Prevalence and comorbidity of mental disorders among adolescents living in residential youth care

Child maltreatment in young adults with residential youth care background: Prevalence and post-placement trends

BACKGROUND

Young adults with residential youth care (RYC) background have often endured various forms of child maltreatment, impacting education, employment, health, mortality, and quality of life. There is limited research on the onset and duration of exposure to maltreatment before placement, as well as the prevalence of maltreatment occurring after children have been placed into out-of-home care.

OBJECTIVE

This study aims to investigate: (1) The sex-specific prevalence and age chronology of self-reported exposure to child maltreatment, and (2) whether the rate of these maltreatment forms differ between the year before and after first out-of-home placement by the Child Welfare Service.

PARTICIPANTS AND SETTING

This study is a part of VINGO, a Norwegian nation-wide 10-year follow-up examining the health and welfare of 157 (107 females) adults with RYC background.

METHODS

The Maltreatment and Abuse Chronology of Exposure Scale was administered as an online questionnaire, and mean scores and percentages of maltreatment forms were compared. Differences between groups were examined using t-tests and Pearson's Chi-Squared test.

RESULTS

Most participants, 154 of 157 (98 %), reported at least one form of child maltreatment. Females reported higher rates of sexual abuse than males (53 % vs. 22 %, p < .001). No other sex differences were found. A majority of participants (63 %) reported decreased maltreatment rates post-placement, while 37 % had stable or increasing rates.

CONCLUSIONS

Young adults with RYC background report high child maltreatment rates. Although out-of-home care provides protection, further development and improvement of initiatives aimed at reducing the risk of revictimization is likely needed.

Evaluation of ANKOMMEN as a group intervention based on life story work for adolescents in residential care in Germany: a single-arm pilot study

BACKGROUND

Adolescents face many challenges when coping with out-of-home placement, and life story work can be helpful in this context. Typically conducted in individual settings, life story work's high resource requirements pose a challenge for implementation in the standard care of youth welfare institutions. To address this issue, the ANKOMMEN intervention was developed as a manualized group program for adolescents in residential care focusing on processing and coping with experiences associated with their out-of-home placement.

METHOD

The intervention was evaluated in a single-arm pilot study with questionnaires administered at three time points (pre-intervention, post-intervention, and 3-month follow-up). The primary outcome was self-efficacy, while secondary outcomes included self-esteem, depressive symptoms, posttraumatic stress symptoms, and behavioral problems. A total of 31 intervention groups with 115 adolescents (M = 14.91 years; SD = 1.45; 52.2% male) were conducted between October 2020 and September 2022 in Germany. Data were analysed using mixed effect models.

RESULTS

Pre-post comparisons revealed increased self-efficacy (d = -0.80) and self-esteem (d = -0.68) among participants with below-average scores prior to the intervention. Additionally, there was a decrease in self-reported depressive symptoms (d = 0.76), self-reported posttraumatic stress symptoms (d = 0.58), self-reported internalizing behavior problems (d = 0.74), caregiver-reported internalizing behavior problems (d = 0.76), and self-reported externalizing behavior problems (d = 0.52) for participants with clinically relevant scores prior to the intervention. These improvements were stable in the 3-month follow-up assessment. Furthermore, the intervention proved its feasibility in standard care within the context of the evaluation study.

CONCLUSIONS

The results of the pilot study provide preliminary evidence for the feasibility and potential effectiveness of ANKOMMEN but further research is needed to obtain valid evidence for the efficacy of the intervention.

Lifetime victimization experiences, depressiveness, suicidality, and feelings of loneliness in youth in care

BACKGROUND

Research has demonstrated the damaging effects of poly-victimization on the mental health of children and adolescents. However, few studies have been conducted in high-risk youth in care (Y-IC) samples.

OBJECTIVE

The study examines the frequency of lifetime victimization and the association of poly-victimization and victimization types on depressiveness, suicidality, and feelings of loneliness among Y-IC.

PARTICIPANTS AND SETTING

164 participants aged 14 and 21 years (M = 17.39, SD = 1.95), who live in family-based care or residential care.

METHODS

The Juvenile Victimization Questionnaire (JVQ) was used to assess lifetime victimization. The Patient Health Questionnaire (PHQ-9), and the Loneliness Scale-SOEP (LS-S) to measure depressiveness, suicidality, and loneliness. Hierarchical regression models were calculated.

RESULTS

Participants reported on average 12.66 (SD = 6.58) victimization experiences. The female and diverse gender groups reported higher rates of victimization, loneliness, depressiveness, and suicidality than the males. Participants in residential care reported more victimizations and stronger feelings of loneliness than those in family-based care. Poly-victimization was not associated with any of these internalizing symptoms but peer victimization was significantly associated with depressiveness (β = 0.23, p = .002) and loneliness (β = 0.22, p = .006), sexual victimization with depressiveness (β = 0.22, p = .004).

CONCLUSION

Y-IC show high levels of victimization and internalizing symptoms, with higher burden on girls and youth living in residential care. Findings underscore the relevance of social exclusion experiences among peers within Y-IC. Interventions should address multiple forms of victimization, with a special focus on sexual and peer victimization.

Videoconferencing in mental health services for children and adolescents receiving child welfare services: a scoping review

BACKGROUND

Videoconferencing is considered an alternative to face-to-face consultations and a possibility to help overcome access-to-care barriers in mental health care services. Barriers to child and adolescent mental health services are particularly apparent in the case of children and adolescents receiving child welfare services. This scoping review aims to provide an overview of research on videoconferencing in the mental health treatment of children and adolescents receiving support from child welfare services.

METHODS

This scoping review follows the review framework outlined by the Joanna Briggs Institute. The following databases were searched from January 2012 to April 2024: Scopus, Web of Science, PubMed, PsycINFO (Ovid), CINAHL Plus, Social Services Abstracts (ProQuest), Sociological Abstracts (ProQuest), and Google Scholar.

RESULTS

The search yielded 4322 unique records and resulted in the inclusion of 22 articles that met the inclusion criteria. The studies originated from Denmark, England, Australia, Norway, Canada, Chile, and the USA, and were grouped into four areas: (1) videoconferencing to increase access to mental health treatment for vulnerable groups (2) young people's perspectives (3) videoconferencing in interdisciplinary collaborative meetings, and (4) use, awareness, and acceptance of videoconferencing among health and social care providers.

CONCLUSIONS

This scoping review shows that if videoconferencing in mental health care is to become an established and trusted method aimed at children and adolescents receiving child welfare services, several unresolved and potentially negative issues need attention and more research. This particularly applies to whether videoconferencing decreases or exacerbates inequalities in access to mental health services. A further question is whether new barriers are raised by screen-based treatment to threaten good therapeutic relationships, and by extension treatment quality and clinical outcomes.

