An Examination of Exposure to Traumatic Events and Symptoms and Strengths for Children Served in a Behavioral Health System of Care

The impact of child maltreatment on mental health outcome improvements among children and youth accessing community mental health care

BACKGROUND

Although children with histories of maltreatment are more likely to engage with mental healthcare than non-maltreated children, few studies have examined the impact of maltreatment on children's mental health outcome improvement over time.

OBJECTIVE

The current study addresses this gap in the present literature by exploring the ways that histories of physical, sexual, and emotional abuse and exposure to domestic violence can influence children's improvement on mental health outcomes commonly associated with trauma.

PARTICIPANTS AND SETTING

De-identified routine care data from 58 community mental health agencies across Ontario, Canada, representing 16,517 children was obtained. This data represented assessments that occurred between February 2015 and December 2021.

METHODS

General linear models were used to illustrate the effect of each trauma type on change scores computed between baseline and follow-up assessments of externalizing behaviours, risk of harm to others, depressive symptoms, risk of suicide and self-harm, and anxiety, while adjusting for baseline scores, inpatient status, time between assessments, and select demographic variables.

RESULTS

When the effects of each trauma type was considered separately, children without histories of trauma consistently showed greater improvement than those with that trauma across all mental health outcomes (0.07-0.44, p < 0.01). When all trauma types were considered together, sexual abuse was associated with some of the most significant negative impacts on children's mental health improvements.

CONCLUSIONS

Our findings highlight an urgent need for the implementation of standardized, evidence-based assessments that screen trauma histories of children accessing mental health supports and research examining the impact of trauma on children's treatment responsiveness.

A Familial Case Study Exploring the Effects of a Strengths-Based Camp Intervention on Children’s Self-Perception

Childhood victimization can negatively affect children’s self-perception, a multifaceted developmental asset that can be delineated into Global Self-Worth, Social Competence, and Behavioral Conduct. Despite the importance of self-perception, few studies have examined how strengths-based interventions impact self-perception among youth experiencing victimization. Using a familial case study design, the current study evaluated how a camp-based intervention, known as Camp HOPE, affected self-perception among siblings who experienced childhood victimization. Participants included three siblings and their mother who all identify as Black/African American and reside in the Midsouth, United States. The siblings participated in a week-long, overnight camp with other children exposed to victimization. The family was evaluated across three timepoints: pre-camp, 1 month post-camp, and 4 months post-camp. Participating in Camp HOPE appeared to have differential effects on the siblings’ self-perception. Specifically, all three children endorsed small to medium improvements in perceived Behavioral Conduct, but the camp differentially impacted their Global Self-Worth and Social Competence. Findings suggest that Camp HOPE may enhance self-perception among Black/African American children who have experienced victimization. This intervention may also be more accessible and acceptable, compared to traditional treatment formats.

Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders

OBJECTIVE

Systems of care (SOCs) were developed to increase access to and quality of care for children with emotional and behavioral difficulties and their families through the provision of coordinated, community-based, culturally competent, family-driven services. SOCs focus on wraparound care that is individualized to meet each family's needs. Previous research has illustrated significant disparities in outcomes of nonwraparound care on the basis of youths' race-ethnicity. This study aimed to fill a research gap by examining disparities in outcomes for families receiving wraparound care coordination within an SOC.

METHODS

This exploratory study examined racial-ethnic disparities in outcomes observed at intake, during service provision, and at 6-month follow-up among 1,138 youths and their caregivers who participated in wraparound care coordination as part of a statewide SOC between 2016 and 2020. Analyses of variance and regression analyses were executed to investigate whether receiving services and/or the youths' racial-ethnic identity predicted differences in behavioral health outcomes and characteristics of or satisfaction with care. Caregiver-reported outcomes were assessed with the Ohio Scales for Youth, the Child Trauma Screen, and the Caregiver Strain Questionnaire.

RESULTS

Results revealed few racial-ethnic disparities in the characteristics and outcomes of care coordination among participants at intake or in family involvement in the wraparound process. Participants across groups reported similar and significant improvement in outcomes. However, the results indicated some disparities in satisfaction with care.

CONCLUSIONS

Results revealed the positive impact of care coordination on the health and well-being of youths and caregivers across racial-ethnic groups.

Trauma Symptoms and Relationship With Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care

Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth (M _age = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-month follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed.

