Impact of early memories and current experiences of warmth and safeness on adolescents' psychological distress.

A variable-centered and a person-centered approach were performed to examine the role of early memories of warmth and safeness (EMWS) and current experiences of warmth and safeness (CEWS) on depressive and anxious symptoms among adolescents from community and residential youth care (RYC) settings. Variable-centered results revealed EMWS were only indirectly (through CEWS) associated with depressive and anxious symptoms. Person-centered outcomes allowed to identify four different profiles based on EMWS and CEWS, which differed on depressive and anxious symptoms. EMWS and CEWS seem to play an important role in psychological distress during adolescence. CEWS seem to have a protective role on RYC adolescents' psychological distress, even when EMWS were poor.

Perceived social support and quality of life among adolescents in residential youth care: a cross-sectional study.

BACKGROUND: Residential youth care (RYC) institutions aim to provide care and stability for vulnerable adolescents with several previous and present challenges, such as disrupted attachments, wide-ranging adverse childhood experiences, mental health problems, and poor quality of life (QoL). To the best of our knowledge, the present study is the first to provide knowledge of the associations between perceived social support and QoL and to explore the potential moderating effect of perceived social support on QoL for adolescents who have experienced maltreatment and polyvictimization. METHODS: All RYC institutions with adolescents between the ages 12-23 in Norway were asked to participate in the study. A total of 86 institutions housing 601 adolescents accepted the invitation, from which 400 adolescents volunteered to participate. The Child and Adolescent Psychiatric Interview was used to gather information on maltreatment histories and degree of victimization; the Kinder Lebensqualität Fragebogen was used to measure QoL through several domains (overall QoL, physical well-being, emotional well-being, and self-esteem); and the Social Support Questionnaire was used to measure perceived social support. Linear regression and independent samples t-test were used to study the associations between perceived social support and QoL as well as the potential moderating effect of perceived social support in the association between maltreatment history and QoL. RESULTS: Perceived social support was positively associated with QoL for both girls and boys, with domain-specific findings. A higher number of different types of support persons was associated with overall QoL, emotional well-being, and self-esteem for boys, but only with self-esteem for girls. Individual social support from RYC staff and friends was associated with higher QoL for girls. However, perceived social support did not moderate the association between maltreatment history and reduced QoL for either sex. CONCLUSIONS: This study emphasizes the importance of maintaining social support networks for adolescents living in RYC, the crucial contribution of RYC staff in facilitating social support, and the potential value of social skills training for these vulnerable adolescents. Furthermore, a wider range of initiatives beyond social support must be carried out to increase QoL among adolescents with major maltreatment and polyvictimization experiences.

Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence.

Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12-20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6-11%), and the prevalence of DSED was 8% (95% CI 5-11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups.

The Feelings of Others Don't Impress Me Much - Effects of Living Group Climate on Empathy in Adolescent Male Offenders.

The present study is a replication in Germany of a study originally performed in the Netherlands regarding the association between a positive living group climate and self-reported empathy in incarcerated adolescent male offenders (n = 49). A structural equation model was fitted to the data and showed a relation between a positive living group climate and increased empathy after six months. The discussion focuses on group dynamics in youth prisons. The present results open the way to further research into the importance of group processes in residential youth care. A positive living group climate could turn out to be an important factor contributing to the effectiveness of secure institutional treatment.

Prevalence and comorbidity of mental disorders among adolescents living in residential youth care.

Most adolescents are placed in residential youth care (RYC) because of severe psychosocial strains and child maltreatment, which represent risk factors for developing mental disorders. To plan RYC units and ensure that residents receive evidence-based psychiatric interventions, it is necessary to obtain reliable and valid prevalence estimates of mental disorders in this population. However, there is a lacuna of research on diagnoses derived from standardized clinical interviews. The aim of this study was to assess the prevalence and comorbidity of mental disorders applying diagnostic interviews in an entire population of adolescents living in RYC in Norway. All young people in RYC were invited to participate in the study. Eighty-six RYC institutions with 601 eligible adolescents were included and 400 adolescents, 12-20 years old, participated in the study, yielding a response rate of 67 %. Anonymous Child Behaviour Checklist scores for 141 (70 %) of the declining residents were also available, allowing diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) for 541 youths to be estimated. Diagnoses were assessed by trained interviewers with the Child and Adolescent Psychiatric Assessment interview (CAPA). Seventy-six point two per cent (71.5-80.8 CI 95 %) of adolescents received at least one 3-month DSM-IV diagnosis. Prevalence rates for internalizing psychiatric disorders were higher than for behavioural disorders. Comorbidity was high between these two groups. Mental disorders were prevalent among children and youth in RYC. Our results create major concerns and challenge the existing organization of the RYC system.

