An Integrative Data Analysis of Main and Moderated Crossover Effects of Parent-Mediated Interventions on Depression and Anxiety Symptoms in Youth in Foster Care.

Without preventative intervention, youth with a history of foster care (FC) involvement have a high likelihood of developing depression and anxiety (DA) symptoms. The current study used integrative data analysis to harmonize data across four foster and kinship parent-mediated interventions (and seven randomized control trials) designed to reduce youth externalizing and other problem behaviors to determine if, and for how long, these interventions may have crossover effects on youth DA symptoms. Moderation of intervention effects by youth biological sex, developmental period, number of prior placements, and race/ethnicity was also examined. Youth (N = 1891; 59% female; ages 4 to 18 years) behaviors were assessed via the Child Behavior Checklist, Parent Daily Report, and Eyberg Child Behavior Inventory at baseline, the end of the interventions (4-6 months post baseline), and two follow-up assessments (9-12 months and 18-24 months post baseline), yielding 4830 total youth-by-time assessments. The interventions were effective at reducing DA symptoms at the end of the interventions; however, effects were only sustained for one program at the follow-up assessments. No moderation effects were found. The current study indicates that parent-mediated interventions implemented during childhood or adolescence aimed at reducing externalizing and other problem behaviors had crossover effects on youth DA symptoms at the end of the interventions. Such intervention effects were sustained 12 and 24 months later only for the most at-risk youth involved in the most intensive intervention.

Effects of a school readiness intervention on electrophysiological indices of external response monitoring in children in foster care.

This study examined the impact of a school readiness intervention on external response monitoring in children in foster care. Behavioral and event-related potential (ERP) data were collected during a flanker task from children who received the Kids In Transition to School (KITS) Program (n = 26) and children who received services as usual (n = 19) before and after the intervention. While there were no significant group differences on the behavioral data, the ERP data for the two groups of children significantly differed. Specifically, in contrast to the children who received services as usual, the children who received the KITS Program displayed greater amplitude differences between positive and negative performance feedback over time for the N1, which reflects early attention processes, and feedback-related negativity, which reflects evaluation processes. In addition, although the two groups did not differ on amplitude differences between positive and negative performance feedback for these ERP components before the intervention, the children who received the KITS Program displayed greater amplitude differences than the children who received services as usual after the intervention. These results suggest that the KITS Program had an effect on responsivity to external performance feedback, which may be beneficial during the transition into kindergarten.

Intergenerational associations in physical maltreatment: Examination of mediation by delinquency and substance use, and moderated mediation by anger.

Findings as to whether individuals' experiences of physical maltreatment from their parents in childhood predict their own perpetration of physical maltreatment toward their children in adulthood are mixed. Whether the maltreatment experienced is severe versus moderate or mild may relate to the strength of intergenerational associations. Furthermore, understanding of the roles of possible mediators (intervening mechanisms linking these behaviors) and moderators of the intervening mechanisms (factors associated with stronger or weaker mediated associations) is still relatively limited. These issues were examined in the present study. Mediating mechanisms based on a social learning model included antisocial behavior as assessed by criminal behaviors and substance use (alcohol and drug use), and the extent to which parental angry temperament moderated any indirect effects of antisocial behavior was also examined. To address these issues, data were used from Generations 2 and 3 of a prospective three-generational study, which is an extension of the Oregon Youth Study. Findings indicated modest intergenerational associations for severe physical maltreatment. There was a significant association of maltreatment history, particularly severe maltreatment with mothers' and fathers' delinquency. However, neither delinquency nor substance use showed significant mediational effects, and parental anger as a moderator of mediation did not reach significance.

Effects of a school readiness intervention on hypothalamus-pituitary-adrenal axis functioning and school adjustment for children in foster care.

Maltreated children in foster care are at high risk for dysregulated hypothalamus-pituitary-adrenal (HPA) axis functioning and educational difficulties. The present study examined the effects of a short-term school readiness intervention on HPA axis functioning in response to the start of kindergarten, a critical transition marking entry to formal schooling, and whether altered HPA axis functioning influenced children's school adjustment. Compared to a foster care comparison group, children in the intervention group showed a steeper diurnal cortisol slope on the first day of school, a pattern previously observed among nonmaltreated children. A steeper first day of school diurnal cortisol slope predicted teacher ratings of better school adjustment (i.e., academic performance, appropriate classroom behaviors, and engagement in learning) in the fall of kindergarten. Furthermore, the children's HPA axis response to the start of school mediated the effect of the intervention on school adjustment. These findings support the potential for ameliorative effects of interventions targeting critical transitional periods, such as the transition of formal schooling. This school readiness intervention appears to influence stress neurobiology, which in turn facilitates positive engagement with the school environment and better school adjustment in children who have experienced significant early adversity.

