Parental report of outcomes from a randomized trial of in-home family services.

This study conducted a randomized trial to examine the efficacy of the Boys Town In-Home Family Services (IHFS) program for families of high-risk youth. Participants were recruited from a state helpline for families struggling with poor family functioning and child emotional or behavioral issues. Consent was obtained for 300 of which 152 were randomly assigned to participate in IHFS for 3-4 months and 148 were assigned to the services as usual comparison group. For the families in the treatment group, 18% did not participant in the intervention, and 66% of families received 20 or more service hours. Parent report data were collected at intake, post, as well 6 and 12 months after post data collection. Data were collected on constructs such as caregiver strain, family functioning, parenting, family resources, and parent report of child behavior. Piecewise analyses of the intake to post data indicated significantly greater reductions in caregiver strain for the treatment condition. Given the conservative corrections for the use of multiple tests, no other measures demonstrated significant differences. For the piecewise model of the maintenance phase, there were no significant differences between groups aside from caregiver strain that showed a significant improvement for the comparison condition. Supplementary dose-response analyses indicated that for most families there was an ideal dosage of about 25-75 hr to bring about the largest improvements in caregiver strain, parenting skills, and child behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Applying a Cognitive Neuroscience Perspective to Disruptive Behavior Disorders: Implications for Schools.

A cognitive neuroscience perspective seeks to understand behavior, in this case disruptive behavior disorders (DBD), in terms of dysfunction in cognitive processes underpinned by neural processes. While this type of approach has clear implications for clinical mental health practice, it also has implications for school-based assessment and intervention with children and adolescents who have disruptive behavior and aggression. This review articulates a cognitive neuroscience account of DBD by discussing the neurocognitive dysfunction related to emotional empathy, threat sensitivity, reinforcement-based decision-making, and response inhibition. The potential implications for current and future classroom-based assessments and interventions for students with these deficits are discussed.

Washington State Retail Marijuana Legalization: Parent and Adolescent Preferences for Marijuana Messages in a Sample of Low-Income Families.

OBJECTIVE: As legalization of nonmedical retail marijuana increases, states are implementing public health campaigns designed to prevent increases in youth marijuana use. This study investigated which types of marijuana-related messages were rated most highly by parents and their teens and whether these preferences differed by age and marijuana use. METHOD: Nine marijuana-focused messages were developed as potential radio, newspaper, or television announcements. The messages fell into four categories: information about the law, general advice/conversation starters, consequences of marijuana use/positive alternatives, and information on potential harmful effects of teen marijuana use. The messages were presented through an online survey to 282 parent (84% female) and 283 teen (54% female) participants in an ongoing study in Washington State. RESULTS: Both parents and youth rated messages containing information about the law higher than other types of messages. Messages about potential harms of marijuana use were rated lower than other messages by both generations. Parents who had used marijuana within the past year (n = 80) rated consequence/positive alternative messages lower than parent nonusers (n = 199). Youth marijuana users (n = 77) and nonusers (n = 202) both rated messages containing information about the law higher than other types of messages. Youth users and nonusers were less likely than parents to believe messages on the harmful effects of marijuana. CONCLUSIONS: The high ratings for messages based on information about the marijuana law highlight the need for informational health campaigns to be established as a first step in the marijuana legalization process.

Care Coordination Services: A Description of an Alternative Service Model for At-Risk Families.

OBJECTIVE: The objective of this article is to describe a care coordination model that includes promising practices which are supported by both practice-based and research-based evidence. This model was developed to address the gaps of other models, namely an emphasis on skill teaching with parents, the flexibility to adapt to the needs of youth with a wide variety of presenting problems, and model fidelity assessment tools to help scale up the program across multiple locations with fidelity. METHOD: We discuss preliminary administrative and outcome data from 898 youth served across eight locations. RESULTS: Data suggest positive outcomes at departure from service, as well as 6 months and 12 months post case closure. CONCLUSION: Preliminary data indicate that youth with educational and behavioral health challenges can benefit from coordination of services that are both youth guided and family driven. As this program has been scaled up and has an established vehicle of dissemination, it is in a unique position to be tested via more highly controlled and rigorous efficacy trials.

Child maltreatment as a function of cumulative family risk: Findings from the intensive family preservation program.

