Fostering Healthy Futures for Teens: Adaptation of an Evidence-Based Program.

OBJECTIVE: This article describes the process of adapting and implementing a complex, multicomponent intervention for a new population. Specifically, the article delineates the development and implementation of the Fostering Healthy Futures for Teens (FHF-T) program, which is an adaptation and extension of the Fostering Healthy Futures® (FHF) preventive intervention. FHF is a 9-month mentoring and skills group program for 9 to 11 year olds recently placed in foster care. Following the designation of FHF as an evidence-based intervention, there was increasing demand for the program. However, the narrow population for which FHF had demonstrated efficacy limited broader implementation of the existing intervention. FHF-T was designed to extend the reach of the program by adapting the FHF intervention for adolescents in the early years of high school who have a history of out-of-home care. Specifically, this adaptation recognizes key developmental differences between preadolescent and adolescent populations. METHOD: After designing a program model and adapting the program components, the FHF-T mentoring program was implemented with 42 youth over 2 program years. RESULTS: Of the teens who were offered the program, 75% chose to enroll, and 88% of those graduated 9 months later. Although the program evidenced high rates of uptake and participant satisfaction, some unexpected challenges were encountered that will need to be addressed in future iterations of the program. CONCLUSIONS: Too often program adaptations are made without careful consideration of important contextual issues, and too infrequently, these adapted programs are studied. Our process of program adaptation with rigorous measurement of program implementation provides a useful model for other evidence-based programs seeking thoughtful adaptation.

Dissociative symptoms and academic functioning in maltreated children: a preliminary study.

Research has identified numerous negative sequelae of child maltreatment that may adversely impact academic functioning (AF). There is limited research, however, on the relationship between specific trauma symptoms, such as dissociation, and poor AF. This cross-sectional study examined the association between dissociative symptoms and multi-informant reports of AF in a sample of maltreated youth with a history of out-of-home care. Participants included 149 youth and their caregivers and teachers. Dissociative symptoms were measured based on youth report, whereas AF was assessed using (a) standardized measures of academic achievement, (b) youth-report measures of school membership and perceived academic competence, (c) caregiver reports of youths' performance in school, and (d) teacher reports of student grades. Results of multiple regression analyses suggested that dissociative symptoms were generally related to poorer AF after IQ, age, gender, and the total number of school and caregiver transitions were controlled. Implications for school personnel are discussed.

Executive function performance and trauma exposure in a community sample of children.

OBJECTIVE: Though children exposed to familial violence are reported to have difficulties with a range of emotional and behavioral problems (e.g., lower school achievement) that implicate executive function (EF) deficits, relatively little research has specifically examined EF as a function of trauma exposure in children. METHODS: Based on parent report of children's exposure to potentially traumatic events, children (N=110; Age(Mean)=10.39) from an ethnically diverse community sample were compared across three trauma-exposure groups: familial trauma, non-familial trauma, and no trauma. Children completed a battery of tests to assess working memory, behavioral inhibition, processing speed, auditory attention, and interference control. RESULTS: Familial trauma (relative to non-familial and no trauma exposure) was associated with poorer performance on an EF composite (composed of working memory, inhibition, auditory attention, and processing speed tasks); the effect size was medium. Both trauma-exposure status and dissociation symptoms explained unique variance in EF performance after controlling for anxiety symptoms, socio-economic status, and potential traumatic brain injury. While IQ and EF performance were related, SES predicted unique variance in IQ (and not EF) scores, while familial-trauma exposure did not. CONCLUSIONS: The contribution of trauma exposure to basic executive functioning held after taking into account symptoms (anxiety and dissociation), socio-economic status, and possible traumatic brain injury exposure. EF problems may provide one route via which maltreated children become at risk for peer, academic, and behavior problems relative to their peers. PRACTICE IMPLICATIONS: EF problems may provide one route via which maltreated children become at risk for peer, academic, psychological, and behavior problems relative to their peers. Recently, intervention strategies have emerged in the anxiety and mood disorder treatment literatures that appear to effectively target EFs. As future research continues to specify the relationship between child trauma exposure and EF performance, these innovative treatments may have important practice implications for addressing EF deficits.

Stroop performance, dissociation, and trauma exposure in a community sample of children.

Extending previous research with adults, the current study examined Stroop task performance under selective and divided attention demands in a community sample of school-age children (N = 97). Stroop interference scores in both attention conditions were calculated. Higher levels of child-reported dissociation were associated with better interference control under divided attention conditions and worse control under selective attention conditions; lower levels of dissociation were associated with the opposite pattern. Both family violence exposure and Stroop interaction scores explained unique variance in dissociation scores. Although research with adults has generally assumed or implied that cognitive correlates of dissociation are a consequence of dissociation, the current findings with school-age children suggest that future research should evaluate executive function performance (in this case, interference control) as a possible risk factor for dissociation.

Trauma-related predictors of deontic reasoning: a pilot study in a community sample of children.

OBJECTIVE: Deontic reasoning (i.e., reasoning about duties and obligations) is essential to navigating interpersonal relationships. Though previous research demonstrates links between deontic reasoning abilities and trauma-related factors (i.e., dissociation, exposure to multiple victimizations) in adults, studies have yet to examine deontic reasoning abilities in children exposed to trauma. Given that social and safety rules (exemplars of deontic reasoning rules) may appear arbitrary for children in the face of trauma exposure, particularly interpersonal violence perpetrated by adults (i.e., caregivers, close relatives), we predicted that the ability to detect violations of these rules would vary as a function of trauma exposure type (no, non-interpersonal, and interpersonal). Additionally, given previous research linking dissociation and deontic reasoning in adults, we predicted that higher levels of dissociation would be associated with more errors in deontic problems. METHODS: Children exposed to interpersonal violence (e.g., sexual abuse by an adult family member, witnessing domestic violence, or physical abuse in the home) were compared to children exposed to non-interpersonal trauma (e.g., motor vehicle accident, natural disaster) or no trauma on their ability to detect violations of deontic and descriptive rules in a Wason Selection Task and assessed for their level of dissociative symptoms. RESULTS: Dissociation (but not trauma exposure type) predicted errors in deontic (but not descriptive) reasoning problems after controlling for estimated IQ, socio-economic status, and children's ages. CONCLUSIONS: The current study provides preliminary evidence that deontic reasoning is associated with dissociation in children. This pilot study points to the need for future research on trauma-related predictors of deontic reasoning. PRACTICE IMPLICATIONS: Deontic rules are essential to navigating interpersonal relationships; errors detecting violations of deontic rules have been associated with multiple victimizations in adulthood. Future research on violence exposure, dissociation, and deontic reasoning in children may have important implications for intervention and prevention around interpersonal functioning and later interpersonal risk.