Effectiveness of a multidisciplinary treatment with youth-initiated mentoring for youths with mental health needs from multi-problem families: a quasi-experimental study.

BACKGROUND: Children from multi-problem families have an increased risk for experiencing mental health problems. These families face problems in several domains that are often found to be chronic and intergenerational. Yet, the effects of mental health care for youths from multi-problem families are small at best, urging research on new treatment programs. The InConnection approach is an integrated care program to improve resilience of youths with mental health needs from multi-problem families by connecting professional expertise from multiple disciplines with the informal social network of the youth. Youths are asked to nominate a youth-initiated mentor (YIM) from the supportive adults in their network. METHODS: This quasi-experimental study compared the effectiveness of the InConnection approach to treatment as usual in a sample of 107 families (n = 66 intervention group, n = 41 control group) with n = 115 youths receiving treatment (cases). Youths (n = 102 reports, Mage = 15.59 years), parents (n = 85 reports) and case managers (n = 107 reports) responded to questionnaires four times over 15 months. Using these data, we measured youth resilience as the primary outcome, seven secondary outcomes, and three intermediate outcomes. RESULTS: Latent growth models showed only one significant change in outcomes over time across conditions, namely a decrease in case manager-reported child unsafety, and only two condition effects, which were both parent-reported. Parents in the InConnection group reported improvements over time in youth's emotional and behavioral problems and their own positive parenting, whereas control parents reported no changes (ps ≤ 0.013). DISCUSSION: The treatment conditions were not effective in improving most of the youth and parental outcomes over time, except for child safety reported by the case manager. The InConnection approach only outperformed care as usual on two parent-reported outcomes. Future research should examine for whom and under what circumstances the InConnection approach works more convincingly. TRIAL REGISTRATION: Netherlands Trial Register NL7565. Retrospectively registered on 05/03/2019.

Group Climate in Residential Youth Care: Development and Validation of the Group Climate Instrument-Revised.

Group climate in residential youth care is considered to be essential for treatment of youth and young adults. Various instruments exist to measure quality of living group climate, but some are lengthy, use complicated wording, which make them difficult to fill out by youth and individuals with a mild intellectual disability. The present study describes the development and rationale for the Group Climate Instrument-Revised (GCI-R). Construct validity and reliability of the GCI-R were examined by means of Confirmatory Factor Analysis (CFA) in a two-step validation process using a construction sample (n = 190 youth, representing 41 groups) and a validation sample (n = 207 youth, representing 42 groups). Results indicated a good fit of a five-factor model (Support, Growth, Physical Environment, Peer interactions, and Repression). Reliability of the scales was good. These findings indicate that the GCI-R can be used as a parsimonious, valid, and reliable instrument to assess perceptions of group climate in youth. Recommendations for future research and practice are suggested.

Explaining Risk Factors for Successful Family Supervision Orders: Families with Intellectual Disabilities in Child Protection in the Netherlands.

Families with mild to borderline intellectual disabilities (MBID) are overrepresented in child protection, and are at higher risk for long and unsuccessful family supervision orders (FSOs). This is worrisome, as many children apparently are exposed to unsafe parenting situations for longer periods of time. Therefore, the present study examined which child and parental factors and child maltreatment are related to the duration and success of an FSO in families with MBID in the Netherlands. Casefile data were analysed of 140 children with an ended FSO. Results from binary logistic regression analyses showed that in families with MBID, young children, children with psychiatric problems, and children with MBID were at higher risk for a longer duration of FSOs. Furthermore, young children, children with MBID and children who were sexually abused had a lower chance of a successful FSO. Unexpectedly, children who witnessed domestic violence or whose parents were divorced, had a higher chance of a successful FSO. The discussion focuses on implications of these results for treatment and care of families with MBID from the perspective of child protection.

It takes a safe village to raise a child-a commentary on Dana McCoy et al. (2023).

This commentary on the study by McCoy et al. (2023) examining the negative effects of neighborhood violence on the development of toddlers growing up in the city of São Paulo (Brazil) interprets these outcomes from the perspective of ecological system theory, modern brain research, and the prospect of resilience. We argue that societies should give children the opportunity to grow up in a safe and sufficiently affluent social environment in order to give them a chance to achieve their full developmental potential. Governments and the health care system should, therefore, first and foremost invest in safe and stimulating child-rearing environments, informed by scientific research.

Online Delinquent Behaviors of Adolescents: Parents as Potential "Influencers"?

