National training and development curriculum training program impact on placement, permanency, and stability.

BACKGROUND: Resource parent trainings are an important factor in caregiver readiness and retention, which can improve placement stability and permanency achievement for children and youth, especially those who are marginalized. OBJECTIVE: Resource parents need access to evidence-based training programs attentive to caring for children and youth from a variety of diverse backgrounds. This study evaluates placement, permanency, and stability outcomes of children whose resource parents were trained in one such program: the National Training and Development Curriculum (NTDC). PARTICIPANTS AND SETTING: Participants include adults who completed a resource parent training program (N = 3822) and children in their care (N = 2565) in the U.S. states of Florida, Georgia, Illinois, and Missouri. METHODS: This quasi-experimental study involved statistical testing of caregivers and children using AFCARS data. Propensity-score matching was used to control for differences in the child permanency analysis. RESULTS: With a better understanding of the realities of fostering, NTDC participants were slightly less likely to foster after training (OR = 0.6; p < .001), self-selecting out before taking a child into the home. Those who did foster were more likely to foster a child who is a teen (OR = 1.4; p = .004), Asian/Asian American (OR = 3.8; p = .02), Black/African American (OR = 1.6; p < .001), or Hispanic/Latinx (OR = 1.7; p = .002). Children of NTDC caregivers entered legal adoptions (OR = 2.0; p = .003) and guardianships (OR = 2.9; p = .03) at higher rates than children of comparison caregivers, while rates of reunification (OR = 1.3; p = .11) were not statistically different. CONCLUSIONS: Evidence points to the effectiveness of NTDC in preparing resource parents to provide care for a diverse range of children by age, race, and ethnicity, and for those children to achieve permanency.

Evaluation of a Brief Foster Parent/ Case Worker Training to Support Relationship Building Skills and Acceptance of LGBTQ+ Youth in Care.

LGTBQ+ youth in foster care need unique support and acceptance; however, few case workers and caregivers receive specialized training. To address this, the Connecting: Sexual Orientation and Gender Identity Expression (SOGIE) eLearning was developed. This evaluation assesses whether attitudes and behavioral intentions regarding LGBTQ+ youth improved as a result of this training. Caregivers and child welfare professionals showed growth in many areas, including how important they felt it was to learn strategies and skills to support LGBTQ+ youth, as well as their confidence to care for LGBTQ+ youth. The Connecting: SOGIE eLearning is a promising tool for child welfare systems.

[Comparison of manual versus mechanical cervical anastomosis in a prospective series of patients with esophagectomy due to cancer]. / Comparación de la anastomosis cervical manual versus mecánica en una serie prospectiva de pacientes con esofagectomía por cáncer.

OBJECTIVES: The scarce existing literature suggests having a lower rate of anastomotic leakage and less late stricture formation after stapled esophagogastric anastomosis compared to the manual anastomosis technique. The aim of the present study is to compare the surgical outcomes of termino-lateral manual cervical anastomosis versus mechanical anastomosis by later lateral stapling, after transhiatal esophagectomy for cancer. MATERIALS AND METHODS: A retrospective review of patients undergoing transhiatal esophagectomy with manual or mechanical anastomosis for neoplasia was performed at three institutions in Medellin, between 2011 and 2018. Endpoints included leak rate, morbidity, mortality, hospital stay, and endoscopically identified anastomotic strictures requiring dilatation. RESULTS: 68 patients (40 men, 59%) were evaluated, 37 with manual anastomosisand 31 with mechanical anastomosis with similar demographic characteristics. Anastomotic leaks occurred in 13 patients (19.1%), with no difference found between manual and mechanical anastomosis (18.9 vs. 19.3%; p=0.93). Overall morbidity (61%), in-hospital mortality (3%) and length of hospital stay (median 12 days) were not affected by anastomotic technique. Follow-up endoscopic evaluation was available in all patients and anastomotic stricture associated or not with leak was detected in 18 patients (22%), in cases of stricture without leak is more frequent with manual than mechanical anastomosis technique (21.6 vs 6.4%; p=0.07) with longer duration of surgical procedure in case of manual anastomosis (p=0.05). CONCLUSIONS: Our non-randomized study suggests that the manual anastomosis technique results in a shorter surgical time and a lower stricture rate than mechanical anastomosis in cervical esophagogastric reconstruction after transhiatal esophagectomy, with a similar rateof leakage, hospital stay and morbidity and mortality.

