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González-García C, Vassiliadis E, Moreno-Manso JM, Alcántara M, del Valle JF, Bravo A. Changes in Mental Health of Children and Young People in Residential Care: Outcomes and Associated Factors. INTERVENCION PSICOSOCIAL 2023; 32:11-19. [PMID: 37361630 PMCID: PMC10268551 DOI: 10.5093/pi2022a16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 06/28/2023]
Abstract
Several studies have evidenced that children in out-of-home care (OOHC), including foster family care and residential care, reveal high levels of mental health disorders (ranging from 40% to 88%). This study examines the outcomes in mental health reported by key residential workers in a group of children and youth (N = 492) between 8-17 years old who were in residential child care (RCC) in Spain. The research also aims to explore the relationship between mental health outcomes and the provision of mental health services (i.e., receiving any mental health treatment) as well as the influence of child, family, and placement factors. The design of this study includes two measures: a baseline (T1) and a follow-up two years later (T2). The results indicated that 29.9% of young people enjoyed sustained mental health; 26% meaningful improvement in their mental health; 23.5% meaningful deterioration; and the remaining 20.5% showed no meaningful change. One of the main findings was that receiving mental health treatment had a significant impact on mental health outcomes. It is crucial to establish protocols and systematic detection tools to assess mental health and ensure detection and referral to proper treatment.
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Affiliation(s)
| | | | - Juan M. Moreno-Manso
- Universidad de ExtremaduraBadajozSpainUniversidad de Extremadura, Badajoz, Spain;
| | - Mavi Alcántara
- University of MurciaMurciaSpainUniversity of Murcia, Spain
| | | | - Amaia Bravo
- University of OviedoOviedoSpainUniversity of Oviedo, Spain
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Putnam-Hornstein E, Foust R, Cuccaro-Alamin S, Prindle J, Nghiem H, Ahn E, Palmer L. A Population-Based Study of Mental Health Diagnoses and Child Protection System Involvement Among Medicaid-Insured Children. J Pediatr 2023; 252:117-123. [PMID: 36027974 DOI: 10.1016/j.jpeds.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To determine the population prevalence of diagnosed mental health disorders among Medicaid-insured children <18 years old in California based on levels of current and past child protection system (CPS) involvement. STUDY DESIGN In this retrospective, population-based study, we examined the full population of children enrolled in California's Medicaid program for at least 1 month between 2014 and 2015 and who had at least 1 claim during that period (n = 3 352 886). Records for Medicaid-insured children were probabilistically linked to statewide CPS records of maltreatment and foster care placements since 1998. A primary or secondary mental health diagnosis was classified using International Classification of Diseases codes. RESULTS Overall, 14% (n = 470 513) of all children insured through Medicaid in 2014-2015 had a documented mental health diagnosis. Among children with a diagnosis, the percentage with CPS involvement (ie, any report for maltreatment) was nearly twice that of the Medicaid population overall (50.4% vs 26.9%). This finding held across all diagnostic groups but with notable variations in magnitude. A graded relationship emerged between the level of CPS involvement and the likelihood of a mental health diagnosis. Diagnoses among children reported for maltreatment were common, regardless of placement in foster care. CONCLUSIONS Findings document high rates of both mental health diagnoses and past child protection involvement in a population of Medicaid-insured children. Most children reported for maltreatment will never be placed in foster care, underscoring the importance of ensuring that the children who remain at home receive the proper array and coordination of services.
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Affiliation(s)
- Emily Putnam-Hornstein
- Children's Data Network, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Children's Data Network, University of Southern California, Los Angeles, CA, USA; California Child Welfare Indicators Project, University of California at Berkeley, Berkeley, CA, USA.
| | - Regan Foust
- Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Stephanie Cuccaro-Alamin
- Children's Data Network, University of Southern California, Los Angeles, CA, USA; California Child Welfare Indicators Project, University of California at Berkeley, Berkeley, CA, USA
| | - John Prindle
- Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Huy Nghiem
- Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Eunhye Ahn
- Children's Data Network, University of Southern California, Los Angeles, CA, USA; George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Lindsey Palmer
- Children's Data Network, University of Southern California, Los Angeles, CA, USA; Child Maltreatment Solutions Network, Pennsylvania State University, State College, PA, USA
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Soriano-Díaz C, Moreno-Manso JM, García-Baamonde ME, Guerrero-Molina M, Cantillo-Cordero P. Behavioral and Emotional Difficulties and Personal Wellbeing of Adolescents in Residential Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:256. [PMID: 36612578 PMCID: PMC9819573 DOI: 10.3390/ijerph20010256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/26/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
This work studies the emotional and behavioural difficulties and the personal wellbeing of adolescents under protective measures. The sample is made up of 151 adolescents in residential care between 11 and 17 years of age. The instruments used were the Strengths and Difficulties Questionnaire (SDQ) and the Personal Wellbeing Index (PWI). The results indicate that a high percentage of adolescents have emotional and behavioural difficulties. We found a greater presence of behavioural rather than emotional problems in the adolescents. Similarly, we also found that females showed more emotional difficulties than the males. As for personal wellbeing, the results indicate that the adolescents are dissatisfied in several areas of their life, they feel insecure and have a pessimistic view of their future and of their achievements. Furthermore, those adolescents who were admitted to residential care due to something other than child abuse have a greater prosocial behaviour. It can be concluded that the more difficulties the adolescents experience (emotional, behavioural and with their peers), the lower the perception of their personal wellbeing will be. This study allows us to design interventions aimed at promoting psychological wellbeing among these adolescents.
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Sullivan E, Geierstanger S, Soleimanpour S. Mental Health Service Provision at School-Based Health Centers During the COVID-19 Pandemic: Qualitative Findings From a National Listening Session. J Pediatr Health Care 2022; 36:358-367. [PMID: 35074221 PMCID: PMC8598949 DOI: 10.1016/j.pedhc.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION School-based health centers (SBHCs) provide health services to more than six million youth annually. When schools throughout the United States closed in spring 2020, many SBHCs were also forced to close physical operations.. METHOD This study uses qualitative data collected from SBHC representatives nationwide to examine supports and challenges affecting mental health services provision during the COVID-19 pandemic, changes in the provision of these services, and priorities for assessing and supporting student mental health needs in the 2021-2022 school year. RESULTS Partnerships, community and stakeholder buy-in, and student access were key supports to continuous care throughout the pandemic, whereas lack of available staff and lack of in-person access to students were key challenges. Patients demonstrated increased acuity of presenting mental health problems, more immediate and complex mental health challenges, and greater co-morbidities. DISCUSSION SBHCs pivoted, even with limited resources, to meet students' increasing needs for mental health care.
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Eiraldi R, McCurdy BL, Khanna MS, Wolk CB, Glick HA, Rabenau-McDonnell QA, Comly R, Rutherford LE, Banks J, Rufe SA, Popkin KM, Wilson T, Henson K, Wandersman A, Jawad AF. Study protocol: cluster randomized trial of consultation strategies for the sustainment of mental health interventions in under-resourced urban schools: rationale, design, and methods. BMC Psychol 2022; 10:24. [PMID: 35130964 PMCID: PMC8822800 DOI: 10.1186/s40359-022-00733-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background The school is a key setting for the provision of mental health services to children, particularly those underserved through traditional service delivery systems. School-wide Positive Behavioral Interventions and Supports (PBIS) is a tiered approach to service delivery based on the public health model that schools use to implement universal (Tier 1) supports to improve school climate and safety. As our prior research has demonstrated, PBIS is a useful vehicle for implementing mental and behavioral health evidence-based practices (EBPs) at Tier 2 for children with, or at risk for, mental health disorders. Very little research has been conducted regarding the use of mental health EBPs at Tier 2 or how to sustain implementation in schools. Methods/design The main aim of the study is to compare fidelity, penetration, cost-effectiveness, and student outcomes of Tier 2 mental health interventions across 2 sustainment approaches for school implementers in 12 K-8 schools. The study uses a 2-arm, cluster randomized controlled trial design. The two arms are: (a) Preparing for Sustainment (PS)—a consultation strategy implemented by school district coaches who receive support from external consultants, and (b) Sustainment as Usual (SAU)—a consultation strategy implemented by school district coaches alone. Participants will be 60 implementers and 360 students at risk for externalizing and anxiety disorders. The interventions implemented by school personnel are: Coping Power Program (CPP) for externalizing disorders, CBT for Anxiety Treatment in Schools (CATS) for anxiety disorders, and Check-in/Check-out (CICO) for externalizing and internalizing disorders. The Interactive Systems Framework (ISF) for Dissemination and Implementation guides the training and support procedures for implementers. Discussion We expect that this study will result in a feasible, effective, and cost-effective strategy for sustaining mental health EBPs that is embedded within a multi-tiered system of support. Results from this study conducted in a large urban school district would likely generalize to other large, urban districts and have an impact on population-level child mental health. Trial registration ClinicalTrials.gov identifier number NCT04869657. Registered May 3, 2021.