Child- and parent-related determinants for out-of-home care in a nationwide population with neurodevelopmental disorders: a register-based Finnish birth cohort 1997 study

Neurodevelopmental disorders (NDDs) are among the most common health issues in childhood and adolescence. Psychiatric disorders are known to be overrepresented among children using child welfare services and placed in out-of-home care (OHC). Child- and parent-related determinants for OHC among a national population with NDDs were evaluated utilising longitudinal register data from the national Finnish Birth Cohort 1997 (n = 58,802) from birth to 18 years (1997-2015). The cohort members with NDDs (n = 5,143, 9% of total cohort) formed our study population. Based on their history of OHC, cohort members with NDD were categorised to OHC (n = 903) and non-OHC groups (n = 4,240). Of all cohort members with NDDs, 17.6% had a history of OHC. Within NDDs, a significant excess of ADHD diagnosis was observed in the OHC group compared to the non-OHC group (49% vs. 26%). The OHC group with NDDs was significantly characterised by having comorbid psychiatric diagnosis for conduct and oppositional disorders (adj. RR 2.21), substance use disorders (adj. RR 1.61) and depression and anxiety disorders (adj. RR 1.60). Of all parent-related determinants, the most prevailing in the OHC group compared to the non-OHC group, was social assistance received by parent (88% vs. 44.5%). The longer the period (in years) for received social assistance, the greater the likelihood for OHC (adj. RRs range from 2.41 for one year to 5.24 for over 4 years). Further, significantly associating determinants for OHC were parental psychiatric disorders (adj. RR 1.42) and parental death (adj. RR 1.23). Our findings from the population-based cohort of children and adolescents with NDDs highlight the importance of screening and assessment of family situation. Also, effective prevention and treating of comorbid psychiatric disorders, especially conduct and oppositional disorders is essential.

Risk and protective factors of mental health in children in residential care: A nationwide study from Luxembourg

BACKGROUND

Children who grow up in residential care are at high risk for mental health problems. Existing studies have focused on negative mental health indicators and risk factors. There has been less emphasis on identifying protective factors, particularly those associated with positive mental health outcomes.

OBJECTIVE

This study explores positive and negative dimensions of mental health and their links to risk and protective factors in children who have experienced early adversity and trauma and have been placed in residential care.

PARTICIPANTS AND SETTINGS

Children aged 11 to 18 (N = 264) were recruited from residential care homes in Luxembourg, a small, high-income European country.

METHODS

The children completed self-report questionnaires on mental health, perceived stress, school pressure, and participation. Residential care workers provided information on demographic factors, developmental and care history, and pre-care experiences of early adversity and trauma.

RESULTS

Confirmatory factor analysis indicated that subjective well-being, internalising problems, and externalising problems are separate yet interconnected components of mental health. Multiple Indicators Multiple Causes models showed that individual, contextual, and psychosocial predictors contribute differentially to positive and negative mental health outcomes.

CONCLUSIONS

Using a national sample of children in residential care in Luxembourg, this research indicates that subjective well-being, internalising problems, and externalising problems are distinct but related aspects of mental health. 'Child participation' and 'school pressure' displayed strong links with positive mental health outcomes and may serve as a potential path for improving public health interventions for children in care.

Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

'It's not like real therapy': young people receiving child welfare services' experiences of video consultations in mental healthcare in Norway: a mixed methods approach

BACKGROUND

Video consultations has been suggested to lower the threshold for child and adolescent mental healthcare treatment. This study explores how young people receiving child welfare services experience video consultations in child and adolescent mental healthcare. The study is part of a larger Norwegian study of access to health services for this target group.

METHODS

The study has a mixed methods design including qualitative interviews and a quantitative survey, with young people receiving child welfare services. The qualitative interviews included 10 participants aged 15-19. The survey included 232 participants aged 16-24 of which 36 reported having received video consultations in mental healthcare. The interviews were analysed using thematic analysis. The survey data was presented as frequencies to clarify the distribution of positive and negative perceptions of video consultation.

RESULTS

The results show that the participants experienced video consultations as more superficial and less binding, compared to in-person sessions. They raised concerns of the therapeutic relationship, however some found it easier to regulate closeness and distance. In the survey several reported that their relationship with the therapist got worse, and that it was much more difficult to talk on screen. Moreover, a large proportion (42%) claimed that video consultations did not fit their treatment needs overall. However, a minority of the participants found it easier to talk to the therapist on screen.

CONCLUSIONS

The study reveals important weaknesses and disadvantages of online therapy as experienced by young people receiving child welfare services. It is particularly worrying that their criticism involves the relational aspects of treatment, as children receiving child welfare services often have relational experiences which make them particularly sensitive to challenges in relationships. This study shows that youth involvement in decision making of video consultations in therapy has been rare. Clinicians should be aware of these young people's doubts regarding the quality of video consultations in child and adolescent mental health care. Further studies should examine how user involvement can be incorporated in video consultations in therapy and how this could improve experiences and the quality of video consultations.

Co-development of traumatic stress symptoms and externalising behaviour problems among foster children and the effect of complex trauma: a latent growth curve model

OBJECTIVES

Foster children are disproportionately exposed to complex trauma, which may lead to multifaceted impairments that manifest in comorbid emotional and behavioural problems. As little is known about the interactions between comorbid disorders over time, the present study aims to explore the co-development of traumatic stress (TS) symptoms and externalising behaviour problems (EBP), as well as the influence of complex trauma operationalised as cumulative child maltreatment (CM).

SETTING

As part of a 3-year longitudinal study, children from six foster care facilities in Lower Austria were interviewed at three measurement points.

PARTICIPANTS

Of, in total, 263 participating children, the data of 124 children aged 10-18 years (M=13.5, 28% female) could be analysed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Latent growth curve models were used to examine the co-development of TS symptoms (International Trauma Questionnaire) and EBP (Child Behaviour Checklist) over time; gender, age and cumulative CM (Childhood Trauma Questionnaire) acted as time-invariant covariates.

RESULTS

While average TS symptoms decreased over time, EBP remained stable. Findings revealed that the initial severity of EBP was both related to the initial severity of TS symptoms and predictive of their rate of change. Cumulative CM was a significant predictor of initial TS symptoms and EBP even after controlling for age and gender, but not for the rates of change.

CONCLUSIONS

Taken together, our results indicate that EBP and TS symptoms are not only cross-sectionally associated but interact with each other over time. Furthermore, an underlying complex trauma could at least partly determine the severity of the two symptom groups. In accordance with a trauma-informed care approach, our study highlights the importance of trauma-specific screening of high-risk children with complex or diffuse symptoms and argues for the benefits of treatments that focus on improving emotion regulation and social skills in addition to addressing trauma.

[Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020]

Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020 Abstract. Objective: Studies show a high prevalence of mental health problems in children and adolescents in youth-welfare facilities compared to the general population. However, to date, studies on this development over time are lacking. The present study examines the development of mental health problems and psychosocial functioning in the years 2008 to 2020. Method: Mental health problems were assessed with the CBCL, psychosocial functioning with Axis VI of the MAS. In total, data from 3,269 children and adolescents from residential-care facilities located throughout Germany were included in the analysis. Results: a decrease in externalizing behaviour was observed regarding the frequency of mental health problem in children and adolescents in youth-welfare facilities from 2008 to 2020. Particularly boys aged 12 and older show less deviant behavior. Older girls show high internalizing behavior problem scores over time, but there is no consistent trend. More than a quarter of the institutionalized children in youth-welfare institutions show severely impaired psychosocial functioning at a consistent level over time. Conclusions: In light of the age and gender effects associated with the development of mental health problems over time, there is a need to regard the care situation in youth-welfare institutions.

The Development of Young Peoples' Internalising and Externalising Difficulties Over the First Three-Years in the Public Care System

Although we know there are high rates of mental health difficulties amongst young people in out-of-home care (i.e. social welfare-involved children), there is limited evidence on the longitudinal development of these problems, particularly from when they enter the care system. Using the routinely collected carer-reported strengths and difficulties questionnaire, we explored internalising (emotional and peer) and externalising (conduct and hyperactivity) difficulties for 672 young people across their first 3 years in the UK care system (2-16 yrs, 51% boys, 76% Caucasian). In all cases stable profiles (resilient or chronic) were most common, while changing profiles (recovery or delayed) were less common. Findings showed that entry into the care system is not enough of an intervention to expect natural recovery from mental health difficulties. Number of placements and being separated from siblings were associated with greater difficulties. Implications for child welfare and mental health systems are discussed.

Changes in Mental Health of Children and Young People in Residential Care: Outcomes and Associated Factors

Several studies have evidenced that children in out-of-home care (OOHC), including foster family care and residential care, reveal high levels of mental health disorders (ranging from 40% to 88%). This study examines the outcomes in mental health reported by key residential workers in a group of children and youth (N = 492) between 8-17 years old who were in residential child care (RCC) in Spain. The research also aims to explore the relationship between mental health outcomes and the provision of mental health services (i.e., receiving any mental health treatment) as well as the influence of child, family, and placement factors. The design of this study includes two measures: a baseline (T1) and a follow-up two years later (T2). The results indicated that 29.9% of young people enjoyed sustained mental health; 26% meaningful improvement in their mental health; 23.5% meaningful deterioration; and the remaining 20.5% showed no meaningful change. One of the main findings was that receiving mental health treatment had a significant impact on mental health outcomes. It is crucial to establish protocols and systematic detection tools to assess mental health and ensure detection and referral to proper treatment.

Behavioral and Emotional Difficulties and Personal Wellbeing of Adolescents in Residential Care

This work studies the emotional and behavioural difficulties and the personal wellbeing of adolescents under protective measures. The sample is made up of 151 adolescents in residential care between 11 and 17 years of age. The instruments used were the Strengths and Difficulties Questionnaire (SDQ) and the Personal Wellbeing Index (PWI). The results indicate that a high percentage of adolescents have emotional and behavioural difficulties. We found a greater presence of behavioural rather than emotional problems in the adolescents. Similarly, we also found that females showed more emotional difficulties than the males. As for personal wellbeing, the results indicate that the adolescents are dissatisfied in several areas of their life, they feel insecure and have a pessimistic view of their future and of their achievements. Furthermore, those adolescents who were admitted to residential care due to something other than child abuse have a greater prosocial behaviour. It can be concluded that the more difficulties the adolescents experience (emotional, behavioural and with their peers), the lower the perception of their personal wellbeing will be. This study allows us to design interventions aimed at promoting psychological wellbeing among these adolescents.

Personal Stories of Young Women in Residential Care: Health-Promoting Strategies and Wellbeing

Interdisciplinary social work practice produces and circulates narratives of young women in residential care. The dominant narratives often present negative descriptions of this group, and less attention has been paid to their resistance to these "big stories". This study's aim is to illuminate this resistance of young women in residential care and to explore how they narrate their experiences of being children at risk who have become women managing everyday life. This study utilises a narrative approach and includes three selected personal stories: two from the participants and one from the first author's reflections on resistance. Through contextual analysis at the macro, meso and micro levels, we focus on how personal stories can influence interdisciplinary social work services. We found resistance to dominant narratives on the different levels in the chosen stories. Resistance can create space to reconstruct and renarrate reality together and help understand the meaning and power of storytelling and silence. Participants' resistance can be a tool to rebalance the power between social work practitioners and service users. Based on this analysis, we suggest that interdisciplinary collaborative social work should emphasise service users' personal stories to a higher degree and, in this way, increase user participation in residential care.

Striving for Happily Ever After: Supportive Interventions for Youth Leaving Residential Placement. A Systematic Review of Reviews

BACKGROUND

Youth who reenter communities after forensic or residential care are overrepresented in prevalence rates for mental disorders, delinquency, incarceration, low academic achievement, and unemployment. Supportive interventions that aid youth in the reentry to their communities can be crucial for successful reintegration. In systematic reviews (SR) on this topic, only specific interventions or programs are described. Therefore, a summary of evidence about transitional interventions for various groups of reentry youth is needed.

METHOD

This overview of SRs was preregistered in PROSPERO. We searched PsycINFO, Ovid MEDLINE, Cochrane Library, Campbell Library, Web of Science, Sociological Abstracts, Criminal Justice Abstracts, Social Care Online, and Epistemonikos. SRs that fit the search criteria were evaluated using the AMSTAR checklist for methodological quality and the GRADE tool for assessing confidence in effect estimates.

RESULTS

We screened 2,349 publications for eligibility. Eight SRs were included for analysis. The methodological quality of five SRs was critically low, two were of low quality, and one was of moderate quality. Recidivism was reported as the only outcome in five SRs. Detrimental outcomes were reported in five SRs. Confidence in effect estimates was low or very low for all outcomes. Ninety-five percent of primary study populations were from the United States.

CONCLUSION

We offer a rigorous appraisal of SRs on transitional interventions. The gaps of knowledge are vast regarding what works, how it works, and for whom. Development of a knowledge base should include defining the term 'recidivism', systematic reporting of demographics, and identifying effective common elements.

Validation of the Behavioral Health Screen-Depression With Adolescents in Residential Care

Abstract. The purpose of this study was to (1) examine the psychometric properties of the Behavioral Health Screen Depression Subscale (BHS-DS), including internal consistency, factor structure, convergent and discriminant validity, and (2) identify cut-off scores on the BHS-DS to distinguish patients with depression risk and their level of severity among an acute clinical sample of adolescents in residential psychiatric care. Participants included 861 youths ages 10–24 at residential treatment centers who completed a battery of measures, including the BHS-DS and Patient Health Questionnaire (PHQ-9). Factor analysis, bivariate correlation, and Cronbach’s α suggested the BHS-DS is a unidimensional scale with evidence of internal consistency reliability and convergent and discriminant validity. Receiver operating characteristic curve analysis identified four clinical cut-off scores (no, mild, moderate, and severe depression risk). Analysis of variance, Cohen’s kappa (κ), and Wilcoxon signed-rank test results suggested the four groups differ from each other and that the BHS-DS exhibits moderate agreement with the PHQ-9. The BHS-DS demonstrates good psychometric properties among a sample of residential youth, offering clinicians a good alternative to the PHQ-9 in screening for depression.

