Building a specialized model of care for youth involved in sex trafficking in child welfare: A systematic review and interviews with experts-by-experience.

BACKGROUND: Sex trafficking of youth involved in the child welfare system is a critical global issue; however, there are limited counter-trafficking programs designed to specifically meet the needs of this population. OBJECTIVE: The present study aimed to identify components essential to building a model of care for youth involved in sex trafficking in child welfare. The specific goals of this investigation were to: 1) systematically review the literature for programs implemented with child-welfare involved youth at risk of or involved in sex trafficking, and 2) examine convergent and divergent evidence through interviews with experts-by-experience (i.e., survivors and child welfare personnel). PARTICIPANTS AND SETTING: 13 child welfare workers and 6 survivors of sex trafficking. METHODS: Systematic review identified articles that included programs and interventions for youth involved in sex trafficking in child welfare. Interviews with experts-by-experience were analysed through reflexive thematic analysis. Content analysis was used to examine convergent and divergent evidence between the two noted methods of inquiry (systematic review and interviews with experts). RESULTS: Findings from the systematic review support a model of care comprised of two overarching components: 1) wraparound supports, and 2) trained caregivers and supported foster homes. Thematic analyses also revealed that experts thought that an appropriate model of care would require child welfare agencies to take a preventative stance, such as conducting early coordinated risk assessments on all youth in care. Convergent with the literature, experts noted the need for enhanced wraparound supports and specific training for caregivers and service providers. CONCLUSIONS: Components essential to building a model of care for youth at risk of or involved in sex trafficking in child welfare were extracted and discussed based on the evidence gathered.

Characterizing language outcomes following childhood basal ganglia stroke.

The basal ganglia are important for movement and executive function, but its contribution to language is less understood. This study explored language outcomes associated with childhood basal ganglia stroke. A detailed language coding scheme, which examined expressive and receptive language, verbal fluency, narrative discourse, pragmatic/applied language, and academics, was developed from qualitative and quantitative data acquired from neuropsychological testing and reports. Overall intellectual functioning and verbal comprehension was in the average range. Twelve participants had psychological diagnoses, including Learning Disorder. No one had a Language Disorder diagnosis. Among the 18 children who did not receive a diagnosis, many exhibited language issues in the mild to severe range according to our coding scheme. These children had higher-order language difficulties in verbal fluency, narrative, and pragmatic language rather than overt expressive difficulties noted in Diagnostic and Statistical Manual (DSM) diagnostic criteria. There was an association between infarct size and ESL/immersion education, math performance, and presence of a psychological diagnosis. Psychological diagnosis was also associated with literacy skills. The results highlight that language issues following basal ganglia stroke may not be fully captured by standardized neuropsychological tests and psychological diagnoses. Findings reinforce the need to integrate quantitative and qualitative findings when examining language functioning.

The Response to Stress Questionnaire for Parents Following Neonatal Brain Injury.

OBJECTIVE: The Response to Stress Questionnaire-Brain Injury (RSQ-BI) was adapted utilizing a patient-oriented approach, exploring parental stress, coping, and associated mental health outcomes in parents of children with neonatal brain injury. The contributions of social risk, child adaptive functioning, and brain injury severity were also explored. METHODS: Using a mixed-method design, this study explored adapted stressor items on the RSQ-BI. Parents and clinicians engaged in semistructured interviews to examine key stressors specific to being a parent of a child with neonatal brain injury. The adapted RSQ-BI was piloted in a parent sample (N = 77, child mean age 1 year 7 months) with established questionnaires of social risk, child adaptive functioning, severity of the child's injury, coping style, and parent mental health. Descriptive statistics and correlations examined parent stress, coping, and their association with parent mental health. RESULTS: The final RSQ-BI questionnaire included 15 stressors. Factor analysis showed stressors loaded onto two factors related to (a) daily role stressors and (b) brain injury stressors. Using the RSQ-BI, parents reported brain injury stressors as more stressful than daily role stressors. When faced with these stressors, parents were most likely to engage in acceptance-based coping strategies and demonstrated lower symptoms of parent depression and anxiety. CONCLUSIONS: The RSQ-BI provides a valuable adaptation to understand both stressors and coping specific to being a parent of a child with neonatal brain injury. Relevant interventions that promote similar coping techniques are discussed for future care and research.

Cognitive and Academic Outcomes Following Childhood Cortical Stroke.