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Affiliation(s)
- Ricardo Eiraldi
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA. .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Barry L McCurdy
- Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA, 19131, USA
| | - Muniya S Khanna
- OCD and Anxiety Institute, 3138 Butler Pike # 200, Plymouth Meeting, PA, 19462, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locus Walk # 210, Philadelphia, PA, 19104, USA
| | - Henry A Glick
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locus Walk # 210, Philadelphia, PA, 19104, USA.,Wharton School, University of Pennsylvania, 3620 Locust Walk, Philadelphia, PA, 19104, USA
| | - Quinn A Rabenau-McDonnell
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Rachel Comly
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Laura E Rutherford
- Devereux Center for Effective Schools, 2012 Renaissance, Blvd., King of Prussia, PA, 19406, USA
| | - Jayme Banks
- School District of Philadelphia, 440 North Broad Street, Philadelphia, PA, 19130, USA
| | - Steven A Rufe
- School District of Philadelphia, 440 North Broad Street, Philadelphia, PA, 19130, USA
| | - Kristina M Popkin
- School District of Philadelphia, 440 North Broad Street, Philadelphia, PA, 19130, USA
| | - Tara Wilson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Kathryn Henson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Abraham Wandersman
- Department of Psychology, University of South Carolina-Columbia, Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Abbas F Jawad
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
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Dickson KS, Kenworthy L, Anthony L, Brookman-Frazee L. Mental Health Therapist Perspectives on the Role of Executive Functioning in Children's Mental Health Services. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 8:39-54. [PMID: 36950479 PMCID: PMC10027378 DOI: 10.1080/23794925.2021.2013142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Executive functioning is considered a key transdiagnostic factor underlying multiple mental health conditions. Evidence-based interventions targeting executive functioning skills exist and there are ongoing efforts to implement these interventions in routine community-based care. However, there is limited research characterizing therapist perspectives regarding addressing executive functioning within community-based mental health services. The current mixed-methods study aims to characterize mental health therapist perspectives regarding the role of executive functioning in youth clinical presentation and the psychotherapy process and outcomes as well as their experience and training related to executive functioning. Forty-three therapists completed a survey about their perspectives about executive functioning and 14 participated in subsequent focus groups to expand survey results. Results indicated that therapists perceive executive functioning challenges as impacting a large portion of children on their caseload, present across multiple mental health conditions, and that executive functioning is frequently a focus of psychotherapy. Therapists also identified executive functioning challenges as a barrier to therapy engagement and effectiveness. However, therapists reported limited knowledge and training as well as significant motivation for executive functioning training, including executive functioning interventions. Findings confirm the significant role of executive functioning in youth presenting for mental health services and the psychotherapy process and outcomes. Findings also highlight the need for further translation of evidence-based interventions and tools. Challenges as well as potential solutions to inform ongoing and future work seeking to translate and implement evidence-based executive functioning interventions in community mental health services are discussed.
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Affiliation(s)
- Kelsey S. Dickson
- San Diego State University, San Diego, CA
- Child and Adolescent Services Research Center, San Diego,
CA
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders –
Children’s National Hospital, Washington, DC
| | - Laura Anthony
- University of Colorado School of Medicine, Aurora, CO
- Children’s Hospital of Colorado, Aurora, CO
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego,
CA
- University of California, San Diego, CA
- Rady Children’s Hospital-San Diego, CA
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7
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Sociodemographic and clinical characteristics in child and youth mental health; comparison of routine outcome measurements of an Australian and Dutch outpatient cohort. Epidemiol Psychiatr Sci 2021; 30:e74. [PMID: 34809732 PMCID: PMC8611930 DOI: 10.1017/s2045796021000652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AIMS Although of great value to understand the treatment results for mental health problems obtained in clinical practice, studies using naturalistic data from children and adolescents seeking clinical care because of complex mental health problems are limited. Cross-national comparison of naturalistic outcomes in this population is seldomly done. Although careful consideration is needed, such comparisons are likely to contribute to an open dialogue about cross-national differences and may stimulate service improvement. The aim of this observational study is to investigate clinical characteristics and outcomes in naturalistic cohorts of specialized child and adolescent mental health outpatient care in two different countries. METHODS Routinely collected data from 2013 to 2018 of 2715 outpatients in the Greater Area of Brisbane, Australia (CYMHS) and 1158 outpatients in Leiden, the Netherlands (LUMC-Curium) were analysed. Demographics, clinical characteristics and severity of problems at start and end of treatment were described, using Children's Global Assessment Scale (CGAS), Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the parental Strength and Difficulties Questionnaire (SDQ-P). RESULTS Routine outcome measures (CGAS, HoNOSCA, SDQ-P) showed moderate to severe mental health problems at start of treatment, which improved significantly over time in both cohorts. Effect sizes ranged between 0.73-0.90 (CYMHS) and 0.57-0.76 (LUMC-Curium). While internalizing problems (mood disorder, anxiety disorder and stress-related disorder) were more prevalent at CYMHS, externalizing developmental problems (ADHD, autism) prevailed at LUMC-Curium. Comorbidity (>1 diagnosis on ICD10/DSM-IV) was relatively similar: 45% at CYMHS and 39 % at LUMC-Curium. In both countries, improvement of functioning was lowest for conduct disorder and highest for somatoform/conversion disorders and obsessive-compulsive disorders (OCD). Overall, 20-40% showed clinically significant improvement (shift from clinical-range at start to a non-clinical-range at the end of treatment), but nearly half of patients still experienced significant symptoms at discharge. CONCLUSIONS This large-scale outcome study showed both cohorts from Australia and the Netherlands improve during the course of treatment on clinician- and parent-reported measures. Although samples were situated within different contexts and differed in patient profiles, they showed similar trends in improvement per diagnostic group. While 20-40% showed clinically significant change, many patients experienced residual symptoms reflecting increased risk for negative outcome into adulthood. We emphasize cross-national comparison of naturalistic outcomes faces challenges, although it can similarly reveal trends in treatment outcome providing direction for future research: what factors determine discharge from specialized services; and how to improve current treatments in this severely affected population.
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Dickson KS, Galligan ML, Lok H. Short report: A quantitative methodological review of participant characteristics in the literature testing mental health interventions for youth with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:995-1000. [PMID: 34806428 DOI: 10.1177/13623613211056408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Previous research has highlighted the importance of mental health treatment for autistic youth. In that research base, most studies focus on demonstrating the efficacy of a particular intervention with a sample of autistic youth. However, understanding the characteristics of samples used within these studies (i.e. demographics) is an important avenue for expanding this research to a more diverse, representative sample of autistic youth in community settings. As such, the current review examined and characterized participants included within mental health treatment research. We coded studies for various demographics among the youth sample, caregivers, and providers participants. Results indicated that while efforts have been made to increase diversity in research, very few studies including transition-aged youth, those identifying as female, and/or those identifying as non-Caucasian. Clinically, a few studies included youth with lower cognitive abilities and/or those with specific mental health problems (e.g. trauma and depression) or more than one co-occurring mental health conditions. Overall, our results highlight several critical gaps in our current evidence base regarding mental health treatment for autistic youth, including the limited clinical representativeness of both provider and child participants.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, USA.,Child and Adolescent Services Research Center, USA
| | - Megan Ledoux Galligan
- Child and Adolescent Services Research Center, USA.,University of California, Riverside, USA
| | - Ho Lok
- San Diego State University, USA.,Child and Adolescent Services Research Center, USA
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Evidence-Based Treatments in Community Mental Health Settings: Use and Congruence With Children's Primary Diagnosis and Comorbidity. Res Child Adolesc Psychopathol 2021; 50:417-430. [PMID: 34661782 DOI: 10.1007/s10802-021-00877-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
Many evidence-based treatments (EBTs) have been identified for specific child mental health disorders, but there is limited research on the use of EBTs in community-based settings. This study used administrative data from a statewide system of care to examine 1) the extent to which EBTs were provided congruent with the child's primary diagnosis, 2) whether there were differences in effectiveness of EBTs that were congruent or incongruent with the child's primary diagnosis, and 3) whether comorbidity moderated the effectiveness of EBTs for children based on congruence with their primary diagnosis. The sample consisted of 23,895 children ages 3-17 with at least one of the most common diagnoses (attention-deficit/hyperactivity disorder, conduct problems, depressive disorders, anxiety disorders, and post-traumatic stress disorder) who received outpatient psychotherapy. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity. Forty-two percent of children received an EBT congruent with their diagnosis, and these children showed greater improvement than the 35% of children who received no EBT (ES = 0.14-0.16) or the 23% who received an EBT incongruent with their diagnosis (ES = 0.06-0.15). For children with comorbid diagnoses, the use of EBTs congruent with the primary diagnosis was also associated with the greatest improvement, especially when compared to no EBT (ES = 0.22-0.24). Results of the current study support the use of EBTs in community-based settings, and suggest that clinicians should select EBTs that match the child's primary diagnosis to optimize treatment outcomes, especially for children with comorbidity.
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Kuranga AT, Yussuf AD. Psychiatric morbidity amongst adolescents in a Nigerian juvenile correctional facility. S Afr J Psychiatr 2021; 27:1590. [PMID: 34522436 PMCID: PMC8424729 DOI: 10.4102/sajpsychiatry.v27i0.1590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background The high occurrence of psychiatric disorders amongst adolescents within the Juvenile Justice System (JJS) has been confirmed. Most of the available data are from developed countries and some of them focus on just a single psychiatric disorder which may not be representative of the situation in low-income countries, hence the need for more studies in developing countries, including Nigeria. Aim The study aimed to determine the prevalence of psychiatric disorders amongst adolescent residents of a correctional facility. Setting The study was carried out at a Borstal Institution in North-Central Nigeria. Methods A descriptive cross-sectional study design was used. One hundred and twenty adolescents were assessed using the socio-demographic pro forma questionnaire designed by the researcher and the Kiddies Schedule for Affective Disorders and Schizophrenia (KSADS-PL). Data were analysed using EPI-INFO 4.06 d version 6.04 software. Results A total of 62.5% of the male respondents were older than 15 years. The percentage of respondents with a psychiatric disorder was 82.5%. The rate of psychiatric disorders was high with disruptive behaviour disorders being the most common at 40.8%, others were substance use disorders (15.8%), anxiety disorders (14.2%), psychosis (6.7%) and mood disorders (5%). Conclusion This study has established a high prevalence rate of psychiatric disorders amongst incarcerated adolescents. This is in line with the findings of numerous studies worldwide. This study has identified the need to increase awareness and knowledge about the high morbidity of mental disorders in growing juvenile detainee populations. This will allow early identification of adolescents at risk of psychiatric disorders and ensure efficient resource distribution of both JJS service and mental healthcare. Effective and appropriate interventions have shown to improve overall health, quality of life and reduce the rate of recidivism amongst incarcerated juveniles.