[Framework for a Group Intervention Aiming at Coping with out-of-home Placement - Focus Groups in Residential Foster Homes]

Out-of-home placement is a critical life event for affected children and adolescents. We explored the potential content and conditions for a group intervention aiming at coping with this critical life event by the means of three focus groups with n = 13 participants. The participants reported feelings of guilt, uncertainty concerning their future, experiences of loss, and lack of confidence. So far, standardized programs for sharing the participants' out-of-home care experiences had not been established in their child welfare programs. Under certain circumstances, the participants were willing to take part in a group intervention for this purpose. The intervention should aim at the autobiographical integration of the out-of-home placement as well as the promotion of general protection factors. Further qualitative research is needed to adjust the intervention in order to fit the needs of the target population.

Reactive attachment disorder and disinhibited social engagement disorder in adolescence: co-occurring psychopathology and psychosocial problems

Insufficient care is associated with most psychiatric disorders and psychosocial problems, and is part of the etiology of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). To minimize the risk of misdiagnosis, and aid treatment and care, clinicians need to know to which degree RAD and DSED co-occur with other psychopathology and psychosocial problems, a topic little researched in adolescence. In a national study of all adolescents (N = 381; 67% consent; 12-20 years old; 58% girls) in Norwegian residential youth care, the Child and Adolescent Psychiatric Assessment interview yielded information about psychiatric diagnoses and psychosocial problems categorized as present/absent, and the Child Behavior Check List questionnaire was applied for dimensional measures of psychopathology. Most adolescents with a RAD or DSED diagnosis had several cooccurring psychiatric disorders and psychosocial problems. Prevalence rates of both emotional and behavioral disorders were high in adolescent RAD and DSED, as were rates of suicidality, self-harm, victimization from bullying, contact with police, risky sexual behavior and alcohol or drug misuse. Although categorical measures of co-occurring disorders and psychosocial problems revealed few and weak associations with RAD and DSED, dimensional measures uncovered associations between both emotional and behavioral problems and RAD/DSED symptom loads, as well as DSED diagnosis. Given the high degree of comorbidity, adolescents with RAD or DSED-or symptoms thereof-should be assessed for co-occurring psychopathology and related psychosocial problems. Treatment plans should be adjusted accordingly.

Examination of the importance of anger/irritability and limited prosocial emotion/callous-unemotional traits to understand externalizing symptoms and adjustment problems in adolescence: A 10-year longitudinal study

Objective

Within a longitudinal study (10-year follow-up), we aim to examine the role of anger/irritability and limited prosocial emotion/callous-unemotional traits in predicting externalizing symptoms and adjustment problems in individuals formerly in youth residential care institutions.

Method

These dimensions were assessed in 203 young adults, with baseline assessments during youth residential care and a follow-up 10 years later.

Results

In general, emotional problems and psychopathological symptoms did not reduce over time. Analyses of regression revealed that a younger age at baseline, anger/irritability both at baseline assessment, and regarding their aggravation over time refer to significant predictors of the level of externalizing symptoms at 10-year follow-up (R ² = 0.431) and the worsening of externalizing symptoms over time (R ² = 0.638). Anger/irritability has been observed to be a significant predictors of both the level of adjustment problems at 10-year follow-up (R ² = 0.471) and its worsening over time (R ² = 0.656).

Discussion

Our results suggest that dysregulation of anger/irritability is a key factor in the prediction of long-term externalizing symptoms and adjustment problems as well as its worsening over time. Possible implications for intervention and prevention are discussed.

Internalizing Symptoms Among Youth in Foster Care: Prevalence and Associations with Exposure to Maltreatment

Among youth in foster care (N = 303, aged 11-17 years), we investigated prevalence of internalizing symptoms; associations between symptom level and maltreatment types and numbers; and the interaction between gender and maltreatment, on internalizing symptoms. Youth completed Spence Children Anxiety Scale, Short Mood Feelings Questionnaire, and Child and Adolescent Trauma Screen. Compared to community samples, symptom levels above clinical cut-off was more frequent, with social- and generalized anxiety (ES = 0.78-0.88) being most prevalent among youth in foster care. Girls reported more internalizing symptoms (ES = 0.59-0.93). Sexual abuse and neglect were associated with a broader range of internalizing symptoms (ES = 0.35-0.64). Increased incidence of maltreatment was associated with increased levels of symptoms (ES = 0.21-0.22). Associations between maltreatment and symptom level were stronger for girls. This study stresses the importance of broad screening of maltreatment and internalizing symptoms to meet the needs of youth in foster care.

Der Verlauf von psychischen Problemen bei fremdplatzierten Kindern und Jugendlichen bis in deren Erwachsenenalter

Zusammenfassung. Theoretischer Hintergrund: Fremdplatzierte Kinder und Jugendliche sind psychisch hoch belastet, jedoch ist der Verlauf von psychischen Problemen bis in deren Erwachsenenalter weitgehend unbekannt. Fragestellung: Die Prävalenz und der Verlauf von psychischen Problemen bei fremdplatzierten Kindern und Jugendlichen bis ins Erwachsenenalter wurden in dieser Studie untersucht und mögliche Prädiktoren identifiziert. Methode: 164 Kinder und Jugendliche wurden während der Fremdplatzierung und im Erwachsenenalter längsschnittlich mittels Selbstbeurteilungsfragebogen auf psychische Gesamtauffälligkeit, internalisierende und externalisierende Probleme untersucht. Ergebnisse: 62.2 % der Kinder und Jugendlichen zeigten auffällige Werte für die Gesamtauffälligkeit wohingegen es im Erwachsenenalter noch 35.7 % waren. Die stärksten Prädiktoren für die jeweiligen Skalen im Erwachsenenalter waren die psychischen Probleme im Kindes- und Jugendalter. Mädchen zeigten eine erhöhte Wahrscheinlichkeit für internalisierende Probleme im Erwachsenenalter im Vergleich zu Jungen. Diskussion und Schlussfolgerung: Die psychischen Probleme bei fremdplatzierten Kindern und Jugendlichen verringerten sich bis ins junge Erwachsenenalter, dennoch blieb ein beachtlicher Teil chronisch auffällig. Implikationen für die Forschung und Praxis werden diskutiert.

Was wird aus Care Leavern?