In this study we examined whether aspects of parental monitoring of adolescents' online behavior (rules regarding time spent on the internet, rules regarding content of internet use, frequency of communication, and quality of communication about internet use) are related to different kinds of online delinquent behaviors (sexting, spreading viruses, DDoS attacking, hacking, and online threatening) and whether the level of adolescents' problematic (addictive) internet use mediates these relations. In regular Dutch high schools 1,009 adolescents filled out an online questionnaire (with adjusted versions of the ISPP, PIUQ, and the Dutch Youth Crime Monitor). Descriptive statistics showed that, in general, parents do not seem to monitor adolescents' online behavior to a great extent. Furthermore, results of logistic regression analyses and mediation tests showed that fewer rules about online time, more rules about online content, and a good quality of parent-adolescent communication about online behavior are all associated with lower problematic internet use, which in turn is associated with lower odds of several online delinquent behaviors (mediation). Moreover, parental handling of rules about online content is also directly associated with lower odds of spreading viruses, hacking, and online threat.

Academic Motivation of Incarcerated Juveniles From the Perspective of Self-Determination Theory: A Multiple Case Study in Kosovo Context.

This qualitative (multiple case) study investigated incarcerated juveniles' experiences of being enrolled in an educational institution outside the correctional facility, and how this impacted their motivation, well-being, life satisfaction, and future social integration. Self-determination theory was used to understand how youth experienced fulfillment of their psychological needs (i.e., autonomy, competence, and relatedness). Results showed that the need for autonomy and competence were gradually met by education, whereas the need for relatedness was primarily fulfilled through relationships within the existing social network instead of through relationships with peers in the education setting. Reluctance to become acquainted with peers in the education setting may be explained by feelings of self-stigmatization. We conclude that attending education of juveniles outside prison may contribute to their future perspective and rehabilitation, in particular if sufficient attention is paid to opportunities for meaningful contact with (prosocial) fellow students outside the correctional facility.

Research Review: Siblings matter. A multi-level meta-analysis on the association between cannabis use among adolescent siblings.

BACKGROUND: Parents' and peers' cannabis use are well-documented predictors of youth cannabis use, however, relatively little is known about the influence of siblings' cannabis use. Hence, this meta-analysis investigated the association between sibling-youth cannabis use (disorder) and explored moderation by sibling type (monozygotic- vs. dizygotic- vs. non-twins), age, age spacing, birth order, gender, and gender constellations (same- vs. mix- gender pairs). When comparison data of parents' and peers' cannabis use (disorder) were also available in the included studies, separate meta-analyses on associations between parent-youth and peer-youth cannabis use (disorder) were additionally conducted. METHODS: Studies were selected if they included 11- to 24-year-old participants, and investigated associations between cannabis use (disorder) among those youth and their siblings. These studies were retrieved via a search in seven databases (e.g., PsychINFO). A multi-level meta-analysis using a random effects model was performed on the studies, and heterogeneity analyses and moderator analyses were also conducted. PRISMA guidelines were followed. RESULTS: We retrieved 20 studies (most of which originated from Western cultures) with 127 effect sizes for the main sibling-youth meta-analysis and found a large overall effect-size (r = .423), implying that youth had higher cannabis use rates when their sibling used cannabis, and this association was stronger for monozygotic twins and for same-gender sibling pairs. Finally, a medium effect size existed for the associations between parent-youth cannabis use (r = .300) and a large effect size for peer-youth cannabis use (r = .451). CONCLUSIONS: Youth are more likely to use cannabis when their siblings use cannabis. This sibling-youth cannabis use association existed for all sibling constellations, was larger than the association between parent-youth cannabis use, and was similar in magnitude compared to the association between peer-youth cannabis use-suggesting both genetic and environmental influences (e.g., social-learning) between siblings. Hence, it is important not to neglect sibling influences when treating youth cannabis use (disorder).

Victims of Child Abuse Dropping Out of Trauma-Focused Treatment: A Meta-Analysis of Risk Factors.

A substantial number of children who experienced child maltreatment drop out of evidence-based trauma-focused treatments (TF-CBT). Identifying child, family, and treatment-related factors associated with treatment dropout is important to be able to prevent this from happening and to effectively treat children's trauma-related symptoms. Methods: A quantitative review was performed based on a systematic synthesis of the literature on potential risk factors for dropout of trauma-focused treatment in maltreated children. Results: Eight studies were included, that examined TF-CBT, reporting on 139 effects of potential risk factors for dropout. Each factor was classified into one of ten domains. Small but significant effects were found for the "Demographic and Family" risk domain (r = .121), with factors including being male, child protective services involvement or placement, and minority status, and for the "Youth Alliance" risk domain (r = .207), with factors including low therapist-child support and low youth perception of parental approval. Moderator analyses suggested that family income and parental education may better predict the risk for TF-CBT dropout than other variables in the "Demographic and Family" domain. Conclusions: Our results provide a first overview of risk factors for dropout of trauma-focused treatments (TF-CBT) after child maltreatment, and highlight the role of the therapeutic relationship in this. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-022-00500-2.

