Stress, Coping, and Quality of Life Among Custodial Grandparents.

An increasing number of custodial grandparents are raising grandchildren, and intensive childcare is stressful with many negative personal, interpersonal, economic, and health implications. Grandparents' strengths, including resilience, positive caregiving appraisal, and social support should be considered in the face of parenting stress and adversity. Guided by the stress and resilience model, the current study investigated the associations of parenting stress and coping resources with life satisfaction and mental wellness among custodial grandparents (N = 76). Data were collected between December 2020 and April 2021, through collaborations with community-based agencies located in two metropolitan areas, which provide supportive services to custodial grandparents and their families. Findings showed that more parenting stress was associated with less life satisfaction and worse mental health, and that stress management boosted life satisfaction and mental wellness. Grandparents with more informal social support and social service utilization fared better than their counterparts with less social support and no experience of service use. The results of this study suggest that social work interventions should focus on improving stress management to cope with daily and caregiving stressors. Social workers can help with informal social support and formal social services utilization to address caregiving needs among custodial grandparents.

Does Model Matter? Examining Change Across Time for Youth in Group Homes.

Group homes are a frequently used but controversial treatment setting for youth with mental health problems. Within the relatively sparse literature on group homes, there is some evidence that some models of treatment may be associated with more positive outcomes for youth. This article explores this possibility by examining differences across time for youth served in group homes utilizing the Teaching Family Model (TFM) and geographically proximate homes using more eclectic approaches. Data come from a longitudinal quasi-experimental study that included 554 youth. Results suggest that youth showed, on average, significant and rapid improvement during initial months in a group home. Improvement did not differ for TFM and non-TFM homes during this initial period. Post-discharge results, though, show that TFM was associated with continued improvement after discharge and significantly better outcomes by 8 months post-discharge. Results also discuss youth-level factors that may influence outcomes as well as need for additional work to more fully understand processes and practices that are key for maximizing and maintaining youths' positive outcomes during and after group home placements.

Who Goes Where? Exploring Factors Related to Placement Among Group Homes.

Despite their widespread use as a placement option for youth with mental health problems, there is relatively little research on group homes for youth. Available data highlight concerns with practices and treatment within group homes and mixed results on youth-level outcomes. However, existing research appears to collapse a wide range of group residential settings into a single amorphous category. This article explores potential variations among group homes to examine whether different programs are systematically serving different types of youth. It examines, in particular, placement in homes using the teaching family model (TFM) versus homes that do not. Findings suggest that demographics are not significantly associated with TFM placement. However, custody status, types of mental health problems, and use of psychotropic medications are. Homes appear to be serving distinct niches within a geographic area. Implications for future research and policy/practice are discussed.

Caseworker assessments of risk for recurrent maltreatment: association with case-specific risk factors and re-reports.

OBJECTIVE: This article focuses on caseworkers' assessments of risk of maltreatment recurrence among families in contact with social services. Specifically, the article has two primary goals: (1) to examine the association between caseworkers' risk assessments and demographic, child, parent and family-level risk factors; and (2) to examine agreement between caseworkers' risk assessments and any subsequent report, or reports, of maltreatment. METHOD: Data are from the baseline, 12-month, and 18-month assessments of the National Survey for Child and Adolescent Well-Being (NSCAW), a nationally representative sample of youth and families who were the subjects of allegations of maltreatment investigated by child welfare agencies. The sample consisted of a subset of NSCAW participants: cases with a report of child physical abuse or neglect who were not placed in out-of-home care (N=2,139). RESULTS: Analyses indicated that parent-level risk factors and a prior report of maltreatment were most strongly associated with caseworkers' assessments of risk for both physical abuse and neglect cases. A smaller set of factors, which varied by the type of maltreatment, were associated with a subsequent report of maltreatment. Despite some overlap in correlates of risk assessment and subsequent reports, analyses indicated that agreement between caseworkers' assessments of risk and re-reports was low. CONCLUSIONS: Findings suggest that although caseworkers' assessments were associated with a limited set of risk factors from the literature, few of these factors also were associated with a recurrent report of maltreatment. Correspondence between caseworkers' assessments of risk and a subsequent report of maltreatment was low, suggesting that considerable work may be needed to improve accuracy and identification of cases most at risk. PRACTICE IMPLICATIONS: This study provides information to assist caseworkers, administrators, and policymakers in thinking critically about risk assessment policies and procedures. Although caseworkers' assessments of risk were associated with some of the empirical predictors of recurrent maltreatment, their assessments were only slightly better than guessing. Agreement between caseworkers' risk assessments and actual subsequent reports was better for low-risk cases, but primarily because the majority of cases did not have a subsequent report during the study period. Clearly, considerable improvement in risk assessment is needed so that at-risk families can be better identified and the limited services available can be directed toward those most in need.