Zusammenfassung. Theoretischer Hintergrund: Verschiedene Studien zeigen auf, dass ehemals ausserfamiliär platzierte Jugendliche, die viele biologische und psychosoziale Risikofaktoren akkumulieren, im weiteren Lebenslauf häufig eine geringere soziale Teilhabe aufweisen. Fragestellung: Dieser Themenschwerpunkt berichtet von einer Längsschnittstudie (JAEL – Jugendhilfe aus Erfahrung lernen) mit ehemals fremdplatzierten jungen Erwachsenen, die einer Hochrisikostichprobe zugeordnet werden können. Methode: Die Studie kombiniert für ihre Forschungsfragen prospektive und retrospektive Aspekte sowie qualitativ und quantitativ erhobene Daten. Ergebnisse: Der Themenschwerpunkt gibt sowohl eine kurze Einführung in die Methoden und die Rekrutierung der Stichprobe als auch einen Einblick in drei ausgewählte Themen, die in den drei Beiträgen dieses Themenschwerpunktes behandelt werden. Der erste Beitrag berichtet über die Ergebnisse zum Verlauf der psychischen Probleme vom Jugend- bis ins junge Erwachsenenalter. Der zweite Beitrag befasst sich mit Misshandlung und Vernachlässigung in der Kindheit als Risikofaktor für die soziale Teilhabe im jungen Erwachsenenalter, wie z. B. Arbeitslosigkeit, Legalbewährung, sozioökonomische Lage, psychische Gesundheit oder auch Beziehungsfähigkeit. Diese negativen Auswirkungen können durch Selbstwirksamkeitserfahrungen abgemildert werden. Der dritte Beitrag beinhaltet einen der bisher weniger beachteter Längsschnittstudienaspekte, nämlich die Risikofaktoren für eine Persönlichkeitsstörung in einer Hochrisikostichprobe sowie deren Stabilität. Diskussion und Schlussfolgerung: Auf die Bedeutung und Implikationen für Interventionen und Jugendhilfepolitik einerseits und die Forschung in diesem Feld andererseits wird eingegangen.

Hyperactive/impulsive symptoms and autistic trait in institutionalized children with maltreatment experience

The present study examined how maltreatment experience was associated with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) symptoms in children under institutional care. The key caregivers of children and adolescents aged 6 to 18 years who were under institutional care in Nagano prefecture, Japan were asked to answer the background questionnaire, ADHD-Rating Scale, and the Japanese children's version of the Autism-Spectrum Quotient. A total of 378 valid responses were obtained, of which 222 reported maltreatment experience prior to institutionalization. Both hyperactive/impulsive and inattentive scores were significantly higher in the maltreated group. Maltreatment experience was significantly associated with the presence of hyperactive/impulsive symptoms (p = 0.003) and inattentive symptoms (p = 0.027). Particularly, those who had experienced physical abuse were significantly more likely to have hyperactive/impulsive symptoms (p = 0.012) and autistic trait (p = 0.002). Thorough assessment of neurodevelopmental symptoms should be performed when placing children with maltreatment experience into institutional care.

Youth in Residential Care: A Cross-Sectional Mediation Analysis of Youth’s Perceptions of Their Social Images, Self-Representations, and Adjustment Outcomes

Individuals’ perceptions of their social images [i.e., meta-representations (MR)] and perceived stereotyping threat create involuntary stress responses that may affect important outcomes, such as self-esteem, academic achievement, and mental health. This study aimed to (1) analyze the indirect associations between residential care youth’s MR and their psychological adjustment (i.e., externalizing and internalizing problems) through their self-representations (SR) and (2) test the moderating role of youth’s age and residential unit size in those associations. A sample of 926 youth aged between 12 and 25years old filled out self-report questionnaires regarding their representations about how people in general perceive them (i.e., MR) and their SR. Residential care professionals filled in the socio-demographic questionnaires and the Child Behavior Checklist. Data were analyzed through multiple mediation models and moderated mediation models. Results showed that (1) youth’s behavioral MR were indirectly associated with higher internalizing and externalizing behavior through higher levels of behavioral SR and (2) youth’s emotional MR were associated with higher internalizing problems through higher emotional SR, but also with lower internalizing problems through lower levels of behavioral SR. These results emphasize the importance of stimulating positive SR, by showing that they can be a protective factor for youth in residential care.

Early onset externalizing behaviors among forensic psychiatric patients: Identification in child and adolescent psychiatric services

Forensic psychiatric patients constitute a heterogeneous patient group, with common comorbidity within the externalizing spectrum. Increased knowledge on early antecedents in the pathway to severe mental illness and criminality is needed. In this study, we investigated early onset externalizing behaviors in three groups of forensic psychiatric patients 1) patients without contact with child and adolescent psychiatry (CAP), 2) patients with CAP contact, and 3) patients with both CAP contact and institutional placement. Participants (N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden between 2016 and 2020. Data were collected through file information and semi-structured interviews and analyzed with a Bayesian approach. A history of CAP together with an institutional placement during childhood or adolescence was associated with more externalizing disorders, a higher number of convictions over the lifetime, a lower age at first conviction, and a lower age at first self-reported crime. Our findings provide further insight into the importance of early-onset adverse behaviors in the development of later externalizing behaviors, and may be of particular use for practitioners within social services and CAP services.

Executive Processes and Emotional and Behavioural Problems in Youths Under Protective Measures

This research studies the executive processes of youths under protective measures between 13 and 18years of age, as well as the emotional problems they have and the presence of behavioural problems, such as difficulties to control and direct attention, to control one’s own behaviour and inhibit inadequate or ineffective responses (hyperactivity-impulsiveness) and problems related to emotional regulation. In addition, we study the presence of significant differences according to the sex of the youths. We also analyse to what extent the difficulties in the executive processes are related to and can predict the emotional and behavioural problems. The instruments used were Stroop’s Colour and Word Test (Stroop), the Paths Test (TESen), and the System of Evaluation for Children and Adolescents (SENA). The results indicated that the youths had difficulties in such executive processes as execution, speed, and accuracy in carrying out tasks. Furthermore, they had emotion problems, amongst which the symptoms of anxiety are worthy of note; whilst attention deficit, hyperactivity-impulsiveness, and problems related to emotional regulation could also be observed. The data indicated greater difficulties in the executive processes for males than for females. There was a greater emotional symptomatology in the females, whilst there were greater deficits in attention and hyperactivity/impulsiveness in the males. Similarly, the deficits in the executive processes were related to and predicted emotional and behavioural problems. This research suggests the design of a structured programme focused on systematic training in real, daily situations, recommending the use of restorative techniques to work on the affected cognitive skills and techniques aimed at improving the youths’ emotion regulation.

Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder

BACKGROUND

Low self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown.

OBJECTIVE

Investigate global and domain-specific self-esteem in adolescents with RAD or DSED.

PARTICIPANTS AND SETTING

All adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12-20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12-20).

METHODS

Self-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents.

RESULTS

Compared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = -0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = -0.42, p = .005), SA (MD = -0.40, p = .015), AC (MD = -0.22, p = .038), PA (MD = -0.33, p = .048), and SW (MD = -0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = -0.42, p = .012) and SW (MD = -0.32, p = .037). More RAD symptoms were associated with lower SA (B = -0.051, p = .013), AC (B = -0.048, p = .028), RA (B = -0.053, p = .007), and CF (B = -0.052, p = .005). More DSED symptoms were associated with lower SC (B = -0.125, p = .038).

CONCLUSION

Both global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly.

