"I Ran to Make a Point": Predicting and Preventing Youth Runaway from Foster Care.

Youth who run away from foster care experience danger to health and safety and increased risk of adverse child welfare outcomes. By applying a concurrent mixed-methods approach, this study aimed to develop a deeper understanding of runaway risk that used a person-centered lens and amplified youth voices. Collectively, this approach can inform service innovations to support youth placed in out-of-home care. Working with a foster care agency in Kansas, data sources comprised administrative data for youth ages 12 + in care, and interview data with 20 youth, 12 + in care. Quantitative analyses involved latent class analysis followed by multinomial logistic regression to investigate whether the population of youth in care was comprised of subpopulations with differential runaway risk and whether subpopulations would predict runaway behaviors. Qualitative analyses applied modified analytic inductive thematic analysis to explore critical life experiences that may act as risk or protective factors of running away from care. Results revealed four sub-populations which were characterized by their previous family and system experiences. Additionally, class membership, gender, number of siblings, and age were statistically significant predictors of runway behaviors. Youth interviews revealed five key themes on life experiences that mitigate or exacerbate youths' runaway behaviors. Recommendations resulting from this study were provided in three key areas: (1) improving family visitation and maintaining youth connections with self-identified family and non-relative kin; (2) supporting service approaches for youth that honor and amplify their voices, choices, and family connections; and (3) improving placement quality and individualization of services.

Screening for trauma and behavioral health needs in child welfare: Practice implications for promoting placement stability.

BACKGROUND: Although the child welfare field has initiated efforts to use standardized screening for trauma and behavioral health needs, research has rarely examined whether these screenings have influenced permanency outcomes. OBJECTIVE: Using data from three states' federal demonstration projects, we examined whether receipt of trauma and behavioral health screening and results of screening were associated with placement stability (i.e., fewer placements). Our inquiry focused on whether similar patterns of statistical associations would be observed in three distinct state settings. PARTICIPANTS AND SETTING: Samples comprised children in out-of-home care in three states newly implementing trauma and behavioral health screening. The states included a South Central state, New England state, and a Central Midwestern state. RESULTS: In all three states, findings showed children who received screening had a higher number of placements (i.e., placement instability). Likewise, all three states found that children whose screening results indicated greater need, such as higher number of trauma symptoms or lower behavioral health functioning, were more likely to experience a higher number of placements (i.e., placement instability). CONCLUSION: Despite differences in screening tools and state-specific approaches, findings suggest that early screenings may provide important information that could be used to identify children's needs, make appropriate service referrals, establish well-matched placements, and support resource parents and birth parents toward better permanency outcomes. Regardless of potential benefits of early screening, it may be underutilized in the field. Future research is needed to replicate these findings and continue to build an evidence base for trauma and behavioral health screening.

Assessing the efficiency and eco-sustainability of bioremediation strategies for the reclamation of highly contaminated marine sediments.

Coastal sediments subjected to high anthropogenic impacts can accumulate large amounts of polycyclic aromatic hydrocarbons (PAHs) and metals, demanding effective and eco-sustainable remediation solutions. In this study, we carried out bioremediation experiments on marine sediments highly contaminated with PAHs and metals. In particular, we investigated the effects of biostimulation (by the addition of inorganic nutrients), bioaugmentation (by the addition of fungi belonging to Aspergillus sp.) and microbial fuel cell-based strategies on PAH degradation and on changes in metal partitioning. Results reported here indicate that all biotreatments determined a significant decrease of PAH concentrations (at least 60%) in a relatively short time interval (few weeks) and that biostimulation was the most effective approach (>90%). Biostimulation determined a faster degradation rate of high than low molecular weight PAHs, indicating a preferential biodegradation of specific PAH congeners. At the same time, the biotreatments changed the partitioning of metals, including their solubilization, suggesting the need of parallel environmental risk assessment. Our findings also suggest that ex situ biotreatments can have a lower carbon footprint than current management options of contaminated sediments (i.e., landfill disposal and/or disposal in confined aquatic facilities), but integration with other strategies for metal removal (e.g. through bioleaching) from sediments is needed for their safe re-use. Overall, results presented here provide new insights into the development of effective and eco-sustainable bioremediation strategies for the reclamation of highly contaminated marine sediments.

