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Leo HP, Folk JB, Rodriguez C, Tolou-Shams M. Implementation Considerations for Family-Based Telehealth Interventions for Youth in Foster Care: Focus Group Study With Child Welfare System Professionals. JMIR Form Res 2023; 7:e45905. [PMID: 38157238 PMCID: PMC10787329 DOI: 10.2196/45905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families. OBJECTIVE This study aims to understand child welfare system professionals' perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement. METHODS This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework. RESULTS Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68%), White individuals (n=10, 53%), and social workers (n=8, 42%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy. CONCLUSIONS Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin.
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Affiliation(s)
- Hannah P Leo
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Child and Adolescent Psychiatry, New York-Presbyterian, New York, NY, United States
| | - Johanna B Folk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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Evans R, MacDonald S, Trubey R, Noyes J, Robling M, Willis S, Boffey M, Wooders C, Vinnicombe S, Melendez-Torres GJ. Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review. Syst Rev 2023; 12:111. [PMID: 37393358 PMCID: PMC10315047 DOI: 10.1186/s13643-023-02260-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/26/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND The mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years. METHODS For the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics. RESULTS In total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people's skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes. CONCLUSIONS Future intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020177478.
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Affiliation(s)
- Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK.
| | - Sarah MacDonald
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Rob Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | | | - Simone Willis
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Maria Boffey
- DECIPHer, School of Social Sciences, Cardiff University, SPARK, Maindy Road, Cardiff, CF24 4HQ, UK
| | | | - Soo Vinnicombe
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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The Mediating Effect of Group Cohesion Modulated by Resilience in the Relationship between Perceived Stress and Military Life Adjustment. SUSTAINABILITY 2022. [DOI: 10.3390/su14137794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
This study’s purpose was to investigate the relationship among soldiers’ perceived stress, group cohesion, military life adjustment, and resilience. Specifically, we aimed to verify the mediating effect of cohesion and the modulating effect of resilience. In addition, we examined the mediated modulating effect of resilience within the comprehensive relationship among variables. The research participants comprised 300 soldiers from two different army troops, and a total of 285 data points were analyzed, excluding unfinished responses. The main results were as follows. First, we identified the mediated effect of cohesion in the relationship between soldiers’ perceived stress and their military life adjustment. Second, resilience showed a moderating effect in the relationship between soldiers’ cohesion and military life adjustment. Third, while on the path of moving from perceived stress to successful military life adjustment through cohesion, resilience modulated the relationship between cohesion and military life adjustment. Lastly, in this paper, we address this study’s implications and limitations.
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Folk JB, Gill H, Ordorica C, Rodriguez CA, Holloway ED, Meza J, Tolou-Shams M. An Ecodevelopmental Framework for Engaging Diverse Youth in Foster Care and Their Families Into Technology-Based Family Intervention Research Trials. Front Digit Health 2022; 4:866139. [PMID: 35633735 PMCID: PMC9135973 DOI: 10.3389/fdgth.2022.866139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/25/2022] [Indexed: 01/07/2023] Open
Abstract
Family-based interventions delivered via telehealth are a promising mode for overcoming barriers to behavioral health treatment among youth in foster care and their families. There is a dearth of research, however, regarding effectiveness of these interventions for youth in foster care, who commonly exhibit complex behavioral health treatment needs. Clinical research in this area directly relates to equity in service access and quality for these youth and families, with numerous barriers and enabling factors to consider in order to improve engagement in clinical trials and bolster the evidence base. We present a framework to better understand the multi-systemic factors impacting youth and family engagement in clinical research on family-based telehealth interventions, drawing on relevant theory, including the bioecological model and ecodevelopmental theory. We also draw on our experiences conducting technology-based clinical research through the Family Telehealth Project, an evaluation of a brief family-based affect management intervention designed specifically for youth in foster care and their families, as a case example. Recommendations for promoting engagement in clinical research on family-based telehealth interventions with diverse youth in foster care and their families are provided.
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Affiliation(s)
- Johanna B. Folk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Johanna B. Folk
| | - Heman Gill
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Catalina Ordorica
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher A. Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Evan D. Holloway
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jocelyn Meza
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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Saldana L, Ritzwoller DP, Campbell M, Block EP. Using economic evaluations in implementation science to increase transparency in costs and outcomes for organizational decision-makers. Implement Sci Commun 2022; 3:40. [PMID: 35410434 PMCID: PMC9004101 DOI: 10.1186/s43058-022-00295-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
Background Economic evaluations frequently are utilized to compare the value of different interventions in medicine and health in concrete terms. Implementation science also would benefit from the incorporation of economic evaluations, but such studies are rare in the literature. The National Cancer Institute has supported a special collection of articles focusing on economic evaluations in implementation science. Even when interventions are supported by substantial evidence, they are implemented infrequently in the field. Implementation costs are important determinants for whether organizational decision-makers choose to adopt an intervention and whether the implementation process is successful. Economic evaluations, such as cost-effectiveness analyses, can help organizational decision-makers choose between implementation approaches for evidence-based interventions by accounting for costs and succinctly presenting cost/benefit tradeoffs. Main text This manuscript presents a discussion of important considerations for incorporating economic evaluations into implementation science. First, the distinction between intervention and implementation costs is presented, along with an explanation of why the comprehensive representation of implementation costs is elusive. Then, the manuscript describes how economic evaluations in implementation science may differ from those in medicine and health intervention studies, especially in terms of determining the perspectives and outcomes of interest. Finally, referencing a scale-up trial of an evidence-based behavioral health intervention, concrete case examples of how cost data can be collected and used in economic evaluations targeting implementation, rather than clinical outcomes, are described. Conclusions By gaining a greater understanding of the costs and economic impact associated with different implementation approaches, organizational decision-makers will have better transparency for future replication and scale-up. The use of economic evaluations can help to advance this understanding and provide researchers, purveyors or third-party intermediaries, and organizational decision-makers with essential information to facilitate implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00295-1.