Examining the service-related experiences and outcomes of caregivers involved in a system of care who experienced everyday discrimination

Individuals who report everyday experiences of discrimination are at heightened risk for adverse health outcomes and tend to report underutilization of health services. Systems of care (SOCs) have the potential to engage members of minority groups and to reduce health disparities. We examined the service-related experiences of predominantly Latinx caregivers enrolled in a SOC for their children with severe psychological health needs. We used independent samples t-tests and regression analyses to compare relations among service access, perceived service characteristics, and caregiver stress according to whether caregivers reported frequent or infrequent discrimination. The frequent discrimination group scored significantly higher on dimensions of stress and had greater dosage than the infrequent group. There were no differences in relations between service characteristics and outcomes by group. Findings indicated important differences in the service-related experiences and outcomes of caregivers who reported frequent and infrequent discrimination. We discuss limitations and implications.

The Strengths of Youth in a Public Behavioral Health System: Measurement Choices, Prevalence Rates, and Group Differences

Youth with severe emotional and behavioral problems receiving services in public behavioral health systems have strengths that are understudied in research and underutilized in practice. This study explores four alternative strategies (individual item scores, the number of "actionable" strengths, subscales, and a total composite) for summarizing the strengths of youth assessed with the Child and Adolescent Needs and Strengths (CANS) in a large, urban, public behavioral health system. The paper examines whether these summarization strategies produce divergent understandings of the prevalence of strengths across gender, age, and racial groups. Analyses suggest that youth enter this system with high levels of strengths. There are few group differences in strengths across the diverse summarization strategies. Though the practice-preferred method of using individual strengths items provides the most interpretable information about strengths, the aggregation strategies may be useful for programs and systems. Implications for policy and practice are discussed.

The Relation of Exposure to Traumatic Events and Longitudinal Mental Health Outcomes for Children Enrolled in Systems of Care: Results from a National System of Care Evaluation

This study examined the relation between children's history of exposure to potentially traumatic events (PTEs) and clinical and functional mental health trajectories over a 18-month period among a national sample of youth referred for services in children's behavioral health systems of care (SOCs). Using data from the national evaluation of the Comprehensive Community Mental Health Services program for communities funded from 1997 to 2000, the study sample included 9556 children and their families. Latent growth modeling was used to assess the effect of history of exposure to PTEs on trajectories in a number of behavioral health outcomes during the 3-year period following referral to services, controlling for child demographic characteristics (gender, race, and age). Results revealed that, on average, children in SOCs exhibited significant improvements over time on all four outcome measures. Children with a history of exposure to PTEs had higher rates of internalizing and externalizing problem behaviors and functional impairments and fewer behavioral and emotional strengths at baseline, but experienced improvements in these outcomes at the same rates as children without exposure to a traumatic event. Finally, child race, gender, and age also were associated with differences in behavioral health trajectories among service recipients. Implications for SOCs, including approaches to make them more trauma-informed, are discussed.

Interactive Effect of Child Maltreatment and Substance Use on Depressed Mood Among Adolescents Presenting to Community-Based Substance Use Treatment

Adolescents referred to community behavioral health centers (CBHC) for substance use (SU) problems report high rates of child maltreatment. Although SU and maltreatment are independent risk factors for adolescent depression, few studies have examined their interactive effects. This study examined the interactive effects of SU (alcohol and marijuana) and exposure to different types of trauma on depressed mood among 74 adolescents referred to a CBHC for SU. Hierarchical regressions controlling for sex and common adolescent comorbidities showed that sexual abuse had a stronger relationship with depressed mood than other types of maltreatment. Although SU was not independently related to depressed mood, consistent with the self-medication hypothesis, increased SU was associated with lower levels of depressed mood among adolescents with greater exposure to sexual abuse. Results suggest that teens presenting to CBHCs for SU should be assessed for multiple forms of maltreatment and for depressed mood.

The effects of cumulative risk and protection on problem behaviors for youth in an urban school-based system of care

The present study examined the cumulative effects of risk and protective factors on internalizing and externalizing problems for a sample of youth who were diagnosed with a severe emotional disturbance and enrolled in an urban school-based system of care. The sample included 139 Latino and African American children (ages 5-19; 65 % male) and their families. After controlling for demographic variables, the results of hierarchical multiple regression analyses revealed that cumulative risk and protection were significantly related to internalizing problem behaviors, and cumulative protection was negatively related to externalizing problem behaviors. The findings support the importance of including or increasing strength building approaches, in addition to risk reduction, in order to maximize prevention and intervention efforts for system-of-care populations.