Effectiveness of Moral Developmental Interventions for Youth Engaged in Delinquent Behavior: A Meta-Analysis.

There is vast empirical evidence showing that juvenile delinquency is associated with delays in moral development, including moral judgment, empathy, and self-conscious emotions (guilt and shame). Consequently, interventions have been developed that target moral development of juvenile delinquents to reduce criminal offense recidivism. However, a comprehensive synthesis of studies examining the effectiveness of these interventions was not yet available. The present meta-analysis of (quasi-)experimental research therefore examined the effects of interventions that target moral development of youth engaged in delinquent behavior. Interventions that targeted moral judgment (11 studies and 17 effect sizes) showed a significant and small-to-medium effect on moral judgment (d = 0.39), with intervention type as a significant moderator, but no significant effect on recidivism (d = 0.03; 11 studies and 40 effect sizes). No (quasi-)experimental studies were found that targeted guilt and shame in juvenile offenders, and an insufficient number of studies (i.e., only two) were found to conduct a meta-analysis of interventions that target empathy. The discussion focuses on potential ways to improve moral development interventions for youth engaged in delinquent behavior, and provides suggestions for future research.

A Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy.

Previous meta-analyses have found small to moderate associations between child-therapist alliance and treatment outcomes. However, these meta-analyses have not taken into account changes in alliance (i.e., alliance shifts), alliance agreement (i.e., congruence or discrepancies between child-therapist ratings), and the role of alliance as a moderator in relation to treatment outcomes (i.e., an interaction effect of alliance and treatment condition on treatment outcomes). A series of multilevel meta-analyses of 99 studies was conducted to investigate several types of alliance-outcome associations in child and adolescent psychotherapy. Associations between child-therapist alliance and child outcomes (r = 0.17), changes in child-therapist alliance and child outcomes (r = 0.19), child-therapist alliance as a moderator of outcomes (r = 0.09), and parent-therapist alliance and child outcomes (r = 0.13) were small. Associations between child-therapist alliance agreement and outcomes (r = 0.21) and between parent-therapist alliance and parent outcomes (r = 0.24) were small to moderate. This meta-analysis provides the most updated and comprehensive overview of the alliance-outcome association in child and adolescent psychotherapy, showing that the alliance continues to show impact on treatment outcomes. Alliance research in youth psychotherapy has increasingly focused on several complex aspects of the alliance-outcome association, such as the role of changes in alliance, alliance discrepancies, client and therapist variability, and the reciprocal association between alliance and prior symptom change in relation to treatment outcomes. Implications for future research and clinical practice are discussed.

A Meta-Analysis on Differences and Associations between Alliance Ratings in Child and Adolescent Psychotherapy.

OBJECTIVE: The alliance in child and adolescent psychotherapy is widely recognized as an important factor in therapy. Studies on the alliance have increasingly focused on assessment of the alliance as a dyadic construct, measuring both client and therapist alliance ratings. However, cross-informant reports of the alliance in child psychotherapy have not yet been subjected to meta-analysis. Therefore, the present meta-analysis aims to increase knowledge on the degree of convergence and divergence between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. METHODS: A series of three-level meta-analyses of 78 studies was conducted to investigate differences and associations between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. RESULTS: Findings indicated that children and parents in general rated the alliance more positively than their therapists (d = 0.35, d = 0.72, respectively), and that child-therapist and parent-therapist alliance ratings were moderately correlated (r = .32, r = .23, respectively). Associations between child and therapist ratings and observer ratings were moderate to large (r = .43, r = .53, respectively). CONCLUSIONS: It can be concluded that children and parents generally report more positively on the alliance compared to their therapists, which is consistent with research on the alliance in adult populations. The small to moderate associations between alliance ratings indicate that individuals to some extent have a shared perspective on their alliance, and that the various perspectives on alliance should be acknowledged when dealing with children and parents in therapy. Implications for future research are discussed.

Resilience, well-being and informal and formal support in multi-problem families during the Covid-19 pandemic.