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Nowakowski-Sims E. Integrative Body, Mind, and Spirit Interventions used with Parents in the Child Welfare System. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:121-129. [PMID: 35222779 PMCID: PMC8837741 DOI: 10.1007/s40653-021-00388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
Parenting is a critical component of child welfare's intervention efforts; however, child welfare interventions attempt to correct dysfunctional parenting practices rather than address their shared underlying causes, such as parental stress and trauma. Ongoing stress can overload a parents' ability to access logical decision-making capabilities. Parents can utilize integrative body, mind, and spirit interventions to remain calm when they experience chronic stress. These interventions can offer stressed out parents techniques that focus on emotional regulation, and subsequently reduce the risk of child maltreatment. This article offers a comprehensive review of the literature identifying parental stress as a critical component of child welfare as well as the usefulness of including integrative mind, body, and spirit interventions with parents in the child welfare system.
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Keil MF, Leahu A, Rescigno M, Myles J, Stratakis CA. Family environment and development in children adopted from institutionalized care. Pediatr Res 2022; 91:1562-1570. [PMID: 34040161 PMCID: PMC8617065 DOI: 10.1038/s41390-020-01325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/13/2020] [Accepted: 12/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND After adoption, children exposed to institutionalized care show significant improvement, but incomplete recovery of growth and developmental milestones. There is a paucity of data regarding risk and protective factors in children adopted from institutionalized care. This prospective study followed children recently adopted from institutionalized care to investigate the relationship between family environment, executive function, and behavioral outcomes. METHODS Anthropometric measurements, physical examination, endocrine and bone age evaluations, neurocognitive testing, and behavioral questionnaires were evaluated over a 2-year period with children adopted from institutionalized care and non-adopted controls. RESULTS Adopted children had significant deficits in growth, cognitive, and developmental measurements compared to controls that improved; however, residual deficits remained. Family cohesiveness and expressiveness were protective influences, associated with less behavioral problems, while family conflict and greater emphasis on rules were associated with greater risk for executive dysfunction. CONCLUSIONS Our data suggest that a cohesive and expressive family environment moderated the effect of pre-adoption adversity on cognitive and behavioral development in toddlers, while family conflict and greater emphasis on rules were associated with greater risk for executive dysfunction. Early assessment of child temperament and parenting context may serve to optimize the fit between parenting style, family environment, and the child's development. IMPACT Children who experience institutionalized care are at increased risk for significant deficits in developmental, cognitive, and social functioning associated with a disruption in the development of the prefrontal cortex. Aspects of the family caregiving environment moderate the effect of early life social deprivation in children. Family cohesiveness and expressiveness were protective influences, while family conflict and greater emphasis on rules were associated with a greater risk for executive dysfunction problems. This study should be viewed as preliminary data to be referenced by larger studies investigating developmental and behavioral outcomes of children adopted from institutional care.
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Affiliation(s)
- Margaret F. Keil
- grid.94365.3d0000 0001 2297 5165Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD USA
| | - Adela Leahu
- grid.94365.3d0000 0001 2297 5165Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD USA
| | - Megan Rescigno
- grid.266818.30000 0004 1936 914XUniversity of Nevada School of Medicine, Reno, NV USA
| | - Jennifer Myles
- grid.94365.3d0000 0001 2297 5165Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Constantine A. Stratakis
- grid.94365.3d0000 0001 2297 5165Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD USA
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A Systematic Review on Foster Parents' Psychological Adjustment and Parenting Style-An Evaluation of Foster Parents and Foster Children Variables. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010916. [PMID: 34682659 PMCID: PMC8535523 DOI: 10.3390/ijerph182010916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 01/04/2023]
Abstract
The current systematic review aimed to evaluate the variables influencing foster parents’ parenting stress, distress and parenting style, thereby supporting their adjustment and well-being as well as that of foster children. A PRISMA-guided search was conducted in three databases. Observational studies examining parenting stress, parenting distress (subsuming anxiety, depression and stress symptoms) and parenting style—all assessed through validated tools—were considered. A total of 16 studies were included, comprising N = 1794 non-relative foster parents (age range = 30–67 years). Results showed heightened parenting stress over time, both overall and compared to parents at large. Neither foster parents’ nor foster children’s socio-demographic characteristics significantly contributed to the increase in parenting stress; yet child-related stress and children’s externalizing problems were its main predictors. Foster parents’ couple cooperation was associated with reduced parenting stress. Moreover, the authoritative parenting style was associated with parental warmth, while the authoritarian style was associated with foster parents’ greater perceived burden, greater criticism and rejection toward the foster child. Evidence supports the mutual influence between foster parents and children. Foster care services should support foster parents’ needs within a concentric modular system, to ultimately provide better care for both foster parents and children.
