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Wamser-Nanney R, Campbell CL. Factors associated with caregiver help seeking behavior among at-risk children. CHILD ABUSE & NEGLECT 2022; 134:105937. [PMID: 36327764 DOI: 10.1016/j.chiabu.2022.105937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few at-risk school-age children receive needed psychological help, and our understanding of predictors of service use in this population is limited. Many broader contextual factors have received little attention including caregiver's trauma history and social support, father involvement, family functioning, and neighborhood satisfaction. The links between types of and cumulative maltreatment have also been inconsistent, and prior work has not always accounted for children's symptoms. OBJECTIVE The current study examined child, caregiver, family, neighborhood, and maltreatment factors in relation to past-year mental health service use among at-risk eight-year-old children. Cumulative and types of maltreatment were both investigated to help elucidate the role of these experiences. PARTICIPANTS/SETTING/METHOD Eight hundred and forty-five eight-year-old at-risk children (48.3 % male; 59.5 % Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) were included. RESULTS A small portion of children (12.4 %) received psychological help in the previous year. Children's externalizing symptoms, residing with a non-biological caregiver, cumulative maltreatment and sexual and emotional abuse were associated with seeking psychological services, whereas physical abuse, neglect, and domestic violence exposure were not. Other caregiver factors, and family and neighborhood factors were also unrelated. CONCLUSIONS Non-biological caregivers as well as caregivers of children with higher levels of externalizing symptoms may be more inclined to seek out mental health services, along with greater, and specific, maltreatment experiences. These findings indicate that child factors may be key in understanding help seeking, however, it is important to further consider other broader contextual factors in future work.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
| | - Claudia L Campbell
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
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Wamser-Nanney R, Campbell CL. Correlates of caregiver's help seeking behavior among young maltreated children. CHILD ABUSE & NEGLECT 2022; 126:105520. [PMID: 35091133 DOI: 10.1016/j.chiabu.2022.105520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Relatively few maltreated children receive mental health services, despite the importance of treatment in combating the deleterious impact of maltreatment. Characteristics of the child, caregiver, and family have been investigated in relation to caregiver's help seeking behavior for children's psychological difficulties; yet, these associations have been inconsistent, and are very understudied among younger maltreated children. Other aspects of the child's environment, such as father involvement, negative life events, and neighborhood risk and satisfaction have not been examined. It is also uncertain how cumulative maltreatment and the specific forms of maltreatment - sexual, physical, and emotional abuse, neglect, and domestic violence, are associated with mental health consultation. OBJECTIVE The aim of the current study was to utilize an ecological model that included child, caregiver, family, neighborhood, and maltreatment factors to better understand caregiver's help seeking behavior. PARTICIPANTS/SETTING/METHOD The study relied upon 448 six-year-old maltreated children (47.5% male; 48.7% Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study. RESULTS Several factors, including child's gender and externalizing symptoms, and caregiver educational attainment and depression and were associated with mental health consultation. Cumulative maltreatment, however, was unrelated. When the specific forms of maltreatment were included, none of the individual maltreatment types were tied to help seeking behavior. CONCLUSIONS Child and caregiver factors, such as child's level of behavioral challenges as caregiver's level of education and depression, may contribute to decisions regarding seeking services for young, maltreated children. However, neither cumulative nor the forms of maltreatment may correspond with help seeking among young, maltreated children.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA.
| | - Claudia L Campbell
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
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Cheng TC, Lo CC. Providing Health Care to Maltreated Children Receiving Child Welfare Services. HEALTH & SOCIAL WORK 2020; 45:31-39. [PMID: 31970385 DOI: 10.1093/hsw/hlz035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/19/2019] [Accepted: 04/16/2019] [Indexed: 06/10/2023]
Abstract
This study sought associations between maltreated children's receipt of needed health care and five other variables or sets of variables: medical need, social structural factors, access to care, demographic factors, and child welfare intervention. Data for this study came from longitudinal records derived for a sample of 1,465 children (extracted from all records in a national data set) for whom maltreatment had been substantiated. Children in the sample had, following substantiation, either remained in the home or been placed in kinship care or other out-of-home setting. Generalized estimating equations were applied to the data. The results supported a negative association between the sample's receipt of needed health care and three factors: general physical health, age, and remaining in the home after substantiation. Data analysis also supported a positive association between receiving needed care and Medicaid receipt, family income of between 100 percent and 200 percent of federal poverty level, family income above 200 percent of federal poverty level, needed health care services included in child welfare case plan, and wave 2 interview. The study's implications for social work practice include the necessity of accurately identifying children's health problems, of addressing health needs in the case plan, and of coordinating meaningfully with health professionals.
