Experimental Test of Family Resilience Guided by the Social Disorganization Theory of Delinquent Behaviors

Although the influence of neighborhood disadvantage on youth development of delinquent behavior is well established, findings from this research have yet to inform the development of family-centered prevention programming to protect youth from these erosive effects. The current paper examines the role of family integration in buffering the impact of social disadvantage in a sample of N = 298 families randomly assigned either to a control condition or to a family-based prevention program previously shown to enhance marriage and parenting. We first confirmed that neighborhood concentrated disadvantage predicted change in delinquent behaviors across the course of the study. Additionally, replicating prior work, parents participating in the Protecting Strong African American Families (ProSAAF) program, relative to those randomly assigned to the control group, significantly improved their use of effective communication strategies with each other and reduced ineffective conflict in front of youth. This resulted in a significant indirect effect of ProSAAF on change in youth delinquent behaviors. Furthermore, using mediated moderation analysis, the study tested the buffering effect of greater family integration, showing that experimentally produced change in interparental communication skills and the resulting reduction in youth exposure to parental conflict buffered the effect of neighborhood disadvantage on change in youth delinquent behaviors, supporting a mediated moderation model in which family environments buffer neighborhood effects.     

Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N = 114; Motivational Interviewing [MI]-enhanced parent-teen behavior therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.     

Implementing Family-Centered Interventions Within the Public Middle School: Linking Service Delivery to Change in Student Problem Behavior

The Adolescent Transitions Program is a family-centered intervention strategy designed to reduce problem behavior and prevent drug use within a public school environment. A parent consultant within a Family Resource Center (FRC) provided universal, selected, and indicated interventions that enhanced and supported positive parenting practices known to serve as protective factors. Implementation of the 3-year FRC model involved 584 students and their families in 4 middle schools. Analyses focused on the dynamics and effects of parent consultant activities and services. Differences in school “adoption” of the FRC services were found to be a function of both passage of time and school environment. Despite significant variation in implementation across schools, FRC services significantly reduced the growth in problem behavior over the course of the middle-school years. The implications of these findings for dissemination of empirically supported, school-based, family-centered interventions are discussed.     

Appraisals of Child Behavior by Mothers of Problem and Nonproblem Toddlers

Mothers of problem and nonproblem toddlers rated videotapes of their own and unfamiliar children's behavior. They classified the behaviors as positive, negative, or neutral, and evaluated the intensity of the positive or negative behaviors. Ratings did not differ by problem status; however, all mothers classified their own children's behavior as less negative than did an independent observer. Mothers also evaluated all children's negative behavior as less aversive than did the observer. Finally, mothers mistakenly classified less of their own children's behavior as negative and more as positive when compared to their biases in classifying unfamiliar children's behavior.     

The Relationship Between Parenting Style and Children's Adjustment: The Parents' Perspective

We examined the relationship between authoritative and authoritarian parenting styles and socio-emotional adjustment in elementary school children as reported from the parents' perspective. Mothers of first through fifth graders provided information about parenting style as well as children's competencies and problem behaviors. Teachers provided ratings of children's adjustment for a subset of the participants. Results indicated that authoritative parenting was associated negatively with parent- and teacher-rated maladaptive behavior, and positively with indicators of healthy adjustment. Correlations between authoritarian parenting and adjustment were either small or non-significant. Regression analyses indicated that authoritative parenting was more predictive of children's competence than maladaptation (22% versus 10% of variance). The effects of parenting style on adjustment were not moderated by demographic variables, such as the child's gender, grade level, ethnicity, and family income.     

Comparing Individual Behavior Plans from Schools With and Without Schoolwide Positive Behavior Support: A Preliminary Study

School-wide positive behavior support (SWPBS) has been proposed as a proactive and preventive method to reduce problematic behavior in schools. Under this approach, educators and administrators seek to create a school environment that fosters prosocial behavior and attempts to systematically deter problem behaviors before they happen. To date, the relationship between SWPBS and individualized positive behavior support (PBS) plans has not been examined. Specifically, it is unclear whether an atmosphere of SWPBS facilitates the functional behavioral assessment process and the design of PBS plans for students exhibiting severe behavior problems. The purpose of the present study was to investigate whether behavior support plans created in schools employing SWPBS systems were more technically adequate than support plans created in schools utilizing traditional approaches to behavior problems. Results indicated that support plans created at schools with SWPBS systems were more technically adequate than support plans produced at non-SWPBS schools as measured by the Behavior Support Plan-Quality Evaluation (BSP-QE). However, support plans from schools with SWPBS systems were still considered underdeveloped. Limitations and future research are discussed.     

