Effects of child trauma screening on trauma-informed multidisciplinary evaluation and service planning in the child welfare system

Despite the prevalence of exposure to potentially traumatic events (PTEs) among children involved with the child welfare system (CWS), trauma screening is not yet a common practice. The purpose of this study was to assess the impact of embedding a formal trauma screening process in statewide multidisciplinary evaluations for CWS-involved youth. A retrospective record review was conducted with two random samples of cases reflecting both pre- and postimplementation of formal screening procedures (n = 70 preimplementation, n = 100 postimplementation). Findings from the record review indicate statistically significant improvements in the documentation of general, χ2(1, N = 170) = 18.8, p < .001, and specific, χ2(1, N = 170) = 10.7, p = .001, details of children's reactions associated with PTE exposure, as well as increases in providers' recommendations, χ2(1, N = 170) = 18.1, p < .001, and referrals, χ2(1, N = 170) = 4.5, p = .034, for trauma-focused services. The early identification of trauma-related symptoms may help connect children more promptly to trauma-informed evidence-based interventions, which may avert or mitigate the long-term sequelae of child maltreatment and CWS involvement.

Effects of Community-Based Wraparound Services on Child and Caregiver Outcomes Following Child Protective Service Involvement

This study investigated whether statewide delivery of the wraparound service model (WSM) improved child and caregiver outcomes and reduced subsequent child protective service (CPS) contact among families referred to services following a CPS report. Caregivers (n = 247) completed baseline and 6-month interviews to document self-reported engagement in WSM and non-WSM conditions and assess changes in outcomes. Kernel-weighted difference-in-difference (K-DID) models were used to assess program effects, based on reported condition. Child behavior outcomes improved among WSM-engaged families, but differences by condition were non-significant except for internalizing behaviors. Caregiver receipt of WSM was associated with greater retention of behavioral health services, but did not produce statistically significant improvements in their wellbeing. Households in the WSM condition were more likely to be reported to CPS at 6-month follow-up, but this difference was not significant at 12 months and differences in substantiation were not statistically significant. Supplemental analyses compared alternative means of contrasting group effects, highlighting some differences based on method. The WSM produced few significant differential improvements in child or caregiver outcomes and failed to prevent future CPS involvement. Inadequate program fidelity appeared to be a factor in implementation of the WSM, which may have hampered program effectiveness under real-world conditions.

Applying an Implementation Framework to the Dissemination of a School-Based Child Sexual Abuse Prevention Program

Since the 1980s, school-based child sexual abuse (CSA) prevention programs have been the prevailing prevention strategy in the United States. Despite demonstrated effectiveness, there is a lack of infrastructure and educational policy ensuring all students receive these programs. A pragmatic application of the RE-AIM implementation framework, this study provides an overview of a multi-county implementation effort of the school-based CSA prevention program, Safe Touches. Implementation efforts across five counties in a Mid-Atlantic state are described at three levels: organizational (school districts), child, and program facilitator. Children's CSA-related knowledge was measured at four time points: pre-workshop, immediately post-workshop, and then 6 and 12 months post-workshop. Facilitators completed an anonymous survey post-implementation. Over the course of one and a half academic years, Safe Touches was implemented in 718 public school districts, reaching in total 14,235 second-grade students. Students' significantly increased knowledge from pre- to post-workshop and gains were maintained at 6 and 12 months (ps <.001). A total of 29 disclosures of maltreatment were made by students to facilitators during or after the workshop. Facilitators generally adopted Safe Touches and attested to the feasibility and benefits of its large-scale implementation as well as the negligible negative impacts for children. When implemented systematically, school-based CSA prevention is able to reach a high number of students, effectively increase CSA-related knowledge, and facilitates disclosures. To maximize the potential public health impact, it is suggested that state funds be allocated to support the implementation of such programs as part of standard education costs.

Impacts of intergenerational substance use and trauma among black women involved in the criminal justice system: A longitudinal analysis

INTRODUCTION

Intergenerational substance use and trauma disproportionately impact racialized women. Yet, how these factors impact outcomes in women involved in the criminal justice system is understudied.

METHODS

Using data from 443 participants in the Black Women in a Study of Epidemics, we assessed the impact of intergenerational substance use and trauma on participant drug use and open Child Protective Services (CPS) cases over 18 months. In repeated-measures logistic regression, intergenerational substance and trauma were independent variables, while participants' drug use at each follow-up and any open CPS case (s) served as separate dependent variables. Models were adjusted for criminal justice involvement, age, marital status, education, childhood guardian, number of children, and prior year homelessness.

RESULTS

On average, participants were aged 35 years, 64 % had never married, and 44 % were raised by both parents. Two-thirds of women (67 %) reported intergenerational substance use (≥1 parent and/or grandparent with alcohol/drug problems), while only 13 % reported intergenerational trauma. Each increase in the number of parents/grandparents with drug/alcohol problems was associated with 30 % increased odds of participants' drug use (aOR 1.30, 95 % CI: 1.07,1.57) and 40 % increased odds of having an open CPS case (aOR 1.40, 95 % CI: 1.11, 1.78). The association of intergenerational trauma and CPS cases was attenuated with sociodemographic/contextualizing factors.

CONCLUSIONS

Intergenerational substance use and trauma are associated with negative outcomes. Our findings highlight the need for substance use treatment to address the pervasive generational effects of substance use and trauma faced by racialized women in the criminal justice system.

