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McLeigh JD, Singh G, Huang R. The Impact of Health Status on Health Care Utilization of Children in Foster Care. J Dev Behav Pediatr 2024:00004703-990000000-00194. [PMID: 39023862 DOI: 10.1097/dbp.0000000000001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/24/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization. METHODS To estimate relationships between health status and health care utilization, this study used electronic health records from 4976 children in foster care seen at a children's hospital in the southwestern United States, 2017 to 2020. An algorithm classified patients' health status as nonchronic, noncomplex chronic, or complex chronic. Descriptive statistics were used to describe patients and utilization. The χ2, Kruskal-Wallis, and pairwise comparison post hoc tests were used to examine relationships between health status and health care utilization. Zero-inflated negative binomial (ZINB) regression further estimated relationships between health status and health care utilization while factoring in demographic and placement characteristics. RESULTS Within the sample, 35.6% had complex chronic health status. Significant differences were found among health status groups in age, gender, ethnicity, and maltreatment exposure. Both nonparametric pairwise comparisons and the ZINB regression model showed that having complex chronic health was associated with higher utilization of all hospital resources: emergency, admission, primary and specialty care, and various therapies, relative to having noncomplex chronic and nonchronic health. CONCLUSION A high percentage of children in foster care had complex chronic health, and these patients used significantly more resources. This study suggests that hospital-based health clinics focused on children in foster care and care coordination may be warranted.
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Affiliation(s)
- Jill D McLeigh
- Rees-Jones Center for Foster Care Excellence, Children's Health, Dallas, TX
| | - Gunjan Singh
- Rees-Jones Center for Foster Care Excellence, Children's Health, Dallas, TX
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; and
| | - Rong Huang
- Research Administration, Children's Health, Dallas, TX
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Bürgin D, Witt A, Seker S, d'Huart D, Meier M, Jenkel N, Boonmann C, Schmeck K, Fegert JM, Schmid M. Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis. Dev Psychopathol 2023:1-16. [PMID: 37990404 DOI: 10.1017/s0954579423001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
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.
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Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Andreas Witt
- Department of Child and Adolescent Psychiatry, University Psychiatric Services Berne, Berne, Switzerland
| | - Süheyla Seker
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Delfine d'Huart
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Maria Meier
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Constance, Germany
| | - Nils Jenkel
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry - LUMC Curium, Leiden University Medical Center, Leiden, The Netherlands
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm, Ulm, Germany
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department (UPKKJ), University Psychiatric Hospitals, University of Basel, Basel, Switzerland
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McLeigh JD, Malthaner LQ, Tovar MC, Khan M. Mental Health Disorders and Psychotropic Medication: Prevalence and Related Characteristics Among Individuals in Foster Care. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:745-757. [PMID: 37593050 PMCID: PMC10427591 DOI: 10.1007/s40653-023-00547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 08/19/2023]
Abstract
This study sought to provide prevalence data for mental health (MH) diagnoses and psychotropic medication prescriptions among individuals in foster care and to examine their relationships with physical health status, maltreatment type, placement type, and demographic variables. Data were retrieved from electronic health records for 3,067 patients seen at integrated pediatric primary care clinics serving individuals in care. Descriptive and bivariate statistics for presence of MH diagnoses and psychotropic medication prescription were calculated. Multivariable zero-inflated negative binomial regressions were used to assess relationships. Half (50.0%) of patients had at least one MH diagnosis; trauma and stressor-related (31.5%) and attention deficit hyperactivity (22.6%) disorders were most common. 27.8% of patients were prescribed at least 1 psychotropic medication. Complex chronic physical health, having 1 and 2 or more maltreatment exposures, and being 6-11 and 12-20 years of age had significantly higher rates of having a MH diagnosis while being female, Black, Hispanic, and other race were significantly associated with lower rates. Patients with at least 1 MH diagnosis that had complex chronic physical health status, experienced sexual abuse, and were 6-11 and 12-20 years of age had significantly higher rates of psychotropic medication prescription while shelter and kinship placement and female gender were significantly associated with lower rates. Findings suggest that initial and ongoing MH screening is vital for individuals in care so that appropriate interventions can be offered. Results support implementing strategies designed to increase access to MH services for this population, such as integrated care and child psychiatry consult programs. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-023-00547-9.
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Affiliation(s)
- Jill D. McLeigh
- Rees-Jones Center for Foster Care Excellence, Children’s Health, 1935 Medical District Drive, Mailstop ST7.03, Dallas, TX 75235 USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX USA
| | - Lauren Q. Malthaner
- University of Texas Health Science Center School of Public Health, Dallas, TX USA
| | | | - Mohsin Khan
- Rees-Jones Center for Foster Care Excellence, Children’s Health, 1935 Medical District Drive, Mailstop ST7.03, Dallas, TX 75235 USA
- University of Texas Southwestern Medical Center, Dallas, TX USA
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Adhikari S, Ma J, Shakya S, Brøndbo PH, Handegård BH, Javo AC. Self-reported emotional and behavioral problems among school-going adolescents in Nepal-A cross-sectional study. PLoS One 2023; 18:e0287305. [PMID: 37352299 PMCID: PMC10289424 DOI: 10.1371/journal.pone.0287305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/03/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Studies on self-reported emotional and behavioral problems (EBPs) among adolescents are still sparse in many low- and middle-income countries. In Nepal, no such studies have been performed on a larger scale, and little is known about self-reported EBPs in the adolescent population. METHODS This cross-sectional, school-based study on EBPs included 1904 adolescents aged 11-18 years, enrolled in government and private schools located in 16 districts in Nepal. The Nepali version of the Youth Self Report form was used to assess self-reported EBPs, and the Teacher Report Form was used to assess academic performance. Analysis of variance (ANOVA) was used for gender comparisons on adolescents' EBPs and on academic competence. Multiple regression analysis was done to explore correlates of self-reported EBPs. RESULTS The overall prevalence of self-reported EBPs was 14.2%; 15.6% in boys and 12.9% in girls. The mean Total Problems score was 39.27 (standard deviation = 24.16); no gender differences were observed. Boys scored higher on Externalizing Problems and girls scored higher on Internalizing Problems. The effect sizes for gender comparisons were small with Hedges' g ranging from -0.29 to 0.28. Physical illness and negative/traumatic life events were positively correlated with self-reported EBPs, whereas academic performance was negatively correlated. However, the effect sizes were small (η2 < 0.02). CONCLUSION This study helps to narrow the knowledge gap on the prevalence, magnitude, and types of self-reported EBPs in Nepali adolescents. It demonstrated an association between self-reported EBPs and academic performance and linked self-reported EBPs to other factors such as negative/traumatic life events and physical illness. The findings might assist health authorities in the planning of mental health services and may also provide valuable background information to clinicians dealing with adolescent mental health problems.
