Effects of school connectedness on the relationship between child maltreatment and child aggressive behavior: A mediation analysis.

BACKGROUND: Children growing up in a vulnerable and unstable family environment including child maltreatment, poor family functioning, and low social-economic status, are at higher risk of developing undesirable behavioral outcomes compared to peers in the general population. School life plays a critical role during the development of adolescents. OBJECTIVE: The purpose of this study is to examine the role of school connectedness in the relationship between child maltreatment and aggressive behavior. PARTICIPANTS AND SETTING: This study employed the Fragile Family and Child Well-being Study - Year 15. The final analytic sample size is 2285 families. METHODS: Mediation analyses were conducted to evaluate the impact of CPS on child aggressive behavior mediated by school connectedness using OLS regression with robust standard errors. The bootstrap was used to estimate the standard error of the indirect effect. RESULTS: The total effect of CPS contact on child aggressive behaviors was 0.14 (p < .001). The direct effect of CPS contact on child aggressive behavior was 0.13 (p < .001). The indirect effect, that school connectedness significantly mediated the relationship between CPS and child aggressive behavior, was tested and found statistically significant (Coef. = 0.01, p < .05). CONCLUSIONS: Findings of the mediation model suggest that interventions targeted at improving school connectedness among adolescents involved in the child welfare system may promote positive outcomes by reducing aggressive behaviors among youth growing in fragile families. On-going trainings are needed for schoolteachers and social workers to better engage adolescents with child maltreatment at school.

Antipsychotic medications and admission to psychiatric residential treatment facilities among youth in foster care diagnosed with disruptive behavior disorders.

Many youth in foster care are diagnosed with disruptive behavior disorder (DBD), a diagnosis indicative of aggression and behavior problems. These youth, who are at high risk for being placed in psychiatric residential treatment facilities (PRTF), are commonly prescribed antipsychotic (AP) medications off-label. However, treating children in the community is an important goal, and although AP medications can have severe side effects, these prescriptions may help to achieve this goal. In this study, we used Medicaid data to determine whether AP medications reduce the risk of admission to PRTF among two groups of children with DBD: those with DBD only and those who were diagnosed with DBD in addition to at least one of two conditions indicated for AP prescribing (psychosis and bipolar disorder.) Event history models show that AP medications are associated with a high rate of admission, which are likely due to the higher mental and behavioral health needs of youth who are prescribed. However, youth diagnosed with both DBD and indications who are prescribed an AP medication have one-tenth the rate of admission of similar youth who are not prescribed. For youth with DBD only, the findings are inconclusive. Given these mixed results, practitioners should follow clinical guidelines; ensuring youth are treated with psychosocial interventions and other psychotropic medications prior to AP prescribing. Agencies should attempt to address systemic factors such as shortages of foster homes, increased availability of therapeutic foster care, and implementation of in-home prevention services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The impact of Strong Families, Strong Communities on relationship functioning in low-income African American and Hispanic individuals: Findings from a federally funded randomized control trial.

Low-income minorities face many complex barriers to building stable and healthy relationships. AVANCE Houston, a non-profit community-based organization in Houston, Texas, developed the Strong Families, Strong Communities (SFSC) program to address such barriers by providing interactive healthy marriage and relationship skills workshops to low-income English- and Spanish-speaking Hispanic and English-speaking African American individuals. Using a randomized control trial (RCT) design with random assignment to the 7-week treatment group (n = 649) or a 12-month wait-list control group (n = 600), we examined the impact of the program on four dimensions of relationship functioning: relationship satisfaction, connectedness, and quality; and conflict resolution, at post-test and then 6 and 12 months later. Using a repeated measure multilevel model with a difference-in-difference impact estimate, we found that all four dimensions of relationship functioning improved with small effect sizes that were larger than those found in previous relationship education programs for low-income individuals (Cohen's d's of 0.18 for relationship satisfaction, 0.24 for connectedness, 0.19 for quality, and 0.20 for conflict resolution). Findings from this study provide evidence of program effectiveness on dimensions of relationship functioning for low-income minorities, comparable to or better than those seen in other healthy marriage program RCTs. The findings of this impact evaluation are promising regarding the impact of programs like SFSC on dimensions of relationship functioning in low-income Hispanic and African American participants.

Academic Trajectories of Children in Formal and Informal Kinship Care.