The feasibility and utility of trauma screening for children involved in the juvenile justice system

Childhood exposure to potentially traumatic events and adversity is highly prevalent and linked to adverse outcomes. Many children suffering from symptoms related to traumatic stress are not identified or do not receive appropriate trauma-focused treatment, including evidence-based treatments. Trauma screening is a promising strategy to improve identification, but many child-serving staff members have concerns about asking youth and caregivers about trauma. This study aimed to describe staff perceptions about the feasibility, utility, and potential for distress associated with trauma screening. Between 2014 and 2019, the Child Trauma Screen was used in 1,272 trauma screenings completed by juvenile probation officers or mental health clinicians as part of routine practice with youth in the juvenile justice system. Further, 1,190 caregiver reports about youth trauma were completed for youth in the juvenile justice system. Staff completed a brief postscreening survey about the feasibility and utility of the screening and the perceived level of child or caregiver distress. Across staff roles, trauma screening was deemed to be feasible and worthwhile to practice, with very few staff members reporting that children or caregivers appeared very uncomfortable as a result of screening, although some differences in feasibility and utility by staff role did occur. Trauma screening measures appear to be useful and practical in juvenile justice settings when appropriate support is provided, including when administered by nonclinical staff. Nonclinical staff may benefit from additional training, consultation, or support with trauma screening.

Implementation of a Universal School-Based Child Sexual Abuse Prevention Program: A Longitudinal Cohort Study

Child sexual abuse (CSA) is a public health problem of considerable magnitude. The prevailing primary prevention strategies are universal, school-based CSA prevention programs, some of which have been designated as evidence-based, such as Safe Touches. However, to reach their public health impact potential, effective universal school-based CSA prevention programs require effective and efficient dissemination and implementation strategies. The purpose of this study was to demonstrate the reach and effectiveness of a school-based CSA prevention curriculum, Safe Touches, when implemented on a wide scale. Using a longitudinal cohort design, children in second grade classrooms in public elementary schools in five counties received the Safe Touches workshop and completed surveys designed to assess gains in knowledge at four timepoints (one week prior, immediately post-workshop, 6- and 12-months post-workshop). In total, the Safe Touches workshop was delivered in 718 classrooms in 92% of school districts, reaching ~14,235 second graders. Multilevel models (n = 3,673) revealed that Safe Touches significantly increased CSA-related knowledge, and that these gains were maintained 12-months post-workshop (ps < .001). There were some small but significant time-varying effects among participants in schools with a greater percentage of low income and minority students, but these effects largely disappeared 12-months post workshop. This study demonstrates that a single-session, universal school-based CSA prevention program can effectively increase children's knowledge when implemented and disseminated on a wide scale and knowledge gains can be retained 12-months post intervention.

Knowledge Gains from the Implementation of a Child Sexual Abuse Prevention Program and the Future of School-Based Prevention Education

School-based child sexual abuse (CSA) programs effectively increase students' CSA-related knowledge. This study focuses on an implementation trial of Safe Touches, an empirically supported, school-based CSA prevention program, that was disrupted by the COVID-19 pandemic. We sought to demonstrate gains in CSA-related knowledge following Safe Touches but were limited to a pre-post design. A total of 2,210 students across five counties in a Mid-Atlantic state received the Safe Touches workshop between September 2019 and March 2020. McNemar's chi-square test was used to assess changes in the proportion of correct responses pre-workshop (Time 1) and one-week post-workshop (Time 2). Students' CSA-related knowledge increased significantly based on changes in mean CSA knowledge scores and the number of correct item-level responses assessed at Time 1 and Time 2 (p < .000). Leveraging the experience of the facilitators' who delivered these workshops prior to the disruption of implementation, we gathered facilitators' perspectives to explore the viability of offering Safe Touches virtually. In July 2020, 16 facilitators completed an electronic survey designed to understand the viability of a virtual Safe Touches workshop. Three themes emerged from facilitator feedback on virtual programming: student engagement concerns, handling disclosures, and technology access to a virtual program. The findings of this study indicate that the Safe Touches workshop significantly increased CSA-related knowledge and, overall, facilitators supported further exploration and development of a virtual Safe Touches workshop. The transition of empirically supported school-based CSA prevention programs to a virtual delivery modality is necessary to maintain an effective means of primary prevention and opportunity for disclosure.

Taking a School-Based Child Sexual Abuse Prevention Program to Scale: a Cost Analysis

Cost analyses are used to determine overall costs of implementing evidence-based programming and may help decision makers determine how best to allocate finite resources. Child sexual abuse (CSA), regularly viewed as a human rights violation, is also a public health concern estimated to impact 27% of females and 5% of males by age 18. Universal, school-based CSA programs are one prevailing prevention strategy. However, there are no known cost analyses of school-based CSA prevention programming, thereby limiting potential scalability. Using the ingredients method, this cost analysis presents the findings of implementing Safe Touches, an evidence-based universal prevention program, across four sites (i.e., counties) in one mid-Atlantic state. Reaching a total of 14,235 s grade students, results indicate an average cost of $43 per student, an average classroom cost of $859, an average district cost of $10,637, and an average site cost of $154,243. There was a noted decrease in costs when more students were reached, suggesting a need to focus efforts on bolstering the reach of implementation efforts. Sensitivity analyses explored variations in implementation constraints such as personnel and facilities suggesting a range of per-student costs (lower-bound per-student cost = $34; upper-bound per-student cost = $64). Findings presented herein may be used to inform future universal CSA prevention efforts by providing detailed information about the costs of large-scale implementation of an evidence-based program among elementary-aged children.