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Affiliation(s)
- Amudalat T Kuranga
- Department of Behavioural Science, University of Ilorin Teaching Hospital, Kwara State, Nigeria
| | - Abdullahi D Yussuf
- Department of Behavioural Science, University of Ilorin Teaching Hospital, Kwara State, Nigeria
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Baetz CL, Surko M, Moaveni M, McNair F, Bart A, Workman S, Tedeschi F, Havens J, Guo F, Quinlan C, Horwitz SM. Impact of a Trauma-Informed Intervention for Youth and Staff on Rates of Violence in Juvenile Detention Settings. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9463-NP9482. [PMID: 31253054 DOI: 10.1177/0886260519857163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The majority of youth in the juvenile justice system have experienced multiple traumatic events in their lives, including community violence, physical abuse, neglect, and traumatic loss. These high prevalence rates, coupled with the known negative consequences of trauma in childhood and adolescence, have led to a greater emphasis on implementing trauma-informed services and practices within juvenile justice settings. However, although many stakeholders and government entities have expressed support for creating more trauma-informed juvenile justice systems, there is still limited empirical knowledge about which interventions are most effective at improving outcomes, particularly at the organizational or facility level. In an effort to fill this gap, the current study evaluated the impact of a trauma-informed milieu intervention, including skills training for youth and training for staff, on rates of violence at two secure juvenile detention facilities (N = 14,856) located in a large Northeastern city. The analyses revealed that the intervention was significantly related to a reduction of violent incidents in Facility A, with no impact on incidents in Facility B. Follow-up analyses revealed that a larger proportion of eligible youth in Facility A completed the skills group program as compared with eligible youth in Facility B (16% vs. 9%). This finding has important implications for the implementation of trauma-informed interventions for youth in juvenile detention settings, as it suggests that to impact outcomes at the facility level, a minimum threshold of youth may need to be exposed to the intervention. In addition, reductions in violence at Facility A were only realized after both staff training and youth skills components were implemented, suggesting that both components are necessary to create change at the facility level. Future research is needed to further explore the impact of organizational and implementation-level factors on trauma-informed care outcomes in juvenile justice settings.
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Affiliation(s)
| | - Michael Surko
- New York University School of Medicine, New York City, USA
| | - Mahtab Moaveni
- New York University School of Medicine, New York City, USA
| | - Felicia McNair
- New York University School of Medicine, New York City, USA
| | - Amanda Bart
- New York University School of Medicine, New York City, USA
| | - Sara Workman
- New York City Administration for Children's Services, New York City, USA
| | - Frank Tedeschi
- New York University School of Medicine, New York City, USA
| | | | - Fei Guo
- New York University School of Medicine, New York City, USA
| | - Carol Quinlan
- New York University School of Medicine, New York City, USA
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12
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Oerbeck B, Overgaard KR, Hjellvik V, Lien L, Bramness JG. The Use of Antidepressants, Antipsychotics, and Stimulants in Youth Residential Care. J Child Adolesc Psychopharmacol 2021; 31:350-357. [PMID: 33635152 PMCID: PMC8233215 DOI: 10.1089/cap.2020.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objectives: To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Methods: Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age- and gender-adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age, and gender. Results: One thousand eight hundred fifty-six children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥ 13 years. Among those, 423 or 23% used any of the 3 psychotropics, which was significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most of the people. Polypharmacy was not frequent in RC, as only 26% used ≥2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and although the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6-16-year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (95% confidence interval [95% CI]: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (95% CI: 0.9-1.0). Conclusion: The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.
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Affiliation(s)
- Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Address correspondence to: Beate Oerbeck, PhD, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959 Nydalen, Oslo 0424, Norway
| | | | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Faculty of Health and Social Science, Inland University College of Applied Science, Elverum, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Clinical Medicine, UiT—The Arctic University of Norway, Tromsø, Norway
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13
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Hare MM, Graziano PA. The Cost-Effectiveness of Parent-Child Interaction Therapy: Examining Standard, Intensive, and Group Adaptations. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:499-513. [PMID: 32935144 PMCID: PMC7960556 DOI: 10.1007/s10488-020-01083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
This study examined the cost-effectiveness of standard parent-child interaction therapy (PCIT) and three adaptations: intensive-PCIT (I-PCIT), small group PCIT, and large group PCIT. This study used cost-effectiveness analyses to calculate average cost-effectiveness ratios, which represents the average cost for one family to change one standard deviation on each outcome measure: externalizing behavior problems, positive parenting skills, negative parenting skills, child compliance, and parenting stress. While it had the lowest initial set up cost, results indicated that standard PCIT was the least cost-effective option in reducing child disruptive behaviors and in increasing child compliance. Large group PCIT was the most cost-effective in increasing positive parenting skills and child compliance and in reducing negative parenting skills and parenting stress. I-PCIT was the most cost-effective in reducing child disruptive behaviors and the second most cost-effective option in increasing positive parenting skills and child compliance and in decreasing negative parenting. As large group and I-PCIT were the most cost-effective in different domains, both could be recommended to parents as treatment options. Future research should confirm our cost-effective results within community settings.
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Affiliation(s)
- Megan M Hare
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St., Miami, FL, 33199, USA
| | - Paulo A Graziano
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St., Miami, FL, 33199, USA.
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14
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Kim BKE, Johnson J, Rhinehart L, Logan-Greene P, Lomeli J, Nurius PS. The school-to-prison pipeline for probation youth with special education needs. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2021; 91:375-385. [PMID: 34138628 PMCID: PMC8432608 DOI: 10.1037/ort0000538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Juvenile justice-involved youth with special education eligibility may have distinct needs from other justice-involved youth that place them at higher risk of re-offending. This study examines the extent to which the comorbidity of risk factors, such as school challenges and mental and emotional health problems, is related to recidivism among probation youth with a diagnosis eligible for special education. Data came from the Washington State Juvenile Court Assessment provided to 4,317 youth adjudicated to probation for at least 3 months. We used independent sample t-tests and chi-square tests to assess the difference in mental health and school problems (e.g., suspension/expulsion history) between those with and without special education needs. Multiple regression models estimated the unique and cumulative role of special education status, mental health, and school problems in future recidivism. In the study sample, 39.6% (n = 1,708) of the youth had diagnoses eligible for special education; over 42% of these youth had two or more qualifying diagnoses. Controlling for demographics, mental health, and self-regulation skills, our findings suggest that probation youth with special education needs, compared to the rest of the probation youth, were more likely to recidivate. School exclusion increased the number of recidivisms significantly more for justice-involved youth with special education needs than those without special education needs. The findings of the study illuminate important factors for continued justice-involvement as well as insights into service and treatment planning for youth serving probation in the community, especially for those who are eligible for special education. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Laura Rhinehart
- Department of Education, University of California, Los Angeles
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15
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Barnett ML, Lau AS, Lind T, Wright B, Stadnick N, Innes-Gomberg D, Pesanti K, Brookman-Frazee L. Caregiver Attendance as a Quality Indicator in the Implementation of Multiple Evidence-Based Practices for Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:868-882. [PMID: 31799862 PMCID: PMC7269837 DOI: 10.1080/15374416.2019.1683851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study investigated a quality indicator for children's mental health, caregiver attendance in youth psychotherapy sessions, within a system-driven implementation of multiple evidence-based practices (EBPs) in children's community mental health services. METHOD Administrative claims from nine fiscal years were analyzed to characterize and predict caregiver attendance. Data included characteristics of therapists (n = 8,626), youth clients (n = 134,368), sessions (e.g., individual, family), and the EBP delivered. Clients were primarily Latinx (63%), male (54%) and mean age was 11; they presented with a range of mental health problems. Three-level mixed models were conducted to examine the association between therapist, youth, service, EBP characteristics and caregiver attendance. RESULTS Caregivers attended, on average, 46.0% of sessions per client for the full sample and 59.6% of sessions for clients who were clinically indicated, based on age and presenting problem, to receive caregiver-focused treatment. Following initial EBP implementation, the proportion of caregiver attendance in sessions increased over time. Caregivers attended a higher proportion of youth psychotherapy sessions when clients were younger, had an externalizing disorder, were non-Hispanic White, and were male. Further, higher proportions of caregiver attendance occurred when services were delivered in a clinic setting (compared with school and other settings), by bilingual therapists, and the EBP prescribed caregiver attendance in all sessions. CONCLUSIONS Overall, the patterns of caregiver attendance appear consistent with evidence-informed practice parameters of client presenting problem and age. Yet, several improvement targets emerged such as client racial/ethnic background and service setting. Potential reasons for these disparities are discussed.
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Affiliation(s)
- Miya L. Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical, & School Psychology, Santa Barbara, CA
| | - Anna S. Lau
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Teresa Lind
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
| | - Blanche Wright
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Nicole Stadnick
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
| | | | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Lauren Brookman-Frazee
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
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16
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Young S, Adamo N, Ásgeirsdóttir BB, Branney P, Beckett M, Colley W, Cubbin S, Deeley Q, Farrag E, Gudjonsson G, Hill P, Hollingdale J, Kilic O, Lloyd T, Mason P, Paliokosta E, Perecherla S, Sedgwick J, Skirrow C, Tierney K, van Rensburg K, Woodhouse E. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry 2020; 20:404. [PMID: 32787804 PMCID: PMC7422602 DOI: 10.1186/s12888-020-02707-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD. METHODS The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan. RESULTS A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them. CONCLUSIONS This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, PO 1735, Croydon, London, CR9 7AE, UK.
