Connectedness and suicidal ideation among adolescents involved with child welfare: a national survey

Examining Individual and Service Delivery Context Variables and Their Association with the Effectiveness of QPR Suicide Prevention Gatekeeper Training

Suicide prevention training programs have spread rapidly within child and public-serving organizations, due to the alarming increase in youth suicide rates. Yet, within these organizations, roles and responsibilities can shape attitudes and intentions related to suicide prevention, thereby influencing the uptake of prevention efforts. As such, various organizational and individual factors can predict uptake, adoption, and maintenance of prevention efforts (Fixsen et al., 2005). To date, few studies have examined the service delivery context in understanding training effectiveness, especially as it relates to QPR (Question Persuade and Refer), one of the most widely disseminated suicide prevention gatekeeper programs. The purpose of this longitudinal study was to evaluate whether individual and organizational characteristics influenced the effectiveness and sustainability of training outcomes, and whether such differences existed among diverse child and public-serving delivery sectors. Several training outcomes that align with the Theory of Planned Behavior (Ajzen, 1991) were examined, including confidence, attitudes, social norms, and suicide prevention behaviors. Measures were assessed prior to and 90 days after the QPR program among a sample of 858 professionals. Community support personnel uniquely showed improvements on social norms while juvenile justice and child welfare workers engaged in more suicide prevention behaviors post training. While trainees across sectors had improved suicide prevention attitudes, law enforcement personnel were the exception. Organizational climate predicted change in suicide prevention attitudes, confidence, and social norms. Trainees who were older, Latinx, and Black had the most improvement on several training outcome variables, but these findings also varied within service sectors.

What Is Helpful and What Is Challenging for the Caregivers of Young People Receiving Interventions to Prevent Suicide? Caregivers' Perspectives-A Rapid Scoping Review

(1) Background: Suicide is a leading cause of death among young people. Preventing suicide in young people is a priority. Caregivers play a vital role in ensuring interventions for young people experiencing suicide ideation and/or attempts are implemented, and that they are maintained over time. Despite this, little is known about what caregivers find helpful and challenging in relation to suicide prevention interventions. This rapid scoping review is the first to address this gap. (2) Methods: Searches were completed on six electronic databases using keywords relating to 'suicide prevention, 'young people', and 'caregivers'. Ten studies-using both qualitative and quantitative methods, and involving >1400 carers from the United States and Europe-were selected for inclusion. (3) Results: The review shows that caregivers value interventions that are delivered by non-judgmental clinicians, that are suitable to the particular needs of their child, that are available when needed, and that support their confidence and communication. Caregivers experience difficulties with interventions that require their attendance at specific times, and that fail to recognize and/or address their own mental health needs. (4) Conclusions: The findings can be used to inform and improve the intervention design, with the aim of improving outcomes for caregivers and young people.

Flourishing mental health among adults with child welfare contact during childhood: Findings from a nationally representative Canadian survey

This study investigated the prevalence of and factors associated with complete mental health (CMH) among a nationally representative sample of Canadians who had contact with child welfare services before age 16. CMH was defined as (1) the absence of suicidality, mental illness, and substance abuse or dependence in the preceding year; (2) happiness or life satisfaction almost every day in the preceding month, and; (3) social and psychological well-being almost every day in the preceding month. Data came from the 2012 Canadian Community Health Survey - Mental Health. A subsample of 732 adults with child welfare contact during childhood was analyzed using bivariate chi-square analyses and multivariate logistic regression models. Overall, 63.5% of adults with child welfare contact during childhood were in CMH. Those with a post-secondary degree, who were married, who had a confidant, and who used religion or spirituality to cope with daily challenges were more likely to be in CMH. The odds of CMH were higher among those without chronic pain, functional limitations, and a history of depression, anxiety, or substance abuse or dependence. The results of this study indicate significant resiliency among adults following contact with child welfare services during childhood. Implications for appropriate interventions are discussed.