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Zhang N, Yang S, Jia P. Cultivating Resilience During the COVID-19 Pandemic: A Socioecological Perspective. Annu Rev Psychol 2021; 73:575-598. [PMID: 34579547 DOI: 10.1146/annurev-psych-030221-031857] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses wide-ranging impacts on the physical and mental health of people around the world, increasing attention from both researchers and practitioners on the topic of resilience. In this article, we review previous research on resilience from the past several decades, focusing on how to cultivate resilience during emerging situations such as the COVID-19 pandemic at the individual, organizational, community, and national levels from a socioecological perspective. Although previous research has greatly enriched our understanding of the conceptualization, predicting factors, processes, and consequences of resilience from a variety of disciplines and levels, future research is needed to gain a deeper and comprehensive understanding of resilience, including developing an integrative and interdisciplinary framework for cultivating resilience, developing an understanding of resilience from a life span perspective, and developing scalable and cost-effective interventions for enhancing resilience and improving pandemic preparedness. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ning Zhang
- School of Public Health and the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China.,Center for Disease Control and Prevention of Hangzhou, Hangzhou 310016, China.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan 430072, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China; .,International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan 430072, China
| | - Peng Jia
- School of Resources and Environmental Science, Wuhan University, Wuhan 430072, China; .,International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan 430072, China
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Haggerty KP, Barkan SE, Skinner ML, Hanson K. Proximal Outcomes of Connecting, an Evidence-based, Family-focused Prevention Program for Caregivers of Adolescents in Foster Care. CHILDREN AND YOUTH SERVICES REVIEW 2021; 126:106009. [PMID: 34393311 PMCID: PMC8357311 DOI: 10.1016/j.childyouth.2021.106009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Kevin P. Haggerty
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA 98115
| | - Susan E. Barkan
- Partners for Our Children, School of Social Work, P.O. Box 354900, University of Washington, Seattle, WA 98195
| | - Martie L. Skinner
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA 98115
| | - Koren Hanson
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave. NE, Suite, 401, Seattle, WA 98115
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Chen X, He J, Fan X. Applicability of the Ego-Resilience Scale (ER89) in the Chinese Cultural Context: A Validation Study. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2019. [DOI: 10.1177/0734282919889242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the cross-cultural validity of the Ego-Resilience Scale (ER89) in the Chinese cultural context. The ER89 was translated and culturally adapted into Chinese by following the psychometric validation procedures, in an adolescent sample ( N = 943) of 13- to 18-year-olds. A series of psychometric analyses were conducted, including exploratory factor analysis (EFA), confirmatory factor analysis (CFA), analysis for measurement invariance across gender groups, analysis for criterion-related validity evidence, and internal consistency reliability estimates. The results supported the use of ER89 scale in the Chinese cultural context (ER89-C). The empirical findings suggest a two-factor structure of ER89-C (openness to life experiences [OL] and optimal regulation [OR]). The findings also revealed that ER89-C has the expected correlations with external and theoretically related constructs. Overall, ER89-C is shown to possess favorable psychometric characteristics for its use as an assessment tool for ego-resilience level of Chinese adolescents.
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Affiliation(s)
- Xinjie Chen
- University of Macau, China
- Stanford University, CA, USA
| | - Jinbo He
- The Chinese University of Hong Kong, Shenzhen, China
| | - Xitao Fan
- The Chinese University of Hong Kong, Shenzhen, China
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Developing a Quality Assurance System for Multiple Evidence Based Practices in a Statewide Service Improvement Initiative. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:29-41. [PMID: 26036754 DOI: 10.1007/s10488-015-0663-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Efforts to implement evidence based practices (EBP) are increasingly common in child-serving systems. However, public systems undertaking comprehensive improvement efforts that aim to increase availability of multiple practices at the same time may struggle to build comprehensive and user-friendly strategies to develop the workforce and encourage adoption, faithful implementation, and sustainability of selected EBPs. Given that research shows model adherence predicts positive outcomes, one critical EBP implementation support is systematic quality, fidelity, and compliance monitoring. This paper describes the development and initial implementation of a quality assurance framework for a statewide EBP initiative within child welfare. This initiative aimed to improve provider practice and monitor provider competence and compliance across four different EBPs, and to inform funding and policy decisions. The paper presents preliminary data as an illustration of lessons learned during the quality monitoring process and concludes with a discussion of the promise and challenges of developing and applying a multi-EBP quality assurance framework for use in public systems.
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Tung I, Noroña AN, Lee SS, Langley AK, Waterman JM. Temperamental sensitivity to early maltreatment and later family cohesion for externalizing behaviors in youth adopted from foster care. CHILD ABUSE & NEGLECT 2018; 76:149-159. [PMID: 29102869 DOI: 10.1016/j.chiabu.2017.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/29/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
Children in foster care frequently have histories of physical/sexual abuse and neglect, increasing their risk for externalizing behaviors (EB; e.g., aggression). According to the differential susceptibility theory, children with reactive temperaments (e.g., negative emotionality) may be particularly vulnerable to early maltreatment, but may also benefit the most from environmental enrichment such as family cohesion. In a high-risk longitudinal sample of 82 children adopted from foster care in Los Angeles County from 1996 and 2001, we examined predictions of EB from childhood to adolescence/young adulthood from temperament, preadoption maltreatment, and adoptive family cohesion. Overall, results from generalized linear models and generalized estimating equations (GEE) did not support differential susceptibility theory - specifically, youth with early reactive temperament did not exhibit heightened sensitivity to maltreatment nor to later adoptive family cohesion. Instead, reactive temperament was associated with higher EB at initial adoptive placement and escalating EB across childhood, controlling for age, gender, race-ethnicity, preadoption maltreatment, and adoptive family cohesion. Preadoption maltreatment history was unrelated to baseline EB, although sexual abuse history predicted escalating childhood EB post-adoption, whereas exposure to family violence (e.g., domestic violence) inversely predicted EB over time. By late adolescence/young adulthood 11-15 years post-adoption, rates of arrest and substance use in this sample were relatively comparable to normative populations of youth, although older age of adoption predicted more substance use in late adolescence/young adulthood. Findings highlight early reactive temperament and preadoption maltreatment as important risk factors to target for ameliorating patterns of EB growth in the first few years of adoption.