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Affiliation(s)
- Sirjana Adhikari
- Department of Psychology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
- Child & Adolescent Psychiatry Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Jasmine Ma
- Child & Adolescent Psychiatry Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Suraj Shakya
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Per Håkan Brøndbo
- Department of Psychology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Youth Mental Health and Child Welfare—North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Cecilie Javo
- Sami National Competence Center for Mental Health (SANKS), Sami Klinihkka, Finnmark Hospital Trust, Karasjok, Norway
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KARAGÖZ D. Investigation of Clinical Characteristics of Children and Adolescents Followed under Health Precaution. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1167774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to evaluate the sociodemographic and clinical characteristics of children and adolescents who were followed in the child psychiatry clinic in the scope of the health precaution, which is one of the protective and supportive measures of the Child Protection Law. 112 children and adolescents who were followed up at the child psychiatry clinic between 01.01.2020 and 01.01.2022 in the scope of health precaution, participated in this study. The clinic files and social examination reports of the participants were examined retrospectively. It was determined that the most common reasons for taking a health precaution decision are sexual abuse, deficiencies of basic needs/neglect and behavioral problems. Moreover, it showed that the rate of taking health precaution due to sexual abuse was higher in girls however the rate of that due to delinquency was more common in boys. It was determined that 72.3% of the children, who were followed up in the scope of health precaution, were diagnosed with psychiatric disorders, and the most common psychiatric disorders were attention deficit and hyperactivity disorder, major depressive disorder, specific learning disability and intellectual disability, respectively. In the group with psychiatric disorders, it was determined that the deficiencies of basic needs/neglect as a reason for taking health precaution, was significantly common and that the mothers of the children and adolescents in the group with psychiatric disorders had a higher rate of diagnosed psychiatric disorders. Given the fact that abuse and neglect come first among the reasons for the implementation of health precaution; it is vital to develop early intervention programs to protect children from neglect and abuse. Since the effects of neglect and abuse on children can be devastating and long lasting and as it is known that they are risk factors for many psychiatric disorders, regular follow-up and treatment of these children in the scope of health precaution is important.
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Affiliation(s)
- Duygu KARAGÖZ
- MUĞLA SITKI KOÇMAN ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ÇOCUK VE ERGEN RUH SAĞLIĞI HASTALIKLARI ANABİLİM DALI
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Bürgin D, Clemens V, Varghese N, Eckert A, Huber M, Bruttin E, Boonmann C, Unternährer E, O'Donovan A, Schmid M. Adverse and traumatic exposures, posttraumatic stress disorder, telomere length, and hair cortisol – Exploring associations in a high-risk sample of young adult residential care leavers. Brain Behav Immun Health 2022; 26:100524. [PMID: 36213488 PMCID: PMC9535425 DOI: 10.1016/j.bbih.2022.100524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/17/2022] [Accepted: 09/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Childhood adversities (CAs), potentially traumatic exposures (PTEs), and posttraumatic stress disorder (PTSD) are known to increase the risk for poor health outcomes, including diseases of aging and early mortality. Telomere length (TL) and hair cortisol concentrations (HCC) are biomarkers known to be associated with CA and PTEs, and PTSD, but there is considerable heterogeneity in findings. Objectives This study aims to investigate the association of CAs, PTEs, and PTSD with TL and HCC in a high-risk sample of young adults who were previously placed in youth residential care institutions throughout Switzerland. Method Our sample includes 130 participants (30.8% women, M Age = 26.5 ± 3.7 years) with previous youth residential care placements (MPlacements= 3.9). CAs and PTEs, as well as PTSD, were assessed with self-reported questionnaires and semi-structured clinical interviews. Immune cell TL was measured with quantitative polymerase chain reaction (qPCR) in whole blood. Hair samples were collected for HCC measurement and assayed with high-sensitivity ELISA. Multivariate regression models were fitted to describe the associations between CAs, PTEs, and PTSD with TL and HCC, adjusting for covariates. Results In our high-risk sample, a higher burden of CAs, PTEs, Criterion A trauma, and PTSD was associated with longer TL. PTEs, Criterion A trauma, and PTSD were associated with lower HCC, however no significant associations between CAs and HCC were found. The magnitude of these effects varied depending on the dimensional or categorical nature of the stress-phenotype and the specific measure used. Conclusions Our findings are in contrast with many, but not all, previous studies of associations between adversity and both TL and HCC. For instance, our findings are in line with other studies that find a state of hypocortisolism in PTSD. Better measurement of adversities and trauma, multisystem biomarker approaches, and more research in larger high-risk samples at the upper end of the adversity-continuum is warranted. In this high-risk sample,childhood adversities, potential traumatic exposures, criterion A trauma, or posttraumatic stress disorder (PTSD) was associated with longer telomere length (TL). Potentially traumatic exposures, criterion A trauma, and PTSD were associated with lower hair cortisol concentrations. The magnitude of these effects varied depending on the dimensional or categorical nature of the stress-phenotype and the specific measure used. Hypocortisolism might explain findings of longer TL in participants with cumulated adverse and traumatic exposures. Research in high-risk populations is strongly needed as results across the entire spectrum of adversity exposures may not generalize to the top end of the spectrum.