This study examined child maltreatment as a function of cumulative family risk in a sample of at-risk families (N=837) who were referred to an intensive family preservation program because of child behavior problems or suspected child abuse and neglect. The goal of this intensive family preservation program is to improve parenting skills and reduce immediate family stressors that may lead to an increased risk of child abuse and neglect. The findings indicate that the most prominent family risks comprising the cumulative risk scale in our sample were socio-economic disadvantage (e.g., income, unemployment, housing instability) and parental characteristics (e.g., mental/physical health, parental use of alcohol, domestic violence). Further, the results demonstrated a strong quadratic trend in the relationship between cumulative family risk and child maltreatment, and identified a risk threshold effect at three cumulative family risks after which the child risk for maltreatment increased exponentially. These findings are interpreted in the light of the current research on differentiative interventions, supporting differentiated services to the families with low vs. higher risk for child maltreatment.

Focus Groups of Parents and Teens Help Develop Messages to Prevent Early Marijuana Use in the Context of Legal Retail Sales.

OBJECTIVES: The changes in Washington State and Colorado marijuana laws call for the development of new brief family-focused adolescent marijuana use preventive interventions that are relevant for and tailored to the context of legalization for retail sale. To that end, focus groups with parents and teens were conducted to find out about their concerns and needs in the context of legalization. METHODS: Six semi-structured focus groups (3 with parents, 3 with teens) were conducted in Washington State in 2013 related to consequences of teen marijuana use and messages that would be effective in helping to prevent teens from using marijuana in the context of legal adult use. A total of 33 teens and 35 parents participated. RESULTS: Three primary themes were common to these parents and teens: the negative consequences of marijuana use during adolescence on mental, physical, and social health; the need for more or better information; and the need for information/messages to come from trusted sources. The themes related to potential prevention messages include the use of fear; stories about real people; focusing on short-term consequences; and teens needing alternative activities (something better to do). CONCLUSIONS: The results suggest that parents and teens need information about the new retail marijuana legalization law. Teens are open to both information and guidance from parents as long as it is calm and respectful. Firsthand accounts of consequences of marijuana use from peers and adults, rather than threats from authority figures, could hold some promise for persuading teens to avoid marijuana use.

Evaluation of effects of pH and ionic strength on colloidal stability of IgG solutions by PEG-induced liquid-liquid phase separation.

Colloidal stability of IgG antibody solutions is important for pharmaceutical and medicinal applications. Solution pH and ionic strength are two key factors that affect the colloidal stability of protein solutions. In this work, we use a method based on the PEG-induced liquid-liquid phase separation to examine the effects of pH and ionic strength on the colloidal stability of IgG solutions. We found that at high ionic strength (≥0.25M), the colloidal stability of most of our IgGs is insensitive to pH, and at low ionic strength (≤0.15M), all IgG solutions are much more stable at pH 5 than at pH 7. In addition, the PEG-induced depletion force is less efficient in causing phase separation at pH 5 than at pH 7. In contrast to the native inter-protein interaction of IgGs, the effect of depletion force on phase separation of the antibody solutions is insensitive to ionic strength. Our results suggest that the long-range electrostatic inter-protein repulsion at low ionic strength stabilizes the IgG solutions at low pH. At high ionic strength, the short-range electrostatic interactions do not make a significant contribution to the colloidal stability for most IgGs with a few exceptions. The weaker effect of depletion force at lower pH indicates a reduction of protein concentration in the condensed phase. This work advances our basic understanding of the colloidal stability of IgG solutions and also introduces a practical approach to measuring protein colloidal stability under various solution conditions.

Child and Parent Report of Parenting as Predictors of Substance Use and Suspensions from School.

This study examined how child and parent reports of parenting were related to early adolescent substance use and school suspensions. Data were from two time points six months apart on 321 families with an eighth grade student attending one of five schools in the Pacific Northwest. Child- and parent-report measures of family management practices were moderately correlated (r = .29). Child report, but not parent report, of more positive family management practices uniquely predicted a lower likelihood of adolescent substance use. Also, discrepancies between child and parent report of parenting predicted substance use, with child positive report of family management losing its protective association with adolescent substance use when parents had negative reports of their parenting. Parent report, but not child report, of better parenting predicted lower likelihood of suspensions, suggesting that the salience of child and parent report may depend on the type of behavioral outcome.

Randomized trial of parent training to prevent adolescent problem behaviors during the high school transition.