Longitudinal Association Between Child Psychological Abuse and Neglect and Academic Achievement in Chinese Primary School Children: A Moderated Mediation Model

To investigate the relationships among child psychological abuse and neglect (CPAN), children’s learning engagement, family socioeconomic status (family SES), and children’s academic achievement, 271 children (M_age = 9.41 ± 0.81 years old) and their parents participated in this study with a longitudinal design. Results revealed that learning engagement at T1 mediated the relationship between CPAN at T1 and academic achievement at T2 when gender, age, grade, and academic achievement at T1 were under control. Family SES at T1 moderated the relationship between children’s learning engagement at T1 and academic achievement at T2. The association between learning engagement and academic achievement was stronger among children from lower family SES. Our findings highlighted the negative impact of CPAN and the critical role of learning engagement in children’s academic achievement, especially for those from low SES families.

Does Kinship vs. Foster Care Better Promote Connectedness? A Systematic Review and Meta-Analysis

Internationally, there is an increasing trend toward placing children in kinship vs. foster care. Prior research suggests that children in kinship care fare better compared to children in foster care; however, the reasons for this remain unclear. We conducted a systematic review and meta-analysis to examine the hypothesis that kinship care better preserves children's connectedness to caregiver, birth family, culture, and community; which, in turn, is associated with more optimal child outcomes. Thirty-one studies were reviewed that compared children aged 0-18 years in kinship care vs. foster care on levels of connectedness, three of which had outcomes that permitted meta-analysis. Findings indicated that children in kinship vs. foster care were more likely to feel connected to family in general; however, there was not a clear advantage for kinship vs. foster care for caregiver, birth parent, cultural, and community connectedness. While levels of connectedness were generally associated with more adaptive child outcomes for children in both kinship and foster care, no reviewed studies examined the hypothesis that children's connectedness may mediate the relationship between placement type and child well-being and placement outcomes. Results are discussed with respect to limitations and policy implications of the current evidence-base and the need for more rigorous research to help identify how to improve child well-being in home-based care.

Caregiver-Child Relationship Quality as a Gateway for Suicide Risk Resilience: Don't Discount the Men in Mexican Descent Youths' Lives

The purpose of the present study is to determine if connection with female (FC) and male caregivers (MC) could buffer the negative effects of intergenerational acculturative conflict (IAC) on suicide risk among Mexican descent adolescents and emerging adults. The sample included 722 Mexican descent adolescents and emerging adults (age range: 14-25 years, M = 19.69; SD = 1.75) from a U.S. high school and public university located near the United States-Mexico border. The majority of the sample were women (65.9%) and born in the United States (92.8%). Data were collected via self-report measures. The significant findings of linear regression analyses were: 1) Higher MC-IAC was related to higher levels of past year suicide risk, while higher levels of FC and MC connection were related to lower levels; and 2) Both MC and FC connection protected youth against the negative impact of IAC on suicide risk. Results are discussed in terms of the importance of both the MC and FC relationship quality in the context of IAC on suicide risk among Latinx youth. Suggestions will be made to include both MC and FC caregivers in research, prevention, and intervention efforts.

Does the source matter? Social support and suicide attempts among homeless youth

The impact of social support on suicide is understudied among youth experiencing homelessness (YEH). This is problematic because assumptions about the protectiveness of relationships may not generalize to conflictive YEH environments. This study, which included 1047 YEH, used path modeling with a logistic regression estimator to examine associations between social support from family, home-based friends, and street-based friends and past-year suicide attempt. Social support from home-based friends but not family or street-based friends decreased suicide attempt risk. Moreover, social support from home-based friends moderated the association between depression and attempt risk. Targeted programming strengthening home-based-friend relationships represents a valuable endeavor.

Substance use and suicidal ideation among child welfare involved adolescents: A longitudinal examination

BACKGROUND

The purpose of this study was to investigate the longitudinal predictors of alcohol use, marijuana use, and suicidal ideation among maltreated adolescents.

