Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

Test-Retest Reliability of the Spanish Version of the Diagnostic Interview Schedule for Children (DISC-IV)

The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.     

Service and Medication Use and Their Effects on Arrest Rates Among Children with Emotional Disturbances Before Disenrollment from Medicaid

In this study we examine two assumptions that underlie the hypothesis that the outcomes of children with emotional disturbances are negatively affected by the loss of access to mental health services during their transitions to adulthood. The first is that children access mental health services during the pre-transition years, and the second is that these services are effective in reducing poor outcomes. We tested these assumptions using children who lost Medicaid enrollment between their 18th and 20th birthdays in Florida’s Medicaid program using arrests as the outcome. All children with an emotional disturbance received at least one outpatient service. However, while the mean days of service per month were 3, more than half the children received less than one day of service. Fifty-six percent of children received some psychotherapeutic medication treatment. Children with ADHD had the highest number of days of medication per month in both univariate and multivariate analysis. In multivariate analysis, children with disruptive behavior disorders had significantly more days per month of outpatient services than children with any other diagnoses except anxiety disorders. Medication days but not outpatient service days were negatively associated with arrests. Post hoc analysis suggested that children with ADHD who had high medication days had significantly fewer arrests than children with disruptive behavior disorders. This was not the case for children with ADHD and low medication days. Children with ADHD and high medication use may be most at risk of increases in arrests after Medicaid disenrollment as many will lose access to a service that was associated with fewer arrests. Findings suggest the need for reform of the children’s mental health system.     

Examining the efficacy of truth/lie discussions in predicting and increasing the veracity of children's reports

This study investigated whether children's ability to reason about truths and lies influenced their truth-telling behavior. Four-six-year-old children (n=118) played a game that was intended to motivate children to use deception to hide a minor transgression. Next, an interviewer gave children one of four preliminary discussions. Children received a typical forensic truth/lie discussion (TLD), a developmentally appropriate and more elaborate TLD, or one of two discussions that controlled for the time spent conversing with children. Children were interviewed about the event. The results revealed that children's performance on the truth/lie questions did not predict their truth-telling behavior. Regardless of their performance on truth/lie questions, children who received TLD's gave more honest reports than children who did not receive TLD's. These results suggest that discussing truths and lies with children may promote truth-telling behavior. However, the results cast doubt on the validity of using children's performance on truth/lie questions as a measure of competency.     

Supply and demand in early childhood services

Two surveys—a mail survey of a stratified random sample of 387 agencies providing early childhood services and a telephone random digit dialing (RDD) survey of 988 parents of children ages newborn through 8 years in Pennsylvania—addressed the question of supply and demand for early childhood services. Over all forms and circumstances, the supply of early childhood services appears to meet the demand, but the data indicates that existing services do not meet the needs of many parents with respect to the quality, convenience, stability, and cost of such services. Specifically, agency estimates suggested that enrollments approached capacity for full-day and preschool services but not other types. It was estimated that approximately one fourth of all nonemployed mothers and one half of low-income nonemployed mothers said the supply of affordable services was inadequate and a barrier to seeking employment, education, or job training. Three out of four (76.1%) infants (birth to 2 years) and one out of three (35.2%) young children (3–5 years) in services were in unlicensed settings, whereas 4.8% of infants and 7.4% of 3- to 5-year-olds in services were cared for by an older child. One in five parents who used any non-parental service regularly used more than one service to meet their needs. Low-income parents who must work full time had limited access to educational preschool services because most preschools operated only half-day programs. Six percent of all parents using services and 12.5% of users of more than one service said transportation was a problem, and 21.2% of the parents of infants and 8.8% of the parents of 3- to 5-year-olds changed their main service within the last year, mainly because the service terminated or because the parents wanted better quality, convenience, or lower cost.     

Intensive Home Based Services Within a Comprehensive System of Care for Youth

Within a comprehensive mental health service array for youth, Intensive Home Based Services (IHBS) are designed to meet the needs of youth with significant emotional and behavioral problems in their home communities, avoiding the need for out-of-home services, particularly residential care. We examined youth receiving IHBS as their first service in the state of Hawaii system of care (N = 163) to determine how successful IHBS were in preventing the need for more restrictive services within 12 months of intake. Subsequently, we investigated characteristics that might be predictive of a youth’s need for service intensification within 12 months. Logistic regression analyses found that greater age, level of service need, and functional impairment at intake predicted use of more restrictive services within 12 months of intake, whereas gender, ethnicity, diagnosis, service intensity, and clinician credentials did not. Overall, our findings suggested that IHBS were reasonably successful in preventing residential placements, and provided some basis for determining characteristics of youth likely to require more restrictive placements within a one year period.     