BACKGROUND: The Covid-19 pandemic may have had negative effects on youth and parental mental health, especially in high-risk populations such as multi-problem families (i.e., families that experience problems in multiple domains, such as mental health and social network problems). Using one to four assessments during all phases of the Covid-19 pandemic up until January 2022, we examined the associations between pandemic-related stress and mental health (resilience and well-being) of youth and parents from multi-problem families. We also investigated whether experienced informal (i.e., youth informal mentoring) and formal support (i.e., therapist support) served as protective factors in this association. METHODS: A total of 92 youth aged 10-19 years (46.7% girls; mean age 16.00 years) and 78 parents (79.5% female; mean age 47.17 years) filled in one to four questionnaires between March 2020 and January 2022. Multi-level analyses were conducted to account for the nested structure of the data. RESULTS: For youth, pandemic-related stress was associated with lower well-being, but not with resilience. Perceived support from both mentors and therapists was positively associated with youth mental health. Furthermore, high perceived therapist support protected youth from the negative effect of pandemic-related stress on resilience. For parents, pandemic-related stress was not related to mental health, irrespective of therapist support. Yet, therapist support was directly and positively associated with parental mental health. CONCLUSIONS: Youth from multi-problem families who experience pandemic-related stress are at risk of (elevated) mental health problems during the pandemic, specifically if they have no or weak therapist support. The mental health of parents, however, was minimally affected by pandemic-related stress, indicating strength and flexibility. Youth and parents who experienced support during the pandemic reported higher levels of resilience and well-being, demonstrating the importance of support for individuals' mental health during stressful times such as a pandemic.

Identifying effective moderators of cognitive behavioural trauma treatment with caregiver involvement for youth with PTSD: a meta-analysis.

Children can develop post-traumatic stress disorder (PTSD) and mental health symptoms after traumatic events. This meta-analysis evaluated the influence of moderators of cognitive behavioural trauma treatment (CBTT) with caregiver involvement in traumatized children. A total of 28 studies were included, with 23 independent samples and 332 effect sizes, representing the data of 1931 children (M age = 11.10 years, SD = 2.36). Results showed a significant medium overall effect (d = 0.55, t = 2.478, p = 0.014), indicating CBTT with caregiver involvement was effective in treating PTSD (d = 0.70), with somewhat smaller effect sizes for internalizing, externalizing, social, cognitive and total problems (0.35 < d > 0.48). The positive treatment effect was robust; we found somewhat smaller effect sizes at follow-up (d = 0.49) compared to post-test (d = 0.57) assessments. Furthermore, several sample (i.e. child's age, gender, and trauma event), programme (i.e. the duration of treatment, number of sessions), study (i.e. control condition, type of instrument, informant, type of sample), and publication (i.e. publication year and impact factor) characteristics moderated the treatment outcomes of the child. In sum, the results of our meta-analysis might help to improve the effectiveness of cognitive behavioural trauma treatment for youth with PTSD, and guide the development of innovative trauma interventions that involve caregivers. Implications for theory and practice are discussed.

A Cohort Study on the Effect of Parental Mind-Mindedness in Parent-Child Interaction Therapy.

Parent-child interaction therapy (PCIT) is a short-term, evidence-based intervention for caregivers with children aged between 2 and 7 who exhibit behavioral problems. PCIT is effective, but has a high attrition rate ranging from 27% to 69%. We hypothesize that a low level of parental mind-mindedness-the parent's propensity to treat the child as an intentional agent with its own thoughts and emotions-might contribute to premature attrition or cause families to profit less from treatment. To test these hypotheses, we performed a retrospective cohort study in a time-limited, home-based PCIT sample (n = 19) and in a clinic-based PCIT sample (n = 25), to investigate whether parents with a medium-high level of mind-mindedness differ from parents with a medium-low level of mind-mindedness in the outcome measures of PCIT (child's behavioral problems, parenting skills and stress and mothers' anxious and depressed symptoms). Furthermore, we examined if mind-mindedness was related to attrition and (for clinic-based PCIT only) number of sessions. Repeated measures ANOVA showed that mothers with a medium-high level of mind-mindedness displayed more improvement in two parenting skills benefiting a positive parent-child interaction. Furthermore, we found a group effect of mind-mindedness in the PCIT-home sample, with mothers with a medium-high level of mind-mindedness showing better results on most outcome measures. Our findings suggest that adding a mind-mindedness improving intervention prior to or during PCIT could benefit mothers with a medium to low level of mind-mindedness.