One year into COVID-19: What have we learned about child maltreatment reports and child protective service responses?

BACKGROUND

A year has passed since COVID-19 began disrupting systems. Although children are not considered a risk population for the virus, there is accumulating knowledge regarding children's escalating risk for maltreatment during the pandemic.

OBJECTIVE

The current study is part of a larger initiative using an international platform to examine child maltreatment (CM) reports and child protective service (CPS) responses in various countries. The first data collection, which included a comparison between eight countries after the pandemic's first wave (March-June 2020), illustrated a worrisome picture regarding children's wellbeing. The current study presents the second wave of data across 12 regions via population data (Australia [New South Wales], Brazil, United States [California, Pennsylvania], Colombia, England, Germany, Israel, Japan, Canada [Ontario, Quebec], South Africa).

METHOD

Regional information was gathered, including demographics, economic situation, and CPS responses to COVID-19. A descriptive analysis was conducted to provide an overview of the phenomenon.

RESULTS

Across all of the countries, COVID-19 had a substantial negative impact on the operation of CPSs and the children and families they serve by disrupting in-person services. One year into the COVID-19 pandemic, new reports of CM varied across the regions.¹ In some, the impact of COVID-19 on CPS was low to moderate, while in others, more significant changes created multiple challenges for CPS services.

CONCLUSIONS

COVID-19 created a barrier for CPS to access and protect children. The dramatic variance between the regions demonstrated how social, economic and structural contexts impact both CM reports and CPS responses.

Parent-Focused Sexual Abuse Prevention: Results From a Cluster Randomized Trial

This study tested whether a child sexual abuse (CSA) prevention program, Smart Parents-Safe and Healthy Kids (SPSHK), could be implemented as an additional module in evidence-based parent training and whether the added module might detract from the efficacy of the original program. In a cluster randomized trial, six community-based organizations were randomized to deliver Parents as Teachers (PAT) with SPSHK (PAT+SPSHK) or PAT as usual (PAT-AU). CSA-related awareness and protective behaviors, as well as general parenting behaviors taught by PAT were assessed at baseline, post-PAT, post-SPSHK, and 1-month follow-up. Multilevel analyses revealed significant group by time interactions for both awareness and behaviors (ps < .0001), indicating the PAT+SPSHK group had significantly greater awareness of CSA and used protective behaviors more often (which were maintained at follow-up) compared to the PAT-AU group. No differences were observed in general parenting behaviors taught by PAT suggesting adding SPHSK did not interfere with PAT efficacy as originally designed. Results indicate adding SPHSK to existing parent training can significantly enhance parents' awareness of and readiness to engage in protective behavioral strategies. Implementing SPHSK as a selective prevention strategy with at-risk parents receiving parent training through child welfare infrastructures is discussed.

Legislating to Prevent Adverse Childhood Experiences: Growth and Opportunities for Evidence-Based Policymaking and Prevention

Since the landmark study of Adverse Childhood Experiences (ACEs; Felitti et al., American Journal of Preventive Medicine, 14(4):245-258, 1998), there has been a significant growth in efforts to address ACEs and their impact on individual health and well-being. Despite this growing awareness, there has been little systematic review of state legislative action regarding variation in focus or scope or of the broader context impacting the introduction and enactment of ACE-related policy efforts. To inform the role of psychologists and related professionals to contribute to these legislative efforts, we conduct a comprehensive mixed-method analysis of all state bills introduced over the past two decades to investigate the use and impact of ACE research in introduced and enacted state legislative language (51 states, N_{Total Bills} = 1,212,048, N_{ACE Bills} = 425). In addition, these analyses examine congressional office communications (N = 14,916,546 public statements) and voting records (N = 1,163,463 votes) to understand the relationship between legislative members' public discussion of ACEs and their voting behavior on these bills. We find that legislators' public discourse is significantly related to ACE-related policymaking above and beyond political affiliation or demographic characteristics. Furthermore, key legislative language related to domestic violence, evidence-based practice, and prevention were significant predictors of whether an ACE-related bill becomes law-above and beyond the political party in power. These analyses highlight the ways in which ACE-related research has informed state policy. Based upon this work, we offer recommendations for researchers and policymakers.

Experiences With COVID-19 Stressors and Parents' Use of Neglectful, Harsh, and Positive Parenting Practices in the Northeastern United States

OBJECTIVES

To estimate household exposure to COVID-19 related stress and the association with parent report of neglectful, harsh, and positive discipline practices.

METHODS

Cross sectional survey data was collected from 2,068 parents in the Northeastern US. Parents reported personal and household experiences of COVID-19 stressors, their level of distress, and use of neglectful parenting and discipline practices for a randomly selected child in their home. Analyses estimated rates of COVID-19 related stress and parenting practices. Logistic regression was used to assess the relation of COVID-19 stress to parenting behaviors.

RESULTS

Individual and household stressor level, as well as distress were each positively associated with likelihood of neglect. Personal exposure to stressors was minimally related to discipline, but household stressor level and parents' distress were positively associated with harsh and positive discipline.

