Initial Health Outcomes of a Community-Based Collaboration for Children in Foster Care.

Children entering foster care have complex health needs that can persist across the lifespan. Efforts to improve access to primary care services exist; however, few have been tested. This study evaluated the Missoula Foster Child Health Program, a tri-agency, community-based collaboration in Montana, to determine its impact on health outcomes for youth in care. Demographic, health outcome, and child welfare data were collected from 485 children (50 percent male, 50 percent female, aged 0-18). At program admission, children had unmet service needs, lacking a primary care provider (30 percent), a dental provider (58 percent), and required vaccinations (33 percent). Three-quarters of children had at least one health condition, and one-third had a behavioral health concern. Overall, children in the program had significant decreases in physical and behavioral health problems from admission to discharge. Older children and those with fewer placements were more likely to have positive health changes. Data are promising, representing positive health outcomes of a community-based model for children in care.

Addressing Systemic Racism in the American Professional Society on the Abuse of Children Publications.

The United States continues to grapple with longstanding policies and systems that have adversely impacted historically marginalized communities who identify (and are racialized) as non-White. These stem from a legacy of structural and systemic racism, and the long-term consequences of sanctioned colonization. This legacy rests upon a field of scholarly research that is similarly fraught with white supremacy. As a field, we must examine the process of producing and publishing the body of evidence that has codified harmful policies and practices. Although racial and ethnic disparities have been discussed for decades in the child welfare and health systems, systemic racism has received comparatively little attention in academic research and journals. In this commentary, the authors detail concrete steps over the coming years that will advance diversity, equity, inclusion and justice through American Professional Society on the Abuse of Children's (APSACs) flagship journal, Child Maltreatment. The journal is committed to anti-racist publication processes, such that the journal pledges to develop procedures, processes, structures, and culture for scholarly research that promotes diversity, equity, inclusion, and justice in all forms.

Engaging Adolescent Heart Transplant Recipients Through In-App Messaging During Mobile Health Intervention.

Introduction: Adolescents heart transplant recipients experience difficulty with adherence to immunosuppressive medication leading to increased risk of organ rejection, hospitalization, and mortality. Few interventions have been successful to promote medication adherence in adolescent heart transplant patients as most fail to engage the patient in the behavioral change process and support patient-provider communication. The purpose of this study was to explore the nature and degree of in-app communication between adolescent heart transplant recipients and nursing staff during an asynchronous mobile video directly observed therapy intervention. Methods: A content analysis of 894 in-app messages exchanged between 10 adolescent patients and nurses during a 12-week mobile-based intervention was conducted. Two authors used an inductive, iterative process to guide a thematic analysis of the asynchronous in-app messages with high interrater reliability ranging from 81.5% to 100%. Findings: In-app messages fell under 3 broad content categories: (1) interpersonal support and rapport-building, (2) medically related questions and information, or (3) functional information about the intervention and the mHealth app. Results demonstrated the degree to which interpersonal engagement occurred during the intervention, the nature of these exchanges, and their relationship to medication adherence. Conclusions: The study provided insights into the feasibility and benefits of 2-way communication features of the directly observed therapy intervention in promoting engagement and in improving medication adherence among adolescent heart transplant patients. Continued research and clinical focus on patient engagement and impactful aspects of interpersonal communication could aid in the translation of this intervention into standard clinical care at pediatric transplant centers.

How do Students Involved with a Campus Support Program for Students with a History of Foster Care, Relative Care, or Homelessness Fare After Graduation?

Background: Postsecondary education can provide opportunities for students from traditionally hidden populations like those who have experienced foster care or homelessness. To assist these students, campus support programs (CSPs) provide a wide range of services and activities. Objective: Evidence of the impact of CSPs is limited, and little is known about how students who were involved in CSPs fare at or after graduation. This study seeks to address these gaps in knowledge. Methods: This mixed-methods study surveyed 56 young people involved in a CSP for college students who have experienced foster care, relative care, or homelessness. Participants completed surveys at graduation, 6 months post-graduation, and one-year post-graduation. Results: At graduation, over two-thirds of the students felt completely (20.4%) or fairly (46.3%) prepared for life after graduation. Most felt completely (37.0%) or fairly confident (25.9%) that they would get a job after graduation. Six months after graduation, 85.0% of the graduates were employed, with 82.2% working at least full-time. 45% of the graduates were enrolled in graduate school. These numbers were similar a year after graduation. Post-graduation, participants described areas of their lives that were going well, obstacles and hardships faced, changes they would like to see in their lives, and post-graduation needs. Across these areas themes were present in the areas of finances, work, relationships, and resilience. Conclusions: Institutions of higher education and CSP should assist students with a history of foster care, relative care, and homelessness to ensure that after graduation, they have adequate money, employment, and support.

Using research-practice-policy partnerships to mitigate the effects of childhood trauma on educator burnout.