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Affiliation(s)
- David Bürgin
- Research Department for Child and Adolescent Psychiatry, University Psychiatric Hospitals Basel, University of Basel, Basel, Switzerland
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Corresponding author. University Psychiatric Hospitals Basel Research Department for Child and Adolescent Psychiatry Wilhelm-Klein Strasse 27, 4056, Basel, Switzerland.
| | - Vera Clemens
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Nimmy Varghese
- Neurobiological Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Anne Eckert
- Neurobiological Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Mara Huber
- Research Department for Child and Adolescent Psychiatry, University Psychiatric Hospitals Basel, University of Basel, Basel, Switzerland
| | - Evelyne Bruttin
- Research Department for Child and Adolescent Psychiatry, University Psychiatric Hospitals Basel, University of Basel, Basel, Switzerland
| | - Cyril Boonmann
- Research Department for Child and Adolescent Psychiatry, University Psychiatric Hospitals Basel, University of Basel, Basel, Switzerland
| | - Eva Unternährer
- Research Department for Child and Adolescent Psychiatry, University Psychiatric Hospitals Basel, University of Basel, Basel, Switzerland
| | - Aoife O'Donovan
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Marc Schmid
- Research Department for Child and Adolescent Psychiatry, University Psychiatric Hospitals Basel, University of Basel, Basel, Switzerland
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Li S, Xu X, Lai S, Song S, Liu Q. Depression and sleep disorders among AIDS orphans in an HIV/AIDS high-epidemic area in China. Child Care Health Dev 2022; 48:595-604. [PMID: 35023201 DOI: 10.1111/cch.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/19/2021] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Liangshan Yi Autonomous Prefecture is home to the largest population of Yi ethnic minority within mainland China. Due to the high HIV/AIDS epidemic, many Yi children become AIDS orphans who lost one or both parents to AIDS-related causes. This study explored the prevalence and correlates of AIDS orphans' depressive symptom, sleep disorders and their comorbidity. METHODS A cross-sectional survey was conducted to collect pertinent information from 467 AIDS orphans and 856 non-orphans of Yi ethnic minority. Depressive symptoms were screened by a two-item Patient Health Questionnaire (PHQ-2). The symptoms of insomnia were assessed by the Insomnia Severity Index (ISI), which was complemented by one item from the Pittsburgh Quality Sleep Index (PSQI) to measure the frequency of nightmare. RESULTS The prevalence of depression (26.8% vs. 20.4%, P = 0.009) and comorbidity of depression, insomnia and nightmare (7.5% vs. 4.3%, P = 0.046) was significantly higher for AIDS orphans than for non-orphans. Risk factors such as ostracization and self-reported poor physical health had stronger effects on depressive symptoms and sleep disorders for AIDS orphans than for non-orphans. On the other hand, peer support, as an important protective factor, was significantly and negatively associated with depressive symptoms and sleep disorders for AIDS orphans. CONCLUSIONS AIDS orphans of Yi ethnic minority reported higher levels of depressive symptoms and comorbidity of depression and sleep disorders than their non-orphan counterparts. These symptoms were exacerbated by ostracization and self-rated poor physical health but lowered by peer support.
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Affiliation(s)
- Shiying Li
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Xiaohe Xu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China.,Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Shimin Lai
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China
| | - Shasha Song
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China
| | - Qiaolan Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China
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Beal SJ, Ammerman RT, Mara CA, Nause K, Greiner MV. Patterns of healthcare utilization with placement changes for youth in foster care. CHILD ABUSE & NEGLECT 2022; 128:105592. [PMID: 35334304 DOI: 10.1016/j.chiabu.2022.105592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children in foster care experience poor health and high healthcare use. Child welfare agencies frequently require healthcare visits when children enter foster care; subsequent placement changes also disrupt healthcare. Studies of healthcare use have not accounted for placement changes. OBJECTIVE To understand patterns of healthcare use throughout the time a child enters foster care and with placement changes, accounting for mandated visits when children enter foster care or experience a placement change. PARTICIPANTS AND SETTING Children 4 and older in foster care between 2012 and 2017 (N = 2787) with linked child welfare administrative data from one county child welfare agency and one Midwest pediatric healthcare system. METHODS Negative binomial models predicted healthcare days per month that were planned (e.g., scheduled primary/specialty care), unplanned (e.g., emergency care), or missed. RESULTS Planned healthcare days increased as a function of placement changes (Incident Rate Ratio [IRR] =1.69, p < .05) and decreased with placement stability (IRR = 0.92, p < .01). Mandated visits that occurred later in a placement were associated with fewer planned (IRR = 0.81, p < .01) and unplanned (IRR = 0.82, p < .01) healthcare days during that placement. CONCLUSIONS Patterns of planned healthcare over the time children are in one placement and move between placements suggest more can be done to ensure youth remain connected to primary and specialty care throughout placements and placement transitions, s that children are seen as clinically appropriate rather than a function of placement disruption. Findings regarding the timing of mandated visits suggest that delays in mandated care may also reflect lower healthcare use overall.
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Affiliation(s)
- Sarah J Beal
- Department of Pediatrics, University of Cincinnati College of Medicine, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.
| | - Robert T Ammerman
- Department of Pediatrics, University of Cincinnati College of Medicine, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.
| | - Constance A Mara
- Department of Pediatrics, University of Cincinnati College of Medicine, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.
| | - Katie Nause
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.
| | - Mary V Greiner
- Department of Pediatrics, University of Cincinnati College of Medicine, USA; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, USA.