Comparación de la anastomosis cervical manual versus mecánica en una serie prospectiva de pacientes con esofagectomía por cáncer

Objetivos : La escasa literatura existente sugiere haber una menor tasa de fugas anastomóticas y una menor formación tardía de estenosis después de la anastomosis esofagogástrica con grapas comparada con la técnica de anastomosis manual. El objetivo del presente estudio es comparar los resultados quirúrgicos de la anastomosis cervical manual termino-lateral versus la anastomosis mecánica por grapado laterolateral luego de una esofagectomía transhiatal por cáncer. Materiales y métodos : Se realizó una revisión retrospectiva de los pacientes sometidos a esofagectomía transhiatal con anastomosis manual o mecánica por neoplasia en tres instituciones de Medellín, entre 2011 y 2018. Los criterios de valoración incluyeron la tasa de fuga anastomótica, la morbilidad, la mortalidad, la estancia hospitalaria y anastomóticas identificadas las estenosis por endoscopia que requirieran dilatación. Resultados : se evaluaron 68 pacientes (40 hombres, 59%), 37 con anastomosis manual y 31 con anastomosis mecánica con características demográficas similares. Se produjeron fugas anastomóticas en 13 pacientes (19,1%), sin encontrarse una diferencia entre la anastomosis manual y mecánica (18,9 frente a 19,3%; p = 0,93). La morbilidad global (61%), la mortalidad intrahospitalaria (3%) y la duración de la estancia hospitalaria (mediana de 12 días) no se vieron afectadas por la técnica anastomótica. Se dispuso de una evaluación endoscópica de seguimiento en todos los pacientes y se detectó una estenosis anastomótica asociada o no a fugas de la anastomosis en 18 pacientes (22%), los casos de estenosis sin fuga fueron más frecuente con la técnica de anastomosis manual que la mecánica (21,6 vs 6,4%; p=0,07) con una duración mayor del procedimiento quirúrgico en caso de la anastomosis manual (p=0,05). Conclusiones : Nuestro estudio no aleatorizado sugiere que la técnica de anastomosis mecánica cursa con un tiempo quirúrgico menor y una menor tasa de estenosis que la anastomosis manual en la reconstrucción esofagogástrica cervical tras la esofagectomía transhiatal, con una tasa de fuga anastomótica, estancia hospitalaria y morbimortalidad similares.

Objectives : The scarce existing literature suggests having a lower rate of anastomotic leakage and less late stricture formation after stapled esophagogastric anastomosis compared to the manual anastomosis technique. The aim of the present study is to compare the surgical outcomes of termino-lateral manual cervical anastomosis versus mechanical anastomosis by later lateral stapling, after transhiatal esophagectomy for cancer. Materials and methods : A retrospective review of patients undergoing transhiatal esophagectomy with manual or mechanical anastomosis for neoplasia was performed at three institutions in Medellin, between 2011 and 2018. Endpoints included leak rate, morbidity, mortality, hospital stay, and endoscopically identified anastomotic strictures requiring dilatation. Results : 68 patients (40 men, 59%) were evaluated, 37 with manual anastomosis and 31 with mechanical anastomosis with similar demographic characteristics. Anastomotic leaks occurred in 13 patients (19.1%), with no difference found between manual and mechanical anastomosis (18.9 vs. 19.3%; p=0.93). Overall morbidity (61%), in-hospital mortality (3%) and length of hospital stay (median 12 days) were not affected by anastomotic technique. Follow-up endoscopic evaluation was available in all patients and anastomotic stricture associated or not with leak was detected in 18 patients (22%), in cases of stricture without leak is more frequent with manual than mechanical anastomosis technique (21.6 vs 6.4%; p=0.07) with longer duration of surgical procedure in case of manual anastomosis (p=0.05). Conclusions : Our non-randomized study suggests that the manual anastomosis technique results in a shorter surgical time and a lower stricture rate than mechanical anastomosis in cervical esophagogastric reconstruction after transhiatal esophagectomy, with a similar rate of leakage, hospital stay and morbidity and mortality.

Supporting LGBTQ+ Foster Teens: Development of a Relationship-Focused, Self-Guided Curriculum for Foster Families.