The academic achievement places children on a positive trajectory for their lifespan. The aim of this study was to examine the academic trajectories of children in out-of-home care (OOCH) and whether kinship care has a protective effect relative to nonkin foster care. The sample analyzed for this study consists of 519,306 racially diverse youth in North Carolina schools 8 to 11 years old in the school year 2009-2010 (e.g., 27% African American, 12% Latinx, 53% White). Four longitudinal administrative data sources were merged to create this unique sample. Multilevel modeling revealed no difference between formal and non-OOHC, but showed differences between nonkin foster, informal, and non-OOHC. Children's academic performance who reside in formal kinship care is similar to children in non-OOHC.

Cumulative Bullying Experiences, Adolescent Behavioral and Mental Health, and Academic Achievement: An Integrative Model of Perpetration, Victimization, and Bystander Behavior.

Bullying is often ongoing during middle- and high-school. However, limited research has examined how cumulative experiences of victimization, perpetration, and bystander behavior impact adolescent behavioral and mental health and academic achievement outcomes at the end of high school. The current study used a sample of over 8000 middle- and high-school students (51% female; mean age 12.5 years) from the Rural Adaptation Project in North Carolina to investigate how cumulative experiences as a bullying victim and perpetrator over 5 years, and cumulative experiences of bystander behavior over 2 years impacted students' aggression, internalizing symptoms, academic achievement, self-esteem, and future optimism. Following multiple imputation, analysis included a Structural Equation Model with excellent model fit. Findings indicate that cumulative bullying victimization was positively associated with aggression and internalizing symptoms, and negatively associated with self-esteem and future optimism. Cumulative bullying perpetration was positively associated with aggression and negatively associated with future optimism. Cumulative negative bystander behavior was positively associated with aggression and internalizing symptoms and negatively associated with academic achievement and future optimism. Cumulative prosocial bystander behavior was positively associated with internalizing symptoms, academic achievement, self-esteem, and future optimism. This integrative model brings together bullying dynamics to provide a comprehensive picture of implications for adolescent behavioral and mental health and academic achievement.

Parenting Wisely Six Months Later: How Implementation Delivery Impacts Program Effects at Follow-Up.

We evaluated the effectiveness of the Parenting Wisely (PW) program 6 months post intervention and assessed differences based on delivery format. Using a quasi-experimental design, parents (N = 311) participated in the PW program in one of five formats (i.e., parents-only intensive workshop, parents-only 5-week group, parents and adolescents 5-week group, parent and adolescent online, and parent-only online format). An additional 53 parents served as a comparison group. We used the McMaster Family Assessment Device, the Child Behavior Checklist, and the Violent Behavior Checklist to measure family functioning, parenting, and adolescent behavior. Relative to the comparison group, at 6 month follow-up parents who participated in PW reported increases in confidence in their parenting skills, decreases in conflicts with their adolescents, and decreases in adolescent externalizing and violent behavior. Mechanisms of change analyses supported the conceptual model that program effects were related to child behavior changes by influencing positive parenting and decreasing negative family dynamics. PW effectiveness did not vary substantially by delivery format, except for the intensive workshop format, which was less effective than other formats. These findings extend research on PW to include evidence of sustained program effects on adolescent externalizing and violent behaviors in an ethnically diverse, socioeconomically disadvantaged sample. Study findings are relevant to agencies and clinicians who are seeking to implement an evidence-based, flexible parent-training program.

Adverse Childhood Experiences and Child Health Outcomes: Comparing Cumulative Risk and Latent Class Approaches.

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children's Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.

Polysubstance Use Among Adolescents in a Low Income, Rural Community: Latent Classes for Middle- and High-School Students.

PURPOSE: Rural communities are currently being impacted by a nationwide epidemic of prescription opioid misuse. Rural adolescent substance users may be at substantial risk for later addiction to these and other drugs. METHODS: This study uses Latent Class Analysis to identify subtypes of polysubstance users among a sample of 7,074 rural adolescents. Separate models were estimated for middle- and high-school youth. Predictive validity was estimated using cumulative ordinal logistic regression of the classes on a set of youth and family characteristics. FINDINGS: We identified a 4-class solution for both middle- and high-school students marked by initiation of an increasing number of substances used at greater frequency. These classes included Substance Nonusers, Primarily Alcohol Users, Initiators-Low Frequency Users, and Initiators-Moderate-to-High Lifetime Frequency Users. About 6%-10% of youth reported using prescription drugs at least once, and in the moderate-to-high frequency class, middle-school youth were more likely to use prescription drugs and inhalants compared to high-school youth in the same class. The 4 classes were associated with race/ethnicity, and in high school with receiving free/reduced price lunch. CONCLUSION: In general, younger adolescents have lower overall use rates, but within certain classes identified by this analysis, the observed pattern suggests that younger cohorts are turning to prescription drugs and inhalants. These findings support the implementation of universal substance use prevention programs, targeted programs for youth experiencing risk factors associated with substance use, and improved rural substance abuse treatment options.