Externalizing and internalizing symptoms and coping strategies in young victims of abuse

This research analyses the internalizing and externalizing symptoms and the coping strategies of young victims of abuse. These young people are in residential care under protective measures due to abuse. The participants were 61 youths (32 male and 29 female) between 12 and 17 years of age. Different works of research stress the need for an early identification of the psychopathological symptomatology that these adolescents may present in order to provide an adequate psycho-educational intervention. The relationship between the adolescents’ psychopathological symptomatology and the coping strategies and styles they use to resolve problems is studied. It is also analyzed whether internalizing and externalizing problems predict the style and coping strategies of adolescents. Two tests were used: 1. Child and Adolescent Evaluation System (SENA); 2. Adolescent Coping Scales (ACS). The results indicate that young victims of abuse have internalizing and externalizing symptoms. These adolescents are characterized by an unproductive coping style, as well as by the use of coping strategies that are not very functional and ineffective for resolving conflicts. The psychopathological symptomatology is related to and predicts an unproductive coping style, badly adapted to solving daily problems (worrying, blaming oneself, not coping, ignoring the problem, or keeping it to oneself). This research has allowed us to identify the presence of several areas of vulnerability in these young persons which could be playing an important role in their psychosocial maladjustment. The research suggests the design of intervention strategies, for both groups and individuals, aimed at mitigating and modifying the sources of the problems in victims of child abuse.

The Use of Antidepressants, Antipsychotics, and Stimulants in Youth Residential Care

Objectives: To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Methods: Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age- and gender-adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age, and gender. Results: One thousand eight hundred fifty-six children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥ 13 years. Among those, 423 or 23% used any of the 3 psychotropics, which was significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most of the people. Polypharmacy was not frequent in RC, as only 26% used ≥2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and although the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6-16-year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (95% confidence interval [95% CI]: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (95% CI: 0.9-1.0). Conclusion: The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.

Screening for more with less: Validation of the Global Appraisal of Individual Needs Quick v3 (GAIN-Q3) screeners

Multi-morbidity is the norm among adolescents and adults with substance use and other mental disorders and warrants a multi-pronged screening approach. However, the time constraints on assessment inherent in clinical practice often temper the desire for a full understanding of multi-morbidity problems. The 15- to 25-minute Global Appraisal of Individual Needs Quick version 3 (GAIN-Q3) includes screeners for 9 common clinical problems that are short (4 to 10 items) and provide dimensional measures of problem severity in each area that are also categorized to guide clinical decision making. The screeners are summed into a total score that represents a 10th screener for multi-morbidity. This paper provides background on the development of the GAIN-Q3 screeners, their psychometric behaviors, efficiency, and predictive power relative to the 1-2 h full GAIN-I. Based on literature showing differential item and scale functioning by age, analyses were conducted separately using data from 10,625 adolescent and 10,167 adult treatment clients. Despite the condensed lengths of the screening measures compared with their longer versions, the reliability estimates are within the good to excellent range (0.7 to 0.9) in terms of internal consistency for 6 of the 10 screeners for adolescents and 7 of the 10 screeners for adults. In addition, the part to whole correlation for all 10 comparisons for both adolescents and adults are excellent (0.82 to 0.96). Moreover, there is strong evidence for the measures' convergent and discriminant validity and efficiency (i.e., maximum information gathered in as few items possible) relative to the full-length scales as well as relative to other scales in the full GAIN-I. Analyses of the interpretive cut-scores provide accurate identification of cases with high sensitivity and specificity, thus supporting the screeners' capacity to triage. PUBLIC SIGNIFICANCE STATEMENT: This study reports on the ability (GAIN-Q3) to efficiently screen for multiple co-occurring substance use, mental health, and associated problems. Multi-problem presentation in the social service sector is the normal expectation, yet time constraints prevent broad assessment of potentially many problematic areas. The GAIN-Q3 showed convergent and discriminant validity relative to the full-length scales as well as other scales assessed in the GAIN-I. The GAIN-Q3 achieves the desired balance between broad coverage and measurement efficiency to provide ample information to identify the best course of action for an individual.

Perceived social support and quality of life among adolescents in residential youth care: a cross-sectional study

BACKGROUND

Residential youth care (RYC) institutions aim to provide care and stability for vulnerable adolescents with several previous and present challenges, such as disrupted attachments, wide-ranging adverse childhood experiences, mental health problems, and poor quality of life (QoL). To the best of our knowledge, the present study is the first to provide knowledge of the associations between perceived social support and QoL and to explore the potential moderating effect of perceived social support on QoL for adolescents who have experienced maltreatment and polyvictimization.

METHODS

All RYC institutions with adolescents between the ages 12-23 in Norway were asked to participate in the study. A total of 86 institutions housing 601 adolescents accepted the invitation, from which 400 adolescents volunteered to participate. The Child and Adolescent Psychiatric Interview was used to gather information on maltreatment histories and degree of victimization; the Kinder Lebensqualität Fragebogen was used to measure QoL through several domains (overall QoL, physical well-being, emotional well-being, and self-esteem); and the Social Support Questionnaire was used to measure perceived social support. Linear regression and independent samples t-test were used to study the associations between perceived social support and QoL as well as the potential moderating effect of perceived social support in the association between maltreatment history and QoL.

RESULTS

Perceived social support was positively associated with QoL for both girls and boys, with domain-specific findings. A higher number of different types of support persons was associated with overall QoL, emotional well-being, and self-esteem for boys, but only with self-esteem for girls. Individual social support from RYC staff and friends was associated with higher QoL for girls. However, perceived social support did not moderate the association between maltreatment history and reduced QoL for either sex.

CONCLUSIONS

This study emphasizes the importance of maintaining social support networks for adolescents living in RYC, the crucial contribution of RYC staff in facilitating social support, and the potential value of social skills training for these vulnerable adolescents. Furthermore, a wider range of initiatives beyond social support must be carried out to increase QoL among adolescents with major maltreatment and polyvictimization experiences.

Shared residential placement for child welfare and juvenile justice youth: current treatment needs and risk of adult criminal conviction

BACKGROUND

Although child welfare youth and juvenile offenders in residential care have different judicial placement reasons, there seems to be overlap in their demographic and psychosocial backgrounds. This could raise the question whether these adolescents should be placed in strictly separated institutions based on their judicial title (civil or criminal law) or together based on their needs. As systematic knowledge on the effects of shared placement of these groups is limited, the aim of the current paper is to examine the demographic, crime-related and psychosocial characteristics of child welfare and juvenile justice youths in shared residential care and subsequently examine its relationship with offending behavior in adulthood.

METHODS

The sample was drawn from the Swiss study for clarification and goal-attainment in youth welfare and juvenile justice institutions (MAZ.) and consisted 354 juveniles (252 child welfare, 102 juvenile justice; 223 boys, 131 girls) between 10 and 18 years. Mental health problems were assessed with the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2), official adult criminal conviction data up to 10 years later was obtained from the Swiss Federal Office of Statistics. Three sets of logistic regressions were conducted investigating any, violent and non-violent convictions.