The majority of pediatric neuropsychological stroke research has focused on perinatal stroke outcomes given its relative frequency. Meanwhile, childhood-onset stroke is under-represented in the literature, resulting in limited knowledge about its neurocognitive sequelae. This retrospective study examined cognitive outcomes in children and youth (n = 27) with childhood arterial ischemic stroke (stroke occurring between 29 days and 18 years of life) isolated to the cortical region. Intellectual, academic, language, visual-perception, visual-motor integration, fine motor coordination, and executive function scores were examined relative to normative means. Results indicate that although these children are doing well in terms of general intellectual ability, they demonstrate lower scores on tasks of processing speed and fine motor coordination. Exploratory analysis also revealed that of the personal and neurologic factors examined, age at stroke was positively correlated with perceptual reasoning and fine motor control, age at assessment was negatively correlated with math calculation abilities, and maternal education was positively correlated with working memory and parent-reported behavioral regulation and impulse inhibition abilities. While neurologic variables were not predictive of cognitive neuropsychological outcomes, those with significant poorer performance had higher rates of medium/large, right-sided lesions with frontal lobe involvement. Our results highlight the overall resilience of the injured developing brain but also the vulnerability of specific cognitive skills within this unique population.

From Diagnoses to Ongoing Journey: Parent Experiences Following Congenital Heart Disease Diagnoses.

OBJECTIVE: Using qualitative and quantitative methods, the current cross-sectional study examined parents' experiences at the time of their child's diagnosis, what they thought helped their child recover, barriers to support, and identified needs for future models of care. METHOD: The sample included 26 parents (22 mothers, 3 fathers, and 1 mother/father pair) of children with CHD, ranging in age between 6 months and 4 years with a mean age of 2 years. RESULTS: Qualitative results were organized around five themes: (a) They (medical team) saved my child's life, (b) My child is going to be okay, (c) Not out of the woods, (d) Optimizing support for my child and myself, and (e) What still gets in the way. Parents uniformly expressed a need for greater mental health support for their children as well as programs to improve parents' skill and confidence, with no difference between age groups (< 2 years and > 2 years of age). Common barriers to service included distance and time off work. CONCLUSION: Parents' experiences informed both acute and long term implications following CHD diagnoses, and highlight current gaps in mental health care. Direction for clinical care and improved intervention opportunities are discussed.

Longitudinal Academic Outcomes of Children with Secondary Attention Deficit/Hyperactivity Disorder following Pediatric Stroke.

The current longitudinal study examined academic outcomes of children diagnosed with secondary attention deficit-hyperactivity disorder (S-ADHD) following stroke in comparison to children with stroke-only and children with developmental ADHD (D-ADHD), and explored potential predictors of progress in these groups. We followed 55 children (n = 17 S-ADHD, n = 18 stroke-only, and n = 20 D-ADHD) over approximately four years. Children with S-ADHD and D-ADHD were more likely to have a comorbid learning disability, but children with S-ADHD were more likely to have declines in their reading scores over time. No individual or neurological factors accounted for declines. Math scores were equally likely to decline across all youth.

Understanding Early Childhood Resilience Following Neonatal Brain Injury From Parents' Perspectives Using a Mixed-Method Design.

OBJECTIVES: The current study used a mixed-method design to qualitatively examine parents' definitions of resilience and factors they believed optimized their child's early outcome following neonatal brain injury. This was followed by quantitative analyses of early developmental and mental health outcomes and their relation to salient biopsychosocial factors. METHODS: Participants were parents of children diagnosed with neonatal brain injury due to stroke or hypoxic-ischemic encephalopathy (N=51; age range of children 18 months to 8 years). The Parent Experiences Questionnaire (PEQ) was used to qualitatively analyze parents' open-ended responses about their child's early experiences and outcome. The Child Behavior Checklist (CBCL) and Scales of Independent Behaviour Early Developmental Form (SIB-ED) parent ratings were used to measure child resilience from a quantitative perspective, identifying "at-risk" and "resilient" children using standard cutoffs. "Resilient" and "at-risk" children were compared on biopsychosocial variables using univariate t tests and chi-square analyses. RESULTS: Parents provided five unique definitions of their child's positive outcomes, and many children demonstrated resilience based on parent perspectives and quantitative definitions. Supporting factors included close medical follow-up, early intervention, and intrinsic factors within the child and parent. Group comparisons of "resilient" and "at-risk" children highlighted the importance of parent mental health across these early developmental and mental health outcomes. CONCLUSIONS: Many children were described as resilient during the early years by parents using qualitative and quantitative approaches. Findings highlighted the importance of parent well-being in promoting optimal early outcomes. (JINS, 2019, 25, 390-402.).

Predictors of Cognitive and Academic Outcome following Childhood Subcortical Stroke.

Childhood arterial ischemic stroke often involves basal ganglia and thalamus but little is known about neuropsychological outcomes in this group. We examined intellectual ability, academics, attention, executive function, and psychological diagnoses in children and adolescents (6-20 years of age) with childhood stroke involving the basal ganglia (n = 32) or thalamus (n = 12). Intellectual ability was age-appropriate but working memory was significantly lower than expected. Compared to the normative mean, the stroke group exhibited significantly weaker performance in reading comprehension, math fluency, attention, and greater challenges with executive function. Children with basal ganglia stroke had weaker working memory and were more likely to receive diagnoses of Attention Deficit Hyperactivity Disorder and Anxiety Disorder than those with thalamic stroke. Lesion size was most important in predicting working memory ability, whereas age at stroke and age at test were important in predicting academic ability.