DISCUSSION

Indicators of COVID-19 stress (e.g., exposure to stressors and distress) each uniquely predicted parents' use of neglect, particularly physical and family-based sub-types, and use of harsh and positive discipline practices. Results suggest that parents may require additional support to provide appropriate care for their children while coping with the increased rates of stress associated with the pandemic and the resulting public health response.

Validating the Child Trauma Screen Among a Cross-Sectional Sample of Youth and Caregivers in Pediatric Primary Care

Pediatric primary care providers have an important role in addressing the health effects of trauma, yet routine screening is rare. This study evaluated whether the 10-item Child Trauma Screen (CTS) could identify youth experiencing posttraumatic stress disorder (PTSD) symptoms. Participants were 107 caregiver-youth pairs aged 7 to 17 years old, 55.8% male, and 76.4% Hispanic who were recruited at an urban pediatric primary care clinic. Youth and caregivers separately completed the CTS and the UCLA PTSD Reaction Index for DSM-5 (RI-5) prior to their medical visit. Half of youth experienced at least one type of trauma, and one sixth reported elevated PTSD symptoms. The CTS was highly correlated with the RI-5 on PTSD symptom severity, and correctly classified 85% of youth based on likely PTSD diagnosis. The brief CTS can accurately identify youth suffering from PTSD symptoms, and may be particularly feasible to implement in busy primary care practices.

Enhancing Capacity for Trauma-informed Care in Child Welfare: Impact of a Statewide Systems Change Initiative

Youth involved in the child welfare system (CWS) are disproportionally impacted by the negative effects of exposure to trauma. While efforts to develop trauma-informed CWSs are accelerating, little research is available about the effects of these efforts on system capacity to respond to the needs of youth exposed to trauma. No studies evaluate longer-term effects of these efforts. In 2011, Connecticut implemented CONCEPT, a multi-year initiative to enhance capacity of the state's CWS to provide trauma-informed care. CONCEPT used a multi-component approach including workforce development, deployment of trauma screening procedures, policy change, improved access to evidence-based trauma-focused treatments, and focused evaluation of program effects. Changes in system capacity to deliver trauma-informed care were assessed using statewide stratified random samples of child welfare staff at three time points (Year 1: N = 223, Year 3: N = 231, Year 5: N = 188). Significant improvements across nearly all child welfare domains were observed during the first 3 years of implementation, demonstrating system-wide improvements in capacity to provide trauma-informed care. These gains were maintained through the final year of implementation, with continued improvements in ratings of collaboration between child welfare and behavioral health settings on trauma-related issues observed. Responses documented familiarity with and involvement in many of the CONCEPT activities and initiatives. Staff reported greater familiarity with efforts to increase access to specific evidence-based services (e.g., TF-CBT) or to enhance trauma-related policy and practice guidelines, but less familiarity with efforts to implement new practices (e.g., trauma screening) in various sectors. Staff also reflected on the contribution of these components to enhance system capacity for trauma-informed care.

Considering the child welfare system burden from opioid misuse: research priorities for estimating public costs

The negative impact of opioids on those who misuse them has been widely documented. Despite significant spillover effects in the form of elevated rates of child maltreatment and child welfare system (CWS) involvement for children affected by parental opioid misuse, the public costs of opioid misuse to the CWS remain largely undocumented. This work seeks to understand the value and limitations of public data in estimating the costs of the opioid epidemic on the CWS. National data from federal sources are combined with best estimates of the association between opioid misuse and child services system utilization. The limitations of this work are explored, and future research priorities are outlined. Ultimately, this work illustrates the need to (1) improve data quality related to parental opioid misuse and CWS linkages; (2) better estimate the number of children and families coming into contact with the CWS as a result of parental opioid misuse; (3) improve predictions of CWS trajectories, including investigation, service provision, and foster care entry among this population; and (4) better estimate the CWS costs associated with patterns of system involvement resulting from parental opioid misuse. This information is crucial to ensuring the production of high-quality system involvement and cost projections related to the opioid crisis.

Effects of individual risk and state housing factors on adverse outcomes in a national sample of youth transitioning out of foster care

INTRODUCTION

Compared to their peers, youth who leave the foster care system without permanency experience greater risks for adverse young adult outcomes, including homelessness, incarceration, substance abuse, and early child birth. Extant literature focuses on individual-level factors related to adversity. In this study, we estimated the impact of state and individual-level risk and protective factors on adverse 19-year-old outcomes among a cohort of U.S. transition age youth.

METHODS

We used multilevel modeling to analyze prospective, longitudinal data from two waves of the National Youth in Transitions Database (N = 7449). These data were linked to the Adoption and Foster Care Reporting System, the Administration for Children and Families budget expenditures, and the American Community Survey for the period from 2011 to 2013.

RESULTS

Approximately 30% of the variation in each of the 19-year-old outcomes could be attributed to state-level effects. Residence in a state that spent above average of CFCIP budget on housing supports reduced the risk of homelessness and incarceration. Living in a state with a higher proportion of housing-burdened low-income renters significantly increased the risk of substance abuse and child birth. Individual-level risks were significant: racial/ethnic minority, male gender, past risk history, placement instability, child behavioral problems, residence in group home or runaway. Remaining in foster care at age 19 reduced the odds of homelessness, incarceration, and substance abuse.

CONCLUSION

Macro factors, including financial support for transition-age youth, and broader housing market characteristics, have a bearing on young adult outcomes, and raise policy questions across social and human service sectors.