A Longitudinal Study of Child Maltreatment and Mental Health Predictors of Admission to Psychiatric Residential Treatment Facilities.

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.

The Impact of Teen Court on Rural Adolescents: Improved Social Relationships, Psychological Functioning, and School Experiences.

Teen Court is a prevention program aimed at diverting first time juvenile offenders from the traditional juvenile justice system and reintegrating them into the community. Few studies have examined if Teen Court impacts adolescent functioning. We examined how Teen Court participation impacted psychosocial functioning, social relationships, and school experiences in a sample of 392 rural Teen Court participants relative to two comparison samples, one from the same county as Teen Court (n = 4276) and one from a neighboring county (n = 3584). We found that Teen Court has the potential to decrease internalizing symptoms, externalizing behavior, violent behavior, parent-adolescent conflict, and delinquent friends, and increase self-esteem and school satisfaction.

Risk and protective factors across multiple microsystems associated with internalizing symptoms and aggressive behavior in rural adolescents: Modeling longitudinal trajectories from the Rural Adaptation Project.

The current study examined risk and protective factors across microsystems that impact the development of internalizing symptoms and aggression over 4 years in a sample of culturally diverse, rural adolescents. We explored whether risk and protective factors across microsystems were associated with changes in rates of internalizing symptoms and aggressive behavior. Data came from the Rural Adaptation Project (RAP), a 5-year longitudinal panel study of more than 4,000 students from 26 public middle schools and 12 public high schools. Three level HLM models were estimated to predict internalizing symptoms (e.g., depression, anxiety) and aggression. Compared with other students, risk for internalizing symptoms and aggression was elevated for youth exposed to risk factors in the form of school hassles, parent-child conflict, peer rejection, and delinquent friends. Microsystem protective factors in the form of ethnic identity, religious orientation, and school satisfaction decreased risk for aggression, but were not associated with internalizing symptoms, whereas future orientation and parent support decreased risk for internalizing symptoms, but not aggression. Results indicate that risks for internalizing symptoms and aggression are similar, but that unique protective factors are related to these adolescent behavioral health outcomes. Implications and limitations were discussed. (PsycINFO Database Record

Family dynamics and aggressive behavior in Latino adolescents.

OBJECTIVES: Despite high prevalence rates and evidence that acculturation is associated with adolescent behavioral and mental health in Latino youth, little research has focused on aggressive behavior for this population. The aim of the current study was to fill this research gap by examining the influence of several aspects of family functioning, including parent-adolescent conflict, parent worry, and parent marital adjustment, on aggression among Latino adolescents. METHOD: Data come from the Latino Acculturation and Health Project (LAHP), a longitudinal investigation of acculturation in Latino families in North Carolina and Arizona. Hierarchical linear modeling was used to estimate a longitudinal rater effects model of adolescent aggression as reported by 258 Latino adolescents each paired with 1 parent for a total of 516 participants across 4 time points over a span of 18 months. RESULTS: Results indicated a general decline in aggression over the study window. In addition, parent-adolescent conflict and parent worry predicted higher adolescent aggression whereas parent marital adjustment predicted lower adolescent aggression. CONCLUSIONS: The salience of family risk factors for aggression among Latino adolescents is discussed. (PsycINFO Database Record

Risk assessment with actuarial and clinical methods: Measurement and evidence-based practice.