Prevalence of Adverse Childhood Experiences in Students with Emotional and Behavioral Disorders in Special Education Schools from a Multi-Informant Perspective.

Adverse childhood experiences (ACEs) are associated with an increased risk of developing severe emotional and behavioral problems; however, little research is published on ACEs for students with emotional and behavioral disorders (EBD) in special education (SE) schools. We therefore systematically explored the prevalence, type and timing of ACEs in these students from five urban SE schools in the Netherlands (Mage = 11.58 years; 85.1% boys) from a multi-informant perspective, using students' self-reports (n = 169), parent reports (n = 95) and school files (n = 172). Almost all students experienced at least one ACE (96.4% self-reports, 89.5% parent reports, 95.4% school files), and more than half experienced four or more ACEs (74.5% self-reports, 62.7% parent reports, 59.9% school files). A large majority of students experienced maltreatment, which often co-occurred with household challenges and community stressors. Additionally, 45.9% of the students experienced their first ACE before the age of 4. Students with EBD in SE who live in poverty or in single-parent households were more likely to report multiple ACEs. Knowledge of the prevalence of ACEs may help understand the severe problems and poor long-term outcomes of students with EBD in SE.

Measuring Aggression in German Youth Prison-A Validation of the German Reactive-Proactive Aggression Questionnaire (RPQ) in a Sample of Incarcerated Juvenile Offenders.

The aim of the present study was to examine construct validity and reliability of the German reactive proactive aggression questionnaire (RPQ) in a sample of delinquent boys (N = 156). A confirmatory factor analysis with a two-factor model of reactive and proactive aggression showed a good fit to the data. The factor structure of the original RPQ could be fully replicated in the German translation, and Cronbach's alphas were good for both subscales. Concurrent validity of the RPQ was demonstrated by significant correlations with the subscales of the inventory of callous unemotional traits. In future studies, the German RPQ can be used to assess reactive and proactive aggression in judicial and forensic psychiatric care in Germany. The present findings also provide support for the use of the RPQ in cross-cultural comparisons.

What makes Dutch youth comply with preventive COVID-19 measures? An explorative study.

The measures to contain the spread of COVID-19 are challenging for youth, especially the social isolation measures. These measures are antagonistic to healthy youth development, which requires sufficient social contact with peers and adults. This explorative study examined what factors are associated with adherence to COVID-19 measures in a sample of Dutch youth (N = 263; 79.8% female) with ages ranging between 16 and 24 years (M = 21.1 years; SD = 2.44 years), who completed an online questionnaire about their compliance to measures, resilience, coping strategies, mental health, and availability of a natural mentor. Results showed that youth with fewer depressive symptoms adhered better to measures of social distance. Youth who were less suspicious, more resilient, and those with an active coping strategy or a natural mentor more often complied with COVID-19 measures. These results can be used to help youth comply with the COVID-19 measures.

A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents.

This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect (d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems.

Music therapy for stress reduction: a systematic review and meta-analysis.

Music therapy is increasingly being used as an intervention for stress reduction in both medical and mental healthcare settings. Music therapy is characterized by personally tailored music interventions initiated by a trained and qualified music therapist, which distinguishes music therapy from other music interventions, such as 'music medicine', which concerns mainly music listening interventions offered by healthcare professionals. To summarize the growing body of empirical research on music therapy, a multilevel meta-analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the strength of the effects of music therapy on both physiological and psychological stress-related outcomes, and to test potential moderators of the intervention effects. Results showed that music therapy showed an overall medium-to-large effect on stress-related outcomes (d = .723, [.51-.94]). Larger effects were found for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list controls instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted in Non-Western countries compared to Western countries. Implications for both music therapy and future research are discussed.

Cross-age peer mentoring for youth: A meta-analysis.

Although most mentoring programs for youth are structured around intergenerational relationships, a growing number of programs rely on cross-age peer mentoring. Such programs capitalize on the availability of youth mentors to promote positive outcomes in younger peers. This study used a multilevel meta-analytic approach to estimate the effect size of cross-age peer mentoring programs and evaluate potential moderators of peer mentoring program effectiveness. Analyses included six studies and revealed a medium-sized overall effect of cross-age peer mentoring programs (g = 0.45). Several characteristics moderated effect sizes, with larger effects for programs that were conducted outside of the school setting (i.e., weekend, summer, or in community settings), conducted in urban settings, and had moderate/high levels of adult oversight and supervision. Results highlight the potential benefits of cross-age peer mentoring for youth.