Caseworker assessment of child risk and functioning and their relation to service use in the child welfare system

Children within the child welfare system are more likely to experience emotional and behavioral problems than children not involved with the system. Many states have adopted standardized risk and assessment measures to inform decision-making on appropriate levels of care related to placement or service intensity for children within the system. This study examined the relationship of caseworker ratings of risk across multiple domains to youth functioning and service use for a sample of children open to the child welfare system. The study identified a stratified random sample of youth who were between the ages of five and 21 and open to the child welfare system (n = 184). Stratification was based on current placement (i.e., in-home, foster home, congregate care, and juvenile justice placements). Administrative data was used to access caseworker ratings of risk across child, parent, and family domains using a standardized risk assessment tool. Children's caseworkers (n = 103) completed a standardized measure of child functioning and reported on youth utilization of services across multiple sectors including specialty mental health, school-based, juvenile justice, and medical settings. Regression analyses using variance-corrected estimation for clustered data (by caseworker) revealed higher levels of child risk were associated with poorer child functioning, which, in turn, were associated with higher rates of multi-sector service use. Recommendations and future directions are discussed.

Multisystem-Involved Youth: A Developmental Framework and Implications for Research, Policy, and Practice

Multisystem-involved youth are children and adolescents concurrently served in the child welfare, behavioral health, and/or juvenile justice systems. These youth are a high risk and vulnerable population, often due to their experience of multiple adversities and trauma, yet little is known about their multiple needs and pathways into multisystem involvement. Multisystem-involved youth present unique challenges to researchers, practitioners, and policymakers. In this article, we summarize the literature on multisystem-involved youth, including prevalence, characteristics, risk factors, and disparities for this population. We then describe a developmental cascade framework, which specifies how exposure to adverse experiences in childhood may have a "cascading" or spillover effect later in development, to depict pathways of multisystem involvement and opportunities for intervention. This framework offers a multidimensional view of involvement across service systems and illustrates the complexities of relationships between micro- and macro-level factors at various stages and domains of development. We conclude that multisystem-involved youth are an understudied population that may represent majority of youth who are already served in another service system. Many of these youth are also disproportionately from racial and ethnic minority backgrounds. Currently, for multisystem-involved youth and their families, there is a lack of standardized and integrated screening procedures to identify youth with open cases across service systems; inadequate use of available instruments to assess exposure to complex trauma; inadequate clinical and family-related evidence-based practices specifically for use with this population; and poor cross-systems collaboration and coordination that align goals and targeted outcomes across systems. We make recommendations for research, practice, and systems development to address the needs of multisystem-involved youth and their families.

Racial/ethnic differences in alcohol use trajectories among adolescents involved in child welfare

This study examined racial/ethnic differences in growth trajectories of alcohol use for a nationally representative sample of U.S. adolescents in the child welfare system (CWS), and how individual, family, and child welfare (i.e., proximal) factors predicted alcohol use trajectories for these adolescents. The study included 1,080 Hispanic, African American, and White adolescents aged 11 to 14 years old (at baseline) from the National Survey of Child and Adolescent Well-Being dataset, which is a nationally representative sample of U.S. children in the CWS. Latent growth modeling was used to determine alcohol use growth over 36 months, and multigroup analyses were conducted to examine racial/ethnic differences on alcohol use trajectories and the proximal factors predicting these trajectories. Findings indicated that CWS adolescents demonstrated similar trends in alcohol use growth and initiation compared to adolescents in the general population, especially the Hispanic CWS adolescents. This may reflect an overall shift in nativity status of Hispanic youth in the overall U.S. population. African American adolescents had the fewest significant predictors; this may suggest that factors more relevant for these adolescents and their alcohol use are missing from CWS research. Family-level factors were found to differentially affect use for CWS adolescents compared to adolescents in the general population. Overall, these findings point to a need for improvements in the assessment of CWS adolescents of color in research and practice settings to fully capture the complexity of experiences for these youth and their families. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Risk and Protective Factors for Alcohol, Marijuana, and Cocaine Use Among Child Welfare-Involved Youth

Youth involved in child welfare services (CWS) are at elevated risk for substance use. CWS involvement may provide an opportunity for intervention to prevent subsequent use; however, little is known about mitigating substance use risk in this population. Using data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), the present study examined individual, psychological, and contextual risk factors (e.g., prior substance use, depression, posttraumatic stress, maltreatment experiences) and protective factors (e.g., caregiver monitoring, peer relationships) following CWS involvement (Wave 1) in relation to alcohol, marijuana, and cocaine use 36 months later (Wave 3). The nationally-representative sample of CWS-involved youth was restricted to individuals who were aged 11 years or older at Wave 1 and had at least a partial interview at Wave 3 (N = 763). Three logistic regression models showed that Wave 1 substance use increased the likelihood of marijuana and cocaine use at Wave 3 [marijuana OR = 1.41 (1.19-1.68); cocaine OR = 1.26 (1.07-1.50)] but not binge alcohol use [OR = 1.44 (0.95-2.19)]. Other risk and protective factors had limited predictive value for Wave 3 substance use. The present findings suggest that initiating substance use prior to or at the time of CWS involvement is a critical risk factor for later substance use. Substance use screening and referral to treatment is imperative for CWS-involved youth.