Child welfare agencies have adopted assessment tools and instruments to inform the level of risk and guide the agency's level of intervention with the family. Actuarial assessments may be more uniform but inflexible with respect to practice wisdom whereas clinical or consensus-based assessments are more comprehensive and intuitive but lack objectivity. The purpose of the current study is to compare clinical and actuarial methods of risk assessment used by child welfare workers to make decisions about substantiation and services. The current study examined the (1) association between clinical and actuarial dimensions, (2) association between actuarial dimensions and outcomes, (3) association between clinical dimensions and outcomes, (4) caseworker primary use of actuarial dimensions, and (5) caseworker supplementary use of actuarial dimensions. Findings indicated that the actuarial may not be solely predictive of agency intensity with respect to case decision and service provision. Our findings suggest that dual-measurement does inform intensity, and we speculate from these findings that the measures may be involved with decision-making in a complex way. This study may be best viewed as a means by which researchers begin to parse how decisions are made; with this information, instruments may be better tailored to facilitate clinical, critical thought.

Substance use in rural adolescents: The impact of social capital, anti-social capital, and social capital deprivation.

Middle- and high-school substance use is a pressing public health problem in the United States. Despite similar or, in some cases, elevated rates of substance use among rural youth, much of the extant research on adolescent substance use has focused on urban areas. The current study aims to uncover forms of social capital (e.g., ethnic identity), social capital deprivation (e.g., parent-child conflict), and anti-social capital (e.g., delinquent friends) that impact the use of alcohol, cigarettes, and marijuana in a sample of middle- and high-school students from the rural south. It was hypothesized that social capital factors would be associated with decreased substance use while social capital deprivation and anti-social capital factors would be associated with increased substance use. The hypotheses were tested using logistic regression models with generalized estimating equations. The findings indicated that for middle school youth, anti-social capital in the form of aggression and delinquent friends was significantly associated with an increased likelihood of using alcohol, cigarettes, and marijuana. For high school students, anti-social capital in the form of aggression and delinquent friends and social capital deprivation in the form of neighborhood crime were significantly associated with an increased likelihood of using alcohol, cigarettes, and marijuana. Violent behavior was also significantly associated with an increased likelihood of using marijuana. Females reported less substance use in both middle and high school; reports of use increased with age. Implications are discussed. Given the salience of social capital deprivation, substance use programs should emphasize the skills necessary to avoid or disengage from antisocial relationships.

Multi-level risk factors and developmental assets associated with aggressive behavior in disadvantaged adolescents.

The current study examined multilevel risk factors and developmental assets on longitudinal trajectories of aggressive behavior in a diverse sample of rural adolescents. Using ecological and social capital theories, we explored the impact of positive and negative proximal processes, social capital, and contextual characteristics (i.e., school and neighborhood) on adolescent aggression. Data came from the Rural Adaptation Project, which is a 5-year longitudinal panel study of more than 4,000 middle and high school students from 40 public schools in two rural, low income counties in North Carolina. A three-level HLM model (N = 4,056 at Wave 1, 4,251 at Wave 2, and 4,256 at Wave 3) was estimated to predict factors affecting the change trajectories of aggression. Results indicated that negative proximal processes in the form of parent-adolescent conflict, friend rejection, peer pressure, delinquent friends, and school hassles were significant predictors of aggression. In addition, social capital in the form of ethnic identity, religious orientation, and school satisfaction served as buffers against aggression. Negative proximal processes were more salient predictors than positive proximal processes. School and neighborhood characteristics had a minimal impact on aggression. Overall, rates of aggression did not change significantly over the 3-year study window. Findings highlight the need to intervene in order to decrease negative interactions in the peer and parent domains.

Physically Abused Children's Adjustment at the Transition to School: Child, Parent, and Family Factors.

Childhood physical abuse predicts emotional/behavioral, self-regulatory, and social problems. Yet factors from multiple ecological levels contribute to children's adjustment. The purpose of this study was to examine the degree to which the social-emotional adjustment of physically abused children in first grade would be predicted by a set of child-, parent-, and family-level predictors in kindergarten. Drawing on a short-term longitudinal study of 92 physically abused children and their primary caregivers, the current study used linear regression to examine early childhood child (i.e., gender, IQ, child perceptions of maternal acceptance), parent (i.e., parental mental health), and family relationship (i.e., sensitive parenting, hostile parenting, family conflict) factors as predictors of first grade internalizing and externalizing symptomatology, emotion dysregulation, and negative peer interactions. We used a multi-method, multi-informant approach to measuring predictors and children's adjustment. Internalizing symptomatology was significantly predicted by child IQ, parental mental health, and family conflict. Externalizing symptomatology and emotion dysregulation were predicted by child IQ. Although a large proportion of variance in measures of adjustment was accounted for by the set of predictors, few individual variables were unique predictors of child adjustment. Variability in the predictors of adjustment for physically abused children underscores the need for individualized treatment approaches.

