Screening for trauma and behavioral health needs in child welfare: Practice implications for promoting placement stability

Economic insecurity in young adulthood among children maltreated during early adolescence

BACKGROUND

Children living in foster care as teenagers often experience greater economic insecurity during adulthood than their peers. However, few studies examine the association between foster care entrance during early adolescence and later economic outcomes.

OBJECTIVE

Examine whether entrance into foster care in early adolescence is associated with employment, monthly earnings, and participation in the Supplemental Nutrition Assistance Program (SNAP) relative to an observationally similar counterfactual population.

PARTICIPANTS AND SETTING

Using statewide administrative data from Wisconsin, I limited my study population to early adolescents exposed to alleged maltreatment between ages 10 through 13 who return to the home or achieve permanency by age 18. Economic security outcomes were examined at age 23.

METHODS

Propensity score matching generated a counterfactual group that was similar to children who entered foster care (N = 1252). Odds of employment and SNAP usage were modeled with logistic regressions, while earnings were estimated with zero-inflated negative binomial regressions.

RESULTS

On average, foster care entrance was not associated with later economic difficulties. Among children who entered foster care, longer stays predicted elevated likelihood of employment (OR 1.18, 95 % CI 1.04, 1.33), while more placements within foster care were associated with greater odds of receiving SNAP (OR = 1.38, 95 % CI 1.01, 1.90).

CONCLUSION

Overall, entrance into foster care during early adolescence was not associated with earnings, employment, or SNAP participation relative to the matched sample.

Pathways of Care: A longitudinal study of children in care in Australia: Introductory article for special issue on Pathways of Care Longitudinal Study

The Pathways of Care Longitudinal Study (POCLS) is the first large-scale prospective longitudinal study of children and young people in out-of-home care in Australia. It includes a cohort of all 4126 children and young people (age 0 to 17 years) who entered out-of-home care for the first time over an 18-month period from May 2010 to October 2011 in New South Wales, with a focus on 2828 of these children with final court orders. It involved interviews with participating caregivers for children on final orders and standardised assessments for the children in their care as well as interviews for 7-17 year-olds, together with linked administrative data from a range of agencies for all 4126 children. Data for the interview cohort includes information on children's development, permanency and wellbeing while in care, tracking their physical health, socio-emotional wellbeing and cognitive development, as well as their experiences in care, and after they exit care to return home, or to guardianship and adoption. POCLS currently includes data from five waves of interviews with caregivers and the children in their care. This special issue includes articles that present findings from a range of analyses across various domains from the first four waves of the study. This introductory article outlines the Australian context of the study, its conceptual framework, design and methodology. Using a range of analytical approaches, the nine articles expose an array of issues, including children's developmental, socio-emotional and academic outcomes and trajectories (including reunification), associated with factors such as placement type, stability, pre-care maltreatment, disability, and age at entry to care, and caregiver stress.

Aberrant resting-state functional connectivity associated with childhood trauma among juvenile offenders

Individuals with history of childhood trauma are characterized by aberrant resting-state limbic and paralimbic functional network connectivity. However, it is unclear whether specific subtypes of trauma (i.e., experienced vs observed or community) showcase differential effects. This study examined whether subtypes of childhood trauma (assessed via the Trauma Checklist [TCL] 2.0) were associated with aberrant intra-network amplitude of fluctuations and connectivity (i.e., functional coherence within a network), and inter-network connectivity across resting-state networks among incarcerated juvenile males (n = 179). Subtypes of trauma were established via principal component analysis of the TCL 2.0 and resting-state networks were identified by applying group independent component analysis to resting-state fMRI scans. We tested the association of subtypes of childhood trauma (i.e., TCL Factor 1 measuring experienced trauma and TCL Factor 2 assessing community trauma), and TCL Total scores to the aforementioned functional connectivity measures. TCL Factor 2 scores were associated with increased high-frequency fluctuations and increased intra-network connectivity in cognitive control, auditory, and sensorimotor networks, occurring primarily in paralimbic regions. TCL Total scores exhibited similar neurobiological patterns to TCL Factor 2 scores (with the addition of aberrant intra-network connectivity in visual networks), and no significant associations were found for TCL Factor 1. Consistent with previous analyses of community samples, our results suggest that childhood trauma among incarcerated juvenile males is associated with aberrant intra-network amplitude of fluctuations and connectivity across multiple networks including predominately paralimbic regions. Our results highlight the importance of accounting for traumatic loss, observed trauma, and community trauma in assessing neurobiological aberrances associated with adverse experiences in childhood, as well as the value of trained-rater trauma assessments compared to self-report.

Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children's Mental Health Systems: A Case Study of the Gateway CALL Demonstration

The mental health needs of children and youth involved in the child welfare system remain largely unmet. Service cascades are an emerging approach to systematizing mental health screening, assessment, and treatment referral processes. However, evidence is minimal and inconsistent regarding the effectiveness of such approaches for improving mental health service access and outcomes. In an effort to address this gap, this study presents a case-study of the implementation fidelity and treatment outcomes of the Gateway CALL service cascade. Study analyses involved longitudinal data collected as part of a larger evaluation of Gateway CALL. Specifically, descriptive and linear mixed model analyses were conducted to assess the implementation of service cascade components, and changes in mental health outcomes (behavior problems) among 175 children placed out-of-home during the study. Study analyses found that although fidelity was strong early in the service cascade, implementation began to break down once components involved more than one service system (child welfare, mental health). However, results also indicated that parent-reported child behavior problems decreased significantly over time, despite later cascade components being implemented with poor fidelity to the Gateway CALL service model. For children and youth involved in child welfare systems, service cascades like Gateway CALL have the potential to significantly improve both mental health service receipt and outcomes. To maximize the effectiveness of such approaches, later phases of implementation may require increased attention and support, particularly regarding processes and outcomes that cross child welfare and mental health service systems.