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Anthony R, Moore G, Page N, Hewitt G, Murphy S, Melendez-Torres GJ. Measurement invariance of the short Warwick-Edinburgh Mental Wellbeing Scale and latent mean differences (SWEMWBS) in young people by current care status. Qual Life Res 2021; 31:205-213. [PMID: 34050443 PMCID: PMC8800901 DOI: 10.1007/s11136-021-02896-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Studying mental wellbeing requires the use of reliable, valid, and practical assessment tools, such as the Short version of the Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Research on the mental wellbeing of children in care is sparse. The current study aims to: (1) examine the unidimensionality of SWEMWBS; (2) assess measurement invariance of SWEMWBS across children and young people in care compared to their peers not in care; and (3) investigate the latent factor mean differences between care status groups. METHODS We used data from the 2017 School Health Research Network Student Health and Wellbeing (SHW) survey, completed by 103,971 students in years 7 to 11 from 193 secondary schools in Wales. The final data include a total of 2,795 participants (46% boys), which includes all children in care and a sub-sample of children not in care who completed the SWEMWBS scale fully and answered questions about their living situation. RESULTS Confirmatory factor analysis supported the unidimensionality of SWEMWBS. The SWEMWBS is invariant across groups of young people in foster, residential and kinship care compared to children and young people not in care at configural, metric and scalar levels. Findings from latent mean comparisons showed that young people in care reported lower mental wellbeing than their peers, with those in residential care reporting the lowest scores. CONCLUSIONS Findings suggest that SWEMWBS is a valid scale for measuring differences in mental wellbeing for young people in care similar to the population.
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Affiliation(s)
- Rebecca Anthony
- Centre for Development, Evaluation, Complexity, and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, Cardiff, UK
| | - Graham Moore
- Centre for Development, Evaluation, Complexity, and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Nicholas Page
- Centre for Development, Evaluation, Complexity, and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Gillian Hewitt
- Centre for Development, Evaluation, Complexity, and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, Cardiff, UK
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity, and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, Cardiff, UK
| | - G. J. Melendez-Torres
- College of Medicine and Health, South Cloisters, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
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Cusimano MD, Lamont R, Zhang S, Mishra A, Carpino M, Wolfe D. A Life Course Study on Traumatic Brain Injury and Physical and Emotional Trauma in Foster Children. Neurotrauma Rep 2021; 2:123-135. [PMID: 33778808 PMCID: PMC7992293 DOI: 10.1089/neur.2020.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Foster children are exposed to high levels of abuse, violence, and other adverse events throughout their childhood and adolescent years. Forms of brain injury, notably traumatic brain injury (TBI), are understudied in the foster child population. This study aimed to explore different forms of brain injury and their cognitive, behavioral, and psychological/emotional effects on current and former foster children using a life course perspective. A thematic analysis with a life course perspective was used to examine semi-structured, open-ended interviews conducted with current and previous foster children between the ages of 16 and 29 years. The study included 47 participants: 25 males (53%) and 22 females (47%) with an average age of 21 years and an average of 11.2 years of education. Of 47 current and previous foster children between the ages of 16 and 29, two-thirds had sustained one or more TBIs. Through a thematic analysis, four overarching and inter-related themes emerged from the data: frequent TBI, normalization (of abuse, violence, injury, and neglect), emotional trauma, and dangerous coping methods such as alcohol use in 94% and recreational drug use in 81%. Normalization of adverse events, emotional trauma, and the use of dangerous coping methods occurred in 66%, 81%, and 49% of participants, respectively, and are the cumulative toxic long-term effects of early negative life experiences and repeated forms of brain injury. Early and continued exposure to TBI, abuse, violence, and/or neglect with continued maladaptive behaviors suggests that the participants may have experienced changes in brain structure and function over their lives that provided the milieu for continued vulnerability to personal and future injury to future generations. These behavioral and perceptual changes point to a toxic combination of injuries that result in continued vulnerability to repeated injury through contextual exposure to risks and maladaptive normalization, emotional trauma, and risky coping styles.
