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.

Does severity of physical neglect moderate the impact of an efficacious preventive intervention for maltreated children in foster care?

Physically neglected youth are at increased risk of mental health problems, but there are few interventions that have demonstrated efficacy in reducing mental health symptoms for this vulnerable population. The Fostering Healthy Futures (FHF) program, which consists of mentoring and skills groups, was developed for preadolescent youth in foster care. In a published randomized controlled trial with 156 youth, FHF demonstrated positive impacts on mental health functioning. The current study sought to determine whether FHF might be particularly effective in ameliorating the impact of neglectful family environments. Because it was not possible to isolate a neglected-only subgroup, as most children with physical neglect histories had experienced other types of maltreatment, we tested the hypothesis that intervention effects would be stronger among children with more severe physical neglect. Findings did not support this hypothesis, however, as severity of physical neglect did not significantly moderate the impact of the intervention on psychosocial outcomes.

Does subtype matter? Assessing the effects of maltreatment on functioning in preadolescent youth in out-of-home care.

OBJECTIVES: Attempts to understand the effects of maltreatment subtypes on childhood functioning are complicated by the fact that children often experience multiple subtypes. This study assessed the effects of maltreatment subtypes on the cognitive, academic, and mental health functioning of preadolescent youth in out-of-home care using both "variable-centered" and "person-centered" statistical analytic approaches to modeling multiple subtypes of maltreatment. METHODS: Participants included 334 preadolescent youth (ages 9-11) placed in out-of-home care due to maltreatment. The occurrence and severity of maltreatment subtypes (physical abuse, sexual abuse, physical neglect, and supervisory neglect) were coded from child welfare records. The relationships between maltreatment subtypes and children's cognitive, academic, and mental health functioning were evaluated with the following approaches: (1) "Variable-centered" analytic methods: a. Regression approach: Multiple regression was used to estimate the effects of each maltreatment subtype (separate analyses for occurrence and severity), controlling for the other subtypes. b. Hierarchical approach: Contrast coding was used in regression analyses to estimate the effects of discrete maltreatment categories that were assigned based on a subtype occurrence hierarchy (sexual abuse > physical abuse > physical neglect > supervisory neglect). (2) "Person-centered" analytic method: Latent class analysis was used to group children with similar maltreatment severity profiles into discrete classes. The classes were then compared to determine if they differed in terms of their ability to predict functioning. RESULTS: The approaches identified similar relationships between maltreatment subtypes and children's functioning. The most consistent findings indicated that maltreated children who experienced physical or sexual abuse were at highest risk for caregiver-reported externalizing behavior problems, and those who experienced physical abuse and/or physical neglect were more likely to have higher levels of caregiver-reported internalizing problems. Children experiencing predominantly low severity supervisory neglect had relatively better functioning than other maltreated youth. CONCLUSIONS: Many of the maltreatment subtype differences identified within the maltreated sample in the current study are consistent with those from previous research comparing maltreated youth to non-maltreated comparison groups. Results do not support combining supervisory and physical neglect. The "variable-centered" and "person-centered" analytic approaches produced complementary results. Advantages and disadvantages of each approach are discussed.

RCT of a mentoring and skills group program: placement and permanency outcomes for foster youth.

OBJECTIVE: To examine the impact of a mentoring and skills group intervention for preadolescent children in foster care on placement stability and permanence at 1-year postintervention. METHODS: A randomized controlled trial was conducted with 9- to 11-year-old children who were maltreated and placed in foster care (n = 54 control; n = 56 intervention). State child welfare records provided information on number of placement changes, placement in residential treatment, and case closure (ie, permanency). Rates of adoption and reunification were also examined. Analysis was by intention to treat. RESULTS: After controlling for baseline functioning and preintervention placement history, intervention youth were 71% less likely to be placed in residential treatment (odds ratio [OR] = 0.29, 95% confidence interval [CI] 0.09-0.98). There were no significant treatment differences in predicting placement changes or permanency for the total sample. Among a subsample of children living in nonrelative foster care at baseline, intervention youth had 44% fewer placement changes (incidence ratio = 0.56, 95% CI 0.34-0.93), were 82% less likely to be placed in a residential treatment center (OR = 0.18, 95% CI 0.03-0.96), and were 5 times more likely to have attained permanency at 1 year postintervention (OR = 5.14, 95% CI 1.55-17.07). More intervention youth had reunified 1-year postintervention [χ(2)(1, N = 78) = 3.99; P < .05], and the pattern of findings suggested that intervention youth had higher rates of adoption. A significant interaction [χ(2)(1, N = 110) = 5.43; P = .02] demonstrated that the intervention attenuated the impact of baseline behavior problems on placement changes. CONCLUSIONS: The findings suggest that participation in a 9-month mentoring and skills group intervention leads to greater placement stability and permanence, especially for children in nonrelative foster care.

