Care improves self-reported daily functioning of adolescents with emotional and behavioural problems.

Emotional and behavioural problems (EBP) have a negative impact on various life domains of adolescents. Receiving care for EBP may improve the functioning of adolescents with EBP, but evidence on long-term outcomes in real-life settings is lacking. We, therefore, investigated self-reported functioning in different life domains of adolescents with various EBP, and the role of care during a three-year period. We used data from the TAKECARE study, which consist of a care and community cohort. We followed adolescents aged 12 and over (n = 733) during 3 years over five assessment rounds. Using the Strengths and Difficulties Questionnaire, self-reported functioning was measured in four life domains: home life, friendships, classroom learning and leisure activities. We categorized the respondents into four groups: (1) adolescents without emotional and behavioural problems (n = 298); (2) adolescents with emotional problems (n = 192); (3) adolescents with behavioural problems (n = 80); and (4) adolescents with both emotional and behavioural problems (n = 163). The development of functioning over time was analyzed using longitudinal ordinal (probit) regression analyses. Adolescents with both emotional and behavioural problems reported poorer functioning at baseline in all domains and adolescents who received care reported poorer functioning at baseline compared to adolescents who did not receive care. Regarding the change in functioning during the 3 years, adolescents who received care showed improved functioning in all domains. We found improved functioning after care, even if the problems may not have been solved. Psychosocial care can contribute to the functioning of adolescents with EBP, which can have major effects on their future life.

Trajectories of care for children and adolescents with psychosocial problems: a 3-year prospective cohort study.

BACKGROUND: Care for children and adolescents with psychosocial problems is aimed at reducing problems. There may be a relationship between the intensity and duration of care provision and improvement of these outcomes, but evidence on this issue is lacking. We therefore examined the association between care trajectories based on duration and intensity of care for children, and the reduction in psychosocial problems after 3 years. METHODS: We obtained a cohort of all children entering psychosocial care in one region (n = 1,378), the TAKECARE cohort, and followed it for 3 years, with five assessment rounds. Retention in the final round was 85.8%. Psychosocial problems were measured using the parent report of the Total Difficulty Score of the Strength and Difficulties Questionnaire (SDQ-TDS). We constructed trajectories for intensity of care using growth mixture modelling and assessed the association between duration and intensity of care trajectories and SDQ-TDS after 3 years. RESULTS: After 3 months 60.6% of children and adolescents were receiving care, after 1 year 38.7% were receiving care and after 3 years 26.0%. Regarding intensity of care, three trajectories were found: one with minimal intensity during all 3 years, a second with initially medium intensity and strong reduction within 1 year, and a third with high intensity and a reduction after 1 year. Although the psychosocial problems of children and adolescents were reduced during the 3-year period, the rate of decline was relatively less marked for children and adolescents with longer care trajectories. CONCLUSION: Overall, children and adolescents with psychosocial problems who received care had improved outcomes at follow-up. However, increased provision of care does not automatically lead to reduction of problems, and although overall psychosocial problems are reduced, a substantial subgroup has longer lasting problems.

Development of atypical parental behavior during an inpatient family preservation intervention program.

Since failed reunification is a detrimental outcome for children, particularly infants and toddlers, the aim of this study was to gain insight into support to families in multiple-problem situations to help them achieve sustainable good-enough parenting. Therefore, we examined outcomes of an assessment-based inpatient family preservation program. We prepared a thorough target-population description (n = 70) using file analysis. Next, we examined atypical parental behavior during the intervention using the Atypical Maternal Behavior Instrument for Assessment and Classification with a repeated measures design (n = 30). The family files revealed a great number of issues at the family, parent, and child levels, such as practical matters, problems in parent functioning and between parents, and difficulties in the broader environment. We found a significant decline in three dimensions of atypical parental behavior over time. This program has great potential in supporting vulnerable families in their pursuit of family preservation.