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Affiliation(s)
- Michael D. Cusimano
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Lamont
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stanley Zhang
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anamika Mishra
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Melissa Carpino
- Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David Wolfe
- Centre for School Mental Health, Faculty of Education, Western University, London, Ontario, Canada
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Smales M, Savaglio M, Morris H, Bruce L, Skouteris H, Green (nee Cox) R. “Surviving not thriving”: experiences of health among young people with a lived experience in out-of-home care. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2020. [DOI: 10.1080/02673843.2020.1752269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Madelaine Smales
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University , Clayton, Australia
| | - Melissa Savaglio
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University , Clayton, Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University , Clayton, Australia
| | - Lauren Bruce
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University , Clayton, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University , Clayton, Australia
- Warwick Business School, Warwick University , Coventry, UK
| | - Rachael Green (nee Cox)
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University , Clayton, Australia
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Naughton AM, Cowley LE, Tempest V, Maguire SA, Mann MK, Kemp AM. Ask Me! self-reported features of adolescents experiencing neglect or emotional maltreatment: a rapid systematic review. Child Care Health Dev 2017; 43:348-360. [PMID: 28238208 DOI: 10.1111/cch.12440] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neglect is often overlooked in adolescence, due in part to assumptions about autonomy and misinterpretation of behaviors being part of normal adolescent development. Emotional maltreatment (abuse or neglect) has a damaging effect throughout the lifespan, but is rarely recognized amongst adolescents. Our review aims to identify features that adolescents experiencing neglect and/ or emotional maltreatment report. METHOD A rapid review methodology searched 8 databases (1990-2014), supplemented by hand searching journals, and references, identifying 2,568 abstracts. Two independent reviews were undertaken of 279 articles, by trained reviewers, using standardised critical appraisal. Eligible studies: primary studies of children aged 13-17 years, with substantiated neglect and/ or emotional maltreatment, containing self-reported features. RESULTS 19 publications from 13 studies were included, demonstrating associations between both neglect and emotional maltreatment with internalising features (9 studies) including depression, post traumatic symptomatology and anxiety; emotional maltreatment was associated with suicidal ideation, while neglect was not (1 study); neglect was associated with alcohol related problems (3 studies), substance misuse (2 studies), delinquency for boys (1 study), teenage pregnancy (1 study), and general victimization for girls (1 study), while emotionally maltreated girls reported more externalising symptoms (1 study). Dating violence victimization was associated with neglect and emotional maltreatment (2 studies), while emotional abuse of boys, but not neglect, was associated with dating violence perpetration (1 study), and neither neglect nor emotional maltreatment had an association with low self-esteem (2 studies). Neither neglect nor emotional maltreatment had an effect on school performance (1 study), but neglected boys showed greater school engagement than neglected girls (1 study). CONCLUSIONS If asked, neglected or emotionally maltreated adolescents describe significant difficulties with their mental health, social relationships, and alcohol or substance misuse. Practitioners working with youths who exhibit these features should recognize the detrimental impact of maltreatment at this developmental stage, and identify whether maltreatment is a contributory factor that should be addressed.
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Affiliation(s)
- A M Naughton
- Designated Doctor Safeguarding Children, National Safeguarding Team, Public Health Wales NHS Trust, UK
| | - L E Cowley
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - V Tempest
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - S A Maguire
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - M K Mann
- Support Unit for Research Evidence, Cardiff University, Cardiff, UK
| | - A M Kemp
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
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Deutsch SA, Fortin K. Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care. Curr Probl Pediatr Adolesc Health Care 2015; 45:286-91. [PMID: 26364980 DOI: 10.1016/j.cppeds.2015.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed.