Psychosocial Consequences of Intimate Partner Violence (IPV) Exposure in Maltreated Adolescents: Assessing More than IPV Occurrence.

The majority of research on the psychosocial impact of intimate partner violence (IPV) exposure for children has focused on IPV occurrence. The current study extended this research by examining three dimensions of IPV exposure: frequency, proximity, and severity, and tested whether these dimensions predicted variance in adolescents' psychosocial problems over-and-above that accounted for by IPV occurrence. Participants included 140 adolescents and their caregivers, who were recruited for an intervention involving maltreated youth placed in out-of-home care. After controlling for IPV occurrence, exposure to community violence, and severity of maltreatment, results indicated a positive association between the multidimensional IPV index and youth report of psychosocial problems. There was also a trend for a positive association between the IPV index and caregiver report of psychosocial problems for boys. The study's results are discussed in terms of their implications for prevention researchers and child welfare agencies.

Attention Problems Mediate the Association between Severity of Physical Abuse and Aggressive Behavior in a Sample of Maltreated Early Adolescents.

Empirical evidence has accumulated documenting an association between childhood physical abuse and aggressive behavior. Relatively fewer studies have explored possible mediating mechanisms that may explain this association. The purpose of the current study was to examine whether caregiver- and youth-reported attention problems mediate the association between physical abuse severity and aggressive behavior. A sample of 240 maltreated early adolescents (ages 9-11) and their caregivers were interviewed within 14 months of being removed from the home. Results from multiple regression analyses indicated that caregiver- and youth-reported attention problems were partial mediators of the association between physical abuse severity and aggressive behavior. These associations were significant even after controlling for children's intellectual functioning, sex, age, and severity of other maltreatment types. Possible explanations for the detrimental impact of physical abuse on behavior are discussed, along with the implications of the current study's results for interventions aimed at reducing early adolescent aggressive behavior.

Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations?

For children in out-of-home care, a significant gap exists between those who need services and those who receive them. Screening all children in out-of-home care is recommended to reduce this gap. This study was designed to determine if recommendations from mental health and educational screening evaluations were related to service implementation for youth in out-of-home care. Screening evaluations were completed with 171 maltreated youth (ages 9 to 11) in out-of-home care within the prior year. Written reports summarizing the findings were provided to children's caseworkers. Service utilization was assessed at baseline (T1; before screening reports were completed) and follow-up (T2; 9-12 months later) interviews. For children not already receiving services at T1, logistic regression analyses tested the association between T1 recommendations for services and new service implementation by T2. Mental health (youth-report) and educational (teacher-report) outcomes were analyzed separately. Screening evaluations identified 22% of children with unmet mental health needs and 36% with unmet educational needs at T1. Children who received a recommendation for new services (i.e., all of those with unmet needs) were more likely to receive mental health (OR=2.50, p=.06) and/or educational (OR=3.54, p=.04) services by T2 than children who did not receive recommendations for services. While recommendations increased the odds of receiving services, almost half of the children with unmet mental health needs did not receive services, and 84% of children with unmet educational needs did not receive services by T2. Much work remains to ensure youth receive needed services.

Psychosocial consequences of caregiver transitions for maltreated youth entering foster care: the moderating impact of community violence exposure.

Youth who experience a greater number of caregiver transitions during childhood are at risk for developing a host of psychosocial problems. Although researchers have examined individual-level factors that may moderate this association, no known studies have examined the impact of community-level factors. The current study investigated whether community violence exposure (CVE) moderated the association between number of prior caregiver transitions and increases in levels of externalizing and internalizing problems for a sample of youth entering foster care. Participants included 156 youth (aged 9-11 at first assessment) removed from their homes because of maltreatment. Youth provided reports of caregiver transitions and CVE at baseline, and caregivers, teachers, and youth reported on externalizing and internalizing problems 18-22 months later. Results from hierarchical multiple regression analyses indicated that youth with a greater number of caregiver transitions and higher levels of CVE evidenced significant increases in levels of psychosocial problems. The results of the study are discussed in terms of their implications for child welfare services.

Cumulative risk exposure and mental health symptoms among maltreated youth placed in out-of-home care.

OBJECTIVE: Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study was to elucidate the relation between cumulative risk and mental health symptomatology. METHODS: The study consisted of a sample of 252 maltreated youths (aged 9-11) placed in out-of-home care. RESULTS: Analyses confirmed the high-risk nature of this sample and identified seven salient risk variables. The cumulative risk index comprised of these seven indicators was a strong predictor of mental health symptoms, differentiating between children who scored in the clinical range with regard to mental health symptoms and those who did not. Finally, the data supported a linear model in which each incremental increase in cumulative risk was accompanied by an increase in mental health problems. CONCLUSION: This is the first known study to examine cumulative risk within a sample of youths in out-of-home care.