Investigating the Relationship between Trauma Symptoms and Placement Instability.

BACKGROUND: Placement stability while in foster care has important implications for children's permanency and well-being. Though a majority of youth have adequate placement stability while in foster care, a substantial minority experience multiple moves during their time in care. Research on correlates of placement instability has demonstrated a relationship between externalizing behaviors and placement instability. Likewise, evidence suggests higher levels of trauma are associated with increased externalizing behaviors. However, few studies have examined the relationship between trauma symptoms and placement instability. OBJECTIVE: The purpose of this study was to investigate whether children with clinically significant trauma symptoms had higher odds of placement instability. PARTICIPANTS AND SETTING: Administrative data collected as a part of a summative evaluation for a federally-funded trauma III grant project were used. The sample included 1,668 children ages 5 and older who entered foster care during a 30-month period in a Midwestern state and completed a self-reported trauma screen within 120 days of entering care. METHODS: Hierarchical logistic regression was conducted to examine the contributions of trauma symptoms scores to placement instability, above and beyond demographic characteristics and case characteristics. RESULTS: Results from the final analytic model, which controlled for demographic and case characteristics, showed that children with clinically significant trauma symptoms (i.e., scores ≥19) had 46% higher odds of experiencing placement instability (OR = 1.46, 95% CIs [1.16, 1.82], p = .001). Findings support the need to screen for and treat trauma symptomology among youth in foster care.

[Rare case of nonparasitic chyluria]. / Seltener Fall einer nichtparasitären Chylurie.

Chyluria, a symptom that is very rare in the western world, describes the excretion of chyle into the urogenital system. We present the case of a 61-year-old woman with a severe form of nonparasitic chyluria. We were able to detect the fistula due to a newly developed diagnostic combination of Sudan III red with ureterorenoscopy. Prior to this, we had performed a lymphoscintigraphy twice without detecting the lymphorenal fistula, although lymphoscintigraphy is the current diagnostic standard. This is the first case report of severe, nonparasitic chyluria.

Parenting intervention effects on reunification: A randomized trial of PMTO in foster care.

Evidence-supported parenting interventions (ESPIs) have expanded into child welfare because a growing research base has demonstrated positive results among children with serious emotional and behavioral problems. Despite a clear federal policy emphasis on reunification, few randomized trials have tested ESPIs with biological families of children in foster care; even fewer studies have investigated the distal outcomes of ESPIs. The aim of the current study was to examine the effects of Parent Management Training, Oregon (PMTO) model on reunification. Children in foster care with emotional and behavioral problems were randomized to in-home PMTO (n = 461) or services as usual (SAU) (n = 457). Cox regression models tested whether children in the PMTO group achieved higher rates of reunification. We applied life tables data for integrals calculations to estimate days saved in foster care. Analyses were conducted as intent-to-treat (ITT), and per protocol analysis (PPA). ITT results showed reunification rates were 6.9% higher for the PMTO group (62.7%) than the SAU group (55.8%) with 151 days saved per typical child. PPA indicated that intervention completion strengthened effects as PMTO completers' reunification rates (69.5%) were 13.7% higher than the SAU group (55.8%), and were 15.3% higher than non-completers (54.2%). Days saved were also greater for completers as compared to the SAU group (299 days) and non-completers (358 days). Overall, findings suggest that an in-home parenting intervention positively affected reunification as delivered to biological parents of children and youth in foster care with serious emotional and behavioral problems. Implications and future considerations for research are discussed.

A prospective, randomized trial comparing thulium vapoenucleation with holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic obstruction: perioperative safety and efficacy.