LGBTQ+ youth are over-represented in the foster care system. Child welfare systems across the country have been struggling with how to make their systems work better for the LGBTQ+ youth they serve. One strategy is developing foster caregiver trainings that bolster caregivers' knowledge and support of LGBTQ+ youth in their care. This study has three aims: (1) to provide an overview of a module designed to support relationship building between LGBTQ+ youth in foster care and their caregivers, (2) to describe the theater testing procedure used to assess usability of the developed module with foster caregivers and adults, and (3) to share the results of the theater test. Overall, participants provided positive usability feedback about the module activities, as well as a wide variety of recommendations for strengthening the content for widespread use. Participants felt the module should be directed specifically toward caregiver skill development rather than toward both caregiver and youth support. This module represents one example of how materials focused on building foster caregivers' knowledge and support have the potential to help LGBTQ+ teens who are overrepresented in the foster care system.

Developing Relationship-Building Tools for Foster Families Caring for Teens who are LGBTQ2S.

Youth who identify as lesbian, gay, bisexual, transgender, queer/questioning, and two-spirit (LGBTQ2S) are disproportionally represented in the foster care population and often face discrimination within the system. This article summarizes findings from focus groups with youth in care who are LGBTQ2S, foster caregivers, and child welfare workers to explore (a) the unique challenges and support-related needs of youth in care who are LGBTQ2S and their foster caregivers, and (b) strategies for building better relationships between these youth and caregivers. Findings can be used to improve youth placement stability.

Defining and achieving permanency among older youth in foster care.

Permanency is a key child welfare system goal for the children they serve. This study addresses three key research questions: (1) How do older youth in foster care define their personal permanency goals? (2) How much progress have these youth made in achieving their personal permanency goals and other aspects of relational permanency, and how does this vary by gender, race, and age? and (3) What transition-related outcomes are associated with relational permanency achievement? Surveys were conducted with 97 youth between the ages of 14 and 20 currently in care. Over three-fourths of participants had an informal/relational permanency goal; however, only 6.7% had achieved their goal. Of eight additional conceptualizations of relational permanency assessed, the one associated with achievement of the highest number of key transition outcomes was Sense of Family Belonging. The transition outcomes with the most associations with permanency achievement were physical health and mental health. Relational permanency is a highly personal part of the transition process for youth in care, warranting personalized supports to ensure individual youths' goals are being addressed in transition planning. Permanency achievement may also provide a foundation for supporting youth in achieving other key transition outcomes.

Fostering Higher Education: A Postsecondary Access and Retention Intervention for Youth with Foster Care Experience.

Most youth in foster care aspire to obtain higher education, but face daunting obstacles in doing so. While societal interest and effort to support foster youth in achieving higher education has grown, very few supports have evidence to show that they are effective at improving postsecondary outcomes. In an effort to address the dearth of clearly articulated, evidence-based postsecondary support approaches for foster youth, we have developed Fostering Higher Education (FHE), a comprehensive, structured, and evaluable postsecondary access and retention intervention composed of elements (professional educational advocacy, substance abuse prevention, mentoring) that are either evidence based or promising based on the scientific literature and their ability to address the outcomes of interest. This paper describes the development and youth usability and practitioner feasibility testing of the FHE intervention approach, which was developed through funding from the National Institute on Drug Abuse. Youth usability feedback was primarily positive, with the majority of participants indicating they found the FHE activities interesting and useful, and were comfortable participating in them. Practitioner feasibility feedback was also primarily positive, with almost unanimous ratings of the FHE intervention components as very important to provide to youth and that all would be feasible for an organization to implement, though the mentoring components were seen as slightly less feasible than other components. Next steps and implications of this intervention development process are discussed.

Professional and youth perspectives on higher education-focused interventions for youth transitioning from foster care.

Youth transitioning from foster care to adulthood access and succeed in college at much lower rates than the general population. A variety of services exist to support youth with their postsecondary goals, but few if any have evidence for their effectiveness. As part of a National Institute on Drug Abuse-funded intervention development project to design Fostering Higher Education, a structured, testable postsecondary access and retention intervention for youth transitioning from foster care to adulthood, focus groups were conducted with community stakeholders to collect recommendations for how to most effectively structure the intervention. Analyses of focus group findings resulted in four theme groups: (1) general recommendations for intervention development; (2) recommendations for an educational advocacy intervention component; (3) recommendations for a mentoring intervention component; and (4) recommendations for a substance abuse prevention intervention component. These themes offered a variety of important insights for developing interventions in a way that is usable for youth and feasible for communities to implement.

Using communities that care for community child maltreatment prevention.