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Beal SJ, Mara CA, Nause K, Ammerman RT, Seltzer R, Jonson-Reid M, Greiner MV. Effects of Child Protective Custody Status and Health Risk Behaviors on Health Care Use Among Adolescents. Acad Pediatr 2022; 22:387-395. [PMID: 34023491 PMCID: PMC8606009 DOI: 10.1016/j.acap.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine whether current protective custody status (ie, youth currently in the temporary or permanent custody of child protective services, eg, foster and kinship care) contributes to increased health care utilization compared to youth never in protective custody. Health characteristics (eg, mental health diagnoses) and behaviors (eg, substance use) were expected to account for differences in health care use among the two groups. METHODS Retrospective child welfare administrative data and linked electronic health records data were collected from a county's child welfare system and affiliated freestanding children's hospital between 2012 and 2017. Youth currently in protective custody (n = 2787) were identified and demographically matched to peers never in custody (n = 2787) who received health care from the same children's hospital. Health care use, health risk behaviors, and social, demographic, and diagnostic data were extracted and compared for both cohorts. RESULTS In baseline models, health care use was higher for youth in protective custody compared to peers. In adjusted models that included health risk behaviors and patient characteristics, protective custody status was associated with decreased primary and missed care, and no longer a significant predictor of other types of health care use. CONCLUSIONS Youth had significantly higher utilization while in protective custody than their demographically similar peers; however, health risk behaviors appear to account for most group differences. Identification of current custody status in pediatric settings and addressing health risk behaviors in this population may be important for health care systems interested in altering health care use and/or cost for this population.
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Affiliation(s)
- Sarah J. Beal
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7029, Cincinnati, OH 45229 USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Constance A. Mara
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7029, Cincinnati, OH 45229 USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Katie Nause
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7029, Cincinnati, OH 45229 USA
| | - Robert T. Ammerman
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7029, Cincinnati, OH 45229 USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Rebecca Seltzer
- Bernam Institute of Bioethics, Johns Hopkins School of Medicine, 1809 Ashland Ave, Baltimore, MD 21205 USA
| | - Melissa Jonson-Reid
- Brown School of Social Work, Washington University, 1 Brookings Dr, St. Louis, MO 63130 USA
| | - Mary V. Greiner
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229 USA
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Jäggi L, Schmid M, Bürgin D, Saladin N, Grob A, Boonmann C. Shared residential placement for child welfare and juvenile justice youth: current treatment needs and risk of adult criminal conviction. Child Adolesc Psychiatry Ment Health 2021; 15:2. [PMID: 33478550 PMCID: PMC7819213 DOI: 10.1186/s13034-020-00355-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Lena Jäggi
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - David Bürgin
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Nadine Saladin
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Alexander Grob
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
- Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.
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11
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Gardenhire J, Schleiden C, Brown CC. Attachment as a Tool in the Treatment of Children Within Foster Care. CONTEMPORARY FAMILY THERAPY 2019. [DOI: 10.1007/s10591-018-09487-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Jamnik MR, DiLalla LF. Health Outcomes Associated With Internalizing Problems in Early Childhood and Adolescence. Front Psychol 2019; 10:60. [PMID: 30761037 PMCID: PMC6362404 DOI: 10.3389/fpsyg.2019.00060] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/09/2019] [Indexed: 12/28/2022] Open
Abstract
Physical and mental health problems are becoming more common among the general population. Studies examining mental and physical health often indicate that mental illness early in life is associated with more detrimental health outcomes later. However, additional work is needed to better identity which psychological problems may contribute to poorer health outcomes. Given recent increases in childhood anxiety and depression specifically, it is beneficial to further investigate the relationship between internalizing problems, both early and later in life, and related health problems. Furthermore, little work has focused on studying internalizing problems in children as young as preschool-aged. Therefore, the current project used a longitudinal design to assess the effects of preschool and adolescent internalizing problems on health-related problems in adolescence. We analyzed data from 70 youth (47% male) who had been tested in our lab when they were 5 years old and then were administered questionnaires over a telephone interview when they were adolescents, between the ages of 12 and 20 years old. We used multi-informant measures, including parent-report at age 5 and youth-report at follow-up, 7 to 15 years later. Parents reported on children's internalizing behavior problems and negative emotionality (NE). Youth reported on their own internalizing behavior problems as well as health problems, physical activity, and overeating behaviors. Path modeling was used to examine predictions of internalizing and health behaviors. At age 5, parent-reported NE and internalizing problems were related, in addition to 5-year-old internalizing predicting health problems and overeating at follow-up. At follow-up, youth-reported internalizing was positively related to health problems and negatively related to physical activity, suggesting some similarities and differences between parent and youth responses. Additionally, girls reported significantly higher rates of internalizing and health problems at follow-up. These results indicate a significant relationship between preschool-aged and adolescent internalizing problems and related health outcomes experienced in adolescence.
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Affiliation(s)
- Matthew R Jamnik
- Department of Psychology, Southern Illinois University Carbondale, Carbondale, IL, United States
| | - Lisabeth F DiLalla
- Family and Community Medicine, Southern Illinois University School of Medicine, University School of Medicine, Carbondale, IL, United States
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13
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The Mental Health of Adolescents Residing in Court-Ordered Foster Care: Findings from a Population Survey. Child Psychiatry Hum Dev 2018; 49:443-451. [PMID: 29027060 DOI: 10.1007/s10578-017-0763-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The mental health of a representative sample of 230 adolescents residing in foster care in New South Wales, Australia, was estimated in a state-wide epidemiological survey from carer-report responses on the Child Behavior Checklist (CBCL) and the Assessment Checklist for Adolescents (ACA). Rates of CBCL total problems, externalizing and internalizing scores above the borderline range cut-points were 49, 44 and 29% respectively, representing a relative risk of 3.8, 3.7 and 2.7 respectively in comparison to Australian children at large. These rates are 10-14% lower than that previously estimated for pre-adolescent Australian children in foster care. Whereas older age is associated with poorer mental health among pre-adolescent children in foster care, the present study findings suggest that this effect does not extend into adolescence. Around half of adolescents residing in foster care have mental health difficulties requiring referral to treatment services, including attachment- and trauma-related difficulties that are uncommon among clinic-referred children at large.