Cost Effectiveness of a School Readiness Intervention for Foster Children.

OBJECTIVE: Many young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC). METHOD: Randomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness. RESULTS: KITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD. CONCLUSIONS: The cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefits and improvements in school readiness for young children in foster care.

Parenting and the development of effortful control from early childhood to early adolescence: A transactional developmental model.

Poor effortful control is a key temperamental factor underlying behavioral problems. The bidirectional association of child effortful control with both positive parenting and negative discipline was examined from ages approximately 3 to 13-14 years, involving five time points, and using data from parents and children in the Oregon Youth Study-Three Generational Study (N = 318 children from 150 families). Based on a dynamic developmental systems approach, it was hypothesized that there would be concurrent associations between parenting and child effortful control and bidirectional effects across time from each aspect of parenting to effortful control and from effortful control to each aspect of parenting. It was also hypothesized that associations would be more robust in early childhood, from ages 3 to 7 years, and would diminish as indicated by significantly weaker effects at the older ages, 11-12 to 13-14 years. Longitudinal feedback or mediated effects were also tested. The findings supported (a) stability in each construct over multiple developmental periods; (b) concurrent associations, which were significantly weaker at the older ages;

Decreasing Risk Factors for Later Alcohol Use and Antisocial Behaviors in Children in Foster Care by Increasing Early Promotive Factors.

Children in foster care are at high risk for poor psychosocial outcomes, including school failure, alcohol and other substance abuse, and criminal behaviors. Promoting healthy development by increasing broad-impact positive skills may help reduce some of the risk factors for longer-term negative outcomes. School readiness has been linked to a number of positive outcomes across childhood, adolescence, and adulthood, and may also boost intermediary positive skills such as self-competence. This paper presents findings from a longitudinal study involving 192 children in foster care who were 5 years old at the start of the study. They participated in a randomized controlled trial of a school readiness program to prepare them for kindergarten. Outcomes were assessed at third grade (9 years old) on variables associated with risk for later involvement in substance use and delinquency. These included positive attitudes towards alcohol use, positive attitudes towards antisocial behaviors, and involvement with deviant peers. Results showed that the intervention decreased positive attitudes towards alcohol use and antisocial behaviors. Further, the mediating role of children's self-competence was tested. The intervention positively influenced children's third-grade self-competence, which in turn, decreased their involvement with deviant peers. Findings suggest that promoting school readiness in children in foster care can have far-reaching, positive effects and that increased self-competence may be a mechanism for reducing risk.

Adverse Consequences of School Mobility for Children in Foster Care: A Prospective Longitudinal Study.

Few prospective studies have examined school mobility in children in foster care. This study described the school moves of 86 such children and 55 community comparison children (primarily Caucasian), living in a medium-sized metropolitan area in the Pacific Northwest who were approximately 3 to 6 years old at the study start. Additionally, the effects of moves from kindergarten through Grade 2 on academic and socioemotional competence in Grades 3 through 5 were examined. A greater number of early school moves was associated with poorer later socoemotional competence and partially mediated the effects of maltreatment and out-of-home placement on socioemotional competence. This was the case only for children with poorer early learning skills in kindergarten. Implications for preventive intervention are discussed.

Improving child self-regulation and parenting in families of pre-kindergarten children with developmental disabilities and behavioral difficulties.

The transition to school may be particularly difficult for children with developmental disabilities and behavioral difficulties. Such children are likely to experience problems with self-regulation skills, which are critical to school adjustment. Additionally, inconsistent discipline practices and low parental involvement in children's schooling may contribute to a poor transition to school. This study employed a randomized clinical trial to examine the effects of a school readiness intervention that focused on children's self-regulation skills as well as parenting and parental involvement in school. Results showed that the intervention had positive effects on children's self-regulation in kindergarten as measured by teacher and observer reports. Additionally, the intervention significantly reduced ineffective parenting prior to school entry, which in turn affected parental involvement. This finding is significant because it demonstrates that parental involvement in school may be increased by efforts to improve parenting skills in general. Overall, the study demonstrated that school adjustment across kindergarten among children with developmental disabilities and behavioral difficulties can be enhanced through an intervention aimed specifically at improving school readiness skills.

Immediate Effects of a Program to Promote School Readiness in Low-Income Children: Results of a Pilot Study.