Debido a que un fracasado intento de reunificación es un resultado perjudicial para los niños, particularmente los infantes y niños muy pequeñitos, la meta de este estudio fue adquirir percepciones en cuanto al apoyo a familias en situaciones de problemas múltiples para ayudarles a lograr una crianza sostenible suficientemente buena. Examinamos, por tanto, resultados de un programa de paciente interno para la preservación de la familia (FP) basado en evaluación. Preparamos una detallada descripción de la población de enfoque (n = 70) usando análisis de registros. Examinamos conductas atípicas de los padres durante la intervención usando el Instrumento de Conducta Materna Atípica para Evaluación y Clasificación (AMBIANCE) con un diseño de medidas repetidas (n = 30). Los registros familiares revelaron un gran número de asuntos al nivel de la familia, los padres y los niños, tales como asuntos prácticos, problemas en el funcionamiento de los padres y entre padres, y dificultades en el más amplio entorno. Encontramos una baja significativa en tres dimensiones de conducta atípica de los padres a lo largo del tiempo. El programa FP tiene un enorme potencial para apoyar a familias vulnerables en su esfuerzo por preservar la familia.

Puisque la réunification échouée est un résultat détrimentaire pour les enfants, en particulier les nourrissons et les jeunes enfants, le but de cette étude était d'explorer le soutien aux familles dans des situations avec de nombreux problèmes afin de les aider à atteindre un parentage durable et suffisant. Nous avons donc examiné les résultats d'un programme de maintien familial (abrégé ici MF en français) fondé sur l'évaluation et en hospitalisation. Nous avons préparé une description approfondie de la population cible (n = 70) en utilisant une analyse par dossier. Nous avons examiné le comportement parental atypique durant l'intervention en utilisant AMBIANCE, l'instrument de comportement maternel atypique pour l'évaluation et la classification avec une conception à mesures répétées (n = 30). Les dossiers familiaux ont révélé un grand nombre de problèmes au niveau de la famille, du parent et de l'enfant, tels que des problèmes pratiques, des problèmes dans le fonctionnement du parent ou entre les parents, et des difficultés dans le milieu plus large. Nous avons trouvé une baisse importante sur trois dimensions du comportement atypique parental au fil du temps. Le programme MF offre de grandes possibilités dans le soutien aux familles vulnérables dans leur quête de maintien familial.

Testing Syndromes of Psychopathology in Parent and Youth Ratings Across Societies.

As societies become increasingly diverse, mental health professionals need instruments for assessing emotional, behavioral, and social problems in terms of constructs that are supported within and across societies. Building on decades of research findings, multisample alignment confirmatory factor analyses tested an empirically based 8-syndrome model on parent ratings across 30 societies and youth self-ratings across 19 societies. The Child Behavior Checklist for Ages 6-18 and Youth Self-Report for Ages 11-18 were used to measure syndromes descriptively designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. For both parent ratings (N = 61,703) and self-ratings (N = 29,486), results supported aggregation of problem items into 8 first-order syndromes for all societies (configural invariance), plus the invariance of item loadings (metric invariance) across the majority of societies. Supported across many societies in both parent and self-ratings, the 8 syndromes offer a parsimonious phenotypic taxonomy with clearly operationalized assessment criteria. Mental health professionals in many societies can use the 8 syndromes to assess children and youths for clinical, training, and scientific purposes.

Do Foster Parents and Care Workers Recognize the Needs of Youth in Family Foster Care with a History of Sexual Abuse?

Children in family foster care have the right to participate in decisions regarding their life, however, adults often advocate on behalf of children. This Q methodological study explored whether shared perspectives among foster parents and care workers resemble shared perspectives of youth regarding the psychosocial needs experienced by youth with a history of sexual abuse. Participants sorted a set of statement cards according to what they thought was most important for youth. By-person factor analyses examined how the Q sorts of foster parents and care workers related to those of youth. The results showed that foster parents mostly recognized the group of youth who value an instrumental relationship with their carers, while care workers mostly recognized the group of youth who value support of both foster and birth parents with regard to their preparation for independent living. The two youth groups characterized by ambivalence and autonomy were barely recognized. Results are discussed in light of the expected roles of foster parents and care workers, and youth's contact with birth parents. Lastly, this study highlights the importance of youth participation, because youth offer unique and varying perspectives about their needs.

