Child Protective Service Referrals Involving Exposure to Domestic Violence: Prevalence, Associated Maltreatment Types, and Likelihood of Formal Case Openings.

Childhood exposure to domestic violence (CEDV) is widely understood as potentially harmful to children. Accordingly, many child welfare systems in the United States construe CEDV as maltreatment when the exposure results in harm or threatened harm to the child. The purpose of the current study was to investigate substantiated child welfare referrals directly related to CEDV to better understand the prevalence and patterns of CEDV-related maltreatment and how child welfare workers respond under the "harm or threatened harm" standard. Data were drawn from 23,704 substantiated referrals between 2009 and 2013 in a large Midwestern child welfare system. Approximately 20% of substantiated referrals were CEDV related. A plurality of CEDV-related referrals included both a male caregiver and female caregiver who were co-substantiated for maltreatment. The most common maltreatment types substantiated for these referrals were neglect based rather than abuse based, and just under a quarter (23%) of CEDV-related referrals were formally opened for services. Referrals involving co-occurring substance abuse were most likely to be opened for services based on predicted probabilities derived from multilevel modeling. Implications for policy and practice are considered.

Timing matters: A randomized control trial of recovery coaches in foster care.

Substance use disorders are a major problem for child welfare systems. The abuse of and dependence on alcohol and drugs by parents increases the risk of child maltreatment and interferes with efforts to locate a permanent home for children in foster care. The current study focuses on an intervention designed to increase the probability of reunification for foster children associated with substance using families. We focus specific attention on the timing of the intervention, in particular the timing of comprehensive screening and access to substance abuse services in relation to the temporary custody hearing. A diverse group of children (n=3440) that were placed in foster care and associated with a parent diagnosed with a substance use disorder were randomly assigned to either a control (services as usual) or experimental group (services as usual plus a recovery coach for parents). Binomial logistic regression models indicated that early access to substance use services matters (within two months of the temporary custody hearing) but only when parents were connected with a recovery coach. Additional findings indicated that the recovery coach model eliminated racial disparities in reunification. The implications of these findings are discussed.

Child Welfare and the Transition to Adulthood: Investigating Placement Status and Subsequent Arrests.

Studies of the transition to adulthood in child welfare focus almost exclusively on youth in foster care. Yet, research indicates that maltreated children who remain in the home may display similar risks as compared with their peers in formal foster care settings. Utilizing administrative data from child welfare, juvenile justice and adult corrections, the current study fills a gap in the literature by analyzing justice outcomes for older adolescents involved with the child welfare system regardless of their placement status. We focus on both intact family cases and formal foster care placements. The diverse sample (11% Hispanic, 8% African American, 6% Native American, 9% multi-racial, 56% female) included open child welfare cases involving 17 year olds (n = 9874). Twenty-nine percent of adolescents were associated with a long term out of home placement and 62% were associated with an intact family case. Event history models were developed to estimate the risk of subsequent offending. Adolescents associated with long term foster care placement were significantly less likely to experience a subsequent arrest as compared with adolescents associated with a long term intact family case. Males, African Americans and adolescents associated with neglect were also more likely to experience a subsequent arrest. Limited focus on the intact family population in child welfare represents a lost opportunity to support critical developmental gains and facilitate a smooth transition to adulthood.

Prevalence and correlates of truancy in the US: results from a national sample.

Truancy has been a persistent problem in the United States for more than 100 years. Although truancy is commonly reported as a risk factor for substance use, delinquency, dropout, and a host of other negative outcomes for youth, there has been surprisingly little empirical investigation into understanding the causes and correlates of truancy using large, nationally representative samples. Using the adolescent sample (N = 17,482) of the 2009 National Survey on Drug Use and Health (NSDUH), this study presents the prevalence of truancy and examines individual, school engagement, parental, and behavioral correlates of truancy. Overall, 11% of adolescents between the ages of 12-17 reported skipping school in the past 30 days. Results from multinomial logistic regression models indicate skipping school was robustly associated with an increased probability of reporting externalizing behaviors, less parental involvement, and engagement and lower grades in school. Implications for theory, prevention, and policy are discussed.

Travel distance to outpatient substance use disorder treatment facilities for Spanish-speaking clients.