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.
| | - Nicoletta Adamo
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
- Service for Complex Autism and Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK
| | | | | | | | | | | | - Quinton Deeley
- National Autism Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Emad Farrag
- South London & Maudsley NHS Foundation Trust, Maudsley Health, Abu Dhabi, UAE
| | - Gisli Gudjonsson
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter Hill
- Independent Consultant in Child and Adolescent Psychiatry, Private Practice, London, UK
| | - Jack Hollingdale
- Michael Rutter Centre, South London and Maudsley Hospital, London, UK
| | | | | | - Peter Mason
- ADHD and Psychiatry Services Limited, Liverpool, UK
| | | | | | - Jane Sedgwick
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
- Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Caroline Skirrow
- Cambridge Cognition, Cambridge, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Kevin Tierney
- Neuropsychiatry Team, National Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kobus van Rensburg
- Adult ADHD and AS Team & CYP ADHD and ASD Service in Northamptonshire, Northampton, UK
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
- Compass, London, UK
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17
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Stadnick NA, Lau AS, Dickson KS, Pesanti K, Innes-Gomberg D, Brookman-Frazee L. Service use by youth with autism within a system-driven implementation of evidence-based practices in children's mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2094-2103. [PMID: 32686469 DOI: 10.1177/1362361320934230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Public mental health systems play an important role in caring for youth with autism spectrum disorder. Like other dually diagnosed populations, youth with autism spectrum disorder may receive services in the context of evidence-based practice implementation efforts within public mental health systems. Little is known about service use patterns within the context of system-driven implementations efforts for this population. This case-control study examined mental health service patterns of 2537 youth with autism spectrum disorder compared to 2537 matched peers receiving care in the Los Angeles County Department of Mental Health, the largest public mental health department in the United States, within the context of a system-driven implementation of multiple evidence-based practices. Although not the primary target of this implementation effort, youth with autism spectrum disorder were served when they met criteria for the services based on their presenting mental health symptoms. Comparative analyses using administrative claims data were conducted to examine differences in mental health utilization patterns and clinical characteristics. Findings revealed significant differences in the volume and duration of mental health services as well as differences in the service type and evidence-based practice delivered between youth with and without autism spectrum disorder. Results provide direction targeting implementation efforts for youth with autism spectrum disorder within a public mental health system care reform.
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Affiliation(s)
- Nicole A Stadnick
- University of California, San Diego, USA.,Dissemination and Implementation Science Center, University of California San Diego, USA.,Child and Adolescent Services Research Center, USA
| | - Anna S Lau
- University of California Los Angeles, USA
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, USA.,San Diego State University, USA
| | - Keri Pesanti
- Los Angeles County Department of Mental Health, USA
| | | | - Lauren Brookman-Frazee
- University of California, San Diego, USA.,Dissemination and Implementation Science Center, University of California San Diego, USA.,Child and Adolescent Services Research Center, USA.,Autism Discovery Institute, Rady Children's Hospital San Diego, USA
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18
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Practices Derived from the Evidence Base for Depression Predict Disruptive Behavior Progress in Adolescent Community Mental Health Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:219-232. [PMID: 32661788 DOI: 10.1007/s10488-020-01068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Disruptive behavior problems develop along multiple causal pathways and are associated with a wide variety of co-occurring problems, including mood disorders. In usual care, effective treatment practices for youth disruptive behavior might differ from what the efficacy research suggests, given treatment setting and population demographic differences. The current study examined whether practices derived from the evidence base for disruptive behavior and/or depressed mood predicted progress on disruptive behavior problems in an adolescent usual care sample. Monthly clinical data, including therapeutic practices, treatment targets, and progress on selected treatment targets, for 1210 youth ages 13-17 who received intensive in-home services and were treated for disruptive behavior problems were examined utilizing multilevel modeling techniques. Practices derived from the evidence base for only depressed mood and practices derived from both disruptive behavior and depressed mood literatures predicted disruptive behavior progress, while practices derived from only the disruptive behavior evidence-based literature did not. All five practice elements exclusive to depressed mood treatment predicted positive disruptive behavior progress, while two of eleven disruptive behavior practices and four of seven practices derived from both problem areas predicted positive progress. Findings held when other predictors were included as covariates, including youth age and functional impairment. Although directionality remains unclear and further research is vital, usual care settings might present barriers to disruptive behavior treatment as prescribed by the evidence base, and youth-focused treatments based on depressed mood treatments merit further examination as a potentially promising route to effective treatment in such settings.
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Gatov E, Muir L, Mowat V, Elkader A, Yang J, Kopp A, Cairney J. Acute and outpatient service utilisation prior to, during, and following enrolment in community-based mental health treatment among children and youth in Central Ontario: A proof of concept for cross-sectoral data linkage. J Paediatr Child Health 2020; 56:928-935. [PMID: 31997491 DOI: 10.1111/jpc.14779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 12/30/2019] [Accepted: 01/01/2020] [Indexed: 11/28/2022]
Abstract
AIM Given the fragmentation of mental health and addictions (MHA) services for children and youth, comprehensive data on utilisation patterns are lacking. We sought to describe MHA-related service use across the community, acute and outpatient sectors. METHODS We used linked health-administrative data sets to identify a cohort of individuals aged <18 who received MHA treatment in a large community organisation in Ontario, Canada between 1 April 2007 and 31 March 2012. We described their socio-demographic characteristics, examined their MHA-related concurrent service use in acute care and outpatient physician settings (primary care providers, paediatricians and psychiatrists), and compared service utilisation prior to, during and following enrolment using Poisson regressions. RESULTS Among 7285 children and youth receiving community MHA treatment, there were 481 concurrent MHA-related emergency department visits, 173 hospitalisations and 12140 outpatient physician visits. The average age at enrolment was 10.5 years, and 64% of clients were enrolled for ≥3 months. MHA-related emergency department use significantly declined from 1 year prior, compared to 1 year following receipt of community MHA treatment (112 vs. 82 visits per 1000 person-years, P < 0.001), particularly in females, ages 10-14, those living in higher-income neighbourhoods and urban areas, and those with anxiety disorders. MHA hospitalisations also declined (45 vs. 32, P < 0.001), while outpatient physician visits increased (1750 vs. 1874, P < 0.001). CONCLUSIONS Our study suggests that community-based MHA treatment may be effective in diverting children and youth away from acute care and highlights the importance of data linkage as a means to better understand the complexity of cross-sectoral MHA service use.
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Affiliation(s)
- Evgenia Gatov
- Mental Health and Addictions Program, ICES, Toronto, Ontario, Canada
| | - Lindsay Muir
- Planning and Research, Kinark Child and Family Services, Markham, Ontario, Canada
| | - Vicki Mowat
- Planning and Research, Kinark Child and Family Services, Markham, Ontario, Canada
| | - Alex Elkader
- Planning and Research, Kinark Child and Family Services, Markham, Ontario, Canada
| | - Julie Yang
- Mental Health and Addictions Program, ICES, Toronto, Ontario, Canada
| | - Alexander Kopp
- Mental Health and Addictions Program, ICES, Toronto, Ontario, Canada
| | - John Cairney
- Mental Health and Addictions Program, ICES, Toronto, Ontario, Canada.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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20
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Oerbeck B, Overgaard KR, Hjellvik V, Bramness JG, Hansen BH, Lien L. The Use of Sleep Medication in Youth Residential Care. J Child Adolesc Psychopharmacol 2020; 30:335-341. [PMID: 31976753 PMCID: PMC7310223 DOI: 10.1089/cap.2019.0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Methods: Participants were youth 0-20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). Results: A total of 2171 youths were identified in RC at mean age 14 years (82% ≥ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5-2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3-1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylum seekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Conclusion: Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.
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Affiliation(s)
- Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Address correspondence to: Beate Oerbeck, PhD, Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424 Oslo, Norway
| | | | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Jørgen G. Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Berit Hjelde Hansen
- Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Faculty of Health and Social Science, Inland University College of Applied Science, Elverum, Norway
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21
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Galvan T, Gudiño OG. Impact of Youth Problem Type on Specific Dimensions of Caregiver Strain in Latino Families. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Grant B, O’Loughlin K, Holbrook H, Althoff R, Kearney C, Perepletchikova F, Grasso D, Hudziak J, Kaufman J. A multi-method and multi-informant approach to assessing post-traumatic stress disorder (PTSD) in children. Int Rev Psychiatry 2020; 32:212-220. [PMID: 31880487 PMCID: PMC7190440 DOI: 10.1080/09540261.2019.1697212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Trauma exposure is highly prevalent among children globally, and is associated with elevated rates of PTSD. The goal of this study was to systematically evaluate the effects of multiple informants and multiple screening measures on the identification of specific PTSD symptoms and rates of PTSD diagnoses. Participants in this study included 350 maltreated children from two cohorts, one recruited from Connecticut (n = 130), and the other from Vermont (n = 220). Both cohorts completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED) before a PTSD self-report measure. The KSADS psychiatric interview was also completed with the Connecticut cohort, with best-estimate ratings generated using parent and child interview, child self-report, and teacher questionnaire data. In addition to the SCARED and PTSD self-report scale, parents of the Vermont cohort completed the Child Behavioural Checklist. Significant differences emerged between parent and child report of sleep, nightmares, concentration, and irritability problems, suggesting the need for multiple informants in PTSD screening. Children also under-reported nightmares when asked in the context of a trauma-specific screening tool. As child trauma is associated with a broad range of psychiatric sequelae, comprehensive assessment using both general symptomatology and trauma-specific measures is recommended, since children often shut down when completing trauma measures.