Children from low-income backgrounds demonstrate poorer school readiness skills than their higher-income peers. The Kids in Transition to School (KITS) Program was developed to increase early literacy, social skills, and self-regulatory skills among children with inadequate school readiness. In the present study, 39 families participated in a pilot efficacy trial conducted through a community collaboration to examine the feasibility and impact of the KITS program with families from disadvantaged neighborhoods. Participating families were demographically representative of the larger populations in the participating school districts. Children who received the intervention demonstrated significantly greater improvements in letter naming, initial sound fluency, and understanding of concepts about print than their peers who did not participate in the intervention, as well as decreases in aggressive responses to peer provocation and increases in self-regulation skills. Results suggest that a brief, focused school readiness intervention is feasible to conduct with low-income families and may improve critical skills.

Reducing Suicidal Ideation in Preadolescents With a History of Foster Care by Promoting School Readiness in Early Childhood.

Preadolescents with a history of foster care placement report suicidal ideation (SI) at higher rates than their peers, which increases their risk for suicide attempts in adolescence. Despite these increased risks, few interventions have been shown to reduce SI in these youth. This study examined the main and mediated long-term effects of a program to increase school readiness in children in foster care at age 5 years on SI when the children were ages 9-11 years, 4-6 years after the intervention ended. Children who received the intervention were less likely to report SI, although the difference did not reach statistical significance. The intervention reduced SI indirectly through its positive effect on children's self-esteem at age 9 years. Implications for programming to reduce SI and subsequent suicide attempts in youth with a history of foster care are discussed.

Early adverse care, stress neurobiology, and prevention science: lessons learned.

There is growing evidence that some of the difficulties observed among children who have experienced early adverse care (e.g., children internationally adopted from institutional care and maltreated children in foster care) involve experience-induced alterations in stress-responsive neurobiological systems, including the hypothalamic-pituitary-adrenocortical (HPA) system. Thus, incorporating stress neurobiology into prevention research could aid in identifying the children most in need of preventive intervention services, elucidating the mechanisms of change in effective interventions, and providing insight into the differential responses of children to effective interventions. However, integrating stress neurobiology and prevention research is challenging. In this paper, the results of studies examining HPA system activity in children who have experienced early adverse care are reviewed, the implications of these results for prevention research are discussed, and critical steps for successfully incorporating stress neurobiology into prevention research are identified.

Intervention Effects on Health-Risking Sexual Behavior Among Girls in Foster Care: The Role of Placement Disruption and Tobacco and Marijuana Use.

The present study examined the effects of the Middle School Success intervention (MSS), a program to promote healthy adjustment in foster girls, on their health-risking sexual behavior, using a randomized controlled trial (RCT) design. As hypothesized, girls in the intervention condition (n = 48) showed significantly lower levels of health-risking sexual behavior than did girls in the control condition (n = 52) at 36 months postbaseline. Further path analysis indicated that this intervention effect was fully mediated through its effects on girls' tobacco and marijuana use. Findings highlight the importance of providing preventive intervention services to foster girls during early adolescence.

Immediate Effects of a School Readiness Intervention for Children in Foster Care.

RESEARCH FINDINGS: School readiness is a strong predictor of adjustment in elementary school and beyond. Children in foster care are at particular risk for academic and social difficulties in school. Limitations in self-regulatory skills and caregiver involvement among these children might contribute to a lack of school readiness. This study presents the immediate effects on school readiness of a targeted, short-term intervention designed to improve children's early literacy, prosocial, and self-regulatory skills during the summer before kindergarten entry: Kids in Transition to School (KITS). Using a randomized controlled trial design, 192 children in foster care were assigned to either an intervention or services as usual comparison condition. Multimethod, multiagent assessments were conducted immediately prior to and following the completion of the intervention. The results from structural equation modeling indicated that the intervention had significant, positive effects on early literacy and self-regulatory skills. PRACTICE: An efficacious, short-term, readily scalable, theoretically-based intervention targeted at specific vulnerabilities for children in foster care may help to improve their school readiness and eventual school adjustment.

Growth in externalizing and internalizing problems in childhood: a prospective study of psychopathology across three generations.

Three generations of participants were assessed over approximately 27 years, and intergenerational prediction models of growth in the third generation's (G3) externalizing and internalizing problems across ages 3-9 years were examined. The sample included 103 fathers and mothers (G2), at least 1 parent (G1) for all of the G2 fathers (99 mothers, 72 fathers), and 185 G3 offspring (83 boys, 102 girls) of G2, with prospective data available on the G2 fathers beginning at age 9 years. Behavior of the G2 mother, along with father contact and mother age at birth were included in the models. Intergenerational associations in psychopathology were modest, and much of the transmission occurred via contextual risk within the family of procreation.