Is more better? Examining whether enhanced consultation/coaching improves implementation.

It is extremely challenging to implement evidence-based interventions in community-based agencies with sufficient quality, fidelity, and intensity to produce desired changes in practice and outcomes. This is particularly difficult to do within the confines of existing service providers' time, personnel, and resource constraints. Over the past 15 years, Together Facing the Challenge (TFTC) has been developed, tested, and disseminated in an effort to address this set of issues to improve treatment foster care (TFC). Data from the initial randomized trial showed improved practice and outcomes in TFTC compared to usual TFC. These initial results came from study-led training and follow-up consultation. Subsequent dissemination activities suggested potential need for more intensive support for TFTC supervisors to produce more consistent and sustained implementation of the model. The current randomized trial extends this work by comparing the previously tested standard consultation versus enhanced consultation that incorporated more of a coaching approach. Initial results suggest that enhanced coaching/consultation was associated with improvements in the small- to medium-effect size range. Results are promising, but require additional work to more fully understand how and whether to enhance supports as agencies implement new evidence-based approaches. (PsycINFO Database Record

Psychiatric disorder, impairment, and service use in rural African American and white youth.

BACKGROUND: The Caring for Children in the Community Study examined the prevalence of DSM-IV psychiatric disorders and correlates of mental health service use in rural African American and white youth. METHODS: Four thousand five hundred youth aged 9 to 17 years from 4 North Carolina counties were randomly selected from school databases. Parents completed telephone questionnaires about their children's behavior problems. A second-stage sample of 1302 was identified for recruitment into the interview phase of the study, and 920 (70.7%) of these were successfully interviewed at home using the Child and Adolescent Psychiatric Assessment and related measures of service use. RESULTS: Weighted back to general population estimates, 21.1% of youth had 1 or more DSM-IV psychiatric disorders in the past 3 months. Prevalence was similar in African American (20.5%) and white (21.9%) youth. The only ethnic difference was an excess of depressive disorders in white youth (4.6% vs 1.4%). Thirteen percent of participants (36.0% of those with a diagnosis) received mental health care in the past 3 months. White youth were more likely than African American youth to use specialty mental health services (6.1% vs 3.2%), but services provided by schools showed very little ethnic disparity (8.6% vs 9.2%). The effect of children's symptoms on their parents was the strongest correlate of specialty mental health care. CONCLUSIONS: In this rural sample, African American and white youth were equally likely to have psychiatric disorders, but African Americans were less likely to use specialty mental health services. School services provided care to the largest number of youths of both ethnic groups.

Patterns of maltreatment and diagnosis across levels of care in group homes.

Patterns of Axis I psychiatric diagnosis and maltreatment history were explored among youth in group homes, including match of clinical need to level or restrictiveness of care. Data on demographics, diagnoses, maltreatment, and group home level of care (Level I, II, or III homes, representing lower to higher intensity of supervision and treatment) were obtained from 523 youth who participated in a quasi-experimental study of group homes. Three quarters of youth had a diagnosis and two-thirds of youth had a maltreatment history. Youth in higher level homes had more diagnoses and higher rates of all disorders except adjustment disorders. Youth in Level I homes had a history of more maltreatment types, particularly high rates of neglect. Sexual abuse, physical abuse, and emotional abuse were most common among youth in higher level homes. Regardless of diagnosis history, comparable proportions of youth had a maltreatment history, and similar patterns were found across levels of care. Together, findings indicate that group homes with varying degrees of restrictiveness serve youth with different psychiatric diagnosis and maltreatment histories. Youth triaged to higher level homes had more diagnoses, while youth placed in the least restrictive homes had a history of more maltreatment subtypes. Further, distinct patterns of diagnosis types and maltreatment subtypes were seen across homes. Implications include the importance of assessing unique clinical needs of youth to promote an appropriate match to level of care and treatment plan.