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14
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Vacaru VS, Sterkenburg PS, Schuengel C. Self-concept in institutionalized children with disturbed attachment: The mediating role of exploratory behaviours. Child Care Health Dev 2018; 44:476-484. [PMID: 28895183 DOI: 10.1111/cch.12521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/07/2017] [Accepted: 08/19/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Self-concept is seen as both an outcome of sociocognitive and emotional development, and a factor in social and mental health outcomes. Although the contribution of attachment experiences to self-concept has been limited to quality of primary attachment relationships, little is known of the effects of disturbed attachment on self-concept in institutionalized children. Thus, the current study examined associations between disturbed attachment behaviours in institutionalized children and self-concept, testing limited exploration as an explanatory factor. METHODS Thirty-three institutionalized children, aged 4-12, participated in a multimethod and multi-informant assessment of disturbed attachment behaviours (i.e., Disturbances of Attachment Interview and Behavioral Signs of Disturbed Attachment in Young Children), self-concept (i.e., Pictorial Scale of Perceived Competence and Social Acceptance for Young Children), and exploratory behaviours (i.e., Student Exploratory Behaviours Observation Scale). Analyses were conducted using bootstrapping techniques. RESULTS Global self-concept converged with teacher-rated children's self-concept, except for physical competence domain. Disturbed attachment behaviours were identified in 62.5% of the children, and this was associated with lower levels of exploration and lower scores on self-concept, compared with children without disturbed attachment behaviours. Furthermore, exploratory behaviours mediated the effects of disturbed attachment behaviours on self-concept. CONCLUSIONS Institution-reared children with disturbed attachment behaviours were likely to have a negative perception of self and one's own competences. Limited exploratory behaviours explained this linkage. Targeting disordered attachment in children reared in institutions and their caregivers should become a high priority as a means for preventing socioemotional development issues.
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Affiliation(s)
- V S Vacaru
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - P S Sterkenburg
- Department of Clinical Child and Family Studies, VU University, Amsterdam, The Netherlands.,EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.,Bartiméus, Doorn, The Netherlands
| | - C Schuengel
- Department of Clinical Child and Family Studies, VU University, Amsterdam, The Netherlands.,EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
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15
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Raman S, Ruston S, Irwin S, Tran P, Hotton P, Thorne S. Taking culture seriously: Can we improve the developmental health and well-being of Australian Aboriginal children in out-of-home care? Child Care Health Dev 2017; 43:899-905. [PMID: 28736897 DOI: 10.1111/cch.12488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children in out-of-home care have well-documented health and developmental needs. Research suggests that Aboriginal children in care have unmet health and intervention needs. In metropolitan Sydney, Kari Aboriginal Resources Inc. (KARI), an Aboriginal organization, provides support to indigenous children in care, including clinical assessment and intervention. We wanted to determine the health and developmental needs of a subset of children in out-of-home care with KARI, who had been in stable care for at least a year. We wanted to identify child, carer, and intervention characteristics that contributed to children doing well. We also wanted to identify enablers and barriers to providing culturally competent intervention. METHODS We used mixed methods. From the KARI clinic database over the past 3 years, we identified children who had been in stable care with KARI for >12 months. We compared clinical measures and outcomes for these children with results from previous audits. We carried out a group discussion and key informant interviews with therapists and caseworkers to identify risk and resilience factors for each child, as well as enablers and barriers to culturally competent intervention. RESULTS The health and developmental profile of the 26 children identified as being in stable care was similar to that of previous audits. Most (88%) were getting speech pathology intervention; one third were getting occupational therapy and psychological intervention; most children and their carers attended cultural programmes. The majority of children (25/26) improved in their developmental health. Caseworkers and therapists identified risk and resilience factors related to child, carer, and home characteristics. They also identified elements of good practice; systemic issues prevented some interventions from being carried out. CONCLUSIONS There are challenges delivering a trauma-informed, culturally respectful service to Aboriginal children in out-of-home care in an urban setting, but it can be done if attention is paid to culture and the enablers and barriers are identified.
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Affiliation(s)
- S Raman
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - S Ruston
- Kari Aboriginal Resources Inc., Liverpool, NSW, Australia.,Allied Health Department, Liverpool Hospital, Liverpool, NSW, Australia
| | - S Irwin
- Kari Aboriginal Resources Inc., Liverpool, NSW, Australia
| | - P Tran
- Kari Aboriginal Resources Inc., Liverpool, NSW, Australia.,Allied Health Department, Liverpool Hospital, Liverpool, NSW, Australia
| | - P Hotton
- Child Protection Unit, Sydney Children's Hospital, Randwick, NSW, Australia
| | - S Thorne
- Kari Aboriginal Resources Inc., Liverpool, NSW, Australia
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16
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Lohaus A, Chodura S, Möller C, Symanzik T, Ehrenberg D, Job AK, Reindl V, Konrad K, Heinrichs N. Children's mental health problems and their relation to parental stress in foster mothers and fathers. Child Adolesc Psychiatry Ment Health 2017; 11:43. [PMID: 28878817 PMCID: PMC5585922 DOI: 10.1186/s13034-017-0180-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 07/31/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study focuses on children living in foster families with a history of maltreatment or neglect. These children often show adverse mental health outcomes reflected in increased externalizing and internalizing problems. It is expected that these adverse outcomes are associated with increased parental stress levels experienced by foster mothers as well as foster fathers. METHODS The study sample included 79 children living in foster families and 140 children living in biological families as comparison group. The age of the children ranged from 2 to 7 years. Mental health problems were assessed with the Child Behavior Checklist, while parenting stress was measured with a parenting stress questionnaire including subscales on the amount of experienced stress and the amount of perceived support. The Child Behavior Checklist assessments were based mainly on maternal reports, while the parental stress assessments were based on maternal as well as paternal reports. RESULTS As expected the results showed increased externalizing and internalizing scores for the foster children accompanied by increased parental stress experiences in the foster family sample (however only in the maternal, but not in the paternal stress reports). The stress differences between the foster and biological family groups disappeared, when the children's mental health problem scores were included as covariates. Moreover, especially the externalizing scores were strong predictors of parental stress in both, the groups of foster and biological parents. The amount of perceived social support was associated with reduced parental stress, but only in the group of biological fathers. CONCLUSION The emergence of parental stress in biological as well as foster parents is closely related to child characteristics (mainly externalizing child problems). Possible implications for the reduction of parental stress are discussed as a consequence of the present results.