Speaking With and Without Words-An Analysis of Foster Children's Expressions and Behaviors That Are Suggestive of Prior Sexual Abuse.

This exploratory study reports on foster children's informal self-disclosures of previously unknown histories of sexual abuse. Data were collected from 40 children's files, and an inductive thematic analysis of verbal and behavioral expressions was conducted. Findings suggest that foster children's self-disclosures can be fragmented, spontaneous, narrative, or triggered and often occur during everyday activities in the foster family. The children disclose their past by referring to the perpetrator or the severity of the abuse or by acting out, mostly by reenacting sexual abuse experiences. In addition, some children use childish vocabulary focusing on genitals or sexual acts they were involved in or want to be involved in. Last, some foster children seem to be linguistically challenged to disclose that a female person abused them or that they were forced to reciprocate sexually. This study adds to the understanding of the complex process of child sexual abuse disclosure in the context of foster care.

ASSESSING PARENTING IN THE CONTEXT OF REUNIFICATION OF INFANTS/TODDLERS AND THEIR FAMILIES: HOW TO FACE THE CHALLENGES?

Since a substantial portion of infants and toddlers reenter care after reunification, the question of whether family reunification is feasible needs to be answered very cautiously. How parenting is assessed is of major importance in answering this question, but the quality of these assessments is often poor. With an eye to improving current practice, we conducted an integrative review, in which we analyzed the challenges related to the assessment of parenting vis-à-vis reunification and linked relevant knowledge from research with significant know-how from practice. The challenges appear to be embedded in the struggle to define (especially good enough) parenting and the complex context of child protection. As an answer to the challenges, the integrative review resulted in a framework of four key components required for sufficient parenting-assessment practice: (a) the use and development of expertise; and (b) providing families aiming for reunification with an intervention that is intensive, (c) flexible, and (d) organized as teamwork. Providing families with such an intervention gives them the opportunity to make substantial changes in their parenting and helps professionals assess the capacity of parents to grow to an acceptable level of caretaking for their child. Further implications for research and practice are discussed.

Salivary cortisol: a possible biomarker in evaluating stress and effects of interventions in young foster children?

Young foster children undergo an early separation from their caregiver(s) and often experience severe stress before placement. However, a considerable part of the children do not show apparent signs of distress, making it difficult for the foster carer to be aware of the amount of stress in their foster child. Potential evidence for using salivary cortisol levels as a dimension to evaluate the amount of stress in young foster children is reviewed. Moreover, the applicability of salivary cortisol in the evaluation of stress-reducing interventions for young foster children is discussed. A systematic review was performed using the databases Medline, Psychinfo, Embase, Ebscohost, and Academic Search Premier. Nine studies were traced in which salivary cortisol was used to measure stress in children placed in family foster care or in adoptive families. Stress in general but also neglect, early loss of a caregiver, a younger age at first placement, and a higher number of placements were associated with an altered hypothalamic-pituitary-adrenal (HPA) axis function in foster children. Moreover, four studies on the effect of stress-reducing interventions on HPA-axis functioning of young foster children were found. These studies suggest that caregiver-based interventions can actually help to normalize the HPA-axis function in foster children, and that such changes co-occur with improved behavioral functioning. Although the results from the papers discussed in this review suggest that diurnal cortisol with a wake up and a bedtime measurement may be a relevant tool to evaluate stress in young foster children, this cannot yet be concluded from the present studies, because statistical data from the studies on foster care and adoption in this review were not robust and researchers used different methods to collect the salivary cortisol. Still, it is noteworthy that all studies did find the same pattern of reduced levels in relation to chronic stress (caused by maltreatment and neglect of the child).

Non-suicidal self-injury in adolescence: a longitudinal study of the relationship between NSSI, psychological distress and perceived parenting.

