Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program.

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors' experiences working with this population.

Heterogeneity in Trajectories of Child Maltreatment Severity: A Two-Part Growth Mixture Model.

This study examined the trajectories of maltreatment severity and substantiation over a 24-month period among children (N = 82,396) with repeated maltreatment reports. Findings revealed 2 different longitudinal patterns. The first pattern, Elevated Severity, showed a higher level of maltreatment during the initial incident and increased maltreatment severity during subsequent incidents, but the substantiation rates for this class decreased over time. The second pattern, Lowered Severity, showed a much lower level of severity, but the likelihood of substantiation increased over time. The Elevated Severity class was composed of children with an elevated risk profile because of both individual and contextual risk factors including older age, female gender, caregivers' substance use problems, and a higher number of previous maltreatment reports. Implications of the findings are discussed.

The use of a participatory approach to develop a framework for assessing quality of care in children's mental health services.

The purpose of this study was to develop a framework for assessing the quality of children's mental health services that reflects the primary concerns and perspectives of diverse stakeholders. A participatory research approach was adopted in order to incorporate caregivers of children with mental health problems, mental health service providers, and managed care administrators in identifying and developing quality of care indicators and methods for assessment. This research occurred in three phases that moved from very qualitative and exploratory to more quantitative as we sought to refine and verify the resulting Quality of Care Framework. We found that the use of a participatory approach was beneficial in ensuring the validity of research tools and utility of the framework, and also greatly increased the sense of ownership of research findings among participants.

Promoting cross-sector partnerships in child welfare: qualitative results from a five-state strategic planning process.

Little is known about effective strategic planning for public and private child welfare agencies working together to serve families. During a professionally facilitated, strategic planning event, public and private child welfare administrators from five states explored partnership challenges and strengths with a goal of improving collaborative interactions in order to improve outcomes for children and families. Summarizing thematic results of session notes from the planning event, this article describes effective strategies for facilitation of such processes as well as factors that challenge or promote group processes. Implications for conducting strategic planning in jurisdictions seeking to improve public/private partnerships are discussed.

A business model for managing system change through strategic financing and performance indicators: a case study.

This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children's system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change.

Children placed in out-of-home care: risk factors for involvement with the juvenile justice system.

In previous research, child maltreatment has been associated with several negative outcomes, including delinquency. This study uses administrative data to examine risk factors, including the severity and chronicity of maltreatment, for juvenile justice involvement among children, ages 7 to 17, who were placed in out-of-home care in Florida (N = 13,212). The results of multivariate Cox regression analysis indicated that among specific types of maltreatment, sexual abuse was associated with the risk of faster placement only in a detention center. Additionally, findings from this study suggest that maltreatment chronicity but not maltreatment severity increases the chances of earlier involvement with the juvenile justice system among children who were placed in an out-of-home care. Implications of these findings are discussed.

Innovations in implementation of trauma-informed care practices in youth residential treatment: a curriculum for organizational change.

Children in the child welfare system frequently experience trauma within the caregiving relationship. These traumatic experiences may be compounded by system trauma and place these children at high risk of emotional disorders and placement in out-of-home (OOH) mental health treatment programs. This article reviews the literature on trauma and children in the child welfare system and discusses a study of trauma-informed practices in OOH treatment programs and the curriculum Creating Trauma-Informed Care Environments, which resulted from study findings.

Exploring relationships as mediators of treatment outcomes among commercially sexually exploited youth.

BACKGROUND: Research indicates that youth exposed to commercial sexual exploitation tend to have extensive histories of trauma, including physical abuse, sexual abuse, and neglect, which increases their vulnerability to exploitation. Trauma literature finds youth who present to treatment with greater behavioral health needs tend to have higher trauma scores than youth with fewer behavioral health needs (Copeland et al., 2007; Finkelhor et al., 2007). OBJECTIVE: There is, however, limited research on the role of youth strengths as a buffer against the outcomes associated with trauma. With this in mind, the purpose of this study was to examine the relationship between Adverse Childhood Experiences (ACE scores) and youth outcomes such as risk behaviors, behavioral needs, and impairment in functioning across major life domains. Secondly, we explored how this relationship might be better explained by examining youth strengths as mediators-specifically, peer relationships and the stability of significant relationships in the youth's life. PARTICIPANTS AND SETTING: Data on clients served in a treatment program specialized for commercially sexually exploited youth were used for this research. RESULTS: Results indicated that youth with higher ACE scores had a greater number of risk behaviors, behavioral needs, and impairment in functioning across major life domains. Findings of the mediation analysis provide some support that peer relationships and relationship stability, at least in part, mediates the relationship between ACEs and youth outcomes. Post hoc analyses indicated youth strengths mediated 9-18% of the total effect of ACE scores on youth outcomes. CONCLUSIONS: Developing peer relationships and sustaining significant relationships can mitigate some of the adverse effects of trauma experienced by exploited youth.

