Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were used to examine youth receiving out-of-home treatment. Propensity score matching was used to examine the effect of out-of-home treatment on outcomes. Males, older youth, and youth with prior involuntary examinations, felony charges, misdemeanor charges, or inpatient psychiatric treatment were more likely to be placed in treatment group care. Treatment foster care placement was more likely for youth with prior treatment foster care episodes. Propensity matching results indicated that youth in treatment foster care had greater reductions in felony charges, and were less likely to return to out-of-home treatment in the following 6 months. While often placed in group care settings, youth with prior criminal justice encounters, especially for felony charges, may be better served in treatment foster care programs.     

Evaluating Supervision Models in Functional Family Therapy: Does Adding Observation Enhance Outcomes?

This study examined the effects of observation‐based supervision Building Outcomes with Observation‐Based Supervision of Therapy (BOOST therapists = 26, families = 105), versus supervision as usual (SAU therapists = 21, families = 59) on (a) youth externalizing behavior problems and (b) the moderating effects of changes in family functioning on youth externalizing behaviors for adolescents receiving Functional Family Therapy (FFT). Exploratory analyses examined the impact of supervision conditions on youth internalizing problems. In 8 community agencies, experienced FFT therapists (M = 1.4 years) received either BOOST or SAU supervision in a quasi‐experimental design. Male (59%) or female (41%) adolescents were referred for the treatment of behavior problems (e.g., delinquency, substance use). Clients were Hispanic (62%), African American (19%), Non‐Hispanic White (12%), or Other (7%) ethnic/racial origins. Therapists (female, 77%) were Hispanic 45%, African American (19%), White Non‐Hispanic (30%), or other (4%) ethnic/racial backgrounds. Analyses controlled for the presence or absence of clinically elevated symptoms on outcome variables. Clinical outcomes were measured at baseline, 5 months, and 12 months after treatment initiation. Clients with externalizing behavior above clinical thresholds had significantly greater reductions in problem behaviors in the BOOST versus the SAU conditions. Clients below thresholds did not respond differentially to conditions. Supervisors in BOOST had more experience with the FFT model; as such, the observed results may be a result of supervisor experience. The BOOST supervision was associated with improved outcomes on problem behaviors that were above clinical thresholds. The findings demonstrate the importance of addressing client case mix in implementation studies in natural environments.     

Demographic,Clinical, and Geographic Predictors of Placement Disruption among Foster Care Youth Receiving Wraparound Services

The effective delivery of wraparound depends upon the availability of a wide range of community-based services. This study seeks to determine the impact of proximity to resources on the effectiveness of a wraparound program for stabilizing foster care placements among a sample of youth. We present a methodology for deriving proximity scores for individual clients using Geographic Information Systems technology, and incorporate this score into a model for predicting placement disruption among youth in foster care receiving services within a wraparound model aimed at preventing placement disruptions. Cox Regression is used to predict length of time until placement disruption using clinical, demographic, and service proximity measures. Risk of placement disruption is predicted by trauma experiences, risk behaviors, and age, and is reduced by the presence of child strengths and proximity to resources. The impact of proximity to resources on placement disruption varies by land use type, suggesting that proximity exerts a greater impact on youth in rural and suburban areas than in urban areas where wraparound service delivery models may be able to overcome distance and other barriers. Implications for the implementation of wraparound programs as well as service system planning are discussed.     

Minority Stress,Activism, and Health in the Context of Economic Precarity: Results from a National Participatory Action Survey of Lesbian,Gay, Bisexual,Transgender, Queer,and Gender Non‐Conforming Youth

Lesbian, gay, bisexual, transgender, queer, and gender non‐conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14–24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.     

Religious Activity and Pastoral Counseling Among Protestant Youth with SED

The past decade has shown a surge of interest in faith-based resources for a variety of social problems. However, these resources have not been systematically studied for children with emotional and behavioral problems. We investigated religious activity and use of pastoral counseling among Protestant youth with serious emotional disorders (SED) (N=464) and examined associated youth and caregiver characteristics. Findings indicate that the majority of SED youth do participate in religious activities, but do not frequently receive pastoral counseling for their problems. Youth with fewer externalizing problems as well as minority youth had an increased likelihood of participation in religious activities, while youth with more psychosocial impairment had an increased likelihood of using pastoral counseling. Implications of this study for research and practice are discussed.     

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.     