OBJECTIVE: The present study investigates whether either adolescents' psychological distress and/or perceived parenting predicted the occurrence of NSSI. Furthermore, the consequences of NSSI are examined in a three-wave longitudinal study. DESIGN: The sample at time 1 (age 12) consisted of 1396 adolescent reports and 1438 parent reports. At time 2 (age 13), 827 adolescent reports and 936 parent reports were obtained. Time 3 (age 14) included 754 adolescent reports and 790 parent reports. Psychological distress of adolescents was measured using the Strengths and Difficulties Questionnaire. Perceived parenting behaviors were examined by the Parental Behavior Scale and the Psychological Control Scale. RESULTS: A total of 10% of the adolescents engaged in NSSI at least once before age 15. Higher psychological distress of adolescents at time 1 was associated with the presence of NSSI at time 2 or 3. The association between psychological distress at time 1 and perception of decreased parental rule setting at time 3 was mediated by the presence of NSSI at time 2. CONCLUSIONS: The present study showed that psychological distress at age 12 predicts NSSI over time and that parental awareness of NSSI changes the perception of parenting behaviors.

Attachment narratives in refugee children: interrater reliability and qualitative analysis in pilot findings from a two-site study.

Although forced migration research on refugee family functioning clearly points to the potential breakdown of parental availability and responsiveness in the context of cumulative migration stressors, studies exploring attachment security in refugee children are surprisingly lacking so far. The authors report their findings from a 2-site, small-scale administration of an attachment measure, adapted for use with refugee children aged between 4 and 9 years from a reliable and validated doll-play procedure. We evaluated interrater reliability and conducted a qualitative analysis of refugee children's narrative response to identify migration-specific representational markers of attachment quality. The level of agreement among 3 independent coders ranged between .54 to 1.00 for both study samples, providing initial psychometric evidence of the measure's value in assessing child attachment security in this population. The exploratory analysis of migration-related narrative markers pointed to specific parameters to be used in parent-child observational assessments in future validation of the attachment measure, such as parental withdrawal or trauma-communication within the parent-child dyad.

Differences in psychological symptoms and self-competencies in non-suicidal self-injurious Flemish adolescents.

The aim of the present study was to examine differences in psychological symptoms and sense of self-competence between adolescents with and without non-suicidal self-injurious behavior. We collected data in a sample of 281 Flemish adolescents. Psychological symptoms and self-competencies were assessed by means of the Youth Self-Report (YSR) and NSSI was assessed using the Self-Harm Inventory (SHI-22). Results showed significant differences between adolescents with and without NSSI on all psychopathological subscales. Furthermore, adolescents engaging in NSSI reported significantly lower scores on social competence, but equal levels on other competencies. Results revealed that externalizing problems and attention/thought/social problems are significantly associated with NSSI. Results also showed that having a higher score on aggressive behavior or thought problems increases the chance of belonging to the NSSI group; whereas a higher score on the social competence scale decreases the chance of belonging to the NSSI group. Clinical implications of these findings are discussed.

Racial/ethnic and gender disparities in child protection decision-making: What role do stereotypes play?

BACKGROUND: A wide range of studies have revealed racial/ethnic and gender disparities in child protection decision-making. OBJECTIVE: This study investigated whether disparities are mediated by stereotypes that professionals may hold, by applying the Stereotype Content Model (SCM) which suggests that stereotypes are formed by perceptions of sociability, morality, and competence. PARTICIPANTS AND SETTING: 258 professionals (133 current staff and 125 trainees) from Colorado participated in the study. METHODS: The study applied a 2 × 3 randomized experimental vignette design. Participants read a case in which the gender of the parent responsible for maltreatment (mother or father) and race/ethnicity of the family (white, Black, or Latinx) varied. RESULTS: A SEM model (CFI = .94, RMSEA = .05) with free parameters for trainees and current staff was estimated. No significant association between stereotypes and race/ethnicity and gender appeared. However, evidence for disparities emerged. In the trainee group, scores to decide for a supervision order were higher for white fathers, Black mothers, Latinx mothers, and Latinx fathers (ß = 0.18 to 0.25) compared to white mothers. Current staff provided larger risk scores for Black mothers and both Latinx parents (ß = 0.20 to 0.22) compared to the white mother, resulting in increased inclinations to decide for a supervision order (ß = 0.26). Lastly, negative perceptions of morality increased supervision order scores (ß = -0.55 to -0.36). CONCLUSIONS: Evidence for disparities in decision-making appeared, but the study could not confirm that these disparities were mediated by stereotypes. Furthermore, perceptions of morality seemed to impact decision-making processes.