RESULTS

Univariate results showed that that the child welfare sample included more females, more juveniles with the Swiss nationality, and was younger at the time of assessment and at first placement compared to the juvenile justice sample. Furthermore, child welfare youths showed less alcohol/drug use problems and offending behavior than their juvenile justice counterparts. Unadjusted models demonstrated that committing authority predicted adult criminal convictions, but that this distinction disappeared when it was controlled for demographic, crime-related and psychosocial factors. Gender and time at risk were found to be related to adult conviction in all three models. In addition, alcohol/drug use problems were risk factors for general, previous convictions for violent, and traumatic experiences for non-violent convictions in adulthood.

CONCLUSIONS

Our results support the approach of placement in residential care institutions based on treatment needs instead of on judicial title. Special attention should be devoted to trauma informed care and substance use coping. However, more research is needed.

A Systematic Review of Some Reliability and Validity Issues regarding the Strengths and Difficulties Questionnaire Focusing on Its Use in Out-of-Home Care

PURPOSE

A systematic review was conducted to analyze the inter-rater reliability, cross-informant consistency, test-retest reliability, and temporal stability of the Strengths and Difficulties Questionnaire (SDQ), and its ability to discriminate.

METHOD

We searched three databases for articles about the SDQ (parent, teacher, and self-report version), used samples of children up to age 18 and reported inter-rater reliability, cross-informant reliability, test-retest reliability, temporal stability, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS

Focusing on the TDS, inter-rater, and cross-informant reliability showed acceptable values, but respondent types (e.g., mothers and fathers) are not interchangeable. Test-retest reliability and temporal stability were also acceptable, and not excessively high. Specificity and NPV were acceptable but not sensitivity and PPV.

DISCUSSION AND CONCLUSION

Greater transparency is needed about who the respondent is when the term "parents" is used. The SDQ is an important supplement to service-as-usual assessments by social care professionals.

Internalizing Symptom Profiles Among Youth in Foster Care: A Comparison Study

Background: A high prevalence of anxiety and depression is found among youth in foster care. There is limited knowledge on the anxiety and depression symptom profiles of youth in foster care. We examined latent profiles of anxiety and depression symptoms across three unique youth samples and whether youth in foster care were more or less likely to belong to specific symptom profiles than their peers recruited from clinical or general youth populations. We also investigated if these profiles were predicted by sex and age. Methods: Self-reported anxiety and depression symptoms were assessed by Spence Children's Anxiety Scale and Short Mood and Feelings Questionnaire. Data were pooled from three youth samples (N = 2,005; mean age = 13.9 years, range = 11-18 years) comprising youth in foster care (n = 245), a clinical youth sample (n = 107), and a general population youth sample (n = 1,653). Symptom profiles were identified using latent profile analyses. Multinominal logistic regression was used to predict the latent profile membership. Results: Three profiles that differed both in symptom level and shape were identified and labeled as low, medium, and high symptom profile. Compared to the general population youth sample, youth in foster care had a higher likelihood of belonging to the high symptom profile, but not the medium symptom profile. Youth from the clinical sample had an increased risk of belonging to the medium and high symptom profiles compared to the youth in foster care and general population youth samples. Across samples, girls yielded a higher likelihood of having a medium or high symptom profile. Increasing age was associated with a higher likelihood of being in the high symptom profile. Conclusion: Compared to their counterparts in the general population, youth in foster care are at risk of belonging to a class of youth with high symptom levels across subtypes of internalizing symptoms, indicating the importance of systematic and broad assessment of internalizing symptoms among these youth. Knowledge on the symptom profiles of anxiety subtypes and depression increases our understanding of the treatment needs of youth in foster care.

The Stress of Caring-Resilience and HPA-Axis Activity in Hair Samples of Youth Residential Caregivers

Background: Professional caregivers in youth residential care institutions experience frequent verbal and physical aggression as well as multiple stressors as part of their everyday work, leading to high levels of burnout and staff turnover. Resilience might buffer against psychophysiological stress response and therefore be crucial for well-being in professional caregivers. Objectives: We aimed to investigate if measures related to resilience [sense of coherence (SoC), self-efficacy and self-care] and attachment security of caregivers were cross-sectionally associated with stress markers in hair samples [cortisol and dehydroepiandrosterone (DHEA)]. Method: Participants (n = 134; 64.2% women) reported on individual resilience measures and provided hair samples for cortisol and DHEA assays. Attachment was assessed in a subsample using the Adult Attachment Projective Picture System (AAP, n = 69). Linear regression models were fitted to estimate the association between resilience measures and the Cortisol:DHEA ratio, cortisol and DHEA, controlling for gender and age. Results: SoC was associated with a lower Cortisol:DHEA ratio (β = -0.36, p < 0.001), driven by a positive association between SoC and DHEA levels (β = 0.28, p = 0.002). Self-care was also associated with lower Cortisol:DHEA ratios (β = -0.24, p = 0.005), due to self-care being associated with higher DHEA (β = 0.21, p = 0.016). HPA-axis measures were not associated with self-efficacy nor with attachment patterns in a subsample. Conclusions: Our findings imply that youth residential care institutions might benefit from programs focusing on enhancing SoC and self-care practices. Fostering a meaningful, comprehensible and manageable professional climate in caregiving environments and implementing self-care in routine practices might enhance not only well-being but also physical health of professional caregivers and in this way buffer adverse health effects of chronic stressors.

Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence

Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12-20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6-11%), and the prevalence of DSED was 8% (95% CI 5-11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups.

The Use of Sleep Medication in Youth Residential Care

Objectives: To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Methods: Participants were youth 0-20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). Results: A total of 2171 youths were identified in RC at mean age 14 years (82% ≥ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5-2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3-1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylum seekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Conclusion: Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.

Victimization and substance use among adolescents in residential child care

BACKGROUND

Adolescents in Residential Child Care (RCC) report high levels of victimization. This has been linked to mental health problems and a higher risk of substance use and substance use problems. The present study aimed to evaluate the specific impact of different forms of victimization on alcohol and cannabis use problems among adolescents in RCC, attending to sex differences.

METHODS

321 adolescents from 38 residential therapeutic care facilities in Spain participated in the study. Thirty-six different forms of victimization were evaluated, as well as alcohol and cannabis use problems. Impact of polyvictimization and specific forms of victimization on alcohol and cannabis use problems and disorders were calculated using Analysis of Variance (ANOVA) and logistic regression models.

RESULTS

Girls in RCC reported significantly more experiences of victimization. Polyvictimization was associated with alcohol use problems but not cannabis use problems. Property, domestic and community victimization showed the highest predictive role regarding alcohol and cannabis use disorders, with significant interactions with sex and migrant family background.