BACKGROUND: The effects of COVID-19 pandemic on children have been immense. OBJECTIVE: In this commentary, we argue for the need to utilize research-practice-policy partnerships to address the issue of educator burnout and Secondary Traumatic Stress. PARTICIPANTS AND SETTING: Education systems have the potential to be the site of public health interventions in helping to identify and address the needs of children and families. METHODS: In this commentary, we review the literature on child trauma and adversity, educator burnout, and research-practice-policy partnerships. RESULTS: With the return to in-person learning, educators, and the systems in which they work are overwhelmed by the magnitude of mental health challenges presenting in the classroom due to child trauma. As a result, many educators are reporting high levels of compassion fatigue, secondary trauma, and burnout, which are known predictors of leaving the workforce. Many of the strategies employed to address educator compassion fatigue, secondary trauma, and burnout focus directly on the individual level (e.g., deep breathing, yoga). Yet the compassion fatigue, secondary trauma, and burnout are rooted in larger system failures to address the growing needs of children and families. CONCLUSIONS: By bringing together key community members, including educators, and utilizing local data to inform policy decisions, actionable, trauma-informed solutions can create the conditions for thriving educators and therefore, thriving children.

"Business as Usual": Child Protective Services Workers' Perceptions and Experiences of and Responses to Client-Perpetrated Violence.

Client-perpetrated violence (CPV) against child protective services (CPS) workers is prevalent and problematic for workers and clients leading to psychological distress, physical injury, and compromised service delivery. With accumulating evidence of prevalence and detrimental consequences, few studies examine the characteristics of violent incidents among CPS workers. This study explores how CPS workers perceive CPV through exploring characteristics of incidents that they experienced. We applied components of the stress process model to consider the importance of workers' perspectives when interpreting violence and its effects. We used inductive, thematic analysis to analyze interview data focused on workers' experiences with CPV during their first 3 years as CPS workers. The qualitative subsample (N = 34) was drawn from the Florida Study of Professionals for Safe Families (FSPSF), a statewide, longitudinal sample of recently hired frontline child welfare workers. With few exceptions, workers experienced a variety of physical and nonphysical violence. Some experienced more frequent exposure than others, particularly those who defined yelling as violent. Workers identified predictable patterns of violent circumstances and people, and commonly felt that their agencies treated violence as "business as usual." The high prevalence of violence, often predictable, indicates the importance of promoting a violence-free workplace through agency culture and responding to workers' reports of CPV with empathy and support. In addition, given workers' diverse perceptions of CPV, a manual could provide definitions of CPV, procedures to increase worker safety, and procedures to respond effectively to violence. Skill-based trainings can support workers at all levels to minimize, yet prepare for and handle, violence.

Elementary School-Aged Children in Therapeutic Residential Care: Examining Latent Classes, Service Provision, and Outcomes.

BACKGROUND: Approximately one-third of children in residential care are elementary-school aged. Yet, little is known about the subset of younger children in residential care and the nature of these placements. OBJECTIVE: This study identified latent classes of younger children in residential care and compared the purposes for placement, treatment processes, and outcomes across classes. PARTICIPANTS AND SETTING: The sample included 216 children (ages 5-10) placed in therapeutic residential care. METHODS: A three-step latent class model was used to estimate conditional effects of class membership on impairment at discharge, length of stay, and discharge placement. A content analysis of a randomly selected sample of case records from each class was used to explore placement processes. RESULTS: There were three classes identified (class 1: child welfare/multi-problem families; class 2: mental-health/angry-oppositional; class 3: strong families/attachment). All classes experienced large improvements in functioning. Children in class 3 were in care longer (CI95% 1.72, 15.48) and experienced greater reductions in impairment (CI95% -11.17, -32.06) than class 2. Classes did not differ in rates of discharge to family-based care, however, more children in classes 1 (20.9%) and 3 (21.6%) discharged to group-based placements than class 2 (11.1%). The content analysis revealed similarities in reasons for placement and treatment processes across classes with some distinctions. Service goals were similar across classes and focused on emotional management, social skills, and developing trust. CONCLUSION: The results supported individualized approaches to facilitate discharge to stable, family-based care and reduced risks for re-entry and prolonged out-of-home care for younger children.

Systems theory as a framework for examining a college campus-based support program for the former foster youth.

Increased attention to former foster youth pursuing post-secondary education has resulted in the creation of college campus based support programs to address their need. However, limited empirical evidence and theoretical knowledge exist about these programs. This study seeks to describe the application of systems theory as a framework for examining a college campus based support program for former foster youth. In-depth semi-structured interviews were conducted with 32 program stakeholders including students, mentors, collaborative members, and independent living program staff. Using qualitative data analysis software, holistic coding techniques were employed to analyze interview transcripts. Then applying principles of extended case method using systems theory, data were analyzed. Findings suggest systems theory serves as a framework for understanding the functioning of a college campus based support program. The theory's concepts help delineate program components and roles of stakeholders; outline boundaries between and interactions among stakeholders; and identify program strengths and weakness. Systems theory plays an important role in identifying intervention components and providing a structure through which to identify and understand program elements as a part of the planning process. This study highlights the utility of systems theory as a framework for program planning and evaluation.