On the bright side: Young people's most positive memories of family foster care.

This study explored what contributes to successful family foster care from the perspective of young people by asking them about their most positive memory of family foster care. Forty-four Dutch adolescents and young adults (aged 16-28) participated in this study and shared their most positive memory in a short interview. Their answers were qualitatively analyzed using reflexive thematic analysis, supplemented with an analysis of the structure of their memories. The thematic analysis resulted in the themes Belongingness, Receiving support, Normal family life, It is better than before, and Seeing yourself grow. The structural analysis showed that young people both shared memories related to specific events, as well as memories that portrayed how they felt for a prolonged period of time. In addition, young people were inclined to share negative memories alongside the positive memories. These results highlight that, in order to build a sense of belonging, it is important that of foster parents create a normal family environment for foster children and provide continuous support. Moreover, the negative memories shared by participants are discussed in light of a bias resulting from earlier traumatic experiences.

Holding harm: narrative methods in mental health research on refugee trauma.

In this article, we question narrative inquiry's predominant ethics of benefit when engaging in narrative research on trauma and social suffering. Through a particular focus on the use of a narrative methodology in a refugee health study, we explore the potential risk and protective function of narrative trauma research with vulnerable respondents. A review of ethical questions emerging during the course of a multiple-case study with refugee families documents how narrative methods' characteristics clearly revisit the impact of traumatization on autonomy, narrativity, and relationship building in participants and, thus, evoke the replay of traumatic experience within the research relationship itself. Blurring a straightforward ethics of benefit, this reactivation of trauma accounts for the research relationship's balancing movement between reiterating and transforming traumatic distress, and urges for the need to contain coexisting aspects of both harm and benefit in developing narrative research with traumatized participants.

Adult attachment in the context of refugee traumatisation: the impact of organized violence and forced separation on parental states of mind regarding attachment.

Starting from an outline of the refugee experience as a process of cumulative traumatisation, we review research literature on mental health outcomes in refugees. Next, an integration of findings on relational processes in refugee families documents the role of the family unit as a key interactive context patterning the impact of sequential traumatisation. Relating these trauma- and migration-specific family processes to their central dimension of provision or disruption of emotional availability in a context of chronic adversity, we aim to explore the development of unresolved and insecure parental states of mind regarding attachment during forced migration. Starting the research report, a method discussion on the administration of 11 Adult Attachment Interviews with adult refugees as part of an explorative multiple case study integrates deontological and technical reflections on the use of the Adult Attachment Interview in a context of ongoing traumatisation. The paper then presents findings on adult attachment in refugees and highlights representational processes involved in the potential disruption of caregiver availability during refugee traumatisation.

The effects of migrant background and parent gender on child protection decision-making: An intersectional analysis.

BACKGROUND: Disparities in decision-making are a recognized concern within child protection systems and imply that marginalized groups are being treated unequally compared to majoritized groups. Previous studies reported that both ethnicity and the gender of the parent that maltreated the child seem associated with an increased likelihood that child protection agencies provide services after an investigation or that children are placed out of their homes. OBJECTIVE: We investigated whether migration background and the gender of the parent who maltreated the child seem associated with the decision whether a case was opened for continuing services. In addition, we inspected whether the intersections between migration background and parent gender were correlated with disparities in decision-making. PARTICIPANTS AND SETTING: Our multinational sample consisted of 1189 cases that were involved with child protection agencies in England, the Netherlands, and Germany. METHODS: We systematically coded and analyzed child protection case files. We conducted logistic regression analysis to investigate for disparities in decision-making. RESULTS: The intersectional analysis showed that maltreatment committed by mothers (OR = 2.25, p =  .001) and migrant fathers (OR = 2.21, p =  .030) was associated with an increased likelihood to provide ongoing services. However, country specific analyses showed that these effects were most pertinent in the English sample. CONCLUSIONS: These findings suggest a need to address migration background and gender disparities in child protection practice. Future research could investigate whether other contextual factors (e.g. characteristics of the professional and agency) seem associated with disparities in decision-making.