Understanding the findings of resilience-related research for fostering the development of African American adolescents.

African American youth face a number of challenges to prosocial development that the majority of American youth never encounter. Despite this, the research clearly documents that African American youth often are resilient in the face of these challenges. This article explores various factors associated with resilience in African American children and their implications for practitioners. An ecologic framework described by Bronfenbrenner is used as an organizing framework for understanding interventions at the micro-, mezzo-, and exo-system levels. In this article, the importance of identity formation, maintenance of social networks, and exposure to safe and supportive environments is expressed in conjunction with recommendations for practitioners. Practitioners are encouraged to stress the promotion of ethnic and racial identity and self-efficacy with the youth and their family and the involvement of the youth and family in meaningful activities through local community centers, schools, churches, and other organizations serving youth. A case study of an African American girl, from age 16 into adulthood and motherhood, is presented to illustrate the interplay between protective and risk factors.

Continuing our organizational mission: A new name for a new time.

This editorial explains the need for a new name for the American Orthopsychiatric Association (ORTHO). As ORTHO continues their work into the 21st century, they want to better reflect their global membership and focus, increasing the number of partnerships with individuals and organizations, and commitment to a just society. Therefore, ORTHO is changing their name to the Global Alliance for Behavioral Health and Social Justice. It is crucial to underscore that, although the organizations name is changing, the values and principles that inform their work will remain the same. The mission statement of the Global Alliance for Behavioral Health and Social Justice is "to inform policy, practice, and research to prevent behavioral health disorders and to promote conditions to ensure that people with disorders can be full participants in society." (PsycINFO Database Record

Can the actions of child welfare case managers predict case outcomes?

This study examined the effect of efforts made by child welfare case managers to involve parents in case processes on two divergent case outcomes: reunification and the termination of parental rights (TPR). The sample was comprised of a cohort of children who received child protection services while in out-of-home care during fiscal year 2009-2010 and were randomly selected by the Florida Department of Children and Families (DCF) for their case management quality of practice reviews. Findings revealed that when child welfare case managers made efforts to encourage and support parents in participating in child-related decisions and activities, there were increased chances for timely reunification. However, these same efforts were only associated with a lower risk of TPR for mothers and not for fathers. Implications of these findings are discussed.

Implementation of Medicaid Managed Long-Term Services and Supports for Adults With Intellectual and/or Developmental Disabilities in Kansas.

Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.

New frontiers in building mental, emotional and behavioral health in children and youth: Introduction to the special section.

The passage of the Patient Protection and Affordable Care Act (ACA; 2010) has had tremendous influence on behavioral health in the United States (Alker & Chester, 2015). Shortly after its passage, the editors of this special section became interested in examining the provisions of the ACA related to care for mental, emotional, and behavioral disorders in children and youth and synthesizing their implications in the context of other contemporary trends in children's behavioral health promotion. We first developed a white paper with the goal of increasing our own understanding of these issues and their possible influence on the status quo of designing, implementing, financing, and evaluating behavioral health services for children and their families. From our discussions came the idea of developing a special section in the American Journal of Orthopsychiatry featuring input from researchers who have been exploring these issues and who have tangible and relevant examples of "new frontiers" in building mental, emotional, and behavioral health for children and youth. The result is the current special section, the purpose of which is to highlight the importance of prevention in behavioral health and to explore examples of efforts that have used a broad public health approach to prevention and early intervention in mental, emotional, and substance use disorders in children and youth. Before introducing the seven articles in this special section, we describe in detail our foundational thinking about building mental, emotional, and behavioral health for children and youth, as expressed in our initial white paper on this topic. (PsycINFO Database Record

The Psychometric Properties of the Simple Screening Instrument for Substance Abuse.