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Affiliation(s)
- Irene Tung
- Department of Psychology, University of California, 1285 Franz Hall, Los Angeles, CA 90095, USA.
| | - Amanda N Noroña
- Department of Psychology, University of California, 1285 Franz Hall, Los Angeles, CA 90095, USA
| | - Steve S Lee
- Department of Psychology, University of California, 1285 Franz Hall, Los Angeles, CA 90095, USA
| | - Audra K Langley
- Department of Psychiatry and Biobehavioral Sciences, University of California, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Jill M Waterman
- Department of Psychology, University of California, 1285 Franz Hall, Los Angeles, CA 90095, USA
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Steenbakkers A, Ellingsen IT, van der Steen S, Grietens H. Psychosocial Needs of Children in Foster Care and the Impact of Sexual Abuse. JOURNAL OF CHILD AND FAMILY STUDIES 2017; 27:1324-1335. [PMID: 29576728 PMCID: PMC5854738 DOI: 10.1007/s10826-017-0970-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Children in family foster care, especially those who have experienced sexual abuse, require a safe and nurturing environment in which their psychosocial needs are met. However, there is limited knowledge on how youth prioritize various needs and what impact previous experiences have on these needs. In this study, we asked youth (formerly) in family foster care to indicate their psychosocial needs, and analyzed if youth with a history of sexual abuse have different needs. A Q methodological study was conducted with 44 youth (age 16-28). Fifteen of them reported sexual abuse during their childhood. Using by-person factor analyses, respondents who share similar subjective views were grouped together. Qualitative interpretations of the factors show differences and similarities between and within the two groups, related to help from others, being independent, processing the past, and working toward the future. Although the needs of youth with and without experiences of sexual abuse seem mostly similar, one group of sexually abused youth specifically indicated not wanting an emotional connection to foster parents, but instead a strictly instrumental, professional relationship. This study captured the diverse perspectives of youth themselves, revealing that children in foster care differ with regard to what they consider as (most) important safety, belonging, self-esteem and self-actualization needs.
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Affiliation(s)
- Anne Steenbakkers
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
| | | | - Steffie van der Steen
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
| | - Hans Grietens
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
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Salehinejad MA, Nejati V, Derakhshan M. Neural correlates of trait resiliency: Evidence from electrical stimulation of the dorsolateral prefrontal cortex (dLPFC) and orbitofrontal cortex (OFC). PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Dishion T, Forgatch M, Chamberlain P, Pelham WE. The Oregon Model of Behavior Family Therapy: From Intervention Design to Promoting Large-Scale System Change. Behav Ther 2016; 47:812-837. [PMID: 27993335 PMCID: PMC5389456 DOI: 10.1016/j.beth.2016.02.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/15/2015] [Accepted: 02/03/2016] [Indexed: 11/18/2022]
Abstract
This paper reviews the evolution of the Oregon model of family behavior therapy over the past four decades. Inspired by basic research on family interaction and innovation in behavior change theory, a set of intervention strategies were developed that were effective for reducing multiple forms of problem behavior in children (e.g., Patterson, Chamberlain, & Reid, 1982). Over the ensuing decades, the behavior family therapy principles were applied and adapted to promote children's adjustment to address family formation and adaptation (Family Check-Up model), family disruption and maladaptation (Parent Management Training-Oregon model), and family attenuation and dissolution (Treatment Foster Care-Oregon model). We provide a brief overview of each intervention model and summarize randomized trials of intervention effectiveness. We review evidence on the viability of effective implementation, as well as barriers and solutions to adopting these evidence-based practices. We conclude by proposing an integrated family support system for the three models applied to the goal of reducing the prevalence of severe problem behavior, addiction, and mental problems for children and families, as well as reducing the need for costly and largely ineffective residential placements.
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Affiliation(s)
| | - Marion Forgatch
- Implementation Sciences International Inc., and Oregon Social Learning Center
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Wang D, Ogihara M, Gallo C, Villamar JA, Smith JD, Vermeer W, Cruden G, Benbow N, Brown CH. Automatic classification of communication logs into implementation stages via text analysis. Implement Sci 2016; 11:119. [PMID: 27600612 PMCID: PMC5011842 DOI: 10.1186/s13012-016-0483-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 07/28/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To improve the quality, quantity, and speed of implementation, careful monitoring of the implementation process is required. However, some health organizations have such limited capacity to collect, organize, and synthesize information relevant to its decision to implement an evidence-based program, the preparation steps necessary for successful program adoption, the fidelity of program delivery, and the sustainment of this program over time. When a large health system implements an evidence-based program across multiple sites, a trained intermediary or broker may provide such monitoring and feedback, but this task is labor intensive and not easily scaled up for large numbers of sites. We present a novel approach to producing an automated system of monitoring implementation stage entrances and exits based on a computational analysis of communication log notes generated by implementation brokers. Potentially discriminating keywords are identified using the definitions of the stages and experts' coding of a portion of the log notes. A machine learning algorithm produces a decision rule to classify remaining, unclassified log notes. RESULTS We applied this procedure to log notes in the implementation trial of multidimensional treatment foster care in the California 40-county implementation trial (CAL-40) project, using the stages of implementation completion (SIC) measure. We found that a semi-supervised non-negative matrix factorization method accurately identified most stage transitions. Another computational model was built for determining the start and the end of each stage. CONCLUSIONS This automated system demonstrated feasibility in this proof of concept challenge. We provide suggestions on how such a system can be used to improve the speed, quality, quantity, and sustainment of implementation. The innovative methods presented here are not intended to replace the expertise and judgement of an expert rater already in place. Rather, these can be used when human monitoring and feedback is too expensive to use or maintain. These methods rely on digitized text that already exists or can be collected with minimal to no intrusiveness and can signal when additional attention or remediation is required during implementation. Thus, resources can be allocated according to need rather than universally applied, or worse, not applied at all due to their cost.