START NOW WebApp-promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial.

BACKGROUND: Adolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled "Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions". METHODS: The study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups. DISCUSSION: This study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels. TRIAL REGISTRATION {2A AND 2B}: ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.

Cultural and Religious Equity and Disparity in the Group Climate Experience of Moroccan Girls in Dutch Residential Youth Care Settings.

BACKGROUND: The group climate within residential youth care institutions is considered a transactional process, both within a group of youth from various cultural backgrounds and between them and their group workers. The ongoing interaction between the cultural characteristics of these girls may influence the quality of the group climate. This study aimed to provide an in-depth account of the living group climate experiences and perceptions of Dutch girls with a Moroccan cultural background in Dutch residential groups. METHOD: Interpretative phenomenological analysis was employed to explore the girls' group climate experiences. RESULT: Three major themes emerged, namely (a) level of involvement of Moroccan girls in their living group, (b) perceptions of Moroccan girls' sense of belonging in a living group, and (c) cultural and religious equality or disparity results in two interaction patterns. The findings revealed that equality or disparity in language, culture, and religion affect Moroccan girls' experiences and perceptions of the living group climate. A crucial finding was that cultural and religious disparity leads to interaction patterns wherein the girls pre-emptively exclude themselves from receiving support from native group workers. CONCLUSION: Professionals must be aware of the cultural and religious dynamics, including the interplay and impact of cultural and religious equality and disparity, influencing Moroccan girls' group climate experiences.

To Change or Not to Change? A Study regarding the Satisfaction of Care Workers and Adolescents with the Motivational Interviewing Based Residential Youth Care Training Program Up2U.

Long-term behavioral change is often difficult to achieve with adolescents staying in residential youth care. To achieve long-term behavioral change, we developed the Up2U training program to enhance these adolescents' intrinsic motivation for change. Based on motivational interviewing and solution-focused therapy, Up2U is designed for conducting one-on-one conversations with adolescents in residential youth care. The aim of this study is to evaluate the experiences that adolescents and care workers have had with Up2U. The results of semi-structured interviews show that, in general, the care workers were satisfied with Up2U. They identified the clarity, conciseness, and sample questions as positive elements of Up2U. In contrast, the care workers regarded the extensiveness and the implementation of Up2U as less positive. The adolescents also seemed to be positive about the use of Up2U during one-on-one conversations. In conclusion, although both care workers and adolescents were generally satisfied, there is still room for improvement.

The Effects of the Compassionate Mind Training for Caregivers on Professional Quality of Life and Mental Health: Outcomes from a Cluster Randomized Trial in Residential Youth Care Settings.

Background: Psychological distress is highly noticeable among caregivers working in residential youth care (RYC). Maintaining and enhancing caregivers' professional mental health and quality of life is crucial to achieve effective outcomes in RYC. Nevertheless, trainings to protect caregivers' mental health are scarce. Considering the buffering effect over negative psychological outcomes, compassion training could be beneficial in RYC. Objective: This study is part of a Cluster Randomized Trial examining the effects of the Compassionate Mind Training for Caregivers (CMT-Care Homes), looking at professional quality of life and mental health of caregivers working in RYC. Method: The sample was composed of 127 professional caregivers from 12 Portuguese residential care homes (RCH). RCHs were randomly allocated at experimental (N = 6) and control group (N = 6). Participants were assessed at baseline, post-treatment, and 3 and 6-month follow-ups, answering to the Professional Quality of Life Scale and the Depression, Anxiety and Stress Scale. Program effects were tested using a two-factor mixed MANCOVA, with self-critical attitude and education degree as covariates. Results: MANCOVA showed a significant Time × Group interaction effects (F = 1.890, p = .014; ηp2 = .050), with CMT-Care Homes participants presenting lower scores on burnout, anxiety, and depression at 3 and 6-months follow-ups, when compared with controls. Participants that received CMT-Care Homes considered the program useful to deal with pandemic threats and with youth during lockdowns. Conclusion: This study shows the benefits of the CMT-Care Homes in helping professional caregivers reducing burnout, anxiety and depression, and dealing with pandemic challenges in RYC.Trial registration: This cluster randomized trial was registered at ClinicalTrials.gov (TRN: NCT04512092) on 6th August 2020.