The prevention of mental, emotional, and behavioral (MEB) disorders among children and adolescents is a national priority. One mode of implementing community-wide MEB prevention efforts is through evidence-based community mobilization approaches such as Communities That Care (CTC). This article provides an overview of the CTC framework and discusses the adaptation process of CTC to prevent development of MEBs through preventing child abuse and neglect and bolstering child well-being in children aged 0 to 10. Adaptations include those to the intervention itself as well as those to the evaluation approach. Preliminary findings from the Keeping Families Together pilot study of this evolving approach suggest that the implementation was manageable for sites, and community board functioning and community adoption of a science-based approach to prevention in pilot sites looks promising. Implications and next steps are outlined. (PsycINFO Database Record

Psychometric properties of the Transitions from Foster Care Key Leader Survey.

This study summarizes the development and piloting of the Transitions from Foster Care Key Leader Survey (TFC-KLS), an instrument designed to measure change in systems serving young people transitioning from foster care to adulthood. The Jim Casey Youth Opportunity Initiative's logic model was used as a basis for instrument development. The instrument was piloted with 119 key leaders in six communities. Seven of eight latent scales performed well in psychometric testing. The relationships among the 24 measures of system change were explored. A CFA testing overall model fit was satisfactory following slight modifications. Finally, a test of inter-rater reliability between two raters did not find reliable reporting of service availability in a supplemental portion of the survey. The findings were generally positive and supported the validity and utility of the instrument for measuring system change, following some adaptations. Implications for the field are discussed.

Better futures: a randomized field test of a model for supporting young people in foster care with mental health challenges to participate in higher education.

The purpose of the study was to conduct a preliminary efficacy evaluation of the Better Futures model, which is focused on improving the postsecondary preparation and participation of youth in foster care with mental health challenges. Sixty-seven youth were randomized to either a control group that received typical services or an intervention group, which involved participation in a Summer Institute, individual peer coaching, and mentoring workshops. Findings indicate significant gains for the intervention group on measures of postsecondary participation, postsecondary and transition preparation, hope, self-determination, and mental health empowerment, as compared to the control group. Youth in the intervention group also showed positive trends in the areas of mental health recovery, quality of life, and high school completion. Implications for future research and practice are discussed, while emphasizing the capacities of youth in foster care with mental health conditions to successfully prepare for and participate fully in high education.

Adapting an evidence based parenting program for child welfare involved teens and their caregivers.

The scarcity of caregivers and the unique vulnerability of teens involved with the child welfare system necessitate effective strategies for ensuring that caregivers are prepared and supported in the important role they play with children and youth within the child welfare system. They are in a position, through the establishment of a strong, positive, supportive connection with the youth, to potentially minimize the impacts of recent trauma and interrupt a negative trajectory by preventing the youth's initiation of high-risk behavior. In this paper we describe the process used to systematically adapt Staying Connected with Your Teen™, an evidence-based, prevention-focused parenting program found in other studies to reduce the initiation of teens' risky behaviors, for use with foster teens and their relative or foster caregivers. This work has been guided by the ADAPT-ITT framework developed by Wingood and DiClemente (2008) for adapting evidence-based interventions. Qualitative work conducted in Phase 1 of this study identified the need for the development of a trusted connection between foster youth and their caregivers, as well as tools for helping them access community resources, social services, and educational supports. This paper describes the process used to develop new and adapted program activities in response to the needs identified in Phase 1. We conducted a theater test with dyads of foster youth and their caregivers to get feedback on the new activities. Findings from the theater test are provided and next steps in the research are discussed which include examining program usability, fidelity, feasibility, and testing this new prevention program that has been tailored for child welfare involved youth and their caregivers. This intervention program has the potential to fill an important gap in the availability of preventive programming for caregivers of teens in foster care.

The value of a college degree for foster care alumni: comparisons with general population samples.

Higher education is associated with substantial adult life benefits, including higher income and improved quality of life, among others. The current study compared adult outcomes of 250 foster care alumni college graduates with two samples of general population graduates to explore the role higher education plays in these young adults' lives. Outcomes compared include employment, income, housing, public assistance, physical and mental health, happiness, and other outcomes that are often found to be related to educational attainment. Foster care alumni college graduates were very similar to general population college graduates for individual income and rate of employment. However, foster care alumni graduates were behind general population graduates on factors such as self-reported job security, household earnings, health, mental health, financial satisfaction, home ownership, happiness, and public assistance usage. Results have implications for policy and practice regarding the most effective means of supporting postcollege stability of youths with foster care experience.

Trauma exposure and PTSD among older adolescents in foster care.