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Affiliation(s)
- Dingding Wang
- Department of Computer Science, Florida Atlantic University, 777 Glades Road EE 403, Boca Raton, FL, USA
| | - Mitsunori Ogihara
- Department of Computer Science and Center for Computational Science, University of Miami, 1320 S. Dixie Highway, Miami, FL, USA
| | - Carlos Gallo
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine Northwestern University, 750 N. Lake Shore Dr., Chicago, IL, USA
| | - Juan A Villamar
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine Northwestern University, 750 N. Lake Shore Dr., Chicago, IL, USA
| | - Justin D Smith
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine Northwestern University, 750 N. Lake Shore Dr., Chicago, IL, USA
| | - Wouter Vermeer
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine Northwestern University, 750 N. Lake Shore Dr., Chicago, IL, USA
| | - Gracelyn Cruden
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, USA
| | - Nanette Benbow
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine Northwestern University, 750 N. Lake Shore Dr., Chicago, IL, USA
| | - C Hendricks Brown
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine Northwestern University, 750 N. Lake Shore Dr., Chicago, IL, USA.
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Fisher PA, Beauchamp KG, Roos LE, Noll LK, Flannery J, Delker BC. The Neurobiology of Intervention and Prevention in Early Adversity. Annu Rev Clin Psychol 2016; 12:331-57. [DOI: 10.1146/annurev-clinpsy-032814-112855] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Philip A. Fisher
- Department of Psychology, University of Oregon, Eugene, Oregon 97403;
| | - Kate G. Beauchamp
- Department of Psychology, University of Oregon, Eugene, Oregon 97403;
| | - Leslie E. Roos
- Department of Psychology, University of Oregon, Eugene, Oregon 97403;
| | - Laura K. Noll
- Department of Psychology, University of Oregon, Eugene, Oregon 97403;
| | - Jessica Flannery
- Department of Psychology, University of Oregon, Eugene, Oregon 97403;
| | - Brianna C. Delker
- Department of Psychology, University of Oregon, Eugene, Oregon 97403;
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Zilberstein K, Popper S. Clinical competencies for the effective treatment of foster children. Clin Child Psychol Psychiatry 2016; 21:32-47. [PMID: 25172873 DOI: 10.1177/1359104514547597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite a high level of documented mental health needs among children who have experienced foster care, research indicates that treatment outcomes are often disappointing. In order to improve outcomes, evidence-based treatments for attachment, trauma and behavioral difficulties are often promoted for this population. However, little research exists on whether or not those interventions effectively address the unique and complex mental health needs of many foster children. While a rather robust literature exists on foster children's multifaceted difficulties, most treatments do not fully represent that range and complexity in their interventions. This article attempts to begin to fill that gap by outlining the knowledge and skills clinicians must acquire if they are to effectively treat foster children. Treatment of foster children should be seen as a subspecialty within the field of child mental health, and trainings that help clinicians gain more knowledge of foster children's unique needs should be more available.
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Fisher PA. Review: Adoption, fostering, and the needs of looked-after and adopted children. Child Adolesc Ment Health 2015; 20:5-12. [PMID: 25678858 PMCID: PMC4321746 DOI: 10.1111/camh.12084] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND This review of the literature examines adoption, fostering, and the needs of looked-after and adopted children. Three domains of research about looked-after children are examined. FINDINGS There is extensive evidence that early adverse experiences affect psychological and neurobiological development in looked-after and adopted children. There is also evidence that some looked-after and adopted children show remarkable resilience in the face of adversity; intervention research provides evidence of the ability to reduce risks and promote positive outcomes in this population. The intervention studies have revealed not only the potential for improved behavioral trajectories but also the plasticity of neurobiological systems affected by early stress. CONCLUSION Foster and adopted children face many challenges, but scientific knowledge also provides reason for hope and information about how to maximize positive outcomes.
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Affiliation(s)
- Philip A. Fisher
- Oregon Social Learning Center, Eugene, OR 97401; Department of Psychology, 1227, University of Oregon, Eugene, OR 97403, USA
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Thornberry TP, Matsuda M, Greenman SJ, Augustyn MB, Henry KL, Smith CA, Ireland TO. Adolescent risk factors for child maltreatment. CHILD ABUSE & NEGLECT 2014; 38:706-22. [PMID: 24075569 PMCID: PMC4056983 DOI: 10.1016/j.chiabu.2013.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/22/2013] [Accepted: 08/15/2013] [Indexed: 05/04/2023]
Abstract
We investigate adolescent risk factors, measured at both early and late adolescence, for involvement in child maltreatment during adulthood. Comprehensive assessments of risk factors for maltreatment that use representative samples with longitudinal data are scarce and can inform multilevel prevention. We use data from the Rochester Youth Development Study, a longitudinal study begun in 1988 with a sample of 1,000 seventh and eighth graders. Participants have been interviewed 14 times and, at the last assessment (age 31), 80% were retained. Risk factors represent 10 developmental domains: area characteristics, family background/structure, parent stressors, exposure to family violence, parent-child relationships, education, peer relationships, adolescent stressors, antisocial behaviors, and precocious transitions to adulthood. Maltreatment is measured by substantiated reports from Child Protective Services records. Many individual risk factors (20 at early adolescence and 14 at later adolescence) are significantly, albeit moderately, predictive of maltreatment. Several developmental domains stand out, including family background/structure, education, antisocial behaviors, and precocious transitions. In addition, there is a pronounced impact of cumulative risk on the likelihood of maltreatment. For example, only 3% of the youth with no risk domains in their background at early adolescence were involved in later maltreatment, but for those with risk in 9 developmental domains the rate was 45%. Prevention programs targeting youth at high risk for engaging in maltreatment should begin during early adolescence when risk factors are already at play. These programs need to be comprehensive, capable of addressing the multiple and interwoven nature of risk that is associated with maltreatment.
