Feasibility of Connecting, a Substance-Abuse Prevention Program for Foster Teens and their Caregivers

Family, Mental Health, and Placement Outcomes of a Low-cost Preventive Intervention for Youth in Foster Care

This study assessed secondary outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years within Washington State were recruited and randomly assigned into either the Connecting program (n = 110) or a treatment-as-usual control condition (n = 110). The program included a 10-week sequence of self-directed family activities and DVDs with video clips. Survey data were collected from caregivers and youth at baseline, immediately post-intervention, and at 12 and 24 months post-intervention; placement data was collected from the child welfare department as well. Intention-to-treat analyses focused on 5 classes of secondary outcomes at 24 months post-intervention: caregiver-youth bonding, family climate, youth risk behavior attitudes, youth mental health, and placement stability. There were no intervention effects in the full sample. In subgroup analyses, among older youth (ages 16 - 17) but not younger youth (ages 13 - 15), the Connecting condition (vs. controls) yielded more frequent caregiver-reported bonding communication, bonding activities, warmth, and positive interactions, as well as less favorable youth attitudes towards early initiation of sexual behavior and substance use, and fewer youth self-injurious thoughts. Consistent with the social development model, the divergent outcomes between younger and older youth suggests Connecting's driving mechanisms involve social processes that undergo critical shifts between early and mid-adolescence. Overall, the Connecting program showed promise in older youth for long-term promotion of caregiver-youth bonding, healthy behaviors, and mental health, but did not demonstrate long-term efficacy in facilitating stable or permanent placement of youth in care.

Two-Year Risk Behavior Outcomes from Connecting, a Prevention Program for Caregivers and Youth in Foster Care

This study experimentally tested risk behavior outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years from across Washington State were recruited and randomly assigned to either the self-directed program with supplemental support (n = 110) or a treatment as usual control condition (n = 110). Program materials included a workbook with family activities and DVDs with video clips. Over the 10-week program, participants received motivational support contacts to prompt program completion. Survey data were collected from youth and their caregivers at baseline, directly following intervention, then again at 12 and 24 months post-intervention. Intervention effects at 24-month follow-up were found to be moderated by age. Among 16- to 17-year-old youth at follow-up, there was an intervention benefit yielding reduced use of any substance (OR = 0.71, 95% CI [0.54, 0.93], p = 0.01) and nonviolent delinquency (OR = 0.73, 95% CI [0.57, 0.94], p = 0.02). There was no intervention effect among adolescents aged 13 to 15 years for any risk behaviors. This evidence suggests that the developmental timing of a self-directed, family-focused preventive intervention for youth and their caregivers in the foster care system may influence risk behaviors that typically emerge in late adolescence. ClinicalTrials.gov Identifier: NCT03157895.

Modeling changes in adolescent health risk behaviors approaching and just after the time of emancipation from foster care

BACKGROUND

Emancipated foster youth frequently engage in behaviors that contribute to poor health. Whether health risk behaviors increase following emancipation or are established while in foster care remains unclear.

OBJECTIVE

This secondary data analysis examined substance use and attitudes toward sexual risk behaviors to understand continuity in risk behaviors among foster youth before emancipation and following emancipation.

PARTICIPANTS AND SETTING

Youth ages 16-20 (N = 151) who had been in foster care for at least 12 months and were expected to emancipate were recruited. The urban county where the study was conducted allowed youth to remain in foster care until 21 years of age.

METHODS

Participants completed surveys assessing substance use and attitudes toward sexual risk behaviors at baseline, 6 and 12 months. Multilevel models estimated trajectories of health behaviors and attitudes, with emancipation timing as the primary predictor. Individual and child welfare characteristics were included as covariates.

RESULTS

Substance use did not change with emancipation (B_s = 0.01, p = 0.81) and positive attitudes about risky sexual behavior significantly decreased as youth approached emancipation (B_s = 1.67, p < 0.01). Placement instability and adversity were not associated with either outcome (ps > 0.08). Females reported more positive attitudes about higher-risk sexual behavior than males (B = 3.09, p < 0.01) and less substance use (B = -1.15, p = 0.03).

CONCLUSIONS

Substance use and attitudes about sexual risk behaviors are established before emancipation; interventions prior to emancipation are necessary to improve health outcomes.

Evaluation of a Brief Foster Parent/ Case Worker Training to Support Relationship Building Skills and Acceptance of LGBTQ+ Youth in Care

LGTBQ+ youth in foster care need unique support and acceptance; however, few case workers and caregivers receive specialized training. To address this, the Connecting: Sexual Orientation and Gender Identity Expression (SOGIE) eLearning was developed. This evaluation assesses whether attitudes and behavioral intentions regarding LGBTQ+ youth improved as a result of this training. Caregivers and child welfare professionals showed growth in many areas, including how important they felt it was to learn strategies and skills to support LGBTQ+ youth, as well as their confidence to care for LGBTQ+ youth. The Connecting: SOGIE eLearning is a promising tool for child welfare systems.

Proximal Outcomes of Connecting, an Evidence-based, Family-focused Prevention Program for Caregivers of Adolescents in Foster Care

This study experimentally tested proximal outcomes of Connecting, a low-cost, self-directed, family-based substance-use prevention program for foster families. Families (n = 220) fostering youth age 11 to 15 years were recruited and randomly assigned into the self-administered program with telephone support (n = 110) or a treatment as usual, control condition (n = 110). Program materials included a workbook with family activities and DVDs with video clips. Survey data were collected from youth and their caregivers at baseline and 4 months later. Results indicate 60% were 'very satisfied' with Connecting, and 85% would recommend Connecting to other caregivers. Analyses revealed foster youth in the program (n = 93) were significantly more likely than controls (n = 104) to report improved problem-solving skills (Cohen's d = .13, p = .02), involvement in making family rules (OR = 2.6, p = .02), and caregiver recognition for positive behavior (OR = 3.8, p = .03) at posttest. Improvement was observed in youth report of intervention-specific communications (B = 0.15, p = 0.07) and improved refusal skills (OR = 2.09, p = .06). No significant effects were found on bonding communication, inconsistent discipline, family conflict, monitoring, and antisocial norms about substance use and violence, nor were there significant effects from any caregiver reports on similar measures. This evidence suggests that a self-administered family-focused preventive intervention can positively influence known risk and protective factors for youth in foster care.

Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis

BACKGROUND

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

METHODS

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

RESULTS

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

CONCLUSION

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.

Supporting LGBTQ+ Foster Teens: Development of a Relationship-Focused, Self-Guided Curriculum for Foster Families

LGBTQ+ youth are over-represented in the foster care system. Child welfare systems across the country have been struggling with how to make their systems work better for the LGBTQ+ youth they serve. One strategy is developing foster caregiver trainings that bolster caregivers' knowledge and support of LGBTQ+ youth in their care. This study has three aims: (1) to provide an overview of a module designed to support relationship building between LGBTQ+ youth in foster care and their caregivers, (2) to describe the theater testing procedure used to assess usability of the developed module with foster caregivers and adults, and (3) to share the results of the theater test. Overall, participants provided positive usability feedback about the module activities, as well as a wide variety of recommendations for strengthening the content for widespread use. Participants felt the module should be directed specifically toward caregiver skill development rather than toward both caregiver and youth support. This module represents one example of how materials focused on building foster caregivers' knowledge and support have the potential to help LGBTQ+ teens who are overrepresented in the foster care system.