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Affiliation(s)
- Arnold Lohaus
- 0000 0001 0944 9128grid.7491.bFaculty of Psychology and Sports Sciences, University of Bielefeld, P.O. Box 10 01 31, 33501 Bielefeld, Germany
| | - Sabrina Chodura
- 0000 0001 0944 9128grid.7491.bFaculty of Psychology and Sports Sciences, University of Bielefeld, P.O. Box 10 01 31, 33501 Bielefeld, Germany
| | - Christine Möller
- 0000 0001 0944 9128grid.7491.bFaculty of Psychology and Sports Sciences, University of Bielefeld, P.O. Box 10 01 31, 33501 Bielefeld, Germany
| | - Tabea Symanzik
- 0000 0001 0944 9128grid.7491.bFaculty of Psychology and Sports Sciences, University of Bielefeld, P.O. Box 10 01 31, 33501 Bielefeld, Germany
| | - Daniela Ehrenberg
- 0000 0001 1090 0254grid.6738.aUniversity of Braunschweig, Institute of Psychology, Humboldtstr. 33, 38106 Brunswick, Germany
| | - Ann-Katrin Job
- 0000 0001 1090 0254grid.6738.aUniversity of Braunschweig, Institute of Psychology, Humboldtstr. 33, 38106 Brunswick, Germany
| | - Vanessa Reindl
- 0000 0000 8653 1507grid.412301.5Department for Child and Adolescent Psychiatry, University Hospital Aachen, Neuenhoferweg 21, 52074 Aachen, Germany
| | - Kerstin Konrad
- 0000 0000 8653 1507grid.412301.5Department for Child and Adolescent Psychiatry, University Hospital Aachen, Neuenhoferweg 21, 52074 Aachen, Germany
| | - Nina Heinrichs
- 0000 0001 1090 0254grid.6738.aUniversity of Braunschweig, Institute of Psychology, Humboldtstr. 33, 38106 Brunswick, Germany
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Ssewanyana D, Nyongesa MK, van Baar A, Newton CR, Abubakar A. Health risk behavior among chronically ill adolescents: a systematic review of assessment tools. Child Adolesc Psychiatry Ment Health 2017; 11:32. [PMID: 28725261 PMCID: PMC5512752 DOI: 10.1186/s13034-017-0172-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/18/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adolescents living with chronic illnesses engage in health risk behaviors (HRB) which pose challenges for optimizing care and management of their ill health. Frequent monitoring of HRB is recommended, however little is known about which are the most useful tools to detect HRB among chronically ill adolescents. AIMS This systematic review was conducted to address important knowledge gaps on the assessment of HRB among chronically ill adolescents. Its specific aims were to: identify HRB assessment tools, the geographical location of the studies, their means of administration, the psychometric properties of the tools and the commonest forms of HRB assessed among adolescents living with chronic illnesses globally. METHODS We searched in four bibliographic databases of PubMed, Embase, PsycINFO and Applied Social Sciences Index and Abstracts for empirical studies published until April 2017 on HRB among chronically ill adolescents aged 10-17 years. RESULTS This review indicates a major dearth of research on HRB among chronically ill adolescents especially in low income settings. The Youth Risk Behavior Surveillance System and Health Behavior in School-aged Children were the commonest HRB assessment tools. Only 21% of the eligible studies reported psychometric properties of the HRB tools or items. Internal consistency was good and varied from 0.73 to 0.98 whereas test-retest reliability varied from unacceptable (0.58) to good (0.85). Numerous methods of tool administration were also identified. Alcohol, tobacco and other drug use and physical inactivity are the commonest forms of HRB assessed. CONCLUSION Evidence on the suitability of the majority of the HRB assessment tools has so far been documented in high income settings where most of them have been developed. The utility of such tools in low resource settings is often hampered by the cultural and contextual variations across regions. The psychometric qualities were good but only reported in a minority of studies from high income settings. This result points to the need for more resources and capacity building for tool adaptation and validation, so as to enhance research on HRB among chronically ill adolescents in low resource settings.
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Affiliation(s)
- Derrick Ssewanyana
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya ,0000000120346234grid.5477.1Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Moses Kachama Nyongesa
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Anneloes van Baar
- 0000000120346234grid.5477.1Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Charles R. Newton
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,grid.449370.dDepartment of Public Health, Pwani University, Kilifi, Kenya
| | - Amina Abubakar
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya ,0000000120346234grid.5477.1Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,grid.449370.dDepartment of Public Health, Pwani University, Kilifi, Kenya
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Guay S, Tremblay N, Goncalves J, Bilodeau H, Geoffrion S. Effects of a peer support programme for youth social services employees experiencing potentially traumatic events: a protocol for a prospective cohort study. BMJ Open 2017; 7:e014405. [PMID: 28647721 PMCID: PMC5623380 DOI: 10.1136/bmjopen-2016-014405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/13/2017] [Accepted: 03/24/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The use of peer support programmes to help workers experiencing potentially traumatic events (PTE) has increased in high-risk organisations in the last decades. However, the scientific evidence of its effectiveness is still very limited. This paper aims to describe the protocol of a prospective cohort study that assesses the efficacy of a peer support programme among youth social services employees exposed to a PTE at work on psychological well-being, work functioning and needs of support. METHODS AND ANALYSIS This is a mixed-methods prospective study that will examine workers' evolution four times over a 12-month period in Canada. This study involves: (1) quantitative data obtained through self-administrated questionnaires among 222 workers, and (2) qualitative in-depth interviews with a subsample of 45 workers. This study will compare findings from a cohort who received the support of a peer following a PTE (peer support-experimental protocol) as part of the experimental protocol of the Montreal Youth Social Services-University Institute (MYSS-UI), the second group of workers did not ask for the peer support (no peer support-experimental protocol) but was part of MYSS-UI, and the third group received standard organisational support from the Monteregie Youth Social Services (MYSS) (standard organisational protocol). ETHICS AND DISSEMINATION The protocol and informed consent form complied with the ethics guidelines of the MYSS-UI. The Research Ethics Board of MYSS-UI and MYSS reviewed and accepted the protocol as required. The results of the study will be published in peer-reviewed journals, presented at research and general public conferences, disseminated via a public report for the institute that funded the project and for all workers. Results of this study will influence decision making regarding intervention policies following PTE and peer support interventions may be expanded throughout the youth social services in Canada and worldwide.