This randomized controlled trial tested a widely used general parent training program, Common Sense Parenting (CSP), with low-income 8th graders and their families to support a positive transition to high school. The program was tested in its original 6-session format and in a modified format (CSP-Plus), which added 2 sessions that included adolescents. Over 2 annual cohorts, 321 families were enrolled and randomly assigned to either the CSP, CSP-Plus, or minimal-contact control condition. Pretest, posttest, 1-year follow-up, and 2-year follow-up survey data on parenting as well as youth school bonding, social skills, and problem behaviors were collected from parents and youth (94% retention). Extending prior examinations of posttest outcomes, intent-to-treat regression analyses tested for intervention effects at the 2 follow-up assessments, and growth curve analyses examined experimental condition differences in yearly change across time. Separate exploratory tests of moderation by youth gender, youth conduct problems, and family economic hardship also were conducted. Out of 52 regression models predicting 1- and 2-year follow-up outcomes, only 2 out of 104 possible intervention effects were statistically significant. No statistically significant intervention effects were found in the growth curve analyses. Tests of moderation also showed few statistically significant effects. Because CSP already is in widespread use, findings have direct implications for practice. Specifically, findings suggest that the program may not be efficacious with parents of adolescents in a selective prevention context and may reveal the limits of brief, general parent training for achieving outcomes with parents of adolescents. (PsycINFO Database Record

Daily Bidirectional Relationships Between Sleep and Mental Health Symptoms in Youth With Emotional and Behavioral Problems.

OBJECTIVE: The present study examined the daily, bidirectional relationships between sleep and mental health symptoms in youth presenting to mental health treatment. METHODS: Youth aged 6 to 11 (36% female, 44% European American) presenting to outpatient behavioral health treatment (N = 25) were recruited to participate in the study. Children and parents completed daily questionnaires regarding the child's sleep, mood, and behavior for a 14-day period, while youth wore an actigraph watch to objectively measure sleep. RESULTS: Examining between- and within-person variance using multilevel models, results indicate that youth had poor sleep duration and quality and that sleep and mental health symptoms were highly related at the daily level. Between-person effects were found to be most important and significant bidirectional relationships exist. CONCLUSIONS: Identifying and addressing sleep problems in the context of mental health treatment is important, as poor sleep is associated with increased symptomology and may contribute to worsened mental health.

A decision support tool to determine cost-to-benefit of a family-centered in-home program for at-risk adolescents.

Family-centered program research has demonstrated its effectiveness in improving adolescent outcomes. However, given current fiscal constraints faced by governmental agencies, a recent report from the Institute of Medicine and National Research Council highlighted the need for cost-benefit analyses to inform decision making by policymakers. Furthermore, performance management tools such as balanced scorecards and dashboards do not generally include cost-benefit analyses. In this paper, we describe the development of an Excel-based decision support tool that can be used to evaluate a selected family-based program for at-risk children and adolescents relative to a comparison program or the status quo. This tool incorporates the use of an efficient, user-friendly interface with results provided in concise tabular and graphical formats that may be interpreted without need for substantial training in economic evaluation. To illustrate, we present an application of this tool to evaluate use of Boys Town's In-Home Family Services (IHFS) relative to detention and out-of-home placement in New York City. Use of the decision support tool can help mitigate the need for programs to contract experts in economic evaluation, especially when there are financial or time constraints.

Evaluation of Boys Town In-Home Family Services with Families Referred by Child Welfare.

This study evaluated the Boys Town In-Home Family Services model with families referred by child welfare for issues related to maltreatment. Participants were 135 parents (mean age = 32.15 years, SD = 9.13) who completed intake and discharge assessments. The target child ranged in age from one month to 17 years (M = 4.54, SD = 4.38). We had a high-risk sample (e.g., 57% and 41% of parents reported being victims of physical and sexual abuse, respectively; 24% of parents reported attempting suicide in their lifetimes). The intervention was implemented with a degree of fidelity consistent with model standards. Reduced levels of perceived stressors were found for several domains of functioning with the largest effects observed for family safety, parental capabilities, and environmental factors. Results serve as an important step in building the evidence base of a widely disseminated intervention.

Parent Training to Reduce Problem Behaviors over the Transition to High School: Tests of Indirect Effects through Improved Emotion Regulation Skills.

Adolescent problem behaviors are costly for individuals and society. Promoting the self-regulatory functioning of youth may help prevent the development of such behaviors. Parent-training and family intervention programs have been shown to improve child and adolescent self-regulation. This study helps fill gaps in knowledge by testing for indirect effects of the Common Sense Parenting® (CSP) program on reduced substance use, conduct problems, and school suspensions through previously identified short-term improvements in parents' reports of their children's emotion regulation skills. Over two cohorts, 321 low income families of 8th graders were enrolled and randomly assigned to either the standard CSP program, an adapted CSP Plus program, or a minimal-contact control condition. Pretest, posttest, 1-year follow-up, and 2-year follow-up survey assessments were completed by parents and students with 94% retention. Intent-to-treat multivariate path analyses were conducted. Neither intervention had statistically significant total effects on the three targeted adolescent outcomes. CSP, but not CSP Plus, had statistically significant indirect effects on reduced substance use and school suspensions at the 1-year follow-up as well as conduct problems and school suspensions at the 2-year follow-up through increased child emotion regulation skills at posttest. Findings provide some support for emotion regulation as one pathway through which the intervention was associated, indirectly, with reduced substance use, conduct problems, and school suspensions among at-risk students over the high school transition.