In their own words: developing the Parent Experiences Questionnaire following neonatal brain injury using participatory design.

PRIMARY OBJECTIVE: This study aimed to create a specific questionnaire (Parent Experiences Questionnaire) about early experiences, service involvement, and needs of children and parents following neonatal brain injury that could be used to inform clinical care and needed interventions. RESEARCH DESIGN AND METHODS: A mixed-method design was utilized, engaging in both qualitative and quantitative methods across three phases. Phase 1 employed participatory design involving 12 parent and clinician participants in semi-structured interviews to address main topics, item importance, and overall impressions of the questionnaire. In phase 2, the questionnaire was piloted by 32 parents. Post hoc revisions added four questions to address current parent and child therapeutic needs in phase 3. MAIN OUTCOMES AND RESULTS: The final questionnaire yielded 24 items addressing topics of early communication between parent and clinicians, early intervention services, efficacy, and barriers in optimizing the child's development and parents' experience. The questionnaire was reviewed positively by a group of parents in phase 2 and demonstrated good acceptance, online feasibility, stability, and association with current parental mental health and child development. CONCLUSIONS: This investigation offers a valuable new questionnaire to inform clinical care regarding discussions with parents about neonatal brain injury, evaluate the perceived efficacy of early intervention services, and guide relevant future intervention efforts.

[Formula: see text]Neurocognitive outcomes in children with unilateral basal ganglia arterial ischemic stroke and secondary hemidystonia.

Dystonia is a movement disorder that involves excessive, involuntary muscle contractions resulting in repetitive movements and/or abnormal posturing. One common cause of unilateral dystonia in childhood is ischemic stroke involving the basal ganglia and/or thalamus. Virtually nothing is known about neuropsychological outcomes in children who have dystonia following basal ganglia stroke. The present study explored whether or not children with secondary dystonia experience additional cognitive challenges when compared to children with similar patterns of brain injury, but no dystonia. We examined intellectual function, academics, and several aspects of executive function in children with unilateral basal ganglia stroke during childhood, comparing those with dystonia and those without. Although groups did not differ in terms of lesion size, we found significantly lower performance on measures of verbal and nonverbal reasoning, inhibitory control, and academic ability in children with secondary dystonia compared to those without. In contrast, there were no significant group differences on parent ratings of their child's executive function in daily life. These findings suggest that maladaptive reorganization following basal ganglia stroke may contribute to the development of secondary dystonia and also to poor intellectual and academic outcomes in this group.

Prevalence and Predictors of Learning and Psychological Diagnoses Following Pediatric Arterial Ischemic Stroke.

This study examined the prevalence of learning and psychological diagnoses and associated neurological and personal-environmental risk factors following perinatal and childhood arterial ischemic stroke. In our sample of 126 children and youth, 52.4% received a diagnosis following their assessment. Specifically, 32% had a single diagnosis and 21% had two or more diagnoses. Learning disability, attention deficit-hyperactivity disorder, and intellectual disability were the most prevalent diagnoses. Associated risk factors varied by diagnosis with lower intellectual functioning being the common risk factor across categories. Seizure status was associated with intellectual disability whereas family history was related to ADHD and comorbid diagnoses.

Preschoolers' credulity toward misinformation from ingroup versus outgroup speakers.

The current research examined preschoolers' credulity toward misinformation from ingroup versus outgroup speakers. Experiment 1 showed that when searching for a hidden toy, Caucasian English monolingual 4-year-olds were credulous toward the false testimony of a race-and-accent ingroup speaker, despite their firsthand observations of the hiding event, but were skeptical when the false testimony was provided by a race-and-accent outgroup speaker. In the same experiment, 3-year-olds were credulous toward the false testimony of both speakers. Experiment 2 showed that when the false testimony was provided by a same-race-only or same-accent-only speaker, 4-year-olds were not particularly credulous or skeptical. The findings are discussed in relation to how intergroup bias might contribute to the selective credulity in the 4-year-olds as well as the factors that might explain the indiscriminate credulity in the 3-year-olds.

Dress Nicer = Know More? Young Children's Knowledge Attribution and Selective Learning Based on How Others Dress.

This research explored whether children judge the knowledge state of others and selectively learn novel information from them based on how they dress. The results indicated that 4- and 6-year-olds identified a formally dressed individual as more knowledgeable about new things in general than a casually dressed one (Study 1). Moreover, children displayed an overall preference to seek help from a formally dressed individual rather than a casually dressed one when learning about novel objects and animals (Study 2). These findings are discussed in relation to the halo effect, and may have important implications for child educators regarding how instructor dress might influence young students' knowledge attribution and learning preferences.