Relations between parental psychological control and childhood relational aggression: reciprocal in nature?

Using a cross-lagged panel design, this study examined the directionality of relations between parental psychological control and child relational aggression. Data were collected from a proportionally stratified sample of 600 Flemish 8- to 10-year-old children at 3 measurement points with 1-year intervals. Reciprocal effects were evident in mother-child dyads. Maternal psychological control was positively related to child relational aggression 1 year later, and child relational aggression was positively related to maternal psychological control 1 year later. The father-child dyads were best represented by unidirectional parent effects. Paternal psychological control was positively related to child relational aggression 1 year later. Surprisingly, these effects emerged only for relational aggression as indexed by mother and father reports and not for relational aggression as indexed by teacher and peer measures.

Associations between parental control and children's overt and relational aggression.

The present study examined specialized associations between parental control and child aggression in a sample of 600 8- to 10-years old children. Parental control dimensions and aggression subtypes were assessed using multiple informants (i.e. children, mothers, fathers, peers, and teachers). In line with expectations, parental physical punishment was positively associated with overt aggression, whereas parental psychological control was positively associated with relational aggression in both girls and boys. In addition, this study demonstrated that if both parents employed similar parenting strategies, it appeared to have a cumulative effect on child aggressive behaviour. Associations involving overt aggression were more pronounced for boys than girls, whereas associations involving relational aggression were not moderated by gender. Overall, the present study contributes to an emerging research field by supporting the hypothesis of specialized associations between parental control and child aggression.

Heuristic decision-making in foster care matching: Evidence from a think-aloud study.

Complex decisions are often based on heuristics, which are shortcuts or simple 'rules of thumb'. Since the matching decision in family foster care is often made in a less-than-ideal setting and riddled with uncertainty, heuristics are expected to be applied in that field of child and youth care on a daily basis. However, the use of heuristics in the matching decision has not been studied empirically until now. This research explores how decision-making heuristics are used by practitioners to determine which foster family is the best fit for a child. A number of 20 matching practitioners from the Netherlands were interviewed using vignettes and a 'think-aloud' methodology to generate an understanding of their reasoning. Two types of vignettes were created: hypothetical children and hypothetical foster families. The interviews were analyzed using a qualitative deductive content analysis focusing on key indicators of three classes of heuristics: recognition heuristics, one-reason heuristics, and trade-off heuristics. The results show that recognition heuristics did not play a decisive role in the matching process; practitioners considered more than one family before making a final decision. The findings for the one-reason heuristics reveal conjunctive decision-making rules; families were rejected based on one negative premise. The analysis of the trade-off heuristics demonstrates that the number of positive premises and the ratio between positive and negative premises predicted the matching decision. However, the total number of premises also predicted the matching decision, which might indicate confirmation bias.

The Needs of Foster Children and How to Satisfy Them: A Systematic Review of the Literature.

Family foster care deeply influences the needs of children and how these are satisfied. To increase our knowledge of foster children's needs and how these are conceptualized, this paper presents a systematic literature review. Sixty-four empirical articles from six databases were reviewed and categorized (inter-rater agreement K = .78) into four categories: medical, belongingness, psychological and self-actualization needs. The results give a complete overview of needs that are specific to foster children, and what can be implemented to satisfy these needs. This study shows psychological needs are studied more often compared to the other categories, which specially relates to much attention for mental health problems. Furthermore, most articles focus on how to satisfy the needs of foster children and provide no definition or concrete conceptualization of needs. Strikingly, many articles focus on children's problems instead of their needs, and some even use these terms interchangeably. This review illustrates that future research should employ a proper conceptualization of needs, which could also initiate a shift in thinking about needs instead of problems.