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Neil AL, Islam F, Kariuki M, Laurens KR, Katz I, Harris F, Carr VJ, Green MJ. Costs for physical and mental health hospitalizations in the first 13 years of life among children engaged with Child Protection Services. CHILD ABUSE & NEGLECT 2020; 99:104280. [PMID: 31783310 DOI: 10.1016/j.chiabu.2019.104280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/03/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Longitudinal data on health costs associated with physical and mental conditions are not available for children reported to child protection services. OBJECTIVE To estimate the costs of hospitalization for physical and mental health conditions by child protection status, including out-of-home-care (OOHC) placement, from birth until 13-years, and to assess the excess costs associated with child protection contact over this period. PARTICIPANTS AND SETTING Australian population cohort of 79,285 children in a multi-agency linkage study. METHODS Costs of hospitalization were estimated from birth (if available) using Round 17, National Hospital Cost Data Collection (2012-13; deflated to 2015-16 AUD). Records of the state child protection authority determined contact status. Data were reported separately for children in OOHC. Hospital separations were classified as mental disorder-related if the primary diagnosis was recorded in ICD-10 Chapter V (F00-F99). RESULTS Hospital separations were more common in children with child protection contact. Physical health care costs per child decreased with age for all children, but were significantly higher for children with contact. Mental health costs per child were always significantly higher for children with contact, with marked increases at 3 ≤ 4 years and 8 ≤ 9 years. Point estimates of annual costs per child were always highest for children with an OOHC placement. The net present value of the excess costs was $3,224 per child until 13- years, discounted at 5 %. CONCLUSIONS Children in contact with child protection services show higher rates and costs for physical and mental health hospitalizations in each of their first 13 years of life.
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Affiliation(s)
- Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Fakhrul Islam
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Maina Kariuki
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, Australia; School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Ilan Katz
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Psychiatry, Monash University, Melbourne, Australia; Neuroscience Research Australia, Sydney, Australia
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia
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Macdonald G, Livingstone N, Hanratty J, McCartan C, Cotmore R, Cary M, Glaser D, Byford S, Welton NJ, Bosqui T, Bowes L, Audrey S, Mezey G, Fisher HL, Riches W, Churchill R. The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis. Health Technol Assess 2018; 20:1-508. [PMID: 27678342 DOI: 10.3310/hta20690] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003889. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geraldine Macdonald
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK.,School for Policy Studies, University of Bristol, Bristol, UK
| | - Nuala Livingstone
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Jennifer Hanratty
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Claire McCartan
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Richard Cotmore
- Evaluation Department, National Society for the Prevention of Cruelty to Children (NSPCC), London, UK
| | - Maria Cary
- King's Health Economics, King's College London, London, UK
| | - Danya Glaser
- University College London and Great Ormond Street Hospital for Sick Children, London, UK
| | - Sarah Byford
- King's Health Economics, King's College London, London, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tania Bosqui
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Lucy Bowes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gill Mezey
- Population Health Sciences and Education, St George's, University of London, London, UK
| | - Helen L Fisher
- King's Health Economics, King's College London, London, UK
| | - Wendy Riches
- Riches and Ullman Limited Liability Partnership, London, UK
| | - Rachel Churchill
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Garcia AR, Gupta M, Greeson JKP, Thompson A, DeNard C. Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing. CHILD ABUSE & NEGLECT 2017; 70:292-302. [PMID: 28668759 DOI: 10.1016/j.chiabu.2017.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.
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Affiliation(s)
- Antonio R Garcia
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States.
| | - Meera Gupta
- Division of Transplant Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA 19104, United States
| | - Johanna K P Greeson
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
| | - Allison Thompson
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
| | - Christina DeNard
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
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Stein BD, Sorbero MJ, Dalton E, Ayers AM, Farmer C, Kogan JN, Goswami U. Predictors of adequate depression treatment among Medicaid-enrolled youth. Soc Psychiatry Psychiatr Epidemiol 2013; 48:757-65. [PMID: 23589098 DOI: 10.1007/s00127-012-0593-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 09/12/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine if Medicaid-enrolled youth with depressive symptoms receive adequate acute treatment, and to identify the characteristics of those receiving inadequate treatment. METHODS We used administrative claims data from a Medicaid-enrolled population in a large urban community to identify youth aged 6-24 years who started a new episode of treatment for a depressive disorder between August 2006 and February 2010. We examined rates and predictors of minimally adequate psychotherapy (four visits in first 12 weeks) and pharmacotherapy (filled antidepressant prescription for 84 of the first 144 days) among youth with a new treatment episode during the study period (n = 930). RESULTS Fifty-nine percent of depressed youth received minimally adequate psychotherapy, but 13 % received minimally adequate pharmacotherapy. Youth who began their treatment episode with an inpatient psychiatric stay for depression and racial minorities were significantly less likely to receive minimally adequate pharmacotherapy and significantly more likely to receive inadequate overall treatment. CONCLUSIONS While the majority of youth appear to be receiving minimally adequate acute care for depression, a substantial number are not. Given current child mental health workforce constraints, efforts to substantially improve the provision of adequate care to depressed youth are likely to require both quality improvement and system redesign efforts.
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Affiliation(s)
- Bradley D Stein
- Community Care Behavioral Health Organization, Pittsburgh, USA.
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