母亲抑郁和惩罚对儿童早期问题行为的影响及父亲的保护作用

儿童早期是母亲消极情绪和行为的易感期,母亲抑郁和消极的教养行为可能导致儿童早期多方面的发展问题,而父亲的积极教养则可能对孩子的健康发展起到保护作用。本研究以184名学前儿童的父亲和母亲为被试,考察母亲抑郁情绪和惩罚行为对儿童问题行为的影响及作用机制,以及父亲积极鼓励在其中的调节作用。结果发现:(1)母亲抑郁显著预测儿童的内向问题行为,母亲惩罚显著预测内向和外向问题行为;(2)母亲抑郁完全通过其惩罚行为影响儿童的外向问题行为,部分通过惩罚影响儿童的内向问题行为;(3)父亲积极鼓励显著调节母亲抑郁对外向问题行为的影响,边缘显著调节母亲抑郁对内向问题行为的影响;父亲积极鼓励对母亲惩罚与内、外向问题行为之间的关系的调节不显著,表明积极的父亲鼓励可以缓冲母亲抑郁对儿童问题行为的影响。     

Maternal Behavior and Children's Early Emotion Regulation Skills Differentially Predict Development of Children's Reactive Control and Later Effortful Control

The role of maternal behavior and children's early emotion regulation skills in the development of children's reactive control, specifically behavioral impulsivity, and later effortful control was examined in a sample of 435 children. HLM analyses indicated significant growth in reactive control across the toddlerhood to early childhood period. Emotion regulation at age-2 positively predicted initial levels of children's reactive control abilities while maternal overcontrol/intrusiveness predicted lower levels of reactive control growth. Maternal behaviors at age-2 predicted children's effortful control abilities at age-5.5. Emotion regulation did not predict effortful control abilities. Maternal behavior and children's early emotion regulation skills may differentially facilitate the development of reactive and effortful control abilities.     

Social interaction in the peer group: Relationship to perceptions of parenting and to children's interpersonal awareness and problem-solving ability

The rates at which 56 preschoolers dispensed positive and negative behaviors toward peers were recorded during classroom free play. The Borke Empathy Scale and the Preschool Interpersonal Problem-Solving Test were administered to the children. The children's mothers and fathers were asked to complete the Iowa Parenting Inventory. Analyses focused on the association between parental modes of functioning and children's peer-group behaviors, and on the association between peer-group behavior and interpersonal awareness and interpersonal problem-solving ability. The analyses indicated that maternal involvement and reasoning guidance and paternal reasoning guidance were significant predictors of children's positive behaviors directed at peers. Maternal reasoning guidance showed an inverse relationship with negative behaviors directed at peers. Interpersonal awareness, but not problem-solving ability, was an effective predictor of behavior with peers. The data reflect the need to examine peer-group social competence from a multifaceted perspective. Implications of the findings for the development of intervention strategies and parent-teacher relations are suggested.     

Children's perceptions of parental behaviors

Children's perceptions of positive and negative parental behaviors were assessed using a newly-developed scale, the Parent Perception Inventory (PPI). Reliability and validity were examined across a sample of 75 children aged 5 to 13 using additional measures administered to the children and measures completed by their parents. The scale showed acceptable levels of internal consistency. No effects of children's age were apparent, but effects of the child's and parent's gender were found. Boys reported more positive parental behaviors, particularly for fathers, and children reported more negative (disciplinary) behaviors by mothers. PPI scores were predictably related to child's self-concept and behavior problems (convergent validity) and generally unrelated to measures of child's achievement (discriminant validity). As predicted by family systems theory, children from nondistressed families viewed their parents as behaving more similarly on the PPI than did children from distressed families.     

A Multilevel Contextual Model of Family Conflict and Deviance

This paper presents a multiple-group multivariate hierarchical specification of family problem behaviors across ethnicities using structural equation modeling techniques which explicitly model the individual-level and family-level covariance matrices in familial problem behavior. Analyses were conducted across White and African American ethnic groups. The sample (N = 1,168; 647 White and 521 African Americans) comprised children and their parents from 392 families. In addition to relations between family conflict and deviant behaviors, covariates were included at each level of analysis: neighborhood desirability at the family (between) level, and age and gender at the individual (within) level. At the between level, neighborhood desirability influenced family conflict and family conflict influenced family levels of deviance. At the within level, conflict was significantly related to individual levels of deviance. Discussion focuses on the substantive results as well as the application of multilevel analyses to contextual influences of family problem behavior.     

Sustaining and Expanding Systems of Care to Provide Mental Health Services for Children, Youth and Families Across America

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.     

The relations of parental emotional expressivity with quality of Indonesian children's social functioning

In Western societies, parental expression of positive emotion has been positively related to the quality of children's social functioning, whereas their expression of negative emotion has been negatively or inconsistently related. The relations of parental expressivity to 3rd-grade Indonesian children's dispositional regulation, socially appropriate behavior, popularity, and sympathy were examined. Parents, teachers, and peers reported on children's social functioning and regulation, and parents (mostly mothers) reported on their own expression of emotion in the family. Generally, parental expression of negative emotion was negatively related to the quality of children's social functioning, and regression analyses indicated that the relations of parental negative expressivity to children's popularity and externalizing behaviors might be indirect through their effects on children's regulation. Unexpectedly, parental expression of positive emotion was unrelated to children's social functioning.     

Children with ADHD in Residential Care

Little is known about the characteristics or functioning of children with ADHD in residential care as compared to their non-ADHD peers. This study evaluated data on 538 children with (n = 125) and without (n = 413) ADHD in residential care to determine demographic, mental health, behavioral, and treatment (i.e., medication use) characteristics. Results revealed that both groups presented elevated risks, however, scores for children with ADHD indicated even greater levels of need. Specifically, differences were found between the two groups on demographics (e.g., family reunification status, restrictiveness of prior out-of-home placements), behavior (e.g., attention problems, rule-breaking and aggressive behaviors) and medication status. Findings suggest there is a need for aftercare services to help support families as children transition from care, interventions to address behavior, and medication management through assessment and monitoring.