Patterns of Trauma Exposure in Childhood and Adolescence and Their Associations With Behavioral Well-Being

The majority of youth living in the United States experience a potentially traumatic event (PTE) by 18 years of age, with many experiencing multiple PTEs. Variation in the nature and range of PTE exposure differentially impacts youth functioning, although this association is poorly understood. We used latent class analysis (LCA) to identify patterns of PTE exposure from caregiver and youth report in a treatment-seeking sample of children and adolescents (N = 701) and examined how these patterns predict youths' behavioral health outcomes. We identified four classes based on both caregiver and youth reports of PTE exposure, with the best-fitting model representing a constrained measurement model across reporters; these included high polyvictimization, moderate polyvictimization (general), moderate polyvictimization (interpersonal), and low polyvictimization classes. Prevalence of classes varied across reporters, and agreement in classification based on caregiver and youth report was mixed. Despite these differences, we observed similar patterns of association between caregiver- and youth-reported classes and their respective ratings of posttraumatic stress disorder and depressive symptoms, as well as both caregiver and therapist ratings of problem behavior, with Cohen's d effect size estimates of significant differences ranging from d = 0.25 to d = 0.51. The PTE exposure classes did not differ with respect to ratings of child functioning. Findings highlight the importance of gathering information from multiple informants.

The Child Trauma Screen: A Follow-Up Validation

Although the prevalence of exposure to potentially traumatic events and associated outcomes among children is well documented, widespread trauma screening remains limited. This study provides additional data supporting the psychometrics of the Child Trauma Screen (CTS), a free, brief, empirically derived measure that was intended as a trauma screen for use across child-serving systems. Participants were an ethnically diverse sample of 187 children aged 6-18 years recruited from an urban children's community mental health clinic. At intake, children and their caregivers completed the CTS and other standardized measures of posttraumatic stress disorder, externalizing behavior, anxiety, and depression. Results indicated that the CTS had strong properties on both child and caregiver reports, including internal consistency (Cronbach's α = .78 for both), convergent validity (r = .83 and r = .86), divergent validity (mean across measures and reporters, r = .31; range r = .01-.70), and criterion validity (sensitivity = 0.83 and 0.76; specificity = 0.95 and 0.79, correct classification 89.3% and 81.4%). Suggested cut points and recommendations for using the CTS as a trauma screen are provided. This study provides further empirical support for the use of the CTS as a brief trauma screening measure and provides recommendations for further research.

Treatment Effects of Parent-Child Focused Evidence-Based Programs on Problem Severity and Functioning among Children and Adolescents with Disruptive Behavior

This study examined the treatment effects of manualized parent-child focused evidence-based programs (EBPs), characterized by an emphasis on parental involvement and engagement, on functioning and problem severity among a statewide sample of children and adolescents referred to outpatient psychiatric clinic for serious and persistent disruptive behavior. Propensity score matching was employed to account for baseline differences between children and adolescents (M_age = 8.4 years; 26% girls; 42% White, 10% Black, 42% Hispanic, 5% other) who received parent-child focused EBPs (treatment group; n = 220) and treatment-as-usual (comparison group; n = 2,543). Children and adolescents who received parent-child focused EBPs showed significantly greater reduction in problem severity compared to the comparison group, indicative of a drop below the clinical threshold for problem behavior. However, the pattern of improvement in problem severity was not paralleled by differential improvement in ratings of child functioning across treatment and comparison conditions. Finally, there were significant differences between the treatment and comparison groups pertaining to certain child and case characteristics that have potential implications for reaching high-risk populations of children and families. These findings support the potential of taking parent-child focused EBPs into scale to promote positive behavioral changes among children and adolescents. Parent-child focused EBPs may serve as an effective remedy that is less restrictive and more conducive to the healthy development of children and adolescents.

Placement and Delinquency Outcomes Among System-Involved Youth Referred to Multisystemic Therapy: A Propensity Score Matching Analysis

Multisystemic therapy (MST) was developed to help youth with serious social, emotional, and behavioral problems. Research on the efficacy and effectiveness of MST has shown positive outcomes in different domains of development and functioning among various populations of youth. Nonetheless, even with a large body of literature investigating the treatment effects of MST, few studies have focused on the effectiveness of MST through large-scale dissemination efforts. Utilizing a large sample of youth involved in a statewide dissemination of MST (n = 740; 43% females; 14% Black; 29% Hispanic; 49% White; Mage = 14.9 years), propensity score matching was employed to account for baseline differences between the treatment (n = 577) and comparison (n = 163) groups. Treatment effects were examined based on three outcomes: out-of-home placement, adjudication, and placement in a juvenile training school over a 6-year period. Significant group differences remained after adjusting for baseline differences, with youth who received MST experiencing better outcomes in offending rates than youth who did not have an opportunity to complete MST due to non-clinical or administrative reasons. Survival analyses revealed rates of all three outcomes were approximately 40% lower among the treatment group. Overall, this study adds to the body of literature supporting the long-term effectiveness of MST in reducing offending among high-risk youth. The findings underscore the potential benefits of taking evidence-based programs such as MST to scale to improve the well-being and functioning of high-risk youth. However, strategies to effectively deliver the program in mental health service settings, and to address the specific needs of high-risk youth are necessary.

The Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study (InterGEN): Design and Methods for Recruitment and Psychological Measures

BACKGROUND

Although studies show that genomics and environmental stressors affect blood pressure, few studies have examined their combined effects, especially in African Americans.

