Changes in Mental Health of Children and Young People in Residential Care: Outcomes and Associated Factors

The effect of a low intensity intervention on the wellbeing of children in the juvenile justice system in India: Results from a pilot study

OBJECTIVE

Children in the Juvenile Justice System (JJS) face multiple adversities that may predispose them to developing mental health (MH) problems. Interventions that enhance the MH and well-being of these children while providing access to appropriate MH care are needed. This study examines the effect of a multipronged, low-intensity intervention on adolescents' well-being, stress levels, MH knowledge, and stigma perceptions in Childcare Institutions (CCIs) across Odisha and Tamil Nadu, India.

METHODS

Implemented in 7 CCIs, the intervention aimed to enhance the MH Literacy (MHL) and well-being of children in the CCIs through the Youth-Friendly Spaces (YFS) using experiential methods. It also sought to improve the MHL of the staff and administration within the JJS and provide access to MH care by linking CCIs to available local resources. Information using validated scales was obtained at baseline and six months.

RESULTS

Only 180 of the 310 children for whom baseline data was available remained in the CCI at six months. A statistically significant improvement in well-being (34.5 +13.7-55.9 +12.2, p < 0.001), stress (18.5 +6.8-17 +6.1, p = 0.044) and stigma (32 +11.9-29.4 +11.4, p = 0.023) scores were observed. Adjusted linear regression analysis showed significant differences across genders, sites, and child types.

DISCUSSION

This intervention, comprising YFS creation, MHL enhancement, and referral system development, is significantly associated with improved well-being of children in CCIs. The results underscore the need for tailored interventions based on gender, location, and child type. The study highlights the potential scalability of such programs in resource-constrained settings for vulnerable children.

Change in Child and Adolescent Needs and Strengths (CANS) scores over time among children and youth in out-of-home care: A latent growth curve analysis

BACKGROUND

Children and youth in out-of-home care (OOHC) have significant behavioral health needs and may not receive relevant treatment. While the literature has urged implementation of standardized assessment of behavioral health needs, and specifically mental, emotional and social wellbeing, for these children and youth, little is known about the extent to which these needs improve over time.

OBJECTIVE

The study purpose was to examine whether improvement in functioning was detected over time based on Child and Adolescent Needs and Strengths (CANS) scores, and how scores improved over time.

PARTICIPANTS AND SETTING

The study examined scores for 6104 children and youth in OOHC between 2016 and 2022 in one state.

METHODS

Total scores for six CANS domains (behavioral/emotional needs, risk behaviors, strengths, cultural factors, life functioning, caregiver resources and needs) were computed for children and youth at five timepoints at baseline and approximately every three months. To explore the trajectory of scores over time we used latent growth curve models and fit a series of increasingly complex models to identify the best fitting form.

RESULTS

While initial levels of CANS domain scores each varied significantly across children and youth, on average CANS domain scores significantly decreased over time between T1 and T3, demonstrating overall improvement. Children and youth with higher initial levels experienced a faster rate of change T1-T3, which tended to slow from T3-T5.

CONCLUSIONS

Understanding whether behavioral health services after the identification of higher initial behavioral health needs contribute to the faster rate of improvement for these youth is an important area of future research. Identifying factors that account for between-youth variability in initial levels and rate of change is important to identify groups of youth who may be more (or less) at risk and to inform intervention.

Child maltreatment and psychopathology among institutionalized and incarcerated adolescents in Nigeria: A latent class analysis approach

BACKGROUND

Child maltreatment (CM) is prevalent among residentially-placed or incarcerated adolescents and is a risk factor for behavioral health disorders. No study conducted in a low-income country has empirically compared the types of CM and adverse outcomes experienced by these high-risk adolescents.

OBJECTIVE

The purpose of this study was to identify profiles of CM-and their association with behavioral health problems among at-risk adolescents in Nigeria.

PARTICIPANTS AND SETTING

Participants comprised adolescents in juvenile detention facilities (N = 102) and adolescents in residential placements (N = 103) aged 10-17 years old.

METHODS

A two-step latent class analysis (LCA) was applied with data from validated self-report measures of CM to identify distinct profiles of maltreatment and their association with validated self-report measures of behavioral health problems and PTSD symptoms.

RESULTS

Three latent classes were identified: (1) witnessing violence and neglect class (N = 20,10 %); physical and emotional abuse class (N = 41,20 %); and multiple maltreatment class (N = 144, 70 %). The physical and emotional abuse class (class 2) and the multiple maltreatment class (class 3) reported significantly higher rates of other adversities (i.e., parent/guardian incarceration and poverty) and more severe angry and irritable symptoms, traumatic experiences, thought disturbances, and somatic complaints when compared to the witnessing violence and neglect class. The multiple maltreatment class had more severe post-traumatic stress disorder (PTSD) symptoms than the other two classes. The witnessing violence and neglect class, however, had more severe anxiety depression symptoms than the other classes and more severe suicidal ideation than the multiple maltreatment class.