Going Home Again: Transitioning Youth to Families After Group Care Placement

This paper presents results from the transitioning youth to families intervention, which aimed to promote family care for youth served in group care programs in the child welfare system. The intervention was conducted in two counties in a Mid-Atlantic state. The effort encompassed administrative case review and family involvement meetings. We assessed the effect of the intervention in promoting placement in family settings within 12 months. We also explored other effects of the intervention identified by participants. Using propensity score matching with administrative data to compare one-year placement settings for the intervention counties and non-intervention counties, a higher rate of family reunification was identified for youth in the treatment counties. To provide a richer contextual understanding of the effects of the intervention, thematic analysis of open-ended comments from youth and caregiver participants was conducted. These resulting themes provided further understanding of the value of the intervention especially in the areas of planning for the transition, improving youth insight about placement options, and the importance of family involvement. Participants also made recommendations for how to enhance the intervention and promote the transition of youth from group care to family settings. Overall, the effect of the intervention in transitioning youth to family settings was nominal; however unanticipated benefits of engaging youth and family in the transition process were noted. From this evaluation, we provide suggestions for future research and the development of effort to transition youth from group care settings.     

Mental Health and Incarcerated Youth. II: Service Utilization

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program (n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities (n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarcenation may benefit from intensive mental health services to prevent out-of-home placement and later incarceration.     

The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics

Abstract

Background: Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate.

Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions.

Methods: The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17?years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery.

Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions.

Discussion: The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.     

Youth Needs at Intake into Trauma‐Informed Group Homes and Response to Services: An Examination of Trauma Exposure,Symptoms, and Clinical Impression

Trauma‐informed care is recommended to improve the quality of group home services for youth. Youth exposure to trauma and associated symptoms are important factors involved in making the clinical impression that determines treatment services. This study considered three dimensions of trauma (exposure, symptoms, and clinical impression) to determine associations with behavioral incidents of youth in trauma‐informed group homes and how trauma was related to changes in psychopathology from intake to discharge. Archival records of youth (N = 1,096), age 9–18 (M = 15.7 years) who received services from January 2013 to December 2017, and departed the program were used. Statistical procedures included hierarchical linear modeling and analysis of covariance. Results indicated trauma symptoms predicted emotional problems and self‐injurious behavior. Youth in high‐ and low‐trauma groups both showed decreases in behavioral incidents and psychopathology, but clinical impression of trauma moderated the change in emotional problems from intake to discharge. Youth deemed by clinicians to have lower trauma (based on history of maltreatment and expression of trauma symptoms) had greater decrease in emotional problems from admission to discharge. Limitations and implications for further research on implementation and effectiveness of trauma‐informed models are discussed.     

Brief report: The development of superstitious beliefs in the effectiveness of treatment of anger: Evidence for the importance of experimental program evaluation in applied settings

Many youth placed in out of home care have serious anger and aggression problems. These youth create much administrative and staff frustration. This frustration can cause program administrators to look to new treatment modalities whether inside or outside of their specific milieu for the therapeutic solutions to these problems. This randomized control group study provides an example of the importance of experimental program evaluation when an applied setting begins a drift towards the use of new treatment modalities. The results showed that both treatment and control groups improved over time but that there was no differences between groups in the daily number of angry incidents, the number of youth negatively terminated from the program, or self-report of state-trait anger expression. The results also suggest that without this research the noneffective intervention would have continued to be funded and given causative status for the observed improvements in referred youth behavior into the foreseeable future. Moreover, the development of these types of superstitious beliefs may lead child care organizations to spend scarce dollars on expensive treatments that do not increase the efficacy of the treatment as usual. Thus, this study shows that there are potential economic and treatment efficacy reasons for the use of experimental program evaluation when new treatments are implemented.     

Outcomes of children with emotional disturbance in residential treatment for educational purposes

A study was conducted of the outcomes of all children and adolescents (N=114) with serious emotional disturbance who had been placed by school districts in residential treatment facilities for educational purposes over a three-year period. Both cost and outcome analyses were conducted. Cost analyses indicated a total annual expenditure in excess of $5 million, or $80,000 per youth per length of stay. Outcome analyses, consisting of ratings of outcomes and outcome interviews with special education directors, revealed that 63% of the youth had either made no or minimal progress, had been discharged with a negative outcome, or had run away. Positive outcomes were achieved in only 25% of the cases, measured by the students' return to school or placement into a vocational training program. Another 11% of the youth were making substantial progress. Analyses of the relationships between outcomes and cost revealed no relationship. However, positive outcomes were associated with shorter lengths of stay. Further, students in the positive outcome categories had more severe functioning deficits at intake than students in the negative outcome categories. The availability of community-based services for the student and family was the single most likely reason reported by special education directors for positive discharge status.     