CONCLUSIONS

Adolescents in RCC reported considerably high levels of victimization and alcohol and cannabis use problems. In this population, property victimization, as well as indirect domestic and community victimization were predictors of further substance use problems, with girls being particularly sensitive to victimization. Migrant family backgrounds can also have an influence on the impact of some victimization forms on substance use. Victimization associated to high-risk environments and families could contribute to explain the high levels of substance use problems in this population.

Emotional, Behavioural and Executive Functioning Problems in Children in Residential Care

This research analyses the emotional and behavioural problems, as well as the problems in the executive functions, of children in residential care under protective measures, between 8 and 12 years of age. We analyse the relationship between the problems with their executive functions and their emotional and behavioural problems, as well as the predictive value of the executive functions for the said emotional and behavioural problems. The instruments used were as follows: five digits test (FDT), behavioural assessment of the dysexecutive syndrome in children (BADS-C) and the system of evaluation for children and adolescents (SENA). The results indicate that the children have difficulties in their executive functions, with such problems as in attention control and regulation, impulsiveness, mental rigidity, behavioural organisation and planning and resolving problems. They also have internalising and externalising problems, as well as difficulties in controlling their emotional reactions and understanding the emotions of others. It becomes evident that the difficulties in their executive functions are related to and predict their emotional and behavioural problems. The research demonstrates the need to intervene in the problems detected through the design of therapeutic programmes and interventions in the residential context.

Organisational models of health services for children and adolescents in out-of-home care: Health technology assessment

AIM

Decades of research confirm that children and adolescents in out-of-home care (foster family, residential care) have much greater health care needs than their peers. A systematic literature review was conducted to evaluate organisational health care models for this vulnerable group.

METHODS

A systematic literature search was undertaken of the following databases: Academic Search Elite, CENTRAL, Cochrane Database of Systematic Reviews, Cinahl, DARE, ERIC, HTA, PsycInfo, Psychology and Behavioural Sciences Collection, PubMed, SocIndex. Randomised and non-randomised controlled trials were to be included. Two pairs of reviewers independently assessed abstracts of the identified published papers. Abstracts meeting the inclusion criteria were ordered in full text. Each article was reviewed independently, by pairs of reviewers. A joint assessment was made based on the inclusion criteria and relevance. Cases of disagreement were resolved by consensus discussion.

RESULTS

No study with low or medium risk of bias was identified.

CONCLUSION

In the absence of studies of acceptable quality, it is not possible to assess the impact of organisational models intended to ensure adequate health and dental care for children and adolescents in out-of-home care. Therefore, well-designed follow-up studies should be conducted following the implementation of such models.

Predictive factors for changes in quality of life among children and adolescents in youth welfare institutions

PURPOSE

Children and adolescents living in youth welfare institutions often have a below average quality of life (QoL), for reasons that include developmental difficulties, history of traumatic experiences, and mental disorders. Youth welfare measures are needed that would have a positive impact, but there is a lack of longitudinal research on which measures are most effective. This study investigated what factors are associated with an improvement in QoL during residential stay.

METHODS

Residents of youth care facilities in Switzerland and their professional caregivers completed questionnaires that addressed QoL, psychopathology, and experience of traumatic events at two time points. In addition, information regarding mental disorders was obtained through structured clinical interviews. Analyses were conducted on the data obtained from 204 respondents aged 11-18 years. Comparisons with a school sample were conducted.

RESULTS

Compared to a school sample, a majority of participants rated their QoL equal, whereas their caregivers rated it as lower. Factors predictive of a poorer QoL were high levels of internalizing and externalizing psychopathology, presence of co-morbidities, and female gender. At the second assessment, the caregivers reported a small improvement, which was associated with reductions in both internalizing and externalizing psychopathology.

CONCLUSIONS

The finding that a reduction in severity of psychopathology may result in an improvement in QoL underlines the importance of providing professional support for mentally ill residents of youth welfare institutions. Further research is needed to determine the causality of this association.

Disparities in healthcare transition support received by adolescents with special healthcare needs

BACKGROUND

Transitioning to adult healthcare systems can be challenging, especially if left unaddressed for adolescents with special healthcare needs (ASHCN), such as those with autism spectrum disorder and attention-deficit/ hyperactivity disorder. While there is evidence of disparities between different demographics regarding general healthcare services, research on healthcare-specific transition planning is lacking. Thus, there is a critical need to continually investigate these disparities.

METHOD

Using nationally representative data from the 2016 National Survey for Children's Health, several analyses were conducted to examine doctor-patient interactions and discussions about transitioning to adult health care. Accounting for demographic and diagnostic indicators allowed for the assessment of disparities.

RESULTS

Findings revealed significant disparities between age, disability and race relative to various healthcare transition support services.

CONCLUSIONS

Findings provide valuable information that can inform the development of training programmes for healthcare providers, influence policy, modify procedures and interventions and highlight the need for increased advocacy for ASHCN.

Attachment disorder and attachment theory - Two sides of one medal or two different coins?

INTRODUCTION

Currently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts. We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9.

METHODS

A total of 135 children aged between 5 and 9 years (M=7.17 years, SD=1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development.

RESULTS

The prevalence of AR in children with AD was 28.6% for the 'secure' form of AR, 17.1% for the 'insecure-avoidant' form, 25.7% for the 'insecure-ambivalent' form, and 28.6% for the 'disorganized' form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills.

CONCLUSIONS

Longitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models.

Come together: case specific cross-institutional cooperation of youth welfare services and child and adolescent psychiatry

BACKGROUND

Due to the increasing rate of children and families who require support from both youth welfare services and from mental health services, a solid cross-institutional cooperation is needed to provide coordinated and integrated help. Studies involving not only qualitative, but also quantitative information from both services regarding not only general, but also case specific views on cross-institutional cooperation and psychosocial needs are lacking.

METHODS

Hence, we collected data from n = 96 children and families who received support from youth welfare office (YWO) and child and adolescents psychiatry (CAP) simultaneously. In a longitudinal survey, we assessed the evaluation of case specific cross-institutional cooperation and psychosocial needs by employees of YWO and CAP as well as descriptive data (including psychopathology of children) over a 6-month period. Repeated-measures ANOVAs were conducted to assess the effects of time and institution (YWO/CAP) on employees' evaluation of case specific cross-institutional cooperation and psychosocial needs as well as children's psychopathology.

RESULTS

The data showed that generally YWO employees rated the case specific communication better than CAP employees. Furthermore, CAP employees estimated psychosocial needs higher than YWO employees did. The employees' evaluation of total case specific cross-institutional cooperation did not differ between the employees of both institutions; it further did not change over time. The case specific evaluations did not correlate between the case responsible employees of YWO and CAP.

CONCLUSION

The data showed satisfaction with the case specific cross-institutional cooperation in general, but meaningful differences in case specific ratings between both institutions indicate the possibility and need for improvement in daily work and cooperation as well as in regulations and contractual agreements. The implementation of more exchange of higher quality and transparency will ensure smoother cross-institutional cooperation. Future research should pursue this topic to convey the need for further improvement in cross-institutional cooperation into decision-making processes and to evaluate the success of innovative projects in this field.