PURPOSE: Youth in foster care represent a highly traumatized population. However, trauma research on this population has focused primarily on maltreatment rather than the full spectrum of trauma experiences identified within the DSM-IV. The current study aims to fill this gap by reporting the prevalence of exposure to specific types of traumatic events for a large sample of youth with foster care experience. The study also reports the likelihood of lifetime PTSD diagnoses associated with each specific type of trauma. METHOD: Data are from a longitudinal panel study of 732 adolescents aged 17 and 18 who were in foster care. Lifetime trauma exposure and PTSD diagnosis were assessed using the Composite International Diagnostic Interview. Statistical comparisons were made using logistic regressions. RESULTS: The majority of respondents had experienced at least one trauma in their lifetime. While overall trauma prevalence did not differ by gender, males were more likely to experience interpersonal violence and environmental trauma, while females were more likely to experience sexual trauma. Caucasian participants reported higher rates of trauma exposure than African-American participants did. The types of trauma associated with the highest probability of a lifetime PTSD diagnosis were rape, being tortured or a victim of terrorists, and molestation. CONCLUSIONS: Youth in foster care are a highly traumatized population and meet diagnostic criteria for PTSD at higher rates than general youth populations. The ongoing impact of trauma may be particularly problematic for these young people given their abrupt transition to independence.

Supporting college success in foster care alumni: salient factors related to postsecondary retention.

The current study aimed to identify factors associated with postsecondary disengagement for young people with foster care experience using survey data from a cross-sectional sample of foster care alumni scholarship recipients. Bivariate and multivariate analyses revealed several factors that differentiated those who did and did not disengage from college. Recommendations are given for improving service provision for youth transitioning from foster care who are considering pursuing higher education.

Increasing participation in prevention research: strategies for youths, parents, and schools.

TOPIC: Subject participation is a critical concern for clinicians and researchers involved in prevention programs, especially for intensive interventions that require randomized assignment and lengthy youth and parent involvement. PURPOSE: This article describes details of an integrated approach used to recruit and retain at-risk high school youths, their parents, and high schools to two different comprehensive, "indicated" prevention programs. SOURCES USED: Parent and youth recruitment and retention data for the two studies is provided in support of the approach described. A coordinated, multilevel approach, organized around cross-cutting issues, is described in detail as a response to the challenges of including vulnerable populations in intervention research. CONCLUSION: Methods are relevant to nurse clinicians who deliver prevention programs, and are important to clinical research that relies upon adequate participation in research programs.

Understanding social support's role in the relationship between maltreatment and depression in youth with foster care experience.

This study investigated whether more complex maltreatment experiences predicted higher levels of depressive symptomatology for young adults and examined the role of social support during late adolescence in that association. Specifically, the study tested whether social support had a direct effect on depression and whether it mediated and/or moderated the relationship between self-reported maltreatment and depression in a sample of 513 youth exiting the child welfare system. Indices of maltreatment types (neglect and physical, sexual, psychological abuse) experienced during two periods (precare and during-care) were used in conjunction with a measure of perceived social support (reflecting support availability and social network sufficiency) in negative binomial regression models predicting depressive symptoms. Both precare and during-care maltreatment were associated with depressive symptoms as a young adult. Social support had a direct effect on depressive symptoms as well as moderation and partial mediation effects on the relationship between maltreatment and depression. Social support's buffering effect was stronger for those experiencing fewer types of maltreatment. This buffering effect appears to diminish as maltreatment histories become more complex.

Prevalence and Timing of Diagnosable Mental Health, Alcohol, and Substance Use Problems among Older Adolescents in the Child Welfare System.

This study reports the prevalence of PTSD, major depression, alcohol abuse/dependence and substance abuse/dependence diagnoses assessed with a structured clinical interview protocol in a population-based, multi-state, age cohort of older adolescents about to exit child welfare systems. PTSD was the most common diagnosis and was observed at rates above those seen in the general population. Rates of specific diagnoses varied according to gender, race, type of child welfare placement, and state of residence. In general, African American youth and those in kinship family foster care were less likely to have mental health and substance use problems. Analysis of the timing of onset relative to entry into care revealed that Caucasian youth were more likely to have diagnoses prior to entry into state custody, and race differentials were less pronounced for diagnosis after placement in foster care. Observed state-to-state differences suggest that age of entry into care and the likelihood of pre-existing mental health and substance use conditions could be attributable to child welfare policies regarding screening and placement.