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Affiliation(s)
- B.R. Grant
- Center for Child and Family Traumatic Stress, Kennedy Krieger Institute, Baltimore, MD,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - K. O’Loughlin
- Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, VT
| | - H.M. Holbrook
- Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, VT
| | - R.R. Althoff
- Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, VT
| | - C. Kearney
- Center for Child and Family Traumatic Stress, Kennedy Krieger Institute, Baltimore, MD
| | - F. Perepletchikova
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
| | - D.J. Grasso
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT
| | - J.J. Hudziak
- Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, VT
| | - J. Kaufman
- Center for Child and Family Traumatic Stress, Kennedy Krieger Institute, Baltimore, MD,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
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Besier T, Fegert J, Goldbeck L. Evaluation of psychiatric liaison-services for adolescents in residential group homes. Eur Psychiatry 2020; 24:483-9. [DOI: 10.1016/j.eurpsy.2009.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 02/24/2009] [Accepted: 02/26/2009] [Indexed: 11/25/2022] Open
Abstract
AbstractObjectiveAdolescents in residential care are a high-risk population for psychiatric disorders. Due to limited access to outpatient treatment, crises often result in psychiatric hospitalizations. These crises are often accompanied by termination of supportive relationships, which increases the risk for further problems. To minimize hospitalizations and to stabilize the psychological state of these adolescents, we developed and evaluated a home-treatment intervention program based on psychiatric liaison-services and compared it to standard medical care (SMC).MethodsThe intervention was applied in 11 German residential group homes (N = 288, M = 14.1 years, SD = 2.7), while adolescents from 15 institutions (N = 336, M = 13.6 years, SD = 3.0) served as a comparison group (CG) (SMC). The frequency and duration of psychiatric inpatient treatment episodes were documented and caregiver-reported behavioural symptoms were assessed at baseline and at 6 and 12 months postintervention.ResultsIn both groups, less than 10% of the adolescents were admitted to psychiatric wards. Compared to SMC, hospitalizations were of shorter duration in the intervention group (IG) (1.30 vs 2.47 days per head within 12 months, p < .001). In both groups, behavioural problems decreased overtime.ConclusionsApplying a home-treatment intervention program to children in residential care helps to stabilize the developmental course of this high-risk population by shortening psychiatric inpatient treatment.
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24
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Lehmann S, Breivik K, Monette S, Minnis H. Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms. CHILD ABUSE & NEGLECT 2020; 101:104374. [PMID: 31982843 DOI: 10.1016/j.chiabu.2020.104374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND In DSM 5, three disorders are related to trauma and/or maltreatment: Post-traumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) but how these disorders relate to each other and to traumatic events is unknown. OBJECTIVE We examined 1. Prevalence of Potentially Traumatic Events (PTEs) and poly-victimization for youths in foster care. 2. Associations between single/multiple PTEs and PTSD, DSED, and the two symptom-clusters that constitute RAD: Failure to seek/accept comfort (RAD A), and Low social-emotional responsiveness/ emotion dysregulation (RAD B). PARTICIPANTS, SETTING AND METHODS Foster youth 11-17 years (N = 303) in Norway completed The Child and Adolescent Trauma Screen. Foster parents completed the RAD and DSED Assessment interview. RESULTS Foster youth reported experiencing, on average, 3.44 PTEs each (range 0-15, SD 3.33), and 52.9 % reported PTSD symptoms at or above clinical cut off. The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD cluster B symptoms (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD cluster A symptoms (Failure to seek/accept comfort). CONCLUSIONS These findings raise new questions about the nature, mechanisms and timing of development of RAD and DSED. Maltreatment assessment needs to encompass a wide range of PTEs, and consider poly-victimization.
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Affiliation(s)
- Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare -West, NORCE Norwegian Research Centre, Bergen, Norway; Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Norway.
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare -West, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sebastien Monette
- Department of Psychology, Université Du Québec à Montréal (UQAM), Canada
| | - Helen Minnis
- Adverse Childhood Experiences Clinical and Research Centre, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
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Palines PA, Rabbitt AL, Pan AY, Nugent ML, Ehrman WG. Comparing mental health disorders among sex trafficked children and three groups of youth at high-risk for trafficking: A dual retrospective cohort and scoping review. CHILD ABUSE & NEGLECT 2020; 100:104196. [PMID: 31575432 DOI: 10.1016/j.chiabu.2019.104196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Individuals at high-risk for trafficking are often subject to preexisting complex trauma that only intensifies during the trafficking experience. This greatly increases their risk of mental illness, although the actual prevalence of mental health disorders in children who are sex trafficked remains unclear. OBJECTIVE To examine the prevalence of mental health diagnoses among a sample of youth identified as being sex trafficked, and to discuss these rates in relation to other high-risk groups reported in the literature. PARTICIPANTS AND SETTING 143 female and male child trafficking victims in Wisconsin. METHODS We retrospectively reviewed individual medical records, identifying mental health diagnoses and behaviors. The results were compared to summarized prevalence data for mental health disorders in sex trafficked, runaway children, juvenile offenders, and foster care children identified via a scoping review. RESULTS We observed significantly higher rates of ADHD (52.4%, p < 0.0001), bipolar disorder (26.6%, p < 0.0001), and PTSD (19.6%, p < 0.05 to p < 0.0001) in our sample of trafficked youth compared to all high-risk groups, as well as for depression (45.5%), anxiety (19.6%), conduct disorder (19.6%), ODD (25.9%), and psychosis (14.0%) relative to multiple groups individually. CONCLUSIONS The complex trauma suffered by child survivors of sex trafficking can impart numerous effects with overlapping symptomatology of many mental health disorders. Survivors' adaptive responses to complex trauma may lead to improper diagnosis and treatment of mental health disorders at the expense of prompt access to trauma-focused therapies. Alternative diagnoses and treatments of this complex dysfunction are discussed.
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Affiliation(s)
- Patrick A Palines
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53213, USA
| | - Angela L Rabbitt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53213, USA.
| | - Amy Y Pan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53213, USA
| | - Melodee L Nugent
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53213, USA
| | - Wendi G Ehrman
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53213, USA
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Stewart SL, Thornley E, Lapshina N, Erickson P, Vingilis E, Hamilton H, Kolla N. Sex differences in youth with mental health problems in inpatient, outpatient and youth justice settings. BMC Psychiatry 2020; 20:11. [PMID: 31941485 PMCID: PMC6964083 DOI: 10.1186/s12888-019-2413-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Approximately 40-70% of justice-involved youth have untreated mental health problems. There is no current research that directly compares the mental health profiles of youth involved in the justice system to that of inpatients and outpatients. The research reported is significant because it directly compares the needs of these population by use of the same suite of standardized assessment tools. METHODS The sample consisted of 755 youth aged 16-19 years recruited from youth justice and mental health facilities in Ontario, Canada. Participants completed semi-structured assessment interviews using the interRAI child and youth suite of instruments to assess for internalizing and externalizing concerns as well as exposure to traumatic life events. RESULTS Findings indicated that justice-involved youth experienced higher levels of certain types of trauma. Analyses examining sex differences indicated that, controlling for age, males in the youth justice group reported higher cumulative trauma compared to male outpatients but not inpatients. Females in the youth justice group reported experiencing higher cumulative trauma compared to female outpatients and inpatients. In addition, controlling for sex and age, the youth justice group reported lower internalizing symptoms scores than inpatients and outpatients. Finally, males in the youth justice group scored lower than inpatients in externalizing symptoms, whereas females within the youth justice group scored higher in externalizing symptoms compared to inpatients and outpatients. CONCLUSIONS Results indicated that youth who are involved with the justice system exhibit significant psychosocial issues that represent complex service needs which require unique interventions in order to be addressed appropriately.
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Affiliation(s)
- Shannon L. Stewart
- 0000 0004 1936 8884grid.39381.30Faculty of Education, Applied Psychology, Western University, 1137 Western Road, Office 1142M, London, Ontario N6G 1G7 Canada
| | - Elizabeth Thornley
- Faculty of Education, Applied Psychology, Western University, 1137 Western Road, Office 1142M, London, Ontario, N6G 1G7, Canada.
| | - Natalia Lapshina
- 0000 0004 1936 8884grid.39381.30Faculty of Education, Applied Psychology, Western University, 1137 Western Road, Office 1142M, London, Ontario N6G 1G7 Canada
| | - Patricia Erickson
- 0000 0001 2157 2938grid.17063.33Department of Sociology, University of Toronto, Toronto, Ontario Canada
| | - Evelyn Vingilis
- 0000 0004 1936 8884grid.39381.30Schulich School of Medicine, Western University, London, Ontario Canada
| | - Hayley Hamilton
- 0000 0000 8793 5925grid.155956.bCentre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Nathan Kolla
- 0000 0000 8793 5925grid.155956.bCentre for Addiction and Mental Health, Toronto, Ontario Canada
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Taussig HN, Weiler LM, Garrido EF, Rhodes T, Boat A, Fadell M. A Positive Youth Development Approach to Improving Mental Health Outcomes for Maltreated Children in Foster Care: Replication and Extension of an RCT of the Fostering Healthy Futures Program. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:405-417. [PMID: 31468553 PMCID: PMC6917986 DOI: 10.1002/ajcp.12385] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Preventing the negative impact of maltreatment on children's mental health requires interventions to be contextually sensitive, grounded in theory and research, and effective in reaching and retaining children and families. This study replicates and extends previous findings of the Fostering Healthy Futures (FHF) program, a 30-week mentoring and skills group intervention for preadolescent maltreated children in foster care. Participants included 426 children recently placed in out-of-home care who were randomized to intervention or control conditions. Outcomes measured 6-10 months postintervention included a multi-informant (child, caregiver, teacher) index of mental health problems as well as measures of posttraumatic stress symptoms, dissociative symptoms, quality of life, and use of mental health services and psychotropic medications. There were high rates of program initiation, retention, and engagement; 95% of those randomized to FHF started the program, 92% completed it, and over 85% of the mentoring visits and skills groups were attended. The FHF program demonstrated significant impact in reducing mental health symptomatology, especially trauma symptoms, and mental health service utilization. These program effects were consistent across almost all subgroups, suggesting that FHF confers benefit for diverse children. Results indicate that positive youth development programming is highly acceptable to children and families and that it can positively impact trauma and its sequelae.