Fostering an affiliative environment in residential youth care: A cluster randomized trial of a compassionate mind training program for caregivers enrolling youth and their caregivers.

BACKGROUND: Affiliation has a positive role on well-being and human development. Most children and youth living in residential youth care (RYC) experienced maltreatment from significant others, becoming a particularly vulnerable group. Their complex needs require well trained caregivers who help them to heal and thrive. OBJECTIVE: This cluster randomized trial sought to test the Compassionate Mind Training program for Caregivers (CMT- Care Homes) effectiveness on affiliative outcomes across time. PARTICIPANTS AND SETTING: A sample of 127 professional caregivers and 154 youth from 12 Portuguese residential care homes (RCH) participated on this study. METHODS: RCHs were randomized to treatment (n = 6) and control (n = 6) groups. Caregivers and youth completed self-report measures at baseline, post-intervention, and 6-month follow-up on social safeness and emotional climate. Caregivers were also evaluated on compassion outcomes. RESULTS: MANCOVA indicated large multivariate time X group effects. Univariate results suggested that caregivers from the treatment group showed improvements in compassion towards others and in self-compassion across time, while the control group gradually deteriorated in both variables. Youth and caregivers from the treatment group noticed a more soothing and safer RCH emotional climate, as well as feeling safer within relationships. At 6-month follow-up, improvements were retained by caregivers, but not by youth. CONCLUSIONS: The CMT- Care Homes brings a new model to RYC, that represents a promising approach in promoting safe relationships and affiliative environments in RCHs. Supervision should be provided to monitor care practices and sustain change across time.

Dimensionality and measurement invariance of the Social Safeness and Pleasure Scale in adolescents from community and residential youth care.

BACKGROUND: Social safeness has been proposed as the individual's perception of the social world as being warmth and soothing. The lack of social safeness has been suggested as a transdiagnostic socio-emotional vulnerability for several mental health difficulties. To date there was no study addressing experiences of social safeness in adolescents. OBJECTIVE: To validate and study the psychometric properties of the Social Safeness and Pleasure Scale to Portuguese adolescents from community and residential care homes. PARTICIPANTS AND SETTING: A total of 731 Portuguese adolescents from community and residential youth care homes participated on this study. The community sample was composed of adolescents recruited from regular schools (208 boys; 224 girls). The residential youth care sample was composed of adolescents placed in residential care homes (145 boys; 154 girls). METHODS: A confirmatory factor analysis was conducted, and measurement invariance investigated. RESULTS: A one-factor solution presented a good fit across all samples and proved to be invariant (configural, metric, scalar and strict measurement invariance). Moreover, internal consistency values were excellent for all samples (α > 0.93) and evidence for construct validity in relation to external variables was found. Means comparisons revealed significant differences between all tested groups. Community adolescents reported higher social safeness in comparison to the adolescents placed in residential care. Within both samples, boys scored higher in the SSPS-A when compared to girls. CONCLUSIONS: These findings provide evidence on the SSPS-A validity and its use across diverse adolescent samples.

Compassionate mind training for caregivers of residential youth care: Early findings of a cluster randomized trial.

BACKGROUND: Compassion plays a significant role in caregiving and its benefits have been largely reported in different settings. Nonetheless, compassion-based interventions have not yet been delivered to Residential Youth Care (RYC) staff. OBJECTIVE: This study presents early findings of a Cluster Randomized Trial on the efficacy of a Compassionate Mind Training program for caregivers of RYC (CMT-Care Homes) following CONSORT guidelines. PARTICIPANTS AND SETTING: Participants were 85 caregivers (89.4% female), aged between 25 and 62 years old, working on a regular basis with adolescents in RYC. METHOD: Eleven Portuguese residential care homes for at-risk adolescents were selected and randomly allocated to the treatment (n = 5) or control (n = 6) conditions. Caregivers were assessed at pre- and post-intervention (n = 41 treatment, n = 44 control) through self-report scales on compassion and emotional climate related outcomes. RESULTS: To investigate CMT-Care Homes effects, a two-factor mixed MANOVA was performed. Multivariate tests showed a significant and large Time × Group interaction effect (Pillais' trace = 0.291, F = 2.719, p = .005, ηp2 = 0.291). Univariate tests indicated significant and positive effects in compassion and fears of compassion (low and medium effect sizes), as well as in soothing related emotions (emotional climate) and social safeness (both with medium effect sizes), in favor of the treatment group. CONCLUSIONS: Findings offer preliminary evidence of the effectiveness of the CMT-Care Homes program, suggesting that this training allows the development of an affiliative mentality in caregivers working within RYC settings.