CONCLUSION

The findings underscore the role of exposure to multiple forms of maltreatment (i.e., poly-victimization) among incarcerated and institutionalized adolescents, and highlight the need to address depression, anxiety, and suicidal ideation in youths who have witnessed violence or experienced neglect. Integrating CM and PTSD screening into mental health service for these vulnerable youth could enhance their rehabilitation and treatment by identifying and remediating the adverse effects of different patterns of poly-victimization and CM.

Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

Temperament Characteristics of Children in Residential Care and Perceived Acceptance/Rejection and Style of Discipline Used by Care Workers

The ability to adapt interpersonal interactions to temperamental characteristics is essential for high-quality care. We analyzed how temperamental and self-regulation differences among children in residential care were related to the affective relationships and discipline styles of their caregivers. A total of 144 children aged 9-16 years (42.6% boys) and their caregivers from 22 residential care homes (Spain) participated. The Early Adolescent Temperament Questionnaire-Revised (EATQ-R) was used to assess temperament, the Affect Scale and Rules and Demands Scale was used to assess children's perceptions of affective relationships and discipline styles among their caregivers, and BRIEF-2 was used to assess children's self-regulation. Perceived warmth/communication was significantly higher than criticism/rejection and children perceived more inductive than rigid or permissive styles. Temperamental-scale fear was positively related to warmth/communication and an inductive style, and negatively related to criticism/rejection and a rigid style, whereas high-intensity pleasure showed the opposite pattern. In addition, some self-regulation and temperament scales explained 26% of the perception of warmth/communication, while others explained 15% of the variability of the rigid discipline style used by care workers. These results can help care workers to adjust their educational strategies according to the temperamental characteristics of this specific population.

Prevalence and correlates of post-traumatic stress disorder and depression among welfare- and justice-involved adolescents in Nigeria

Background: Childhood maltreatment (CM) is higher among welfare- and justice-involved youth than in those not involved in these systems, which increases the risk of depression and post-traumatic stress disorder (PTSD). However, the mechanisms underlying the link between CM and these two psychiatric conditions are less well understood among at-risk populations in low- and middle-income countries.Objective: This study attempts to fill this gap by examining the prevalence of and risk factors for depression and PTSD among at-risk groups in Nigeria.Method: A cross-sectional research design using multistage sampling was adopted. The sample comprised 205 adolescents: justice-involved [102 (49.8%)] and welfare-involved [103 (50.2%)]. In total, 151 (73.7%) were males, while 54 (26.3%) were females. Multivariate logistic regression analysis and multivariate analysis of variance were applied.Results: The results showed that 66.1% of welfare-involved adolescents and 69.6% of justice-involved adolescents reported PTSD, while 68.9% of welfare-involved adolescents and 75.5% of justice-detained adolescents reported depression. Neglect (OR = 0.253; 95% CI 0.146-0.571; p < .001) and witnessing violence (OR = 0.230; 95% CI 0.114-0.597; p < .004) predicted depression. Emotional abuse (OR = 0.186; 95% CI 0.090-0.80; p < .015), witnessing violence (OR = 0.147; 95% CI 0.014-0.876; p < .043), neglect (OR = 0.187; 95% CI 0.14-0.90; p < .008), and physical abuse (OR = 0.27; 95% CI 0.254-0.937; p < .001) predicted PTSD. Also, PTSD significantly differed based on type of placement (F = 6.08, p < .014, η2 = .029), but depression did not differ based on type of placement (F = 2.46, p > .118, η2 = .012).Conclusions: CM profiles are risk factors in PTSD and depression among at-risk groups. CM screening should be included in mental health services of out-of-home placements to prevent the cycle of mental health problems and reoffending. Trauma-focused and cognitive-behavioural therapies have the potential to alleviate the suffering of traumatized adolescents.

Academic Performance in Institutionalized and Noninstitutionalized Children: The Role of Cognitive Ability and Negative Lability

More research is needed to understand the factors that contribute to low academic achievement in institutionalized children. The aim of this study was to investigate the relationship between cognitive and emotion regulation skills and academic performance, by comparing institutionalized and noninstitutionalized Portuguese children. The sample comprised 94 participants (46 institutionalized (22 boys) and 48 noninstitutionalized (23 boys) children), aged between 6 and 10 years, matched for age and sex. We used Raven's Colored Progressive Matrices (RCPM) to measure cognitive abilities. Emotional regulation and negative lability were assessed using the Emotion Regulation Questionnaire (ERC). Academic performance was assessed with the Competence Academic Scale (CAS) of the Portuguese version of the Social Skills Rating System-Teacher Form (SSRS-T). Institutionalized children exhibited poorer academic performance than their noninstitutionalized counterparts (effect size, η2 = 0.174). Cognitive ability (β = 0.28) and negative lability (β = -0.28) were significant predictors of academic performance. In addition to institutionalization, cognitive ability, and the challenges of managing negative emotions may contribute to the observed differences in academic performance. Interventions aimed at fostering cognitive and emotional competencies may play a protective role for institutionalized children facing academic and social difficulties.