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Affiliation(s)
- Stephane Guay
- École de criminologie, Université de Montréal, Montreal, Quebec, Canada
- Trauma Studies Centre, Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
| | - Nicole Tremblay
- Trauma Studies Centre, Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
| | - Jane Goncalves
- Trauma Studies Centre, Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
| | - Henriette Bilodeau
- Département d'organisation et ressources humaines, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Steve Geoffrion
- Trauma Studies Centre, Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
- École de psychoéducation, Université de Montréal, Montreal, Quebec, Canada
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Adolescent Mothers in Foster Care: Relational Ethics, Depressive Symptoms and Health Problems Through a Contextual Therapy Lens. CONTEMPORARY FAMILY THERAPY 2017. [DOI: 10.1007/s10591-017-9417-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Ferrara P, Scancarello M, Khazrai YM, Romani L, Cutrona C, DE Gara L, Bona G. Food security and the nutritional status of children in foster care: new horizons in the protection of a fragile population. Minerva Pediatr 2016; 72:508-513. [PMID: 27733749 DOI: 10.23736/s0026-4946.16.04802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The nutritional status of foster children, the quality of daily menus in group homes and the Food Security inside these organizations have been poorly studied and this study means to investigate them. METHODS A sample of 125 children, ranging in age from 0-17 years, among seven group homes (group A) was compared with 121 children of the general population we (group B). To evaluate nutritional status, BMI percentiles were used. Mean percentiles of both groups were compared through statistical analysis. Both nutritional and caloric daily distributions in each organization were obtained using the 24-hour recall method. A specific questionnaire was administered to evaluate Food Security. RESULTS From the analysis of mean BMI-for-age (or height-for-length) percentiles, did not observe statistically significant differences between group A and group B. The average daily nutrient and calorie distribution in group homes proves to be nearly optimal with the exception of a slight excess in proteins and a slight deficiency in PUFAs. Moreover, a low intake of iron and calcium was revealed. All organizations obtained a "High Food Security" profile. CONCLUSIONS Nutritional conditions of foster children are no worse than that of children of the general population. Foster care provides the necessary conditions to support their growth.
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Affiliation(s)
- Pietro Ferrara
- Institute of Pediatrics, Catholic University Medical School, Rome, Italy -
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Siegel A, Benbenishty R, Astor RA. A Comparison of Adolescents in Foster Care and Their Peers in High School: A Study of Substance Use Behaviors and Attitudes. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016. [DOI: 10.1080/1067828x.2016.1139481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Ron Avi Astor
- University of Southern California, University Park, CA, USA
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Medical Service Utilization Among Youth with School-Identified Disabilities in Residential Care. CHILD & YOUTH CARE FORUM 2015. [DOI: 10.1007/s10566-015-9327-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Heneghan A, Stein REK, Hurlburt MS, Zhang J, Rolls-Reutz J, Kerker BD, Landsverk J, Horwitz SM. Health-risk behaviors in teens investigated by U.S. Child Welfare Agencies. J Adolesc Health 2015; 56:508-14. [PMID: 25744208 PMCID: PMC5564320 DOI: 10.1016/j.jadohealth.2015.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to examine prevalence and correlates of health-risk behaviors in 12- to 17.5-year-olds investigated by child welfare and compare risk-taking over time and with a national school-based sample. METHODS Data from the National Survey of Child and Adolescent Well-Being (NSCAW II) were analyzed to examine substance use, sexual activity, conduct behaviors, and suicidality. In a weighted sample of 815 adolescents aged 12-17.5 years, prevalence and correlates for each health-risk behavior were calculated using bivariate analyses. Comparisons to data from NSCAW I and the Youth Risk Behavior Survey were made for each health-risk behavior. RESULTS Overall, 65.6% of teens reported at least one health-risk behavior with significantly more teens in the 15- to 17.5-year age group reporting such behaviors (81.2% vs. 54.4%; p ≤ .001). Almost 75% of teens with a prior out-of-home placement and 77% of teens with child behavior checklist scores ≥64 reported at least one health-risk behavior. The prevalence of smoking was lower than in NSCAW I (10.5% vs. 23.2%; p ≤ .05) as was that of sexual activity (18.0% vs. 28.8%; p ≤ .05). Prevalence of health-risk behaviors was lower among older teens in the NSCAW II sample (n = 358) compared with those of the 2011 Youth Risk Behavior Surveillance System high school-based sample with the exception of suicidality, which was approximately 1.5 times higher (11.3% [95% confidence interval, 6.5-19.0] vs. 7.8% [95% confidence interval, 7.1-8.5]). CONCLUSIONS Health-risk behaviors in this population of vulnerable teens are highly prevalent. Early efforts for screening and interventions should be part of routine child welfare services monitoring.