Reducing Risks for Problem Behaviors During the High School Transition: Proximal Outcomes in the Common Sense Parenting Trial.

This study tests Common Sense Parenting (CSP)®, a widely used parent-training program, in its standard form and in a modified form known as CSP Plus, with low-income 8th graders and their families during the high school transition. The six-session CSP program proximally targets parenting and child emotion regulation skills. CSP Plus adds two sessions that include youth, and the eight-session program further targets skills for avoiding negative peers and activities in high school. Over two cohorts, 321 families were enrolled and randomly assigned to either CSP, CSP Plus, or minimal-contact control conditions. To date, pretest and posttest assessments have been completed, with 93% retention over about a 6-month interval. Here, analyses of preliminary outcomes from pretest to posttest focus on data collected from parents, who represent the primary proximal intervention targets. Intent-to-treat structural equation modeling analyses were conducted. CSP and CSP Plus had statistically significant effects on increased parent-reported child emotion regulation skills. CSP Plus further showed a statistically significant effect on increased parent perceptions of their adolescent being prepared for high school, but only in a model that excluded the CSP condition. Neither program had a significant proximal effect on parenting practices. Emotion regulation, one indicator of self-control, is a robust protective factor against problem behaviors. Intervention effects on this outcome may translate into reduced problems during high school. Moreover, CSP Plus showed some limited signs of added value for preparing families for the high school transition.

Predictors of participation in parenting workshops for improving adolescent behavioral and mental health: results from the common sense parenting trial.

Engaging and retaining participants are crucial to achieving adequate implementation of parenting interventions designed to prevent problem behaviors among children and adolescents. This study examined predictors of engagement and retention in a group-based family intervention across two versions of the program: a standard version requiring only parent attendance for six sessions and an adapted version with two additional sessions that required attendance by the son or daughter. Families included a parent and an eighth grader who attended one of five high-poverty schools in an urban Pacific Northwest school district. The adapted version of the intervention had a higher rate of engagement than the standard version, a difference that was statistically significant after adjusting for other variables assessed at enrollment in the study. Higher household income and parent education, younger student age, and poorer affective quality in the parent-child relationship predicted greater likelihood of initial attendance. In the adapted version of the intervention, parents of boys were more likely to engage with the program than those of girls. The variables considered did not strongly predict retention, although retention was higher among parents of boys. Retention did not significantly differ between conditions. Asking for child attendance at workshops may have increased engagement in the intervention, while findings for other predictors of attendance point to the need for added efforts to recruit families who have less socioeconomic resources, as well as families who perceive they have less need for services.

Prevalence of physical health issues of youth with school identified disabilities in residential settings: a brief report.

BACKGROUND: Each year a number of youth with a school identified disability are placed in residential care. It has been well documented that these youth enter with elevated rates of behavioral, emotional, educational, mental health, and familial challenges. However, the physical and medical condition of these youth remains unstudied. OBJECTIVE: The purpose of the present study was to determine the prevalence of health and medical problems among a group of youth with school identified disabilities at entrance to a residential care center. METHODS: Archival medical, demographic, and disability status data were obtained for 346 youth served in a large residential care center in the Midwest. Chi-square and correlation tests, and relative risk ratio estimates, were used to evaluate the relationship between medical condition and hypothesized correlates. RESULTS: Findings revealed that over one-third of the sample had at least one medical condition, with asthma being the most prevalent (15.6%). Rates of medical condition differed by disability type and prevalence of asthma differed by race/ethnicity. CONCLUSIONS: Youth with a school identified disability in care demonstrate health care needs that need to be addressed while in care and following community reintegration. Intervention programs and targeted curriculum are needed to teach youth how to manage their health specific needs and how to independently navigate the health care system.

Health-related quality of life among adolescents in residential care: description and correlates.