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Affiliation(s)
- Terence P. Thornberry
- Department of Criminology and Criminal Justice, 2220 LeFrak Hall, University of Maryland, College Park, MD 20742, USA; telephone: +1 301 405 3008
| | - Mauri Matsuda
- Department of Criminology and Criminal Justice, 2220 LeFrak Hall, University of Maryland, College Park, MD 20742, USA; telephone: +1 301 405 3008
| | - Sarah J. Greenman
- Department of Criminology and Criminal Justice, 2220 LeFrak Hall, University of Maryland, College Park, MD 20742, USA; telephone: +1 301 405 3008
| | - Megan Bears Augustyn
- Department of Criminology and Criminal Justice, 2220 LeFrak Hall, University of Maryland, College Park, MD 20742, USA; telephone: +1 301 405 3008
| | - Kimberly L. Henry
- Department of Psychology, Colorado State University, 1879 Campus Delivery, B219d Clark, Fort Collins, CO 80523, USA
| | - Carolyn A. Smith
- School of Social Welfare, University at Albany, 135 Western Avenue, Albany, NY 12222, USA
| | - Timothy O. Ireland
- Department of Criminology and Criminal Justice, Niagara University, Niagara University, NY 14109, USA
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22
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Shonkoff JP, Fisher PA. Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy. Dev Psychopathol 2013; 25:1635-53. [PMID: 24342860 PMCID: PMC4745587 DOI: 10.1017/s0954579413000813] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Half a century of research and program evaluation has fueled a diverse landscape of early childhood policies and practices that produce a range of positive effects on the life prospects of children who face the burdens of significant adversity. Drawing on advances in neurobiology, developmental psychology, developmental psychopathology, and prevention science, this paper presents a framework for elucidating underlying causal mechanisms that explain differences in outcomes, formulating enhanced theories of change about how to shift developmental trajectories, designing creative interventions and rethinking the concept of a two-generation strategy to produce breakthrough impacts, and launching a new era of investment in young children and their families that will achieve greater reductions in intergenerational disparities in learning, behavior, and health than those produced by current best practices. Particular attention is focused on the hypothesis that substantially better outcomes for vulnerable, young children could be achieved by greater attention to strengthening the resources and capabilities of the adults who care for them rather than by continuing to focus primarily on the provision of child-focused enrichment, parenting education, and informal support. Central to achieving this goal is the need to establish an innovation-friendly environment that embraces fast-cycle sharing, supports risk taking, and celebrates learning from failure.
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23
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Jain S, Cohen AK. Fostering resilience among urban youth exposed to violence: a promising area for interdisciplinary research and practice. HEALTH EDUCATION & BEHAVIOR 2013; 40:651-62. [PMID: 23818463 DOI: 10.1177/1090198113492761] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most studies to date have examined negative effects of exposure to community violence, in line with the deficit-based perspective. However, given that most youth exposed to community violence demonstrate positive adaptation or resilience over time, we suggest a shift in perspective, practices, and policies across systems toward identifying and building individual, family, and community assets and strengths that may more effectively support youth who have been exposed to community violence and related risks into competent, caring, and thriving adults. In this article, we review how resilience has been conceptualized and operationalized within the context of community violence, highlight gaps in literature, and offer directions for future public health research and practice. We illustrate this review with practice-based examples from public health work in the San Francisco Bay Area. Future multidisciplinary longitudinal studies that identify protective processes and successful trajectories and rigorous evaluations of strength-based policies, programs, and protective processes are needed.
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Affiliation(s)
- Sonia Jain
- 1WestEd, Health and Human Development Program, Oakland, CA, USA
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24
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Youssef NA, Green KT, Beckham JC, Elbogen EB. A 3-year longitudinal study examining the effect of resilience on suicidality in veterans. Ann Clin Psychiatry 2013; 25:59-66. [PMID: 23376871 PMCID: PMC3622865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND This study prospectively evaluated the correlation and role of resilience and resilience factors in predicting suicidal ideation and attempts in veterans. METHODS In this 3-year longitudinal study, 178 Iraq and Afghanistan war veterans were evaluated for a number of clinical and demographic variables. Longitudinal follow-up was performed at approximately 3 years. RESULTS Resilience at the initial assessment predicted lower suicidality at follow-up, controlling for suicidality at the initial assessment, suggesting a protective effect for resilience. With respect to specific domains of resilience, secure relationships and positive acceptance of change significantly predicted lower suicidality. CONCLUSIONS These findings have important implications for clinical care and for guiding future research efforts to increase resilience among returning soldiers.
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Affiliation(s)
- Nagy A Youssef
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Mid-Atlantic Mental Illness Research, Education, Durham, NC, USA.
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25
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Youssef NA, Green KT, Dedert EA, Hertzberg JS, Calhoun PS, Dennis MF, Beckham JC. Exploration of the influence of childhood trauma, combat exposure, and the resilience construct on depression and suicidal ideation among U.S. Iraq/Afghanistan era military personnel and veterans. Arch Suicide Res 2013; 17:106-22. [PMID: 23614484 PMCID: PMC3640796 DOI: 10.1080/13811118.2013.776445] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study evaluated the effect of childhood trauma exposure and the role of resilience on both depressive symptoms and suicidal ideation. The study evaluated 1,488 military personnel and veterans, who served after September 2001, for depressive, suicidal, and PTSD symptoms, combat exposure, childhood trauma exposure, and resiliency. Participants were enrolled as part of an ongoing multicenter study. Outcome measures were depressive symptoms and suicidal ideation. After controlling for the effects of combat exposure and PTSD, results revealed that childhood trauma exposures were significantly associated with depressive symptoms and suicidal ideation. In addition, resilience was negatively associated with depressive symptoms and suicidal ideation, suggesting a potential protective effect. These findings suggest that evaluation of childhood trauma is important in the clinical assessment and treatment of depressive symptoms and suicidal ideation among military personnel and veterans.