Extremity of Externalizing Behavior and Young Adult Outcomes.

Data from the National Child Development Study were used to explore the relationship between extremity of externalizing behavior problems during childhood and employment-related outcomes in young adulthood. Analyses focused on four heuristic dimensions of extremity (age at onset, density, persistence, and pervasiveness) and three outcomes (school-leaving age, level of qualifications at labor force entry, and social class of job al age 23). Persistence was associated with the most substantial deficits across all outcomes, and temporal proximity was more influential than early onset. The data suggest that school-based and home-based situational behavior problems should not be combined into a single nonpervasive category.

Review of the evidence base for treatment of childhood psychopathology: externalizing disorders.

This article reviews controlled research on treatments for childhood externalizing behavior disorders. The review is organized around 2 subsets of such disorders: disruptive behavior disorders (i.e., conduct disorder, oppositional defiant disorder) and attention-deficit/hyperactivity disorder (ADHD). The review was based on a literature review of nonresidential treatments for youths ages 6-12. The pool of studies for this age group was limited, but results suggest positive outcomes for a variety of interventions (particularly parent training and community-based interventions for disruptive behavior disorders and medication for ADHD). The review also highlights the need for additional research examining effectiveness of treatments for this age range and strategies to enhance the implementation of effective practices.

Pathways into and through mental health services for children and adolescents.

OBJECTIVE: This study examined points of entry into the mental health service system for children and adolescents as well as patterns of movement through five service sectors: specialty mental health services, education, general medicine, juvenile justice, and child welfare. METHODS: The data were from the Great Smoky Mountains Study, a longitudinal epidemiologic study of mental health problems and service use among youths. The sample consisted of 1,420 youths who were nine, 11, or 13 years old at study entry. Each youth and a parent were interviewed at baseline and every year thereafter about the use of services for mental health problems over the three-year study period. RESULTS: Population estimates indicated that 54 percent of youths have used mental health services at some time during their lives. The education sector was the most common point of entry and provider of services across all age groups. The specialty mental health sector was the second most common point of entry for youths up to age 13 years, and juvenile justice was the second most common point of entry for youths between the ages of 14 and 16. Youths who entered the mental health system through the specialty mental health sector were the most likely to subsequently receive services from other sectors, and those who entered through the education sector were the least likely to do so. CONCLUSIONS: The education sector plays a central role as a point of entry into the mental health system. Interagency collaboration among three primary sectors-education, specialty mental health services, and general medicine-is critical to ensuring that youths who are in need of mental health care receive appropriate services.

Use of psychotropic medications by youths in therapeutic foster care and group homes.

This article examines the use of psychotropic medications among youths in residential community-based placements. Data are from a study funded by the National Institute of Mental Health of therapeutic foster care (June 1999 through May 2001) and group homes (January through June 2001). Data were collected from staff by means of in-person interviews. Many youths in both settings received psychotropic medications, and approximately one-half were taking multiple psychotropic medications. After the authors controlled for demographic and clinical factors, the youths in group homes were nearly twice as likely as the youths in therapeutic foster care to receive medication. However, residential setting was not related to polypharmacology. Additional work is needed to study the appropriateness of use and implications of such patterns for research on intervention outcomes.

Intensive home and community interventions.

This article reviews the evidence base for community-based interventions from a systems of care perspective. The article summarizes previous reviews and provides updates and current directions for recent and ongoing studies. As expected, the evidence base is strongest for multisystemic therapy and treatment foster care. A relatively well-developed evidence base is also revealed for case management. The article concludes with recommendations for future directions within each of the designated types of interventions.