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Affiliation(s)
- Amy Heneghan
- Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, CA; Department of Pediatrics, the Case Western Reserve University School of Medicine, Cleveland, OH.
| | - Ruth E K Stein
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York, New York
| | - Michael S Hurlburt
- School of Social Work, University of Southern California, Los Angeles, California
| | - Jinjin Zhang
- Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, California
| | - Jennifer Rolls-Reutz
- Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, California
| | - Bonnie D Kerker
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York; Nathan Kline Institute of Psychiatric Services, Orangeburg, New York
| | - John Landsverk
- Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, California
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York
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24
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Hacker KA, Penfold RB, Arsenault LN, Zhang F, Murphy M, Wissow LS. Behavioral health services following implementation of screening in Massachusetts Medicaid children. Pediatrics 2014; 134:737-46. [PMID: 25225135 PMCID: PMC4179096 DOI: 10.1542/peds.2014-0453] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the relationship of child behavioral health (BH) screening results to receipt of BH services in Massachusetts Medicaid (MassHealth) children. METHODS After a court decision, Massachusetts primary care providers were mandated to conduct BH screening at well-child visits and use a Current Procedural Terminology code along with a modifier indicating whether a BH need was identified. Using MassHealth claims data, a cohort of continuously enrolled (July 2007-June 2010) children was constructed. The salient visit (first use of the modifier, screening code, or claim in fiscal year 2009) was considered a reference point to examine BH history and postscreening BH services. Bivariate and multivariate logistic regression analyses were performed to determine predictors of postscreening BH services. RESULTS Of 261,160 children in the cohort, 45% (118,464) were screened and 37% had modifiers. Fifty-seven percent of children screening positive received postscreening BH services compared with 22% of children screening negative. However, only 30% of newly identified children received BH services. The strongest predictors of postscreening BH services for children without a BH history were being in foster care (odds ratio, 10.38; 95% confidence interval, 9.22-11.68) and having a positive modifier (odds ratio, 3.79; 95% confidence interval, 3.53-4.06). CONCLUSIONS Previous BH history, a positive modifier, and foster care predicted postscreening BH services. Only one-third of newly identified children received services. Thus although screening is associated with an increase in BH recognition, it may be insufficient to improve care. Additional strategies may be needed to enhance engagement in BH services.
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Affiliation(s)
- Karen A. Hacker
- Allegheny County Health Department, and,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert B. Penfold
- Group Health Research Institute, and,Department of Health Services Research, University of Washington, Seattle, Washington
| | | | - Fang Zhang
- Harvard Pilgrim Healthcare Institute, Department of Population Medicine, and
| | - Michael Murphy
- Massachusetts General Department of Child Psychiatry, Harvard Medical School, Boston, Massachusetts; and
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25
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Trout AL, Lambert MC, Nelson TD, Epstein MH, Thompson RW. Prevalence of physical health issues of youth with school identified disabilities in residential settings: a brief report. Disabil Health J 2014; 8:118-22. [PMID: 25091555 DOI: 10.1016/j.dhjo.2014.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 06/13/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Each year a number of youth with a school identified disability are placed in residential care. It has been well documented that these youth enter with elevated rates of behavioral, emotional, educational, mental health, and familial challenges. However, the physical and medical condition of these youth remains unstudied. OBJECTIVE The purpose of the present study was to determine the prevalence of health and medical problems among a group of youth with school identified disabilities at entrance to a residential care center. METHODS Archival medical, demographic, and disability status data were obtained for 346 youth served in a large residential care center in the Midwest. Chi-square and correlation tests, and relative risk ratio estimates, were used to evaluate the relationship between medical condition and hypothesized correlates. RESULTS Findings revealed that over one-third of the sample had at least one medical condition, with asthma being the most prevalent (15.6%). Rates of medical condition differed by disability type and prevalence of asthma differed by race/ethnicity. CONCLUSIONS Youth with a school identified disability in care demonstrate health care needs that need to be addressed while in care and following community reintegration. Intervention programs and targeted curriculum are needed to teach youth how to manage their health specific needs and how to independently navigate the health care system.
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26
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Hacker KA, Penfold R, Arsenault L, Zhang F, Murphy M, Wissow L. Screening for behavioral health issues in children enrolled in Massachusetts Medicaid. Pediatrics 2014; 133:46-54. [PMID: 24298005 PMCID: PMC3876180 DOI: 10.1542/peds.2013-1180] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To understand mandated behavioral health (BH) screening in Massachusetts Medicaid including characteristics of screened children, predictors of positive screens, and whether screening identifies children without a previous BH history. METHODS Massachusetts mandated BH screening in particularly among underidentified groups. 2008. Providers used a billing code and modifier to indicate a completed screen and whether a BH need was identified. Using MassHealth claims data, children with ≥ 300 days of eligibility in fiscal year (FY) 2009 were identified and categorized into groups based on first use of the modifier, screening code, or claim. Bivariate analyses were conducted to determine differences among groups. BH history was examined by limiting the sample to those continuously enrolled in FY 2008 and 2009. Multivariate logistic regression was used to determine predictors of positive screens. RESULTS Of 355,490 eligible children, 46% had evidence of screening. Of those with modifiers, 12% were positive. Among continuously enrolled children (FY 2008 and FY 2009) with evidence of screening, 43% with positive modifiers had no BH history. This "newly identified" group were more likely to be female, younger, minority, and from rural residences (P < .0001). Among children with modifiers; gender (male), age (5-7), being in foster care, recent BH history, and Hispanic ethnicity predicted having a positive modifier. CONCLUSIONS The high rate of newly identified Medicaid children with a BH need suggests that screening is performing well, particularly among underidentified groups. To better assess screening value, future work on cost-effectiveness and the impact on subsequent mental health treatment is needed.
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Affiliation(s)
- Karen A Hacker
- Allegheny County Health Department, 3333 Forbes Ave, Pittsburgh, PA 15213.
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