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Affiliation(s)
- Nagy A Youssef
- a Durham VA Medical Center; Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, USA
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Leve LD, Harold GT, Chamberlain P, Landsverk JA, Fisher PA, Vostanis P. Practitioner review: Children in foster care--vulnerabilities and evidence-based interventions that promote resilience processes. J Child Psychol Psychiatry 2012; 53:1197-211. [PMID: 22882015 PMCID: PMC3505234 DOI: 10.1111/j.1469-7610.2012.02594.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increasing number of children are placed in foster care (i.e., a kin or nonkin family home other than the biological parent) due to experiences of physical, sexual, emotional, or psychological abuse, and/or neglect. Children in foster care are at increased risk for a host of negative outcomes encompassing emotional, behavioral, neurobiological, and social realms. METHODS Areas of risk and vulnerability among foster children are described, including emotional and behavioral deficits, impaired neurobiological development, and social relationship deficits. Evidence suggesting the significance of family placement changes and prenatal exposure to substances as contributing mechanisms is presented. Based on a systematic search of the PsycINFO database (to March 2012), eight efficacious evidence-based interventions for foster families are summarized. FINDINGS Although the development of evidence-based interventions that improve outcomes for foster children has lagged behind the delivery of interventions in other service sectors (e.g., mental health and educational sectors), several interventions across childhood and adolescence offer promise. Service system constraints offer both challenges and opportunities for more routine implementation of evidence-based interventions. CONCLUSIONS Given the increased likelihood of poor outcomes for foster children, increased efforts to understand the pathways to vulnerability and to implement interventions shown to be effective in remediating risks and improving outcomes for this population are indicated. Evaluation of efficacious interventions in countries outside of the United States is also needed.
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Affiliation(s)
- Leslie D Leve
- Oregon Social Learning Center, Eugene, OR 97401, USA.
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Chamberlain P, Roberts R, Jones H, Marsenich L, Sosna T, Price JM. Three collaborative models for scaling up evidence-based practices. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 39:278-90. [PMID: 21484449 DOI: 10.1007/s10488-011-0349-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1) the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based practices that are designed to improve outcomes for children and families in the child welfare, juvenile justice, and mental health systems. The three scale-up models each originated from collaboration between community partners and researchers with the shared goal of wide-spread implementation and sustainability of MTFC/KEEP. The three models were implemented in a variety of contexts; Rolling Cohort was implemented nationally, Cascading Dissemination was implemented within one county, and Community Development Team was targeted at the state level. The current paper presents an overview of the development of each model, the policy frameworks in which they are embedded, system challenges encountered during scale-up, and lessons learned. Common elements of successful scale-up efforts, barriers to success, factors relating to enduring practice relationships, and future research directions are discussed.
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Affiliation(s)
- Patricia Chamberlain
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd., Eugene, OR 97401, USA.
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28
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Van Ryzin MJ, Leve LD. Affiliation with delinquent peers as a mediator of the effects of multidimensional treatment foster care for delinquent girls. J Consult Clin Psychol 2012; 80:588-96. [PMID: 22352857 DOI: 10.1037/a0027336] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study evaluated the ability of delinquent peer affiliation to mediate the effects of multidimensional treatment foster care (MTFC; Chamberlain, 2003) on girls' delinquent behavior. METHOD This study used a sample of girls from 2 cohorts (N = 166; M = 15.31 years old at baseline, range 13-17 years; 74% European American, 2% African American, 7% Hispanic, 4% Native American, 1% Asian, and 13% mixed ethnicity) and measures of delinquent behavior, including general delinquency, number of criminal referrals, and number of days in locked settings. As the mediator, we used self-reports of affiliation with delinquent peers. Our analytic plan specified an intent-to-treat analysis within the framework of a randomized controlled trial comparing MTFC with traditional community-based group care. RESULTS Random assignment to the MTFC program reduced girls' number of criminal referrals and number of days in locked settings at 24 months. The MTFC condition also reduced girls' exposure to delinquent peers at 12 months, which in turn reduced levels of all forms of delinquent behavior at 24 months; indirect effects were statistically significant. CONCLUSIONS Reduction in exposure to delinquent peers mediated MTFC effects on the number of criminal referrals and number of days in locked settings; delinquent peers also served as an intervening variable between MTFC and self-report delinquency, suggesting that, by reducing contact with delinquent peers, MTFC helped to encourage lower levels of self-report delinquency. Existing prevention and intervention programs targeting similar populations may benefit from increased attention to reductions in delinquent peer affiliation in female samples.
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Lipscomb ST, Pears KC. Patterns and Predictors of Early Care and Education for Children in Foster Care. CHILDREN AND YOUTH SERVICES REVIEW 2011; 33:2303-2311. [PMID: 22039312 PMCID: PMC3203023 DOI: 10.1016/j.childyouth.2011.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Shannon T. Lipscomb
- Oregon State University – Cascades Campus, Human Development and Family Sciences, Oregon State University – Cascades Campus, 2600 NW College, Way, Bend, OR 97701, phone: 541-322-3137, fax: 541-322-3139
| | - Katherine C. Pears
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR 97401, phone: 541-485-2711, fax: 541-485-7087
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Anderson LM, Petticrew M, Rehfuess E, Armstrong R, Ueffing E, Baker P, Francis D, Tugwell P. Using logic models to capture complexity in systematic reviews. Res Synth Methods 2011; 2:33-42. [PMID: 26061598 DOI: 10.1002/jrsm.32] [Citation(s) in RCA: 204] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 03/21/2011] [Accepted: 04/13/2011] [Indexed: 11/12/2022]
Abstract
Logic models have long been used to understand complex programs to improve social and health outcomes. They illustrate how a program is designed to achieve its intended outcomes. They also can be used to describe connections between determinants of outcomes, for example, low high-school graduation rates or spiraling obesity rates, thus aiding the development of interventions that target causal factors. However, these models have not often been used in systematic reviews. This paper argues that logic models can be valuable in the systematic review process. First, they can aid in the conceptualization of the review focus and illustrate hypothesized causal links, identify effect mediators or moderators, specify intermediate outcomes and potential harms, and justify a priori subgroup analyses when differential effects are anticipated. Second, logic models can be used to direct the review process more specifically. They can help justify narrowing the scope of a review, identify the most relevant inclusion criteria, guide the literature search, and clarify interpretation of results when drawing policy-relevant conclusions about review findings. We present examples that explain how logic models have been used and how they can be applied at different stages in a systematic review. Copyright © 2011 John Wiley & Sons, Ltd.