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Affiliation(s)
- Heather N Taussig
- University of Denver, Denver, CO, USA
- Kempe Center, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Tara Rhodes
- Colorado Department of Education, Denver, CO, USA
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van der Pol TM, van Domburgh L, van Widenfelt BM, Hurlburt MS, Garland AF, Vermeiren RRJM. Common elements of evidence-based systemic treatments for adolescents with disruptive behaviour problems. Lancet Psychiatry 2019; 6:862-868. [PMID: 31255602 DOI: 10.1016/s2215-0366(19)30085-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 01/01/2023]
Abstract
A growing number of evidence-based systemic treatments for adolescents with disruptive behaviour problems exist. However, it is not clear to what extent these treatments have unique and common elements. Identification of common elements in the different treatments would be beneficial for the further understanding and development of family-based interventions, training of therapists, and research. Therefore, the aim of this Review was to identify common elements of evidence-based systemic treatments for adolescents with disruptive behaviour. Several common elements of systemic treatments were identified, showing a strong overlap between the interventions. Investigation of these common mechanisms and techniques could potentially build strong universal systemic treatment and training modules for a broad spectrum of adolescents with problem behaviours.
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Affiliation(s)
- Thimo M van der Pol
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, Netherlands.
| | - Lieke van Domburgh
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Brigit M van Widenfelt
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, Netherlands
| | - Michael S Hurlburt
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ann F Garland
- Department of School, Family and Mental Health Professions, University of San Diego, San Diego, CA, USA
| | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, Netherlands
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Abstract
Although dissociative symptoms are observed in several psychiatric disorders and linked to antisocial behavior and offending, the relation between dissociation and psychopathology or comorbidity has not been consistently investigated in residential youth yet. This brief report documented prevalence and comorbidity rates of several psychiatric disorders and examined their relation to dissociation in residential youth. The study included 100 male adolescents (Mage = 16.51) admitted to residential youth care facilities. Psychopathology was assessed with the Mini International Neuropsychiatric Interview for children and adolescents (MINI-KID) and dissociation was measured with the Adolescent Dissociative Experiences Scale (A-DES). Externalizing problems (conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder) were the most prevalent (81%) followed by substance abuse/dependence (71%), manic/hypomanic symptoms (40%), anxiety (35%), and depression (33%). High comorbidity was also observed in externalizing problems with alcohol/substance abuse/dependence (67%), manic/hypomanic symptoms (35%), depression (31%), and anxiety (30%). Logistic regression analyses revealed a significant link between dissociation and externalizing problems, depression, and manic/hypomanic symptoms, as well as comorbid externalizing problems and depression or manic/hypomanic symptoms. The findings highlight the need to assess dissociation in order to better understand the multifaceted individual profile of residential youth and incorporate it in the treatment plan.
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Affiliation(s)
- Iro Fragkaki
- Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
| | | | - Maaike Cima
- Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
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30
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Preliminary Validation of the Parental Help-Seeking Stage of Change Measure for Child Behavior Problems. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09525-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Haine-Schlagel R, Dickson KS, Shapiro AF, May GC, Cheng P. Parent Mental Health Problems and Motivation as Predictors of Their Engagement in Community-Based Child Mental Health Services. CHILDREN AND YOUTH SERVICES REVIEW 2019; 104:104370. [PMID: 31258235 PMCID: PMC6599621 DOI: 10.1016/j.childyouth.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Parent or caregiver engagement in child mental health treatment is an important element of treatment effectiveness, particularly for children with disruptive behavior problems. Parent or caregiver characteristics, such as their mental health and/or motivation to participate in treatment, may impact engagement and subsequent treatment outcomes. However, a lack of empirical research exists examining these potential links, particularly in community-based treatment settings. The current pilot study: 1) examines whether parent mental health problems and/or early parent motivation to participate in treatment predict three indicators of parent engagement in child treatment, controlling for the other predictor; and 2) examines and compares the differential influence of parent mental health and parent motivation on each parent engagement indicator. Participants in this study include 19 dyads from 18 therapists who were recruited from community mental health clinics. Results indicated a significant association between parent mental health and session attendance, and a marginally significant association between parent mental health and therapist-rated parent engagement. Parent mental health predicted outcomes above and beyond parent motivation. These findings preliminarily suggest that parent mental health problems early in child mental health treatment may be important to consider as an impactful target to promote parent treatment engagement, in addition to focusing on parent motivation to participate in treatment.
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Affiliation(s)
- Rachel Haine-Schlagel
- San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4502, USA
- Child & Adolescent Services Research Center, 3020 Children’s Way, MC 5033, San Diego, CA 92123, USA
| | - Kelsey S. Dickson
- San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4502, USA
- Child & Adolescent Services Research Center, 3020 Children’s Way, MC 5033, San Diego, CA 92123, USA
| | - Alyson F. Shapiro
- San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4502, USA
| | - Gina C. May
- San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4502, USA
| | - Pui Cheng
- San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4502, USA
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Group Treatment of Fecal Incontinence: A Description of an Interdisciplinary Intervention. J Pediatr Gastroenterol Nutr 2019; 69:e70-e74. [PMID: 31058779 DOI: 10.1097/mpg.0000000000002372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20% to 60% of cases. A combined medical-behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group-based treatment for fecal incontinence in school-aged children, and to present a description of changes in treatment adherence rates that affect clinical effectiveness. METHOD Poop group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6-week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre- to post-treatment. Group sessions focus on the GI system, medication, toilet sitting posture, hydration, fiber, and behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed. RESULTS Nineteen families completed the 6-week protocol. Appropriate stool frequency was improved (P ≤ 0.01), and soiling was reduced (P ≤ 0.00). Medication adherence was also improved (P ≤ 0.04). Treatment results were maintained at 1-month follow-up. DISCUSSION A developmentally targeted intervention and interdisciplinary focus of treatment likely account for treatment successes. CONCLUSION Poop group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment.
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Eiraldi R, McCurdy B, Schwartz B, Wolk CB, Abraham M, Jawad AF, Nastasi BK, Mautone JA. Pilot Study for the Fidelity, Acceptability and Effectiveness of a PBIS Program plus Mental Health Supports in Under-resourced Urban Schools. PSYCHOLOGY IN THE SCHOOLS 2019; 56:1230-1245. [PMID: 33981121 DOI: 10.1002/pits.22272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper describes implementation (fidelity, perceived acceptability) and tier 1 and tier 2 outcomes of a school-wide positive behavior interventions and supports approach (PBIS) including mental health supports at tier 2 in two K-8 urban schools. Interventions for tier 2 consisted of three manualized group cognitive behavioral therapy (GCBT) protocols for externalizing behavior problems, depression and anxiety. tier 1 and tier 2 interventions were implemented with fidelity but program feasibility for tier 2 was in question because school personnel needed a great deal of external support in order to implement the interventions. tier 1 interventions were associated with a decrease in office discipline referrals. Students participating in GCBT showed a significant decrease in mental health diagnostic severity at post-treatment. A discussion of perceived and actual implementation barriers and how they were addressed is provided. Implications for practice in low-income urban schools are discussed.
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Affiliation(s)
| | | | | | | | | | - Abbas F Jawad
- University of Pennsylvania Perelman School of Medicine
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Ruff SC, Jones CL, Clausen JM. A Descriptive Analysis of Long-Term Treatment with Adolescent-Aged Foster Youth. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:331-340. [PMID: 32318203 PMCID: PMC7163907 DOI: 10.1007/s40653-018-0233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Foster youth experience a complex combination of psychological symptoms associated with the experience of abuse and/or neglect. Among adolescents, psychological challenges can be magnified by an increased likelihood of placement disruption once in foster care, longer stays in the system, and numerous barriers that impede access and use of mainstream psychological intervention. This manuscript relies on two studies to learn more about the experience of adolescent-aged foster youth who utilize long-term mental health services coordinated through A Home Within, a national nonprofit committed to reducing treatment barriers by asking licensed therapists to provide pro bono therapy "for as long as it takes." Study 1 evaluates 84 therapist interviews about client demographics, trauma history, and mental health symptoms in an effort to learn more about the concerns and experiences of adolescent-aged youth participating in treatment. Study 2 examines 30 pre/post interviews with therapists to understand outcomes associated with treatment completion, as well as to describe treatment practices. Findings support a need for continued investigation of long-term psychotherapeutic services with foster youth focused on the needs of youth accessing care and best treatment practices with this population of vulnerable youth.
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Affiliation(s)
- Saralyn Carola Ruff
- Psychology Department, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117 USA
| | - Chloe L. Jones
- Psychology Department, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117 USA
- Department of Psychological Sciences, University of Connecticut, Storrs, CT USA
| | - June Madsen Clausen
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA USA
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Disruptive Behavior Treatment Progress as a Function of Therapy Focus and Youth Diagnosis in a Community Mental Health Setting. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:484-494. [PMID: 29177918 DOI: 10.1007/s10488-017-0840-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Monthly disruptive behavior treatment progress for 613 youth ages 7-18 receiving intensive in-home services was examined. Multilevel modeling indicated carrying a depressive mood diagnosis predicted less disruptive behavior progress compared to youth with only externalizing diagnoses. Paradoxically, more monthly focus on disruptive behavior treatment targets predicted lower concurrent progress ratings, while greater focus on depressive mood targets predicted greater disruptive behavior progress for youth with a depressive mood diagnosis. Findings held when other predictors of disruptive behavior progress were included as covariates, including episode length, youth age, and functional impairment. Treatment and research implications are discussed.
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Stewart SL, Poss JW, Thornley E, Hirdes JP. Resource Intensity for Children and Youth: The Development of an Algorithm to Identify High Service Users in Children's Mental Health. Health Serv Insights 2019; 12:1178632919827930. [PMID: 30828248 PMCID: PMC6390227 DOI: 10.1177/1178632919827930] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
Abstract
Children’s mental health care plays a vital role in many social, health care, and
education systems, but there is evidence that appropriate targeting strategies
are needed to allocate limited mental health care resources effectively. The aim
of this study was to develop and validate a methodology for identifying children
who require access to more intense facility-based or community resources.