METHODS

Longitudinal data from this study come from three waves of the National Survey of Child and Adolescent Wellbeing II (NSCAW II). Participants included 1050 adolescents (M_age = 14.13) who were subjects of child abuse or neglect investigations. Items from the Health Risk Behavior Questionnaire were used to measure alcohol and marijuana use. Suicidal ideation was measured using an item from the Childhood Depression Inventory. Data on deviant peer affiliation, caregiver health, maltreatment type, age, race, and gender were also collected.

RESULTS

Marijuana use, suicidal ideation, caregiver drug abuse, deviant peer affiliation, age, and race were predictive of alcohol use. Alcohol use, deviant peer affiliation, age, and time were predictive of marijuana use. Alcohol use, deviant peer affiliation, age, and gender predicted suicidal ideation.

CONCLUSIONS

Longitudinal evidence indicated that individual, family, and peer factors played an important role in predicting alcohol use, marijuana use, and suicidal ideation among child welfare involved adolescents. In addition, this study provides evidence of a potentially reciprocal relationship between alcohol use and suicidal ideation among this population. Intervention efforts for reducing the public health problems of substance use and suicide among child welfare involved adolescents should focus on the importance of peers in influencing thoughts and behaviors, as well as the functional relationship between alcohol use and suicidal ideation.

Risk and Protective Factors for Alcohol, Marijuana, and Cocaine Use Among Child Welfare-Involved Youth

Youth involved in child welfare services (CWS) are at elevated risk for substance use. CWS involvement may provide an opportunity for intervention to prevent subsequent use; however, little is known about mitigating substance use risk in this population. Using data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), the present study examined individual, psychological, and contextual risk factors (e.g., prior substance use, depression, posttraumatic stress, maltreatment experiences) and protective factors (e.g., caregiver monitoring, peer relationships) following CWS involvement (Wave 1) in relation to alcohol, marijuana, and cocaine use 36 months later (Wave 3). The nationally-representative sample of CWS-involved youth was restricted to individuals who were aged 11 years or older at Wave 1 and had at least a partial interview at Wave 3 (N = 763). Three logistic regression models showed that Wave 1 substance use increased the likelihood of marijuana and cocaine use at Wave 3 [marijuana OR = 1.41 (1.19-1.68); cocaine OR = 1.26 (1.07-1.50)] but not binge alcohol use [OR = 1.44 (0.95-2.19)]. Other risk and protective factors had limited predictive value for Wave 3 substance use. The present findings suggest that initiating substance use prior to or at the time of CWS involvement is a critical risk factor for later substance use. Substance use screening and referral to treatment is imperative for CWS-involved youth.

Suicidal because I don't feel connected or vice versa? A longitudinal study of suicidal ideation and connectedness among child welfare youth

Suicide is a major public health problem among youth involved with the child welfare system. Although social connectedness rests at the core of many prevention approaches, we know little about this relationship over time in this vulnerable population. This study tested the hypotheses that inverse relationships would exist between connectedness in three social domains (i.e., caregiver, peers, and school) and suicidal ideation over time. The current study used baseline and 18-month follow-up data from 995 youth who participated in the National Survey of Child and Adolescent Well-Being (NSCAW II)-a nationally representative study of children and families investigated by a child welfare agency conducted from 2008 to 2011. A cross-lagged path model was used for the analysis. There were significant main effects of suicidal ideation at Time 1 on peer connectedness (β= -.17, p < .01) and caregiver connectedness (β= -.12, p < .05) at Time 2, but not on school connectedness (β= -.05, ns). There was no main effect of any of the connectedness variables at Time 1 on suicidal ideation at Time 2. Screening for suicidal ideation is important for managing immediate risk but our findings suggest that such ideation also foreshadows disconnectedness from their primary caregiver and peers in the future. These findings demonstrate that there is clinical value in engaging child-welfare-involved youth and their social systems about how their suicide-related experiences may affect vital social ties. Therefore, there may be merit to designing and exploring the effects of pilot programming focused on mitigating social distancing that suicide-related experiences engender.