OBJECTIVE

We present the recruitment methods and psychological measures of the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) study, which seeks to investigate the individual and combined effects of genetic (G) and environmental (E) (psychological) stressors on blood pressure in African American mother-child dyads. Genetic methods are presented elsewhere, but here we present the recruitment methods, psychological measures, and analysis plan for these environmental stressors.

METHODS

This longitudinal study will enroll 250 mother-child dyads (N = 500). Study participation is restricted to women who (a) are ≤21 years of age, (b) self-identify as African American or Black, (c) speak English, (d) do not have an identified mental illness or cognitive impairment, and (e) have a biological child between 3 and 5 years old. The primary environmental stressors assessed are parenting stress, perceived racism and discrimination, and maternal mental health. Covariates include age, cigarette smoking (for mothers), and gender (for children). The study outcome variables are systolic and diastolic blood pressure.

ANALYSIS

The main analytic outcome is genetic-by-environment interaction analyses (G × E); however, main effects (G) and (E) will be individually assessed first. Genetic (G) and interaction analyses (G × E) are described in a companion paper and will include laboratory procedures. Statistical modeling of environmental stressors on blood pressure will be done using descriptive statistics and generalized estimating equation models.

IMPLICATIONS

The methodology presented here includes the study rationale, community engagement and recruitment protocol, psychological variable measurement, and analysis plan for assessing the association of environmental stressors and blood pressure. This study may provide the foundation for other studies and development of interventions to reduce the risk for hypertension and to propose targeted health promotion programs for this high-risk population.

The Interactive Effects of Stressful Family Life Events and Cortisol Reactivity on Adolescent Externalizing and Internalizing Behaviors

This study investigated the associations between stressful family life events and adolescent externalizing and internalizing behaviors, and the interactive effects of family life events and cortisol reactivity on problem behaviors. In a sample of 100 mothers and their adolescents (M age = 15.09; SD age = .98; 68 % girls), adolescent cortisol reactivity was measured in response to a mother-adolescent conflict interaction task designed to elicit a stress response. Mothers reported on measures of family life events and adolescent problem behaviors. Results indicated that a heightened adolescent cortisol response moderated the relations between stressful family life events and both externalizing and internalizing behaviors. Results support context-dependent theoretical models, suggesting that for adolescents with higher cortisol reactivity (compared to those with lower cortisol reactivity), higher levels of stressful family life events were associated with greater problem behaviors, whereas lower levels of stressful family life events were related to fewer problem behaviors.

Maltreatment, family environment, and social risk factors: Determinants of the child welfare to juvenile justice transition among maltreated children and adolescents

This study prospectively examines the transition from the child welfare system into the juvenile justice system among 10,850 maltreated children and adolescents and explores how patterns of risks, including severity and chronicity of maltreatment, adverse family environment, and social risk factors, affect service systems transition. Almost three percent of maltreated children and adolescents had their first juvenile justice adjudication within an average of approximately six years of their initial child protective services investigation (CPS). Social risk factors, including a child's age at index CPS investigation (older), gender (boys), and race/ethnicity (Black and Hispanic) significantly predicted the risk of transition into the juvenile justice system. Recurrence of maltreatment and experiencing at least one incident of neglect over the course of the study period also increased the risk of transition into the juvenile justice system. However, subtypes of maltreatment, including physical, sexual, and other types of abuse did not significantly predict the risk of juvenile justice system transition. Finally, family environment characterized by poverty also significantly increased the risk of juvenile justice system transition. These findings have important implications for developing and tailoring services for maltreated children, particularly those at-risk for transitioning into the juvenile justice system.

Youth E-cigarette, Blunt, and Other Tobacco Use Profiles: Does SES Matter?

OBJECTIVE

We examined the associations between socioeconomic status (SES) and adolescent polytobacco use profiles (including e-cigarettes and blunts).

METHODS

Adolescents (N = 1932) completed surveys conducted in 2014 in 3 Connecticut high schools. Within a Latent Class Analysis (LCA) framework, logistic regressions examined associations between SES and polytobacco use profiles comprising never, ever, and current e-cigarette, blunt, cigarette, cigar, cigarillo, hookah, and smokeless tobacco use.

RESULTS

We identified 5 classes: (1) current polytobacco users; (2) ever polytobacco users; (3) current e-cigarette, blunt, and cigarette users; (4) ever e-cigarette and blunt users; and (5) never users. Low SES, relative to high SES, was associated with greater likelihood of being: (1) an ever polytobacco user; (2) a current e-cigarette, blunt, and cigarette user; and (3) an ever e-cigarette and blunt user, relative to a never user.

CONCLUSIONS

Low SES is associated with membership in distinct polytobacco use latent classes. Regulatory initiatives that focus exclusively on cigarette use may miss the opportunity to influence adolescent use of other products, which may be especially relevant to low-income individuals. Future research should examine whether targeting a broader range of products reduces SES-related tobacco use disparities.

Reflections on a Community Psychology Setting and the Future of the Field

The 50th anniversary of the Swampscott Conference offers an opportunity to reflect on a community psychology setting, The Consultation Center at Yale, that was formed in response to the 1963 Community Mental Health Act and the 1965 Swampscott Conference. The Center has flourished as a community psychology setting for practice, research, and training for 39 of the 50 years since Swampscott. Its creation and existence over this period offers an opportunity for reflection on the types of settings needed to sustain the field into the future.