Linking Foster Family Characteristics and Mental Health Symptoms of Youth in Care

Youth in foster care are disproportionately at risk for developing internalizing and externalizing problems (Lawrence et al., 2006); however, a history of maltreatment prior to foster care placement does not automatically result in poor mental health outcomes. Among non-foster care youth, the quality of family interactions has been related to adjustment outcomes, such that low family cohesion and high family conflict is associated with poor mental health symptoms (Caples & Barrera, 2006). While little is known about these constructs in foster care placements, they may help explain the variance in internalizing and externalizing problems for youth in foster care. The present study aimed to examine whether characteristics of the foster care environment (i.e., conflict, cohesion) across various placement types (i.e., traditional foster homes, group-care settings) could help explain the link between previous maltreatment exposure and mental health problems. The sample included 178 youth in foster care (M_age?=?15.18, SD?=?1.76) and their foster caregivers living in the Midwest. Youth participants completed self-report measures about prior maltreatment history, current family environment characteristics, and youth internalizing symptoms. Foster caregivers completed measures on current family environment and youth externalizing symptoms. Results indicated that caregiver report, but not youth report, of family cohesion was negatively associated with youth report of internalizing problems. When examining the indirect effects, youth report of family conflict partially accounted for the link between youth self-report of maltreatment and internalizing symptoms (B?=?0.106, 95% CI?=?0.026–0.186). Caregiver report of family conflict fully accounted for the association between youth self-report of maltreatment and caregiver report of youths’ externalizing symptoms (B?=?0.108, 95% CI?=?0.005–0.211). Findings highlight the importance of utilizing multiple informants when measuring foster family environment and suggest that family conflict is particularly salient for the mental health of youth in foster care.

     

Long-term Outcomes of Children and Youth accessing Residential or Intensive Home-based Treatment: Three year follow up

In this study the long-terms outcomes of children and youth with severe mental health problems receiving residential treatment (RT) or an intensive home-based treatment (IHT) were reported. RT is 24-hour mental health intervention in a highly supervised and structured group living setting where individualized and related therapies are provided. Youths attend a day school within the residential environment. IHT developed as an alternative to residential treatment for youth and comprises the same therapeutic interventions provided in the home as opposed to the residential setting. Youths attend their regular school which could be within a specialized setting, such as a day school. At discharge, there were statistically and clinically significant improvements in psychosocial functioning for children and youth in RT and IHT. There were also statistically significant improvements in scores on symptom severity from admission to 12 to 18 months post-discharge, and these improvements were maintained at 36 to 40 months post-discharge. Differences in demographic data between the two groups suggest that the programs may serve two different populations, and that both programs are important components of a comprehensive mental health plan for children and youth.     

Treatment Participation among Children with Conduct Problems and the Role of Telephone Reminders

Children with antisocial, aggressive and disruptive behaviour problems are among the most frequent referrals to mental health services. These young people and their families present with a range of adverse contextual factors and can prove challenging to engage. We examined the characteristics of children with conduct problems, treatment participation, and the impact of telephone reminder calls. Consecutive referrals (N=262) to two child and youth mental health services were randomly assigned to either a reminder call condition or service as usual. In comparison to referrals without conduct problems, conduct problem children presented with greater sources of psychosocial adversity, attended fewer initial appointments and were at greater risk of treatment refusal. Importantly, telephone reminder calls significantly increased treatment attendance, though only for participants with elevated conduct problems. Telephone reminder calls, however, had no impact on treatment refusal, regardless of conduct problem status. The findings highlight a straightforward approach for enhancing treatment participation among a group that has been challenging for mental health services.     