Ontario data based on the interRAI Child and Youth Mental Health instruments
were analysed to identify predictors of service complexity in children’s mental
health. The Resource Intensity for Children and Youth (RIChY) algorithm was a
good predictor of service complexity in the derivation sample. The algorithm was
validated with additional data from 61 agencies. The RIChY algorithm provides a
psychometrically sound decision-support tool that may be used to inform the
choices related to allocation of children’s mental health resources and
prioritisation of clients needing community- and facility-based resources.
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Affiliation(s)
| | - Jeff W Poss
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
| | | | - John P Hirdes
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
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Brownlie E, Beitchman JH, Chaim G, Wolfe DA, Rush B, Henderson J. Early Adolescent Substance Use and Mental Health Problems and Service Utilisation in a School-based Sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:116-125. [PMID: 29929386 PMCID: PMC6405806 DOI: 10.1177/0706743718784935] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This paper reports on substance use, mental health problems, and mental health service utilisation in an early adolescent school-based sample. METHOD Participants were 1,360 grade 7 and 8 students from 4 regions of Ontario, Canada. Students completed an in-class survey on mental health and substance use. The sampling strategy and survey items on demographics, substance use, service utilisation, and distress were adapted from the Ontario Student Drug Use and Health Survey. Internalising and externalising mental health problems were assessed using the Global Assessment of Individual Needs - Short Screener. Distress was defined as fair or poor self-rated mental health. RESULTS Rates of internalising and/or externalising problems above the threshold exceeded 30%; yet, fewer than half had received mental health services in the past 12 mo. Substance use was associated with increased odds of internalising and externalising problems above the threshold and distress. Youth using cannabis had 10-times the odds of exceeding the threshold for internalising or externalising problems. The use of substances other than alcohol or cannabis was associated with increased odds of fair or poor self-rated mental health among grade 8 students. Of the youth who confirmed at least a substance use problem, most also reported mental health problems; this association was stronger among girls than boys. CONCLUSIONS Early adolescent substance use was associated with concurrent self-reported mental health problems in a non-clinical sample. The low levels of service utilisation reported highlight the need for improved access to early identification and intervention to prevent the development of concurrent disorders.
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Affiliation(s)
- Elizabeth Brownlie
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Joseph H. Beitchman
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - David A. Wolfe
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Prevention Science, Centre for Addiction and Mental Health, Toronto, Ontario
- Centre for Research and Education on Violence against Women and Children at the Faculty of Education, Western University, London, Ontario
| | - Brian Rush
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Knoche VA, Summers A, Miller MK. Trauma-Informed: Dependency Court Personnel's Understanding of Trauma and Perceptions of Court Policies, Practices, and Environment. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:495-505. [PMID: 32318171 PMCID: PMC7163849 DOI: 10.1007/s40653-018-0219-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The law and legal processes can affect the psychological and emotional well-being of the people involved. Individuals who are already traumatized can experience stress which triggers prior trauma through court policies, practices, and environment during involvement with the child abuse and neglect court system. However, some courts use trauma-informed policies, practices, and environments which are based on the notion of therapeutic jurisprudence. The purpose of this analysis was to determine if dependency court personnel in larger jurisdictions have differing understandings of trauma, and differing perceptions of court policies, practices, and environment than their counterparts from smaller jurisdictions. Results indicate that smaller jurisdiction personnel have a higher understanding of trauma, as well as perceive themselves to be more trauma-informed in the areas of policy, practice, and environment when compared to larger jurisdiction personnel. Implications are discussed and recommendations from a therapeutic jurisprudence framework are suggested.
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Affiliation(s)
- Victoria A. Knoche
- Interdisciplinary Social Psychology, University of Nevada, Reno, 1664 N Virginia St, MS 1300, Reno, Nevada 89557 USA
| | - Alicia Summers
- Interdisciplinary Social Psychology, University of Nevada, Reno, 1664 N Virginia St, MS 1300, Reno, Nevada 89557 USA
| | - Monica K. Miller
- Interdisciplinary Social Psychology, University of Nevada, Reno, 1664 N Virginia St, MS 1300, Reno, Nevada 89557 USA
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Martinez JI, Haine-Schlagel R. Observational Assessment of Engagement Strategies to Promote Parent Homework Planning in Community-Based Child Mental Health Treatment: A Pilot Study. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:1968-1980. [PMID: 30220834 PMCID: PMC6135535 DOI: 10.1007/s10826-018-1030-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Therapy homework includes tasks given to clients to complete outside of session to facilitate new knowledge/skills or to advance treatment goals. Homework completion, an important element of parent engagement in child mental health (MH) treatment, has been associated with improved child outcomes. The current pilot study assessed the design/assign phase of the therapy homework process to examine a) the extent to which therapists implemented engagement strategies with parents and b) whether therapist deployment of engagement strategies in early treatment predicted subsequent parent participation in homework planning. We included an ethnically-diverse sample of 10 therapists and 11 parent/child dyads receiving community-based MH services who participated in a pilot intervention study. Two observational coding systems were developed to code treatment session recordings for the extent to which a) therapists implemented engagement strategies with parents and b) parents contributed to therapy homework planning. Findings revealed low extensiveness of therapist implementation of engagement strategies with parents. As hypothesized, therapist use of engagement strategies (Collaboration, Empowerment, and Psychoeducation) in early treatment significantly predicted subsequent parent homework planning (sharing perspective on homework planning). However, therapist use of Alliance was unrelated to parent homework planning. These preliminary results suggest that therapist implementation of engagement strategies in early treatment may promote parent participation in homework planning, which is an important precursor to homework completion. This pilot study suggests potential future directions for both research on and training for community-based therapists in implementing successful strategies to promote parent homework planning in child MH treatment.
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Affiliation(s)
| | - Rachel Haine-Schlagel
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
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Docherty M, Kubik J, Herrera CM, Boxer P. Early maltreatment is associated with greater risk of conduct problems and lack of guilt in adolescence. CHILD ABUSE & NEGLECT 2018; 79:173-182. [PMID: 29475174 DOI: 10.1016/j.chiabu.2018.01.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/08/2018] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Previous research indicates a link between childhood maltreatment and elevated conduct problems. Yet the literature is less clear on associations between maltreatment and callousness (e.g., lack of empathy or guilt). This is a critical gap given that callousness is a robust predictor of serious aggressive and violent behavior. We examine the association between substantiated maltreatment events in childhood and adolescence (up to age 13) and conduct problems and lack of guilt at age 14. We analyze self- and parent-report data along with official maltreatment records on 557 youth (50% female; 69% non-white) from a larger dataset (Longitudinal Studies on Childhood Abuse and Neglect; N = 1354). Results of multinomial logistic regression models indicate that youth with histories of substantiated maltreatment events are more likely to have elevated conduct problems and decreased guilt at age 14, particularly if they experienced maltreatment before the age of four years old. Youth who exhibit conduct problems and also appear to lack guilt are more likely to have a personal history of substantiated maltreatment. We discuss our results in terms of their implications for theory and practice.
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Affiliation(s)
| | - Joanna Kubik
- School of Criminology, Rutgers University in Newark, NJ
| | | | - Paul Boxer
- Department of Psychology, Rutgers University in Newark, NJ
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41
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Hadley W, Lansing A, Barker DH, Brown LK, Hunter H, Donenberg G, DiClemente RJ. The longitudinal impact of a family-based communication intervention on observational and self-reports of sexual communication. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:1098-1109. [PMID: 29910594 PMCID: PMC5999025 DOI: 10.1007/s10826-017-0949-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parents can play a vital role in shaping teenagers' sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent-adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent adolescent sexual communication was examined at 12-months among adolescents with mental health problems. Of the 721 parent- adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent-adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent Body-Language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 hours of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12-months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent-adolescent sexual communication among a mental health sample.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI 02903
| | - Amy Lansing
- Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - David H Barker
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI 02903
| | - Larry K Brown
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI 02903
| | - Heather Hunter
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI 02903
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42
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Splett JW, George MW, Zaheer I, Weist MD, Evans SW, Kern L. Symptom Profiles and Mental Health Services Received Among Referred Adolescents. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-017-9244-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Muris P, Roodenrijs D, Kelgtermans L, Sliwinski S, Berlage U, Baillieux H, Deckers A, Gunther M, Paanakker B, Holterman I. No Medication for My Child! A Naturalistic Study on the Treatment Preferences for and Effects of Cogmed Working Memory Training Versus Psychostimulant Medication in Clinically Referred Youth with ADHD. Child Psychiatry Hum Dev 2018; 49:974-992. [PMID: 29767387 PMCID: PMC6208996 DOI: 10.1007/s10578-018-0812-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this naturalistic clinical study, we explored the applicability and clinical effectiveness of Cogmed WMT, pharmacotherapy, and their combination for clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Ninety youth with ADHD (ages 6-16 years) and their parents were offered the possibility to choose one of the three interventions. The motives for choosing various interventions were quite different. Medication was chosen because this treatment was expected to be most effective, but also because the Cogmed WMT program was regarded as too taxing. The choice for Cogmed WMT was mainly negatively motivated: participants tended to be strongly against the use of medication, found it a too rigorous step, or feared side effects and addiction problems. The choice for the combination treatment was strongly positively motivated: parents and youth indicated that they wanted to receive the best possible intervention and part of them also had high expectations of Cogmed WMT. In terms of clinical effectiveness, pharmacotherapy with stimulant medication and the combination treatment produced larger reductions in ADHD symptomatology than Cogmed WMT. Further, results indicated that Cogmed WMT selectively enhanced working memory performance. Finally, after conducting Cogmed WMT, youths and parents were more 'open' to accept pharmacotherapy as intervention, probably because the training increased greater insight in and awareness of the problematic features of ADHD.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands. .,Stellenbosch University, Stellenbosch, South Africa.
| | | | - Lut Kelgtermans
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Sonja Sliwinski
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Ulrike Berlage
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Hanna Baillieux
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Anne Deckers
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ,Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Marieke Gunther
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | | | - Ida Holterman
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ,Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
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Hobbs Knutson K, Meyer MJ, Thakrar N, Stein BD. Care Coordination for Youth With Mental Health Disorders in Primary Care. Clin Pediatr (Phila) 2018; 57:5-10. [PMID: 29090598 DOI: 10.1177/0009922817733740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Many children are treated for mental health disorders in primary care settings. The system of care (SOC) provides a framework for collaboration among pediatric mental health providers, but it is unclear if youth treated for mental health disorders in primary care receive such coordination. At the South Boston Community Health Center from September /2012 to August 2013 for 74 individuals ≤18 years, the odds of contact with SOC agencies (mental health, education, child protective services, juvenile justice and developmental disabilities) were compared for mental health treatment in primary versus specialty care. The odds of SOC contact within primary care were lower compared to specialty care (OR = 0.43, 95% CI = 0.29-0.66), specifically for mental health (OR = 0.54, 95% CI = 0.25-1.2), education (OR = 0.12, 95% CI = 0.050-0.28), and child protective services (OR = 0.64, 95% CI = 0.22-1.9). As care coordination may improve health outcomes, increased support and education for care coordination specific to youth treated for mental health disorders in primary care settings may be warranted.