Impact of a mentoring and skills group program on mental health outcomes for maltreated children in foster care.

OBJECTIVE: To evaluate the efficacy of the Fostering Healthy Futures program in reducing mental health problems and associated problems. DESIGN: Randomized controlled trial. SETTING: Denver metropolitan area. PARTICIPANTS: Children aged 9 to 11 years who were maltreated and placed in foster care. INTERVENTION: Children in the control group (n=77) received an assessment of their cognitive, educational, and mental health functioning. Children in the intervention group (n=79) received the assessment and participated in a 9-month mentoring and skills group program. MAIN OUTCOME MEASURES: Children and caregivers were interviewed at baseline prior to randomization, immediately following the intervention, and 6 months after the intervention. Teachers were interviewed 2 times after baseline. Measures included a multi-informant index of mental health problems, youth-reported symptoms of posttraumatic stress, dissociation, and quality of life, and caregiver- and youth-reported use of mental health services and psychotropic medications. RESULTS: After adjusting for covariates, intent-to-treat analyses demonstrated that the treatment group had fewer mental health problems on a multi-informant factor 6 months after the intervention (mean difference, -0.51; 95% confidence interval, -0.84 to -0.19), reported fewer symptoms of dissociation 6 months after the intervention (mean difference, -3.66; 95% confidence interval, -6.58 to -0.74), and reported better quality of life immediately following the intervention (mean difference, 0.11; 95% confidence interval, 0.03 to 0.19). Fewer youths in the intervention group than in the control group had received recent mental health therapy 6 months after the intervention according to youth report (53% vs 71%, respectively; relative risk=0.75; 95% confidence interval, 0.57 to 0.98). CONCLUSIONS: A 9-month mentoring and skills group intervention for children in foster care can be implemented with fidelity and high uptake rates, resulting in improved mental health outcomes. Trial Registration clinicaltrials.gov Identifier: NCT00809315.

Emotional Maltreatment and Psychosocial Functioning in Preadolescent Youth Placed in Out-of-Home Care.

This paper examines the impact of emotional maltreatment on the psychosocial functioning of youth placed in out-of-home care as a result of maltreatment. Participants included 243 children participating in a randomized controlled trial of a preventive intervention for preadolescent youth placed in out-of-home care. This study analyzed baseline data collected pre-randomization from interviews with children and their out-of-home caregivers and data from child welfare records. Bivariate and regression analyses were used to explore the relationships between emotional maltreatment and interpersonal functioning, self-perception, mental health, and behavioral problems for the total sample and by gender. Findings suggest that subtypes of emotional maltreatment are associated with different outcomes and that males are more negatively impacted by emotional maltreatment than are females.

Does community violence exposure predict trauma symptoms in a sample of maltreated youth in foster care?

Previous studies find that childhood exposure to family and community violence is associated with trauma symptoms. Few studies, however, have explored whether community violence exposure (CVE) predicts trauma symptoms after controlling for the effects associated with family violence exposure (FVE). In the current study, CVE and FVE were examined in a sample of 179 youth with a recent history of maltreatment. CVE was associated with trauma symptoms after controlling for FVE, but FVE was not associated with trauma symptoms after controlling for CVE. In addition, negative coping strategies (e.g., self-harm, interpersonal aggression) partially mediated the association between CVE and trauma symptoms. These findings are discussed in terms of their implications for interventions aimed at addressing the needs of children exposed to violence.

Children's Appraisals of their Experiences in Out-of-Home Care.

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.

Mentoring Children in Foster Care: Impact on Graduate Student Mentors.

Fostering Healthy Futures (FHF) is a randomized controlled trial of an intervention for preadolescent youth placed in foster care as a result of maltreatment. As part of the FHF program, graduate students spend 16-20 hours per week mentoring two youth in foster care and receive intensive training and supervision. During the summer and fall of 2009, 50 of the 52 mentors who participated in the FHF program between the summers of 2002 and 2008 completed an online survey. Almost all reported that their participation in the FHF program was helpful or very helpful in training them to work with high-risk children and families, diverse communities, multiple systems, and other professionals. Qualitative analyses of mentors' responses to open-ended questions yielded several salient themes.

Fostering healthy futures: an innovative preventive intervention for preadolescent youth in out-of-home care.

Although we have not yet demonstrated empirically that the FHF program is effective in addressing mental health, behavioral, and academic issues among preadolescent youth placed in foster care, we believe we have a very promising model. We have successfully negotiated many challenges of conducting a RCT within a child welfare setting, in large part because of the collaboration and support of our community partners. The ultimate goal of this research is to develop more efficacious interventions, thereby reducing adverse life-course outcomes and promoting healthy futures, not only for youth in out-of-home care, but for all youth at risk.