Religious Involvement and Its Association to Risk Behaviors among Older Youth in Foster Care

This study examined religious involvement and its association to risk behaviors (sexual behavior, marijuana use, alcohol use, and cigarette use) among older youth in foster care (N=383). Three dimensions of religious involvement were assessed—church or religious service attendance, religious practices, and religious beliefs. Findings showed that gender, ethnic group membership, sexual abuse history, and placement type were significantly associated with older foster care youth’s religious involvement. Hierarchical logistic regression analyses showed that religious service attendance was associated with reduced odds of youth’s engagement in sexual behavior in the past 2 months and current use of cigarettes. In addition, greater religious beliefs were associated with a reduction in odds of youth’s use of alcohol in the past 6 months and current use of cigarettes. The consideration of religious involvement as a positive influence and resource that may reduce unhealthy risk behaviors among older youth in foster care is discussed.     

Differential patterns of post-shelter placement as a function of problem type and severity

Changes in placement restrictiveness, as a function of problem type and severity, were examined in a sample of 154 children departing a shelter for runaway and homeless youth. Six problem types were identified using a principal components analysis of youth-reported personal and family problems. Four of the six factors obtained represented youth problem types interpreted as reflecting antisocial/conduct problems, victimization by abuse, risk of suicide, and rebellious youth behaviors. The two remaining problem types were interpreted as a chaotic/aggressive family type and a mixed pattern of youth aggression and parental skill deficiency. An analysis of the problem types indicated that youth at higher risk for suicide, and those who came from more dysfunctional families, departed to living environments that were more restrictive than their placements at entry.     

Predictors of multiple concurrent and multiple sexual partnerships among male and female youth aged 18–24 in South Africa

This study aimed to determine predictors of multiple concurrent and multiple sexual partnerships among South African male and female youth. Data were from a cross-sectional population-based household survey of 3 123 youths aged 18 to 24 years from four South African provinces (males = 53.6%, blacks = 97.8%). Results from a sub-sample of being sexually active in the past 12 months (n = 1787) indicate that 5.3% (7.1% in males and 3.1% in females) youth participants had multiple concurrent sexual partners, and 38.8% (50.1% in males and 25.8% in females) had had two or more sexual partners in the past 12 months. Among females, multiple concurrent partnerships were only predicted by lower social network resources. Predictors of multiple sexual partnerships (two or more sexual partners in the past 12 months) among males included high HIV risk perception, never been tested for HIV and hazardous or harmful alcohol use. By contrast, among females, high peer pressure, lower education and ever having taken drugs predicted involvement with multiple sexual partners. Multi-level health promotion interventions are indicated for sexual behaviour change among South African youth.     

Diverting multi-problem youth from juvenile justice: investigating the importance of community influence on placement and recidivism

In the U.S., diversion has increasingly become one of the most utilized alternatives to detention of delinquent youth. Programs providing diversion can vary greatly. Variations in program design make it difficult to evaluate the effectiveness of program outcomes. Utilizing hierarchical linear modeling, this study examines variations in outcome for ten program sites of the New York State MH/JJ Diversion Project. Program and youth predictors were evaluated on two outcomes: out-of- community placement and recidivism. At the individual level, significant mental health and substance abuse problems, age, prior placements, and use of wraparound funds were predictive of youth placements, while significant substance abuse problems were predictive of recidivism. Program variations were found to have a significant impact on youth outcomes. Specifically, sites providing direct (or "in house") care had significantly reduced rates of placement. Study results and implications for future research are discussed.     

Reducing the Biological and Psychological Toxicity of Poverty-related Stress: Initial Efficacy of the BaSICS Intervention for Early Adolescents

This proof-of-concept study tests the initial efficacy of the Building a Strong Identity and Coping Skills (BaSICS) intervention, a selective prevention of internalizing problems program for early adolescents exposed to high levels of poverty-related stress. Eighty-four early adolescents (M_age = 11.36 years) residing in very low-income neighborhoods were randomized to receive the 16-session intervention (n = 44) or to an assessment-only control condition (n = 40). BaSICS teaches coping skills, social identity development, and collective social action to empower youth with the ability to connect with members of their communities and cope with poverty-related stress in positive and collaborative ways. Pretest–posttest analyses showed that intervention adolescents acquired problem-solving and cognitive-restructuring skills and reduced their reliance on avoidant coping. In addition, HPA reactivity was significantly reduced in the intervention youth, but not controls. Finally, intervention youth's internalizing and somatic symptoms as reported by both youth and their parents, showed significant reductions over time, whereas control youth had no such changes. Results provide strong support for this approach to strength-building and symptom reduction in a population of early adolescents exposed to poverty-related stress.