Examining the association between suicidal behaviors and referral for mental health services among children involved in the child welfare system in Ontario, Canada

Although various studies have investigated factors associated with mental health service utilization, few studies have examined factors associated with referral for mental health services among maltreated children. The objective of this study was to examine the association between suicidal thoughts and self-harming behavior and referral for mental health services among children involved in the Child Welfare System in Ontario, Canada. Data for this study were obtained from the Ontario Incidence Study of Reported Child Abuse and Neglect 2013. An estimate 57,798 child maltreatment investigations was analyzed using binary logistic regression with referral for mental health service as the outcome variable. Of the 57,798 cases, 4709 (8.1%), were referred for mental health services. More than seven out of ten maltreated children who engaged in self-harming behavior and two out of three maltreated children who expressed suicidal thoughts were not referred for mental health services. In the multivariate logistic regression model, children who expressed suicidal thoughts had 2.39 times higher odds of being referred for mental health services compared to children with no suicidal thoughts (AOR = 2.39, 99% C.I. 2.05-2.77) and children who engaged in self-harming behavior had 1.44 times higher odds of being referred for mental health services compared to children who did not engage in self-harming behavior (AOR = 1.44, 99% C.I. 1.24-1.67), both after controlling for child demographic characteristics, maltreatment characteristics, and child functioning concerns. Given that referral is the initial step towards mental health service utilization, it is important that child welfare workers receive the necessary training so as to carefully assess and refer children in care who expressed suicidal thoughts or engaged in self-harming behavior for appropriate mental health services. The paper discusses the results and their implications for child welfare policy and practice.

Depressive symptoms and self-harm among youngsters referred to child welfare: The role of trust in caregiver support and communication

Depressive symptoms and self-harm, i.e. non-suicidal self-injury and suicidal behaviors, are highly prevalent in youngsters involved in Child Welfare System (CWS) services. Little research investigates, however, why these CWS youngsters are at risk. We explored whether trust in caregiver support and communication about experiences with primary caregivers, are associated with CWS youngsters' depressive symptoms and/or self-harm. An anonymous online survey of 271 CWS youngsters (10-21 years of age, 57.2% female) was used to assess trust and communication, and depressive symptoms/self-harm. Results showed significant negative associations between self-reported trust in maternal and paternal support, and depressive symptoms/self-harm. Communication about experiences with one's biological mother mediated the relationship between trust in maternal support and depressive symptoms/self-harm. Furthermore, the presence of an additional trustworthy caregiver buffered the impact of low trust in maternal or paternal support on depressive symptoms/self-harm. Implications for interventions targeting CWS youngsters' depressive symptoms and self-harm are discussed.

School connectedness and suicidal thoughts and behaviors: A systematic meta-analysis

Among the protective factors associated with reduced risk for suicide, scientific inquiries into school connectedness are especially important considering that schools are ideally situated to provide interventions reaching the vast majority of youth. Although there is a wealth of research that supports the association between school connectedness and reduced self-report of adolescents having a suicidal thought or making a suicide attempt, inconsistencies in the way studies have measured and operationalized school connectedness limit synthesis across findings. This meta-analytic study investigates the literature exploring associations between school connectedness and suicidal thoughts and behaviors across general and subpopulations (high risk and sexual minority youth) using a random effects model. Eligible studies examined a measure of school connectedness explicitly referred to as "school connectedness" or "connections at school" in relation to suicidal ideation or suicide attempts among youth enrolled in school (Grades 6-12). Multiple metaregression analyses were conducted to explore the influence of school connectedness measurement variation, as well as participant characteristics. Results, including 16 samples, support that higher school connectedness is associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] = 0.536), high-risk (OR = 0.603), and sexual minority (OR = 0.608) adolescents. Findings are consistent when analyzed separately for suicidal ideation (OR = 0.529) and suicide attempts (OR = 0.589) and remain stable when accounting for measurement variability. Although limited by its cross-sectional nature, findings support recent calls to increase school connectedness and proffer important implications for screening and intervention efforts conducted in schools. (PsycINFO Database Record