BACKGROUND: Travel distance and English proficiency skills are widely recognized factors associated with service access and treatment engagement. As Latino populations represent one of the most rapidly growing populations in the United States, methods are needed to better understand availability of linguistically appropriate services in Latino communities. Given regional variability in the density of Latino communities, the current study examines treatment access as travel distance to outpatient substance use disorder treatment facilities in one of the largest and most rapidly changing Latino communities in the United States - Los Angeles County, CA. METHODS: Data from the 2010 U.S. Census and the National Survey of Substance Abuse Treatment Services were analyzed using a geographic information system approach to determine the street-level distance between treatment facilities with services in Spanish and Latino communities throughout L.A. County. This study used an innovative approach that included network analysis and spatial autocorrelation to identify "hot spots," i.e. clusters of census tracts with high-density Latino populations that were relatively far from treatment services in Spanish. RESULTS: The analysis identified several key hot spots with significantly large Latino populations and far street distances to the closest facility offering Spanish-language services. The average distance between these hot spots and the closest facilities was 2.74 miles (SD=0.38), compared to a county average of 2.28 miles (SD=2.60). In several key hot spots, the distance was greater than 3 miles. CONCLUSION: Despite the growing presence of Latinos in L.A. County in 2010, constrained access to services in Spanish was found in geographic locations highly represented by Latinos. The distances identified in this study are almost triple the 1-mile threshold representing reduced access to treatment as determined by other studies. Geographic information systems represent an innovative and user-friendly approach for effectively and efficiently identifying areas with the greatest service needs. This approach can inform policies to increase the capacity of ethnic minority communities to develop linguistically responsive social services.

Service use and treatment barriers among inhalant users.

Inhalant use is a serious global problem with consequences equal to or surpassing those of other drugs. Regrettably, few prior studies have examined inhalant users' patterns of service and treatment utilization. The purpose of this study is to identify factors associated with service use and barriers to treatment among a nationally representative sample of inhalant users. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) reveal that among inhalant users problem severity and substance use disorder comorbidity were associated with substance abuse treatment barriers and service usage. These findings can help improve the service delivery system to provide effective treatments and reduce the risk of emergency department usage, which is among the most expensive and least effective ways to deal with substance abuse.

Profiles of disciplinary behaviors among biological fathers.

This study assesses fathers' discipline of their 3-year-old child. Data are from 1,238 mother and father participants in the Fragile Families and Child Wellbeing Study. Latent class analysis (LCA) of nonaggressive and aggressive behaviors, as reported by mothers, indicated four distinct paternal disciplinary profiles: low discipline, low aggression, moderate physical aggression, and high physical and psychological aggression. Serious forms of psychological aggression directed toward the child were uncommon but may identify those fathers most in need of intervention. Use of nonaggressive discipline was high and nearly equivalent among the parenting profiles. However, child aggressive behavior increased as the child's exposure to paternal aggression increased, even when aggressive discipline was combined with high levels of nonaggressive discipline. Fathers who exhibited more aggression toward their child had higher levels of alcohol use, used more psychological aggression toward the child's mother, and were more likely to spank their child.

Paternal psychosocial characteristics and corporal punishment of their 3-year-old children.

This study uses data from 2,309 biological fathers who participated in the Fragile Families and Child Well-Being Study (FFCWS) to examine associations between psychosocial characteristics and levels of corporal punishment (CP) toward their 3-year-old children over the past month. Results indicate that 61% of the fathers reported no CP over the past month, 23% reported using CP once or twice, and 16% reported using CP a few times in the past month or more. In multivariate models controlling for important sociodemographic factors as well as characteristics of the child, fathers' parenting stress, major depression, heavy alcohol use, and drug use were significantly associated with greater use of CP, whereas involvement with the child and generalized anxiety disorder were not. Girls were less likely to be the recipient of CP than were boys, and child externalizing behavior problems but not internalizing behavior problems were associated with more CP.

Is crack cocaine use associated with greater violence than powdered cocaine use? Results from a national sample.

BACKGROUND: The question of whether crack cocaine use is associated with increased violence compared to powdered cocaine use has not been adequately explored in large nationally representative general population samples. METHODS: This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to 1) determine the comparative prevalences of violent behaviors among crack cocaine users and powdered cocaine users, 2) examine these differences while controlling for sociodemographic variables, lifetime psychiatric, alcohol and drug use disorders (a majority of cocaine users use other substances), and levels of crack cocaine and powdered cocaine use. RESULTS: The likelihood of violence associated with crack cocaine users was greater compared to powdered cocaine users at the bivariate level. However, these differences were almost uniformly statistically nonsignificant when demographic, mood and non-cocaine substance use disorders were controlled for. CONCLUSIONS: The substantial attenuation of the association of crack cocaine use with violence after adjustment suggests that the sociodemographic characteristics, psychiatric variables, and non-cocaine substance use disorders that make some individuals more likely to use crack cocaine than powder cocaine are responsible for the increased prevalence of violence observed among crack users, rather than crack itself.

Assessing criminal justice involvement as an indicator of human immunodeficiency virus risk among women in methadone treatment.