Adapting a parenting intervention for parents aging out of the child welfare system: A systematic approach to expand the reach of an evidence-based intervention.

Parents aging out of the child welfare system face a constellation of unique risk factors that threaten the well-being of themselves and their children. Although parenting interventions are an important resource for providing much-needed services to parents aging out, there is currently a lack of evidence-based parenting interventions that address the unique needs of this population. The purpose of this project was to systematically adapt an evidence-based parenting intervention for parents aging out. An established adaptation framework was used to guide this process, and acceptability and feasibility outcomes were evaluated as part of a pilot study of the adapted intervention. Preliminary intervention adaptations included modifications to program delivery and program content. Study findings indicated a high level of parent satisfaction with the adapted intervention but challenges to feasibility because of inconsistent attendance and the substantial effort required for intervention delivery. This study constitutes a critical first step toward increasing the reach of evidence-based parenting interventions among parents aging out of the child welfare system and underscores the need for continued efforts to develop sustainable and effective parenting services for this at-risk population. (PsycINFO Database Record

Incarcerated Women's Experiences and Perceptions of Participating in Research.

The research process within prisons has largely considered researchers' perspectives. Only one known study explicitly examined incarcerated persons' perceptions and no known studies have explored incarcerated persons' experiences with research on sensitive topics. This study examines incarcerated women's experiences with participating in research on victimization. A thematic analysis was conducted on responses to open-ended questions about participating in a research study from 227 women in two prisons who participated in a study about victimization. Women prisoners were overwhelmingly positive about participating in the research study with the vast majority willing to participate in a future study. Participants believed participating in the study provided opportunities for them to share their story, heal, reflect, grow, and help others. Some women mentioned that discussing certain topics created uncomfortable emotions and memories. Participants perceived benefits of participating in research. Implications for research in prisons are presented.

Child maltreatment reporting patterns and predictors of substantiation: comparing adolescents and younger children.

Adolescents, and especially male adolescents, make up a disproportionately smaller portion of maltreatment reports compared to younger children. This study used the National Child Abuse and Neglect Data System to better understand the characteristics of adolescents reported to Child Protective Services (CPS), to examine whether these characteristics changed over time, and to determine whether certain child or CPS report characteristics predicted CPS involvement. Although adolescents were the focal group, younger children were also analyzed for comparison. Between 2005 and 2010, reports of neglect and the proportion of children of Hispanic and unknown racial/ethnic origins increased. Concurrently, the proportion of cases resulting in CPS involvement declined. Although race/ethnicity predicted CPS involvement, this pattern was not consistent across all age groups or races/ethnicities. The type of alleged maltreatment did not typically predict CPS involvement; however, allegations of sexual abuse among school-aged children and adolescents, particularly among girls, were more likely to result in CPS involvement. These findings can assist child welfare professionals in determining appropriate services tailored to families and developing prevention programs targeting adolescents.

Patterns of mental health, substance abuse, and justice system involvement among youth aging out of child welfare.

Although research on youth aging out of the child welfare system has increased, there has been limited focus on how their experiences vary. In particular, there is a need to examine patterns in the involvement of these youth in other systems, which indicate constellations of challenges facing these young people as they transition out of care and into adulthood. Using administrative data from a large birth cohort of individuals born between 1985 and 1994 whose families have been involved in the child welfare system, this article presents an analysis of the mental health, substance abuse, juvenile justice, and criminal justice system involvement of youth who have aged out of child welfare. Using a 2-step cluster analysis, we identify 5 subgroups of youth. Two of these groups, accounting for almost half of the youth, have little other system involvement and have child welfare care careers of relative stability. The other 3 groups, consisting of just over half of the youth, have much more extensive other system involvement, as well as care careers marked by instability and a greater proportion of time spent in congregate care.

Gene-environment interplay and the importance of self-control in predicting polydrug use and substance-related problems.

Using the National Longitudinal Study of Adolescent Health (Add Health), the current study applies a general biosocial theoretical model to polydrug use and associated substance-related problems. Along with measures of molecular genetic polymorphisms, neurocognitive skills, self-control, and environmental pathogens a recursive path modeling strategy was used to empirically examine the relations between these biosocial measures and polydrug use, alcohol, and drug-related problems in a subsample of 1136 adolescent males (Mean age=21.96, SD=1.73). Results supported the main predictions of the biosocial model finding significant path coefficients across key constructs. In particular, the role of poor self-regulation was found to be sturdy across path models.