The Simple Screening Instrument for Substance Abuse (SSI-SA) is gaining widespread use as a self-report measure of substance abuse; yet, little information exists regarding the instrument's psychometric properties. This study examined the SSI's psychometric properties within a population of 6,664 adult Medicaid enrollees in Florida, who responded to a survey conducted as part of a statewide evaluation of Medicaid services. The SSI-SA had excellent internal consistency (.85). Evidence of the SSI's validity was strong; SSI-SA scores distinguished among individuals with and without substance abuse needs and were significantly correlated with a measure of functioning in daily living. Using the recommended SSI-SA cutoff score of 4 or higher to indicate the presence of a substance abuse problem, the SSI-SA had respectable sensitivity (.82) and specificity (.90).

Behavioral management for children and adolescents: assessing the evidence.

OBJECTIVE: Behavioral management services for children and adolescents are important components of the mental health service system. Behavioral management is a direct service designed to help develop or maintain prosocial behaviors in the home, school, or community. This review examined evidence for the effectiveness of family-centered, school-based, and integrated interventions. METHODS: Literature reviews and individual studies published from 1995 through 2012 were identified by searching PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. Authors chose from three levels of evidence (high, moderate, and low) based on benchmarks for the number of studies and quality of their methodology. They also described the evidence of service effectiveness. RESULTS: The level of evidence for behavioral management was rated as high because of the number of well-designed randomized controlled trials across settings, particularly for family-centered and integrated family- and school-based interventions. Results for the effectiveness of behavioral management interventions were strong, depending on the type of intervention and mode of implementation. Evidence for school-based interventions as an isolated service was mixed, partly because complexities of evaluating group interventions in schools resulted in somewhat less rigor. CONCLUSIONS: Behavioral management services should be considered for inclusion in covered plans. Further research addressing the mechanisms of effect and specific populations, particularly at the school level, will assist in bolstering the evidence base for this important category of clinical intervention.

Contextual and individual-level predictors of abused children's reentry into out-of-home care: a multilevel mixture survival analysis.

OBJECTIVES: This study examined the effects of individual and contextual factors on reentry into out-of-home care among children who were discharged from child protective services in fiscal year 2004-2005. The objectives were to: (1) examine individual and contextual factors associated with reentry, (2) explore whether there are meaningful groups of youth who differ in terms of risk for reentry, and (3) determine whether relatively homogeneous clusters of child welfare agencies, based on contextual characteristics, differ significantly in terms of the reentry rates of the children whom they serve. METHOD: The study design involved a multilevel longitudinal analysis of administrative data based on an exit cohort. Two Cox proportional hazards multilevel mixture models were tested. The first model included multiple individual level predictors and no agency level predictors. The second model included both levels of predictors. RESULTS: The results of multilevel Cox regression mixture modeling indicated that at the individual level, younger age, being placed in out-of-home care because of neglect and having physical, health problems corresponded to a decreased likelihood for reentry. At the agency level, lower average expenditures per child and contracting out case management services were associated with faster reentry into out-of-home care. CONCLUSIONS: This study demonstrates that children who reenter out-of-home care appear to be a homogeneous population and that reentry is associated with both contextual factors and individual characteristics. PRACTICE IMPLICATIONS: The most important implication that can be drawn from the study findings is that reentry may be most effectively prevented by focusing on such factors at the organizational level as contracting out case management services and funding allocation. Child welfare agencies that are responsible for an array of services and decide to contract out case management should consider the use of performance-based contracts and emphasize and strengthen quality assurance approaches for contracted services. In addition, to compensate for lower funding allocated for children served in out-of-home care, child welfare workers should become more familiar with community resources and help connect families to these supports.

Predictors of emotional well-being in at-risk adolescent girls: developing preventive intervention strategies.

This article examines the degree to which various demographic characteristics, personality traits, and environmental factors are associated with overall emotional well-being of 125 adolescent girls whose mothers were involved in welfare reform. Daughters participated in a 4-year, mixed method study and annually completed a structured interview protocol and a sub-group also completed a qualitative interview. The quantitative findings from the study suggest that daughters having an internal locus of control, experiencing fewer negative life events, and reporting stronger parental and teacher social support had enhanced emotional well-being over the 4-year study compared to daughters without these factors. The findings were further elaborated with examples from qualitative interviews conducted with the daughters. The findings were used to propose prevention activities using a tertiary mental health preventive intervention framework.