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Affiliation(s)
- Stephanie Anne Deutsch
- Department of Pediatrics, Safe Place: Center for Child Protection and Health, The Children׳s Hospital of Philadelphia, Philadelphia, PA.
| | - Kristine Fortin
- Department of Pediatrics, Safe Place: Center for Child Protection and Health, The Children׳s Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Winokur M, Holtan A, Batchelder KE. Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment. Cochrane Database Syst Rev 2014; 2014:CD006546. [PMID: 24488572 PMCID: PMC7386884 DOI: 10.1002/14651858.cd006546.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out-of-home settings that will facilitate their safety, permanency, and well-being.However, children in out-of-home placements typically display more educational, behavioural, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system. OBJECTIVES To evaluate the effect of kinship care placement compared to foster care placement on the safety, permanency, and well-being of children removed from the home for maltreatment. SEARCH METHODS We searched the following databases for this updated review on 14 March 2011: the Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, ERIC, Conference Proceedings Citation Index-Social Science and Humanities, ASSIA, and Dissertation Express. We handsearched relevant social work journals and reference lists of published literature reviews, and contacted authors. SELECTION CRITERIA Controlled experimental and quasi-experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care were compared with children placed in non-kinship foster care for child welfare outcomes in the domains of well-being, permanency, or safety. DATA COLLECTION AND ANALYSIS Two review authors independently read the titles and abstracts identified in the searches, and selected appropriate studies. Two review authors assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies.Lastly, we extracted outcome data and entered them into Review Manager 5 software (RevMan) for meta-analysis with the results presented in written and graphical forms. MAIN RESULTS One-hundred-and-two quasi-experimental studies,with 666,615 children are included in this review.The 'Risk of bias' analysis indicates that the evidence base contains studies with unclear risk for selection bias, performance bias, detection bias, reporting bias, and attritionbias, with the highest risk associated with selection bias and the lowest associated with reporting bias. The outcome data suggest that children in kinship foster care experience fewer behavioural problems (standardised mean difference effect size -0.33, 95% confidence interval (CI) -0.49 to -0.17), fewer mental health disorders (odds ratio (OR) 0.51, 95% CI 0.42 to 0.62), better well-being (OR 0.50,95% CI 0.38 to 0.64), and less placement disruption (OR 0.52, 95% CI 0.40 to 0.69) than do children in non-kinship foster care. For permanency, there was no difference on re unification rates, although children in non-kinship foster care were more likely to be adopted(OR 2.52, 95% CI 1.42 to 4.49), while children in kinship foster care were more likely to be in guardianship (OR 0.26, 95% CI 0.17 to 0.40). Lastly, children in non-kinship foster care were more likely to utilise mental health services (OR 1.79, 95% CI 1.35 to 2.37). AUTHORS' CONCLUSIONS This review supports the practice of treating kinship care as a viable out-of-home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.
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Affiliation(s)
- Marc Winokur
- Colorado State UniversitySocial Work Research Center, School of Social Work110 EducationFort CollinsColoradoUSA80523
| | - Amy Holtan
- UiT The Arctic University of Norway, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU North)Faculty of Health SciencesTromsøNorway9037
| | - Keri E Batchelder
- Colorado Department of Human ServicesOffice of Performance and Strategic Outcomes1575 Sherman StDenverColoradoUSA80203
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Kools S, Paul SM, Jones R, Monasterio E, Norbeck J. Health profiles of adolescents in foster care. J Pediatr Nurs 2013; 28:213-22. [PMID: 23036596 PMCID: PMC3540143 DOI: 10.1016/j.pedn.2012.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 08/18/2012] [Accepted: 08/30/2012] [Indexed: 11/26/2022]
Abstract
The purpose of this paper is to describe health profiles of adolescents in foster care. The Child Health and Illness Profile-Adolescent Edition clustered adolescents in foster care into 13 mutually exclusive health profiles using dimensions of satisfaction with health, risks, resilience, and discomfort. Health profiles were further characterized into four health status rankings from best to worst health status. Many reported best health status (39%); nearly equal numbers (30.6%) had profiles indicating poor or worst health status, particularly girls and those with high risk behaviors, aggression, sexual abuse, or suicidality. It is valuable to identify health characteristics of the most vulnerable subgroups of foster youth to tailor specific interventions.
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Affiliation(s)
- Susan Kools
- Department of Family Health Care Nursing, University of California-San Francisco, San Francisco, CA, USA.
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