The Use of Sleep Medication in Youth Residential Care.

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.

Treatment Outcomes of a Shortened Secure Residential Stay Combined With Multisystemic Therapy: A Pilot Study.

ThuisBest is a newly developed family focused treatment that combines secure residential youth care with multisystemic therapy (MST), allowing adolescents to return home after secure residential youth care more quickly. The purpose of this pilot study was to examine treatment outcomes for adolescents in ThuisBest (n = 86, Mage = 15.2 years, 63% boys) and to what degree those treatment outcomes could be predicted by client characteristics. The results showed that externalizing behavior problems and parenting stress had decreased at the end of treatment. After ThuisBest, 83% of the adolescents did not have new police contact, 72% lived at home, and 89% attended school or work. Almost none of the treatment outcomes could be predicted by any of the client characteristics. ThuisBest seems a promising trajectory, as it reduces the length of the stay in secure residential youth care, and may, therefore, be more cost-effective than standard secure residential youth care. However, given the lack of a control-group and follow-up data, findings must be interpreted as preliminary.

Aggressive Incidents in Residential Youth Care.

It is assumed that group climate can have an effect on aggressive behavior in adolescents living in residential facilities, but it is largely unknown whether there are climate differences between the various types of residential institutions, and whether group climate differently affects aggression incidents among adolescents placed in institutions that differ in levels of security (and openness). In current research, the differences in perception of group climate between open, semi-secure, and secure residential youth care facilities were examined as well as the association between group climate and aggression. In total, 159 adolescents (96 males, 63 females) completed the Prison Group Climate Instrument (PGCI), and (aggressive) incidents were recorded during a period of 3 months. Perception of group climate-including support from staff, group atmosphere among adolescents, possibilities for growth, and repression-did not differ between the various types of residential care, except for possibilities for growth. Adolescents in open and semi-secure institutions experienced more possibilities for growth than their peers in secure institutions. A more positive perception of group climate in open institutions proved to be related to less aggressive incidents at the living group. For semi-secure and secure institutions, no relation between group climate and aggression was found. Also, the longer adolescents stayed in residential youth care, the more aggressive incidents occurred.

Refining the COPES to Measure Social Climate in Therapeutic Residential Youth Care.

BACKGROUND: Previous studies have shown that social climate in therapeutic residential youth care (TRC) is important to the welfare of residents, staff, and assessing treatment outcomes. The most influential theory on social climate in residential settings is the theory of Moos. The measurement of the concepts and aspects of this theory using the Community Oriented Programs Environment Scale (COPES) has repeatedly been criticized regarding usability, validity, and reliability, especially for TRC. OBJECTIVE: To improve the usability and psychometric quality of the COPES by shortening and refining the original subscale structure for usage in TRC. METHODS: Four-hundred adolescents living in Norwegian TRC participated. We supplemented confirmatory factor analysis (CFA) with item response theory (IRT) to evaluate model fit, investigate factor loadings, and shorten scales to improve their psychometric qualities and usability in describing social climate in TRC. RESULTS: The original subscales were not acceptable as evaluated by the criteria for CFA and IRT. By removing psychometrically weak items, the instrument was shortened to 40 items within the original ten subscales. This short version showed acceptable psychometric qualities based on both CFA and IRT criteria and the instrument retained its content validity. Finally, the original three higher-order dimensions was not supported. CONCLUSIONS: Compared to the original instrument, the refined 40-item version of the COPES represents a more usable instrument for measuring social climate in TRC. Future studies are needed to confirm the multifaceted refined short version in comparable samples of youth and staff to further investigate predictive value and construct validity.

Stability and Change of Adolescents' Aggressive Behavior in Residential Youth Care.