Intergenerational influences on early alcohol use: independence from the problem behavior pathway.

Conduct problems are a general risk factor for adolescent alcohol use. However, their role in relation to alcohol-specific risk pathways of intergenerational transmission of alcohol use is not well understood. Further, the roles of alcohol-specific contextual influences on children's early alcohol use have been little examined. In a 20-year prospective, multimethod study of 83 fathers and their 125 children, we considered the predictors of child alcohol use by age 13 years. The predictors included fathers' adolescent antisocial behavior and alcohol use, both parents' adult alcohol use, norms about and encouragement of child use, parental monitoring, child-reported exposure to intoxicated adults, and parent-reported child externalizing behaviors. Path models supported an association between fathers' adolescent alcohol use and children's use (ß = 0.17) that was not better explained by concurrent indicators of fathers' and children's general problem behavior. Fathers' and mothers' adult alcohol use uniquely predicted child use, and exposure to intoxicated adults partially mediated the latter path. Other family risk mechanisms were not supported. However, parental alcohol use and child alcohol use were linked in expected ways with family contextual conditions known to set the stage for alcohol use problems later in adolescence.

The Placement History Chart: A Tool for Understanding the Longitudinal Pattern of Foster Children's Placements.

Despite growing concerns about foster placement instability, little information is available regarding the longitudinal patterns of placement histories among foster children. The purpose of the present study was to develop a charting system using child welfare records to facilitate a better understanding of longitudinal patterns of placement history for 117 foster children. The resulting Placement History Chart included all placements that occurred during the observed time period and accounted for various dimensions: number, length, type, and sequence of placements; timing of transitions; and total time in out-of-home care. The Placement History Chart is an effective tool for placing foster care experiences within a broader developmental context. As such, the Placement History Chart can be a valuable research tool for understanding various dimensions and variations of placement transitions among foster children by capturing sequences and cumulative risks over time. Furthermore, this chart can facilitate the development of intervention programs that are developmentally sensitive and effectively address particularly vulnerable subpopulations of foster children.

Girls in Foster Care: Risk and Promotive Factors for School Adjustment Across the Transition to Middle School.

Girls in foster care may face difficulties across the transition to middle school. Latent growth curve modeling was employed to examine trajectories and predictors of academic competence and aggression from and against peers for 75 girls in foster care from the end of elementary school to the 2(nd) year of middle school. Across the transition to middle school, academic competence increased. Poor self-regulation was associated with decreased academic competence, and higher caregiver support was associated with increased academic competence. Frequency of aggression from peers decreased across the transition, with perceived school competence predicting smaller decreases. Aggression against peers dropped initially and then increased to pretransition levels by the end of the 2(nd) year of middle school. Lower caregiver support was associated with higher rates of aggression against peers at the end of the 1(st) year of middle school. The results are discussed in terms of implications for interventions for girls in foster care.

Prereading Deficits in Children in Foster Care.

Reading skills are core competencies in children's readiness to learn and may be particularly important for children in foster care, who are at risk for academic difficulties and higher rates of special education placement. In this study, prereading skills (phonological awareness, alphabetic knowledge, and oral language ability) and kindergarten performance of 63 children in foster care were examined just prior to and during the fall of kindergarten. The children exhibited prereading deficits with average prereading scores that fell at the 30(th) to 40(th) percentile. Variations in prereading skills (particularly phonological awareness) predicted kindergarten teacher ratings of early literacy skills in a multivariate path analysis. These findings highlight the need for interventions focused on prereading skills for children in foster care.

Understanding Health Need and Services Received by Youth in Foster Care in Community Safety-Net Health Centers in Oregon.

Youth in foster care have significant unmet health needs. We assessed health needs and health service use among youth in foster care in Oregon using electronic health record data from 258 community health centers and Medicaid enrollment data from 2014-2016. We identified 2,140 youth in foster care and a matched comparison group of 6,304 youth from the same clinics who were not in foster care, and compared the groups on demographic characteristics, health needs, and health service use. Youth in foster care were significantly more likely to have at least one chronic health condition, at least one mental health condition, and at least one mental health service compared with controls. Youth in foster care were significantly less likely to have a primary care visit. Despite significant mental health needs among youth in foster care, few received mental health care; this lack was greater among African American and Hispanic youth.