Use of Psychotropic Medications among Youth in Treatment Foster Care.

We describe the use of psychotropic medications among youth in treatment foster care (TFC). Data from 240 youth were coded to examine rates of medication use, including polypharmacy and an indicator of "questionable polypharmacy." Fifty-nine percent of youth in TFC had taken a psychotropic medication within the past two months. Of the youth taking psychotropics, 61% took two or more and 22% met criteria for questionable polypharmacy. The majority of youth taking psychotropics also received psychosocial mental health services and were more likely to receive such services than youth not taking medication. Use of psychotropic medication use was not significantly related to demographic factors, maltreatment history, or custody. However, youth with more severe symptoms were more likely to be on medications and to be on multiple medications. Youth with "questionable polypharmacy" were less likely than other youth on multiple medications to have a recent visit to a psychiatrist.

Family Involvement in Treatment Foster Care.

Child mental health policy and practice has increasingly embraced family-driven practice which promotes family involvement in all aspects of planning and service delivery. While evidence for positive outcomes related to family involvement is mounting in traditional residential treatment, there is little information about family involvement in treatment foster care. This study provides data on family involvement in a statewide randomized trial of treatment foster care. The types of family involvement, factors associated with such involvement, and placement outcomes were examined. Nearly eighty percent of youth experienced recent family contact and/or family participation in treatment planning. Implications for research, policy, and practice to increase understanding the role of family involvement are discussed.

Learning For and From the Field: The Experience of Being a Research Interviewer.

This paper provides a narrative on the experience of being a research interviewer on a federally-funded state-wide study of group homes for youth. Despite the centrality of interviewers for much of the research on a wide range of children's services, very little attention has been given to how interviewers experience this role and what supports they need to enact it effectively. The article discusses various aspects of the interviewer job, discusses management and supervisory approaches that support interviewers, and provides lessons learned and anecdotes to illustrate key points. An introduction and concluding thoughts by the study's Principal Investigator provide an overview and potentially relevant lessons for the broader research field.

Prior Trauma Exposure for Youth in Treatment Foster Care.

Very little research has focused on rates of trauma exposure for youth in treatment foster care (TFC). Available research has utilized record review for assessing exposure, which presents limitations for the range of trauma types examined, as records are predominantly focused on abuse and neglect. The current study examines exposure rates and association with emotional and behavioral outcomes for 229 youth in 46 TFC agencies. The youth in this study had exceptionally high rates of trauma exposure by foster parent report, similar to youth in traditional foster care, with nearly half of the sample exposed to four or more types of traumatic events. A composite child abuse and neglect exposure variable was associated with child and adolescent emotional and behavioral outcomes. Implications for services provided as part of TFC are discussed.

Enhancing "usual practice" treatment foster care: findings from a randomized trial on improving youths' outcomes.

OBJECTIVES: This article reports the initial findings from a randomized trial to enhance treatment foster care (TFC) in "usual care" agencies. The intervention, Together Facing the Challenge, was built on a combination of practice-based elements from a prior descriptive study of TFC and selected elements from Chamberlain's evidence-based model (multidimensional treatment foster care) to fill conspicuous gaps in usual practice. The study was designed to examine whether additional training and consultation to staff and treatment foster parents improved outcomes for youths. METHODS: The study was conducted with 247 youths in TFC and their treatment parents from 14 TFC agencies in a southeastern state in 2003-2008. Half of the agencies were randomly assigned to the intervention condition and received study-provided training and consultation. Agencies in the control group continued to provide training and treatment as usual. Data for the analyses presented here were from interviews with treatment parents at baseline, six months, and 12 months. RESULTS: Compared with youths in the control group, youths in the intervention group showed improvement on the three focal domains--symptoms, behaviors, and strengths. Effects were significant for all outcomes at six months. Effects for behaviors remained significant by 12 months. CONCLUSIONS: This study employed a hybrid model to improve practice. It built on current practices in existing agencies and infused additional training and consultation to overcome observed deficits. Such an approach has tremendous potential for moving beyond a singular focus on disseminating evidence-based interventions to a broader view of improving practice in a wide range of agencies.