BACKGROUND: Aggression in residential youth care institutions is a frequent problem. OBJECTIVE: The present short-term longitudinal study examined individual and institutional predictors of aggression in a group of 198 adolescents placed in open, semi-secure and secure residential institutions from the perspective of the importation and deprivation model. METHODS: A total of 198 adolescents in residential youth care filled in questionnaires regarding group climate and aggression with a 3 month interval. Hierarchical multiple regression analyses were performed to test the degree to which individual and contextual factors predict aggression. RESULTS: Very limited support was found for the effect of contextual factors; only repression showed a trend, predicting direct aggression, while gender composition of the living groups yielded a small effect. Girls placed in same-gender groups showed lower levels of indirect (relational) aggression compared to adolescents placed in mixed-gender or boys-only groups, even when controlled for gender and initial levels of aggression. Type of institution (i.e., level of security) did not predict differences in aggression. In particular individual characteristics of the adolescents were associated with later aggression, including initial levels of aggression, showing substantial 3 months stability, age and gender of the adolescents. CONCLUSIONS: These findings are in line with research showing that aggression is relatively stable. Very limited support for environmental effects was found.

Adverse Childhood Experiences in Children with Intellectual Disabilities: An Exploratory Case-File Study in Dutch Residential Care.

Adverse Childhood Experiences (ACEs) are negative childhood events occurring in a child's family or social environment, that may cause harm or distress. Children with intellectual disabilities (ID) and their families are underrepresented in international ACEs research, while current insights can also contribute to the improvement of their health and well-being. Deficiencies in intellectual and adaptive functioning and living circumstances can increase their vulnerability to adversities. In the present exploratory study 69 case-files of children referred to a Dutch national center for residential youth care for children with ID were analyzed to assess the prevalence and associations of ACEs. It was found that almost half (49.3%) of the children experienced 2 ACEs from the original ACEs framework or more (M (mean) = 2.1; SD (standard deviation) = 1.8) and that the number of ACEs in children was related to the presence of ACEs in parents. Both child and parental ACEs were also related to attachment- and trauma- and stressor-related disorders. Finally, living circumstances and multiple ACEs from the expanded ACEs framework, especially related to parental characteristics, were found to be related to ACEs in children with ID. This implicates the importance of a transgenerational approach when further investigating the impact of ACEs on mental and physical health in children with ID (intellectual disabilities).

The Inside Out? Views of Young People, Parents, and Professionals Regarding Successful Secure Residential Care.

Although adolescents often seem to improve in their functioning during residential care, there still is little knowledge on what factors are important in achieving these changes. The present study aims to identify the care factors that are important for adolescents' behavior change during secure residential care. We conducted in-depth interviews with eight adolescents, their parents, eight group care workers and seven teachers concerning their in-care experiences. Both adolescents and parents commonly attributed changes during secure residential care to the treatment environment. Group care workers and teachers did not have a clear, consistent view on the treatment aspects causing positive change with the adolescents. According to the adolescents, good professionals apply a fine balance between rules and freedom, show empathy and are available for support. The view of parents corresponds to this image. Although group care workers are perceived as available for support, adolescents tend to make little use of this help if they experience personal problems during care. The results highlight the importance of responsiveness of secure residential care professionals to the needs and perspectives of adolescents and parents.

Do school teachers and primary contacts in residential youth care institutions recognize mental health problems in adolescents?

BACKGROUND: Studies show that adolescents living in residential youth care (RYC) institutions experience more mental health problems than others. This paper studies how well teachers and primary contacts in RYC institutions recognize adolescents' mental health problems as classified by The Child and Adolescent Psychiatric Assessment diagnostic interviews (CAPA). METHODS: All residents between 12 and 23 years of age living in RYC institutions in Norway and enrolled in school at the time of data collection were invited to participate in the study. Of the 601 available children, 400 participated in the study, namely 230 girls, mean age = 16.9 years, SD = 1.2 and 170 boys, mean age = 16.5 years, SD = 1.5. The Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) were used. The sensitivity and specificity of these instruments were studied. RESULTS: We observed a significant gap between the mental health problems diagnosed by the CAPA interviews and the problems reported by primary contacts on the CBCL and by teachers on the TRF. The CBCL showed a higher sensitivity than the TRF, whereas the TRF showed a higher specificity than the CBCL. Both primary contacts and teachers classified externalizing problems fairly well such as ADHD in both genders and conduct disorder in girls. Both teachers and primary contacts, however, had more problems detecting internalizing problems. Teachers may have a tendency to view most students as healthy and to underestimate the severity of their problems, whereas primary contacts may tend to overestimate the number of problems and view adolescents as sicker than they really are. CONCLUSION: The Child Welfare System should revise their intake procedures to detect possible problems early on and to introduce the necessary treatment. It is important to identify factors that increase healthy school adaption in order for these adolescents to accomplish school in a proper way since education is important for a successful adult life.