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Affiliation(s)
- Laurie M Anderson
- Washington State Institute for Public Policy, Olympia, Washington, USA.
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Eva Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany
| | - Rebecca Armstrong
- Cochrane Public Health Review Group, University of Melbourne, Melbourne, Australia
| | - Erin Ueffing
- Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Phillip Baker
- Central Regional Services, Queensland Health, Australia and School of Public Health, Queensland University of Technology, Kelvin Grove, Australia
| | | | - Peter Tugwell
- Institute of Population Health and Department of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Fisher PA, Van Ryzin MJ, Gunnar MR. Mitigating HPA axis dysregulation associated with placement changes in foster care. Psychoneuroendocrinology 2011; 36:531-9. [PMID: 20888698 PMCID: PMC3610565 DOI: 10.1016/j.psyneuen.2010.08.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 07/09/2010] [Accepted: 08/23/2010] [Indexed: 01/20/2023]
Abstract
Maltreated foster children often exhibit alterations in diurnal hypothalamic-pituitary-adrenal (HPA) axis activity that are characterized by lower cortisol levels upon waking and smaller declines in morning-to-evening cortisol levels. Previous research has shown that this dysregulated pattern is associated with high caregiver stress levels over the course of foster care placements. In contrast, therapeutic interventions that emphasize consistent and responsive caregiving have been associated with more regulated cortisol rhythms. In this paper, two related issues were explored: whether placement changes (i.e., moving between foster homes or from a foster home to a permanent placement) were associated with more blunted daily cortisol rhythms and whether a caregiver-based intervention exerted a protective effect in this context. Because the intervention program has components specifically designed to prepare foster children for placement changes and to maintain consistent parenting techniques despite them, a prevention effect on HPA axis dysregulation during placement changes was hypothesized. The results of linear mixed modeling analyses showed that placement changes predicted dysregulation in cortisol rhythms in the regular foster care group but not in the intervention foster care group. These findings are discussed in terms of implications for child welfare policy and practice.
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Affiliation(s)
- Philip A. Fisher
- Corresponding Author : Oregon Social Learning Center, 10 Shelton McMurphey Boulevard, Eugene, OR 97401; 541-485-2711 (Phone); 541-485-7087 (Fax);
| | - Mark J. Van Ryzin
- Oregon Social Learning Center, 10 Shelton McMurphey Boulevard, Eugene, OR 97401; 541-485-2711 (Phone); 541-485-7087 (Fax);
| | - Megan R. Gunnar
- Institute of Child Development, 51 East River Parkway, Minneapolis, MN 55455; 612-624-2846 (Phone); 612-624-6373 (Fax);
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Relations of resilience and hardiness with sport achievement and mental health in a sample of athletes. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.sbspro.2010.07.180] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kolko DJ, Hoagwood KE, Springgate B. Treatment research for children and youth exposed to traumatic events: moving beyond efficacy to amp up public health impact. Gen Hosp Psychiatry 2010; 32:465-76. [PMID: 20851266 PMCID: PMC2947332 DOI: 10.1016/j.genhosppsych.2010.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/25/2010] [Accepted: 05/25/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Population-based demands for trauma services have accelerated interest in the rapid deployment of efficacious interventions to address the diverse mental health consequences of traumatic experiences. However, optimal strategies for supporting either implementation or dissemination of trauma-focused interventions within healthcare or mental healthcare systems are underdeveloped. METHODS This work offers suggestions for adapting treatment research parameters in order to advance the science on the implementable and practical use of trauma-focused interventions within a public health framework. To this end, we briefly examine the current status of research evidence in this area and discuss efficacy and effectiveness treatment research parameters with specific attention to the implications for developing the research base on the implementation and dissemination of effective trauma practices for children and adolescents. RESULTS Examples from current studies are used to identify approaches for developing, testing and enhancing strategies to roll out effective treatment practices in real-world settings. CONCLUSIONS New approaches that reflect the contexts in which these practices are implemented may enhance the feasibility, acceptability, replicability and sustainability of trauma treatments and services, and thus improve outcomes for a broader population of youth and families.
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Affiliation(s)
- David J. Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Fisher PA, Chamberlain P, Leve LD. Improving the lives of foster children through evidenced-based interventions. VULNERABLE CHILDREN AND YOUTH STUDIES 2009; 4:122-127. [PMID: 20396626 PMCID: PMC2853965 DOI: 10.1080/17450120902887368] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In the United States and England, the use of evidence-based interventions for children in foster care has the potential to decrease the widespread disparities in health and mental health outcomes, improve placement stability and increase the likelihood of children achieving permanency. Nevertheless, there have been few discussions about the systematic implementation of evidence-based practice to address different levels of need and risk in foster care. In this paper, we provide a framework for determining the types of programs needed for children with varied needs along a continuum that includes four categories of options: (1) screen and identify those who are functioning adequately in foster care versus those in need of supplemental services; (2) provide 'enhanced foster care' with additional resources for families and children; (3) implement interventions that target specific problems such as disruptive behavior or school functioning; and (4) implement intensive therapeutic foster-care programming. Examples of interventions in each category are provided, and implications for policy and practice are discussed.
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Affiliation(s)
- Philip A. Fisher
- University of Oregon, Oregon Social Learning Center, and Center for Research to Practice, Eugene, OR, USA
- Corresponding author.
| | - Patricia Chamberlain
- Oregon Social Learning Center and Center for Research to Practice, Eugene, OR, USA
| | - Leslie D. Leve
- Oregon Social Learning Center and Center for Research to Practice, Eugene, OR, USA
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