This study examines the relationship between criminal justice involvement and high-risk sexual partnerships among a random sample of 416 women in methadone treatment in New York City. Logistic regression models were used to estimate the associations between recent criminal justice involvement (arrest or incarceration in the past 6 months) and recent high-risk partnerships (multiple sex partners, sex trading, or sex with a risky partner in the past 6 months) when adjusting for sociodemographic factors and recent regular drug use. Women with recent criminal justice involvement demonstrated higher odds of engaging in high-risk sex partnerships. Although regular drug use was a significant confounder of several of these relationships, recent arrest or incarceration remained significantly associated with multiple sex partnerships, sex with a risky partner, and engaging in unprotected sex and a high-risk partnership even after controlling for regular drug use and other social stressors. This study highlights the vulnerability of drug-involved women offenders to human immunodeficiency virus (HIV) risk and points to the need for investigation into the role of arrest and incarceration as factors that may contribute to HIV infection.

Racial/Ethnic group differences in bipolar symptomatology in a community sample of persons with bipolar I disorder.

To better understand the problems associated with diagnosis of bipolar disorder, especially problems related to race and ethnicity, this study compared whites, African Americans, and Latinos with bipolar I disorder in the presentation of manic symptoms, depressive episodes, functional impairments (Short Form-12), and self-reports of schizophrenia diagnosis. Data for this study were derived from the 2001 National Epidemiologic Survey on Alcohol and Related Conditions, which are nationally representative of United States households. African Americans and Latinos expressed similar rates in presentation of 14 out of 16 manic symptoms compared with whites, with the exception of grandiosity/self-esteem, in which they were more likely to exhibit this symptom compared with whites. Higher rates of depressive episodes were observed among whites, and these episodes occurred significantly earlier compared with African Americans and Latinos. Latinos had slightly higher vitality scores on the SF-12 measures after adjusting for sociodemographic and clinical factors, but no other differences across the groups were observed. Overall, these data show that the expression and functional impairments of bipolar I disorder is very similar across racial ethnic groups using this community-based sample. This is the first community-based study making such comparisons, with results suggesting that provider biases are more likely to explain problems in misdiagnosis than fundamental differences in the presentation of bipolar disorder across racial/ethnic groups.

Profiles of disability among adults with bipolar spectrum disorders.

BACKGROUND: Heterogeneous groups of patients with a spectrum of service needs are commonplace in mental health settings. Although comprehensive assessments are available to measure variations in service needs, numerous challenges still exist when confronting this heterogeneity and many assessments used in clinic settings are lengthy and have not been demonstrated to be consistent over time. OBJECTIVE: The purpose of this study was to identify subgroups of persons with bipolar spectrum disorders, who have similar disability profiles, and to the extent to which the subgrouping is stable over time. METHODS: Participants were recruited from the Continuous Improvement for Veterans in Care-Mood Disorders. Eligible patients (N = 435) were those who received inpatient or outpatient treatment for bipolar disorder at a large urban VA mental health facility in Western Pennsylvania from July 2004 through July 2006. This was a naturalistic cohort study of patients with bipolar spectrum disorders. Baseline and 1-year follow-up data were collected using face-to-face interviews and recorded abstraction. The World Health Organization Disability Assessment Scale was the primary measure used to identify subgroups within this sample. RESULTS: Using a classification strategy called latent profile analysis, this study identified three unique subgroups that showed significant differences in various clinical measures at baseline and follow-up. The largest and most consistent subgroup differences were observed in the current bipolar symptomatology. CONCLUSION: The classification of functional status in the present study can aid clinicians in the identification of bipolar patients, with specific impairment profiles, who may need additional intervention. Future research is needed to understand whether specific interventions targeted at these subgroups can improve the quality of care for this high-need and at-risk population.

Service needs of clients in outpatient substance-use disorder treatment: a latent class analysis.

OBJECTIVE: The purpose of this study was to determine if there are common classes of service needs among clients in outpatient substance-use disorder treatment. METHOD: Data for this study were derived from the National Treatment Improvement Evaluation Survey. This study focused on clients in outpatient treatment (N=2,256). The majority of the subjects were male (74%). Latent class analysis was used to explore different class solutions. RESULTS: A four-class solution exhibited the best fit with the data. Based on the features of the classes, the classes were named "multiple needs," "interpersonal needs," "financial needs," and "low needs." Validation analysis showed that psychiatric problems exhibited the strongest associations with the multiple needs class. CONCLUSIONS: With service needs extending beyond substance-abuse treatment problems, a classification seems to aid in characterizing the heterogeneity of this population and is suggested of the need for packaged service approaches.