The purpose of this article is to describe the health-related quality of life (HRQoL) of adolescents in residential care and to examine selected correlates. A sample of 229 adolescents (mean age=17 years) living in a residential care setting completed a validated measure of HRQoL (PedsQL 4.0 Generic Scales). Mean-level scores for Total HRQoL, Physical HRQoL, and Psychosocial HRQoL were examined, and the percentage of youth scoring below a clinical cutoff value was reported. Demographic and psychotropic medication data for each youth were accessed from an electronic database maintained by the residential care program and used to examine correlates of HRQoL. Approximately 25% of youth had at least 1 HRQoL score in the "at risk" range, indicating a significant proportion of youth in residential care have significant impairments in HRQoL. Younger age and female gender were associated with poorer HRQoL. Psychotropic medication prescriptions were associated with poorer HRQoL. A significant percentage of adolescents in residential care may experience suboptimal HRQoL, and certain demographic and clinical factors appear to be associated with greater risk. Systematic assessment of HRQoL is recommended for youth in residential care, and interventions to promote better HRQoL among youth at particularly high risk may be beneficial.

Implementation assessment of widely used but understudied prevention programs: an illustration from the Common Sense Parenting trial.

Common Sense Parenting is a parent-training program that is widely disseminated, has promising preliminary support, and is being tested in a randomized controlled trial that targets lower-income, urban 8th-grade students and their families (recruited in two annual cohorts) to improve the transition to high school. The workshop-based program is being tested in both standard 6-session (CSP) and modified 8-session (CSP Plus) formats; CSP Plus adds adolescent-skills training activities. To offer a comprehensive picture of implementation outcomes in the CSP trial, we describe the tools used to assess program adherence, quality of delivery, program dosage, and participant satisfaction, and report the implementation data collected during the trial. Results indicated that workshop leaders had high adherence to the program content and manual-stated goal times of the CSP/CSP Plus curriculum and delivered the intervention with high quality. The majority of intervention families attended some or all of the sessions. Participant satisfaction ratings for the workshops were high. There were no significant cohort differences for adherence, quality and dosage; however, there were significant cohort improvements for participant satisfaction. Positive fidelity results may be due to the availability of detailed workshop leader guides, in addition to ongoing training and supervision, which included performance-based feedback.

A framework for testing and promoting expanded dissemination of promising preventive interventions that are being implemented in community settings.

Many evidence-based preventive interventions have been developed in recent years, but few are widely used. With the current focus on efficacy trials, widespread dissemination and implementation of evidence-based interventions are often afterthoughts. One potential strategy for reversing this trend is to find a promising program with a strong delivery vehicle in place and improve and test the program's efficacy through rigorous evaluation. If the program is supported by evidence, the dissemination vehicle is already in place and potentially can be expanded. This strategy has been used infrequently and has met with limited success to date, in part, because the field lacks a framework for guiding such research. To address this gap, we outline a framework for moving promising preventive interventions that are currently being implemented in community settings through a process of rigorous testing and, if needed, program modification in order to promote expanded dissemination. The framework is guided by RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) (Glasgow et al., Am J Publ Health 89:1322-1327, 1999), which focuses attention on external as well as internal validity in program tests, and is illustrated with examples. Challenges, such as responding to negative and null results, and opportunities inherent in the framework are discussed.

Comorbid alcohol and cannabis use disorders among high-risk youth at intake into residential care.

PURPOSE: Alcohol use disorder (AUD) and cannabis use disorder (CUD) are prevalent among high-risk adolescents, such as those referred for residential care. These disorders are often comorbid, and comorbidity is associated with heightened adverse consequences compared with each disorder alone. Little is known about factors that are associated with the development of comorbid AUD and CUD. This study tested individual, family, peer, school, and community variables as common versus specific correlates of singular and comorbid AUDs and CUDs among high-risk youth. METHODS: Participants were 1,662 youth at entry into a large residential group home program. The average age of participants was 15.2 years, and 63% were male. Routine intake assessments, including standardized questionnaires (e.g., Diagnostic Interview Schedule for Children) and structured checklists, provided archival data for the analyses, conducted using multinomial logistic regression (with neither disorder as the reference group). RESULTS: Male gender was a specific positive correlate of CUD-only. Several common positive correlates of the disorder groups were identified, including individual (e.g., anxiety/depression), family (e.g., family history of substance use), peer (e.g., hanging around troubled peers), and school (e.g., truancy) variables. Age at intake and troubled peers had stronger positive associations with comorbid AUD and CUD than with either disorder alone. CONCLUSIONS: Many more common than specific correlates were identified; these variables may be associated with generalized risk for substance use disorders. Two variables were particularly strong positive correlates of comorbid AUD and CUD, and potentially could be targeted in interventions designed to prevent comorbid substance use disorders.