INTRODUCTION AND OBJECTIVES: To compare the perioperative outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO). METHODS: Forty-eight and 46 patients were prospectively randomized to ThuVEP and HoLEP. All patients were assessed preoperatively and 4-week postoperatively. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%). RESULTS: Median age at surgery was 73 (67-76) years and median prostate volume was 80 (46.75-100) cc and not different between the groups (p = 0.207). The median operative time was 60 (41-79) minutes without significant differences between both groups (p = 0.275). There were no significant differences between the groups regarding catheterization time [2 (2-2) days, p = 0.966] and postoperative stay [2 (2-3) days, p = 0.80]). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was higher after HoLEP compared to ThuVEP (15.2 vs. 2.1%, p ≤ 0.022). At 1-month follow-up, peak urinary flow rates (10.7 vs. 22 ml/s), post-void residual volumes (100 vs. 20 ml), International Prostate Symptom Score (20 vs. 10) and Quality of Life (4 vs. 3) had improved significantly (p ≤ 0.005) without significant differences between the groups. CONCLUSIONS: ThuVEP and HoLEP are safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.

Effect of a Parenting Intervention on Foster Care Reentry After Reunification Among Substance-Affected Families: A Quasi-Experimental Study.

Although parental substance abuse has been identified as a risk factor for poor foster care outcomes, current research on effective interventions is limited. A few studies have shown that parenting interventions improved parenting skills and family functioning and decreased time to reunification among children in foster care due to parental substance abuse. However, more research is needed to evaluate whether these interventions positively impact reentry rates. Using propensity score analyses to establish a matched comparison group, survival analyses evaluated the relationship between participation in a parenting intervention, the Strengthening Families Program (SFP), and reentry among a sample of 493 children previously reunified with their parents. The overall reentry rate was 20.9%. Analyses indicated that there was no difference in reentry rates between the SFP (23.7%) and comparison groups (18.6%). Significant predictors of reentry were child behavior problems, family poverty, and reunification between 15 and 18 months from removal.

A study in contrasts: Supports and barriers to successful implementation of two evidence-based parenting interventions in child welfare.

Although evidence-based interventions (EBIs) are spreading to child welfare, research on real-world dynamics of implementation within this setting is scarce. Using a six-factor implementation framework to examine implementation of two evidence-based parenting interventions, we sought to build greater understanding of key facilitators and barriers by comparing successful versus failed EBI implementation in a child welfare setting. Semi-structured interviews were conducted with a purposive sample of 15 frontline practitioners and state-level managers. Interviews were transcribed verbatim and data analysis used a modified analytic approach. Our results showed the successful EBI was viewed more positively on all six factors; however, implementation was multidimensional, multilevel, and mixed with accomplishments and challenges. An accumulation of strengths across implementation factors proved beneficial. Implementation frameworks may be advantageous in organizing and explaining the numerous factors that may influence successful versus failed implementation. While encountering obstacles is largely inevitable, understanding which factors have shaped the success or failure of EBI implementations in child welfare settings may optimize future implementations in this context.

Examining the role of methamphetamine in permanency: A competing risks analysis of reunification, guardianship, and adoption.

Parental methamphetamine use has drawn significant attention in recent years. Despite prior research that shows that parental substance abuse is a risk factor for lengthy foster care stay, little is known about the effect of specific types of substance use on permanency. This study sought to compare the impact of parental methamphetamine use to alcohol use, other drug use, and polysubstance use on the timing of 3 types of permanency: reunification, guardianship, and adoption. Using an entry cohort of 16,620 children who had entered foster care during a 5-year period, competing risks event history models were conducted for each permanency type. Findings showed that, after controlling for several case characteristics, parent illicit drug use significantly impacted the timing of the 3 types of permanency, but alcohol use did not. Methamphetamine, other drug, and polysubstance with methamphetamine use were associated with lower rates of reunification and higher rates of adoption. Guardianship was also predicted by other drug and polysubstance use without methamphetamine; however, methamphetamine use was not associated with guardianship. Notably, the methamphetamine groups comprised the youngest children and had the shortest median time to adoption. Results suggest that type of parental substance use is predictive of permanency exits and that parental illicit drug use may require tailored strategies for improving permanency outcomes. Further implications of the findings are discussed.

Co-Occurrence of Parental Substance Abuse and Child Serious Emotional Disturbance: Understanding Multiple Pathways to Improve Child and Family Outcomes.