Speaker reliability guides children's inductive inferences about novel properties

Prior work shows that children can make inductive inferences about objects based on their labels rather than their appearance (Gelman, 2003). A separate line of research shows that children's trust in a speaker's label is selective. Children accept labels from a reliable speaker over an unreliable speaker (e.g., Koenig & Harris, 2005). In the current paper, we tested whether 3- and 5-year-old children attend to speaker reliability when they make inductive inferences about a non-obvious property of a novel artifact based on its label. Children were more likely to use a reliable speaker's label than an unreliable speaker's label when making inductive inferences. Thus, children not only prefer to learn from reliable speakers, they are also more likely to use information from reliable speakers as the basis for future inferences. The findings are discussed in light of the debate between a similarity-driven and a label-driven approach to inductive inferences.     

Spendthrifts and Tightwads in Childhood: Feelings about Spending Predict Children's Financial Decision Making

Adults differ in the extent to which they find spending money to be distressing; “tightwads” find spending money painful, and “spendthrifts” do not find spending painful enough. This affective dimension has been reliably measured in adults and predicts a variety of important financial behaviors and outcomes (e.g., saving behavior and credit scores). Although children's financial behavior has also received attention, feelings about spending have not been studied in children, as they have in adults. We measured the spendthrift–tightwad (ST–TW) construct in children for the first time, with a sample of 5‐ to 10‐year‐old children (N = 225). Children across the entire age range were able to reliably report on their affective responses to spending and saving, and children's ST–TW scores were related to parent reports of children's temperament and financial behavior. Further, children's ST–TW scores were predictive of whether they chose to save or spend money in the lab, even after controlling for age and how much they liked the offered items. Our novel findings—that children's feelings about spending and saving can be measured from an early age and relate to their behavior with money—are discussed with regard to theoretical and practical implications. Copyright © 2017 John Wiley & Sons, Ltd.     

Mental Health and Other Service Use by Youth in Therapeutic Foster Care and Group Homes

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services.     

System-of-Care Practice Review Scores as Predictors of Behavioral Symptomatology and Functional Impairment

The longitudinal comparison study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program assesses factors in service delivery systems that may shape the impact of systems of care. We evaluated the extent to which services embodying the principles of a system of care, as measured by the System-of-Care Practice Review (SOCPR), affect clinical outcomes for children being served in federally-funded systems of care and matched comparison communities. The participants included 75 children and families selected for participation in the SOCPR. Results indicated that experience of services embodying system-of-care principles at a high level was associated with lower symptom and impairment scores one year after entry into services. Children in systems of care were rated to have experienced high levels of system-of-care principles implemented within their services, and their symptom severity and functional impairment did not vary as a function of their experiences. Children in matched comparison communities had more variable rated experiences of system-of-care principles within their services, and their symptom severity and functional impairment decreased as their experiences of the principles increased.     

Co‐Witness Influence on Children's Memory Reports: The Difference is in the Details1

This study examined the effect of social influence on children's witness reports, with respect to a number of details varying in centrality. Children (N = 115; age = 10 years, 4 months to 13 years, 8 months) were interviewed about a personally experienced event. Half of the children were interviewed together with a confederate who answered the interview questions before the child did, while the other half were interviewed alone. Children were influenced by the confederate's answers to withhold some critical details observed (omission errors), but not to add details not observed (commission errors). When the children were asked to follow up on their reports, truthful reports contained more information than did false reports.     

Ritualistic Behavior in Young Children

The aim of this study was to examine ritualistic behavior at its developmental peak. Children 20–59 months of age were sampled through a national system of daycare centers in Israel (N = 228). The order of onset of the ritual behaviors measured was virtually identical to that reported for an American sample (D. W. Evans et al., 1997). Gender and age effects were found for fearfulness but not for ritualistic behavior. Maternal reports of ritualistic behavior were highly correlated with reported fears, and with shy and emotional temperament. Mothers of the children who were in the top 10% in their use of rituals according to maternal report, worried about their child's ritualistic behavior, even though maternal worry was not correlated with ritualistic behavior for the whole distribution.     

Predictors of Service Utilization Among Youth Diagnosed with Mood Disorders

In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the Multi-Family Psychoeducational Psychotherapy study (MF-PEP), a randomized controlled trial of 165 children aged 8–12 with mood disorders. The children were using an average of two services, with pharmacotherapy and school services as most frequent. Children with bipolar disorders used significantly more and higher quality services than children with depressive disorders. Parent knowledge of mood disorders, area of residence, and perceived need for treatment were all related to the number of services families were utilizing. Parent knowledge of mood disorders and treatment, child’s age, and mood symptom severity were all predictors of the quality of services being utilized. Findings highlight the impact of non-need factors on service utilization and the potential to decrease disparities caused by these factors. For example, increasing efforts to educate both the general public and individual families coming in for treatment about children’s mental health may improve service utilization patterns in this population.     