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Affiliation(s)
| | | | - Nisha Thakrar
- 3 South Boston Community Health Center, Boston, MA, USA
| | - Bradley D Stein
- 4 RAND Corporation, Pittsburgh, PA, USA.,5 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Barnett ER, Boucher EA, Daviss WB, Elwyn G. Supporting Shared Decision-making for Children's Complex Behavioral Problems: Development and User Testing of an Option Grid™ Decision Aid. Community Ment Health J 2018; 54:7-16. [PMID: 28401416 DOI: 10.1007/s10597-017-0136-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 03/25/2017] [Indexed: 11/25/2022]
Abstract
There is a lack of research to guide collaborative treatment decision-making for children who have complex behavioral problems, despite the extensive use of mental health services in this population. We developed and pilot-tested a one-page Option Grid™ patient decision aid to facilitate shared decision-making for these situations. An editorial team of parents, child psychiatrists, researchers, and other stakeholders developed the scope and structure of the decision aid. Researchers included information about a carefully chosen number of psychosocial and pharmacological treatment options, using descriptions based on the best available evidence. Using semi-structured qualitative interviews (n = 18), we conducted user testing with four parents and four clinical prescribers and field testing with four parents, four clinical prescribers, and two clinic administrators. The researchers coded and synthesized the interview responses using mixed inductive and deductive methods. Parents, clinicians, and administrators felt the Option Grid had significant value, although they reported that additional training and other support would be required in order to successfully implement the Option Grid and achieve shared decision-making in clinical practice.
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Affiliation(s)
- Erin R Barnett
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth Trauma Interventions Research Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Elizabeth A Boucher
- Center for Program Design and Evaluation at Dartmouth, 21 Lafayette #373, Lebanon, NH, 03756, USA
| | - William B Daviss
- Department of Psychiatry, Dartmouth-Hitchcock Psychiatric Associates, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Drive, Lebanon, NH, 03756, USA
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46
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Newton-Howes G. What Happens when Children with Attention Deficit/ Hyperactivity Disorder Grow Up? J R Soc Med 2017; 97:531-5. [PMID: 15520147 PMCID: PMC1079646 DOI: 10.1177/014107680409701105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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47
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Barboza GE, Dominguez S, Pinder J. Trajectories of post-traumatic stress and externalizing psychopathology among maltreated foster care youth: A parallel process latent growth curve model. CHILD ABUSE & NEGLECT 2017; 72:370-382. [PMID: 28917187 DOI: 10.1016/j.chiabu.2017.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
Few longitudinal studies have analyzed how violence exposure (e.g. child maltreatment, witnessing community violence) influence both externalizing and Post-Traumatic Stress (PTS) symptoms among children in foster care. Data from three waves of the National Survey of Child and Adolescent Well-Being (1999-2007) (NSCAW; National Data Archive on Child Abuse and Neglect, 2002) were analyzed to investigate the change trajectories of both externalizing and PTS symptomatology among children with a substantiated report of child maltreatment by Child Protective Services (CPS) between October 1999 and December 2000. This study uses data collected at three time points: baseline and approximately 18 (Wave 3) and 36 (Wave 4) months post-baseline. The Child Behavior Checklist (CBCL) scale measured externalizing symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model with a sample of n=280 maltreated youth between the ages of 8 and 15 following home removal. Findings revealed that initial levels of externalizing and PTS symptomatology were both significantly and positively related and co-develop over time. Externalizing symptom severity remained in the borderline range during the first two years in out-of-home care. Both direct and indirect forms of interpersonal violence exposure were associated with initial level of externalizing symptom and PTS symptom severity, respectively. Taken together, our results suggest an underlying process that links early violence exposure to the co-development and cumulative impact of PTS on externalizing behavior above and beyond experiences of maltreatment. We conclude by discussing the key points of intervention that result from a more nuanced understanding of the longitudinal relationship between PTS and externalizing symptoms and the effect of complex trauma on growth in these symptoms over time.
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Affiliation(s)
- Gia Elise Barboza
- Northeastern University, College of Social Science and Humanities, 212 Renaissance Park, Boston, MA 02115, United States.
| | - Silvia Dominguez
- Northeastern University, College of Social Science and Humanities, 212 Renaissance Park, Boston, MA 02115, United States.
| | - Jyda Pinder
- Northeastern University, College of Social Science and Humanities, 212 Renaissance Park, Boston, MA 02115, United States.
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48
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Brownlie EB, Chaim G, Heffernan O, Herzog T, Henderson J. Youth Services System Review: Moving From Knowledge Gathering to Implementation Through Collaboration, Youth Engagement, and Exploring Local Community Needs. ACTA ACUST UNITED AC 2017. [DOI: 10.7870/cjcmh-2017-018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes a two-phase, multi-sectoral project aimed at enhancing youth services addressing substance use in Ontario. In the information gathering phase, a youth-focused website and survey, focus groups, and interviews were used to elicit perspectives from multiple stakeholders. In the implementation phase, capacity-building and consultations on transition-aged youth needs were conducted to inform youth transition-readiness checklists. We discuss the importance of engaging youth as collaborators as well as respondents and the processes used to tailor findings to local contexts for implementation.
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Affiliation(s)
- E. B. Brownlie
- Centre for Addiction and Mental Health and University of Toronto
| | - Gloria Chaim
- Centre for Addiction and Mental Health and University of Toronto
| | | | | | - Joanna Henderson
- Centre for Addiction and Mental Health and University of Toronto
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49
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Pinto RJ, Morgado D, Reis S, Monteiro R, Levendosky A, Jongenelen I. When social support is not enough: Trauma and PTSD symptoms in a risk-sample of adolescents. CHILD ABUSE & NEGLECT 2017; 72:110-119. [PMID: 28797932 DOI: 10.1016/j.chiabu.2017.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/29/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED Social support can mitigate the severity of posttraumatic stress disorder (PTSD) in children and adults following traumatic events. However, little is known about the role of social support in high-risk samples of adolescents from the community. The present study examined the relationship between social support and PTSD symptoms in adolescents exposed to traumatic events and childhood adversity, after adjusting for the effects of potential covariates, including sociodemographic factors, previous childhood adversity, level of exposure, comorbid anxiety, depression symptoms, and substance abuse, and coping strategies. METHOD The participants of the study were 183 adolescents, mean age of 16 years old (M=15.71, SD=1.31), ranged between 13 and 17 years old, 89 (48.6%) males and 94 (51.4%) females. RESULTS The results revealed that 26.2% of the sample met the criteria for probable PTSD. Our statistical model explained 64% of the variance in PTSD symptoms, but social support was not significant after adjusting for covariates. This study found that social support was not enough to reduce PTSD symptoms in adolescents exposed to trauma and adversity. Programs focused only on improving social support may not be effective in reducing mental health symptoms for adolescents, particularly when there has been severe and/or multiple forms of childhood adversity.
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Affiliation(s)
- Ricardo J Pinto
- Faculty of Psychology, University of Lusófona, Oporto, Portugal(1).
| | - Diogo Morgado
- Faculty of Psychology, University of Lusófona, Oporto, Portugal(1)
| | - Sara Reis
- Faculty of Psychology, University of Lusófona, Oporto, Portugal(1)
| | - Rita Monteiro
- Faculty of Psychology, University of Lusófona, Oporto, Portugal(1)
| | - Alytia Levendosky
- Department of Psychology at Michigan State University, United States
| | - Inês Jongenelen
- Faculty of Psychology, University of Lusófona, Oporto, Portugal(1)
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50
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A Longitudinal Study of Child Maltreatment and Mental Health Predictors of Admission to Psychiatric Residential Treatment Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101141. [PMID: 28956825 PMCID: PMC5664642 DOI: 10.3390/ijerph14101141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/17/2022]
Abstract
The child welfare system is an access point for children's mental health services. Psychiatric residential treatment facilities (PRTFs) are the most restrictive, and most expensive setting for children to receive long-term care. Given the high rates of behavioral health concerns among maltreated children in out-of-home care, research is needed to examine the factors that predict entry in PRTFs among children investigated for maltreatment. This exploratory study used cross-sector administrative records linked across multiple systems, including child welfare records and Medicaid claims, from a single state over a five-year period (n = 105,982). Cox proportional hazards modeling was used to predict entry into a PRTF. After controlling for many factors, PRTF entry was predicted by diagnosis code indicating a trauma-related condition, antipsychotic medication prescriptions, and entry into lower levels of out-of-home care, supporting the view that youth are admitted to PRTFs largely due to clinical need. However, PRTF admission is also associated with characteristics of their experiences with the social service system, primarily foster care placement stability and permanency. Implications for practice and research are discussed.
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