This study is a mixed-methods examination of the prevalence and impact of parental substance abuse among families involved in foster care who have a child with a serious emotional disturbance. Data utilized for this study were both administrative and assessment data collected by case managers and parents as part of a federally funded demonstration project in a Midwestern state. At baseline, parent self-report and case manager ratings of family functioning found that parents affected by substance abuse fared worse in domains related to socioeconomics, parental trauma, parental mental health, and social supports when compared to families without parental substance abuse. Case managers and independent raters scored parents affected by substance abuse higher on effective parenting than parents not affected by substance abuse. While all children in the sample have a serious emotional disturbance, parents and case managers rated children's functioning higher among children whose families were characterized by parental substance abuse. These results suggest that, among families who have children with a serious emotional disturbance and are in foster care, those with and without substance abuse may represent two distinct service groups, each with a unique set of needs and contextual factors. For families with parental substance abuse, findings suggest that an appropriate child welfare response should attend to both children's and parent's behavioral health needs and include strategies that are well matched to the families' socioeconomic and social support needs.

Predictors of admission to acute inpatient psychiatric care among children enrolled in Medicaid.

This study examined acute inpatient psychiatric admissions among child Medicaid recipients with a mental health diagnosis in one Midwestern state. The authors used multivariable logistic regression to determine the demographic, clinical, and service factors associated with admissions among 51,233 Medicaid enrolled children 3-17 years old who were identified as having a mental health diagnosis. Compared to available data from other states, the overall acute admission rate was low (2.5 %). Clinical factors were the strongest predictors of hospitalization. Youths with mood, disruptive and psychotic disorder diagnoses were 14.1, 6.2, and 5.8 times more likely than other mental health beneficiaries to experience one or more acute inpatient psychiatric admissions. Other predictors of acute admission included prior hospitalization, receipt of two or more concurrent psychotropic medications, older age, and urban residence. A low rate of acute inpatient admissions may indicate successful delivery of community-based mental health services; conversely, it may suggest underservice to youths with mental health need, particularly those in rural areas. Implications for publicly funded children's mental health care are discussed.

Selecting an EBP to reduce long-term foster care: lessons from a university-child welfare agency partnership.

A growing implementation literature outlines broad evidence-based practice implementation principles and pitfalls. Less robust is knowledge about the real-world process by which a state or agency chooses an evidence-based practice to implement and evaluate. Using a major U.S. initiative to reduce long-term foster care as the case, this article describes three major aspects of the evidence-based practice selection process: defining a target population, selecting an evidence-based practice model and purveyor, and tailoring the model to the practice context. Use of implementation science guidelines and lessons learned from a unique private-public-university partnership are discussed.

Usability testing, initial implementation, and formative evaluation of an evidence-based intervention: lessons from a demonstration project to reduce long-term foster care.

The field of child welfare faces an undersupply of evidence-based interventions to address long-term foster care. The Permanency Innovations Initiative is a five-year federal demonstration project intended to generate evidence to reduce long stays in foster care for those youth who encounter the most substantial barriers to permanency. This article describes a systematic and staged approach to implementation and evaluation of a PII project that included usability testing as one of its key activities. Usability testing is an industry-derived practice which analyzes early implementation processes and evaluation procedures before they are finalized. This article describes the iterative selection, testing, and analysis of nine usability metrics that were designed to assess three important constructs of the project's initial implementation and evaluation: intervening early, obtaining consent, and engaging parents. Results showed that seven of nine metrics met a predetermined target. This study demonstrates how findings from usability testing influenced the initial implementation and formative evaluation of an evidence-supported intervention. Implications are discussed for usability testing as a quality improvement cycle that may contribute to better operationalized interventions and more reliable, valid, and replicable evidence.

Defining a target population at high risk of long-term foster care: barriers to permanency for families of children with serious emotional disturbances.

Long-term foster care (LTFC) is an enduring problem that lacks evidence of effective strategies for practice or policy. This article describes initial activities of a statewide project of the national Permanency Innovations Initiative. The authors sought to: (1) verify the relevance of children's mental health as a predictor of LTFC, (2) describe critical barriers encountered by parents of children with serious emotional disturbances, and (3) identify systems barriers that hinder permanency for this target population.