Measurement of Cruelty in Children: The Cruelty to Animals Inventory

Cruelty to animals may be a particularly pernicious aspect of problematic child development. Progress in understanding the development of the problem is limited due to the complex nature of cruelty as a construct, and limitations with current assessment measures. The Children and Animals Inventory (CAI) was developed as a brief self- and parent-report measure of F. R. Ascione's (1993) 9 parameters of cruelty. The CAI emerged as a reliable, stable, and readily utilized measure of cruelty using parent and child reports. Children (especially the older children) reported higher rates of cruelty than their parents and boys reported more cruelty than girls. Self- and parent-reports showed good convergence with independent observations of cruelty versus nurturance during free interactions with domestic animals. The results indicate that cruelty to animals can be reliably measured using brief child and parent report measures.     

Service Needs of Immigrants and Refugees

This paper evaluates the service needs of immigrants and refugees, paying special attention to their entry status, social, and human capital. Analyses are based on administrative data consisting of 2915 clients collected by the YMCA of Western Ontario, Windsor-Essex Branch (YMO). Results reveal that immigrants’ and refugees’ major service need priorities are (1) government services and language skills, (2) information about Canadian life and access to community services, (3) education and work in Canada, and (4) social and professional networks and community involvement. These service needs varied by the entry status of the immigrant as well as human and social capital. Government-assisted and sponsored refugees identified more service needs than economic immigrants relating to Canadian life, language and skill training, and social networks. Sponsored refugees also identified more needs than the economic immigrants with respect to access to community services and work. Convention refugees’ higher service needs over economic immigrants were related to language training and access to community services. Finally, the service needs of clients with higher education, English proficiency, and ethnic networks were lower than those of their counterparts.     

Homeless Adults’ Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries

Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users’ experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed.     

Mother and Child Perceptions of Child Functioning: Relationship to Maternal Distress

The relationship between maternal distress and mother's reports of psychosocial problems in their children has been well-documented. However, relatively little research has investigated the relationship between maternal and family distress and young children's perception of their own functioning. Using a brief questionnaire designed for use with children, data were collected from 166 mothers and their children aged 5-12 years. Children provided information about their own daily functioning, and mothers provided information about their own, their child's, and their family's psychosocial functioning. Findings indicated that while children generally agreed with the reports of their mothers, children of distressed mothers self-reported better daily functioning than their mothers did. Distressed mothers tended globally to report negatively about themselves, their child, and their family. The present findings suggest that when assessing mothers or children, the reports of children should be considered as well as the reports of mothers.     

Outcome Trajectories for Adolescents in Residential Treatment: A Statewide Evaluation

Although residential treatment represents one of the largest and most expensive components of the mental health service system for children and adolescents, little is known about the anticipated outcomes of this service. Still less is known about the trajectory through which change occurs within these settings. We examined the clinical status of 285 adolescents over a 2-year period after placement in residential treatment by the Department of Mental Health in a western state. Using a growth modeling technique, the rate of change was determined over a set of symptoms measured by the Acuity of Psychiatric Illness—Child and Adolescent Version (CAPI). Results suggest that while adolescents tended to improve overall during the course of their stays, there was considerable variation in which symptoms improved and which did not. Two symptoms actually became reliably worse with treatment. In addition, significant variation in outcomes was demonstrated across sites, with adolescents in one site getting reliably worse during the course of residential treatment. Our findings demonstrate the utility of outcomes management and have significant implications for how residential services for children and adolescents should be managed.     

Characteristics of Traumatic Experience and Survivor Perceptions of Mental Health Services: The 2004–2005 Erie County Community Trauma Survey

Trauma is associated with severe mental illness and substance abuse problems, yet it typically is not addressed sufficiently in treatment. This article reports on an assessment of mental health service recipients and their experience of traumatic events and perceptions of service providers' sensitivity, helpfulness, and knowledge regarding their trauma and service needs using a community-based participatory research model. Demographic characteristics and status of co-occurring disorders were measured. Participants perceived that individual therapists and peer service providers were sensitive to and knowledgeable about their trauma. Group treatment and peer programs were seen as being most helpful. Psychiatric services were seen as being the least sensitive to trauma issues. Implications for practice and research are discussed.     

Narrative skill and testimonial accuracy in typically developing children and those with intellectual disabilities

Children must describe maltreatment coherently for their testimony to be influential in court. We know little about how well children with intellectual disabilities (CWID) describe their experiences relative to typically developing (TD) children, despite CWID's vulnerability to maltreatment. We investigated children's reports of an experienced event and compared coherence in CWID (mild to moderate impairment: 7–11 years) with TD children matched for mental (4–10 years) or chronological age (7–11 years). All children included important markers of narrative coherence in their reports. Children with lower mental ages, particularly those with an intellectual disability, included fewer markers of narrative coherence in their reports than children with higher mental ages. Individual markers of narrative coherence, particularly recall of content, predicted accuracy of testimony and resistance to suggestion even when disability and mental age were taken into account. These findings highlight the importance of helping children to describe their experiences coherently.