Familial influences on internalizing symptomatology in Latino adolescents: an ecological analysis of parent mental health and acculturation dynamics.

The aim of this study was to examine if family system dynamics (e.g., parent mental health, marriage quality, conflict, and cohesion) that have often been overlooked when studying Latino families play a more important role in predicting adolescent internalizing symptoms than acculturation processes. Data comes from the Latino Acculturation and Health Project, a longitudinal investigation of acculturation in Latino families in North Carolina and Arizona (Smokowski & Bacallao, 2006, 2010). Researchers conducted in-depth, community-based interviews with 258 Latino adolescents and 258 of their parents in metropolitan, small-town, and rural areas. Interviews were conducted at four time points at intervals of approximately 6 months. Parent and adolescent ratings of the adolescent's internalizing symptoms were used as the dependent variable in a longitudinal hierarchical linear model with a rater effects structure. Results showed that parent-adolescent conflict and parent mental health (fear/avoidance of social situations and humiliation sensitivity) were significant predictors of adolescent internalizing symptoms. Acculturation scales were not significant predictors; however, internalizing symptoms decreased with time spent in the United States. Females and adolescents from lower socioeconomic status families reported more internalizing symptoms, while participants who had been in the United States longer reported fewer internalizing symptoms. Implications were discussed.

Financial well-being of single, working-age mothers of children with developmental disabilities.

Understanding the financial well-being of single mothers who care for children with developmental disabilities is important to ensure that public policies can be effectively targeted to support these vulnerable families. The authors analyze data from the Survey of Income and Program Participation to describe income poverty, asset poverty, income, net worth, and liquid assets of U.S. single, working-age mothers (n  =  242) of children and adult children with developmental disabilities. The well-being of these mothers was compared to the situation of married mothers of children with developmental disabilities (n  =  345) and of single mothers who did not have children with developmental disabilities (n  =  6,547). Compared with both married mothers of children with developmental disabilities and single mothers without children with developmental disabilities, single mothers of children with developmental disabilities had markedly worse financial well-being across a range of income- and asset-based measures. Single mothers caring for children with developmental disabilities face adverse financial well-being as compared with other mothers. Policy makers should consider targeted measures to improve the financial well-being of these parents.

Racial and ethnic disparities in quality of health care among children with autism and other developmental disabilities.

We examined racial and ethnic disparities in quality of care for children with autism and other developmental disabilities and whether disparities varied for children with autism compared to children with other developmental disabilities. Analyzing data from the National Survey of Children with Special Health Care Needs (N  =  4,414), we compared Black and Latino children to White children. We found racial and ethnic disparities on 5 of 6 quality outcomes. The interaction between race and disability status indicated that disparities in quality indicators were exacerbated among families of children with autism. These analyses suggest that children with autism, particularly those who are Latino and Black, face greater challenges in receiving high-quality health care.

State Medicaid policies and the health care access of low-income children with special health care needs living in the American South.

BACKGROUND: The policy correlates that improve or impede the health care access of children with special health care needs (CSHCN), and particularly children living in the South, are not well understood. METHODS: We analyzed data from the 2005-2006 National Survey of CSHCN (n = 4560 Southern children and 8788 non-Southern children). State Medicaid policy predictors included the frequency of Medicaid eligibility renewals (6 or 12 months) and the level of reimbursement provided for high-complexity and moderate-complexity pediatric office visits. Hierarchical generalized linear modeling was used to examine the association between state Medicaid policy features and 5 indicators of health care access (delayed or foregone care, difficulty using services, difficulty getting referrals, unmet routine care needs, and unmet specialty care needs), after controlling for child, family, and state factors. RESULTS: Low-income Southern CSHCN who lived in states with less-frequent Medicaid eligibility renewal requirements and higher health care provider reimbursement rates had significantly better health care access than did their Southern counterparts in states with more-frequent Medicaid eligibility renewals and lower reimbursement rates. LIMITATIONS: These data are cross-sectional, and causality cannot be inferred. CONCLUSION: Policymakers interested in addressing state budget gaps should be concerned that doing so by increasing the frequency of Medicaid eligibility renewals or by cutting health care provider reimbursement rates may well result in adverse health care access for low-income Southern CSHCN.