Development and validation of a brief trauma screening measure for children: The Child Trauma Screen

OBJECTIVE

Childhood exposure to trauma, including violence and abuse, is a major public health concern that has resulted in increased efforts to promote trauma-informed child-serving systems. Trauma screening is an important component of such trauma-informed systems, yet widespread use of trauma screening is rare in part due to the lack of brief, validated trauma screening measures for children. We describe development and validation of the Child Trauma Screen (CTS), a 10-item screening measure of trauma exposure and posttraumatic stress disorder (PTSD) symptoms for children consistent with the DSM-5 definition of PTSD.

METHOD

Study 1 describes measure development incorporating analysis to derive items based on existing measures from 1,065 children and caregivers together with stakeholder input to finalize item selection. Study 2 describes validation of the CTS with a clinical sample of 74 children and their caregivers.

RESULTS

Results support the CTS as an empirically derived, reliable measure to screen children for trauma exposure and PTSD symptoms with strong convergent, divergent, and criterion validity.

CONCLUSION

The CTS is a promising measure for rapidly and reliably screening children for trauma exposure and PTSD symptoms. Future research is needed to confirm validation and to examine feasibility and utility of its use across various child-serving systems. (PsycINFO Database Record

Child and case influences on recidivism in a statewide dissemination of Multisystemic Therapy for juvenile offenders

Multisystemic Therapy (MST) is an evidence-based treatment for high-risk youth and their families shown to reduce subsequent delinquent activity. This study investigated (1) re-arrest rates of a statewide MST dissemination; and (2) the relation of child, family, and case characteristics to re-arrest rates following receipt of MST. Analyses examined outcomes for 633 youth following referral to MST. Separate models examined predictors of general re-arrest of any type and of more serious misdemeanor or felony arrests. Sixty-five percent of youth experienced a new arrest of any type within 12-months of MST initiation; fewer (53%) experienced a misdemeanor or felony charge in that timeframe. Recipients who were younger, had an externalizing behavior disorder, and had a greater number and severity of pre-MST charges were more likely to recidivate. Findings highlight potential child and case factors that may account for variability in treatment effects when MST is implemented broadly within a system.

The Relation of Exposure to Traumatic Events and Longitudinal Mental Health Outcomes for Children Enrolled in Systems of Care: Results from a National System of Care Evaluation

This study examined the relation between children's history of exposure to potentially traumatic events (PTEs) and clinical and functional mental health trajectories over a 18-month period among a national sample of youth referred for services in children's behavioral health systems of care (SOCs). Using data from the national evaluation of the Comprehensive Community Mental Health Services program for communities funded from 1997 to 2000, the study sample included 9556 children and their families. Latent growth modeling was used to assess the effect of history of exposure to PTEs on trajectories in a number of behavioral health outcomes during the 3-year period following referral to services, controlling for child demographic characteristics (gender, race, and age). Results revealed that, on average, children in SOCs exhibited significant improvements over time on all four outcome measures. Children with a history of exposure to PTEs had higher rates of internalizing and externalizing problem behaviors and functional impairments and fewer behavioral and emotional strengths at baseline, but experienced improvements in these outcomes at the same rates as children without exposure to a traumatic event. Finally, child race, gender, and age also were associated with differences in behavioral health trajectories among service recipients. Implications for SOCs, including approaches to make them more trauma-informed, are discussed.

Building Capacity for Trauma-Informed Care in the Child Welfare System: Initial Results of a Statewide Implementation

Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system (CWS). State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems. This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS, including workforce development, trauma screening, policy change, and improved access to evidence-based trauma-focused treatments during the initial 2-year implementation period. Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified random samples of child welfare staff who completed a comprehensive assessment prior to (N = 223) and 2 years following implementation (N = 231). Results indicated significant improvements in trauma-informed knowledge, practice, and collaboration across nearly all child welfare domains assessed, suggesting system-wide improvements in readiness and capacity to provide trauma-informed care. Variability across domains was observed, and frontline staff reported greater improvements than supervisors/managers in some domains. Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed.

Profiles of Intimate Partner Violence Victimization, Substance Misuse, and Depression Among Female Caregivers Involved with Child Protective Services

Intimate partner violence (IPV) victimization, substance misuse, and depression are highly prevalent among female caregivers involved with child protective services (CPS). Understanding heterogeneity in the occurrence of these problems is essential to improving pathways to intervention for women in this population. Latent class analysis was employed to determine whether there exist homogeneous subgroups of female caregivers who experience different patterns of IPV victimization, substance misuse, and depression. A restricted three-class solution best fit the data, suggesting high risk, moderate risk, and no risk subgroups. A substantial number of female caregivers comprise the high-risk subgroup (33%) in which caregivers reported very high rates of IPV victimization, substance misuse, and depression. Only a very small proportion comprised the no-risk subgroup (9%). Findings emphasize the heterogeneity among subgroups of female caregivers based on these risk factors, which may have implications for practitioners, such as CPS caseworkers, and researchers alike.

Adolescents' and Young Adults' Perceptions of Electronic Cigarettes for Smoking Cessation: A Focus Group Study

INTRODUCTION

Research has shown that adults perceive that electronic cigarettes (e-cigarettes) are effective for smoking cessation, yet little is known about adolescents and young adults' perceptions of e-cigarettes for quitting cigarette smoking. This study describes middle, high school, and college students' beliefs about, and experiences with, e-cigarettes for cigarette smoking cessation.

METHODS

We conducted 18 focus groups (n = 127) with male and female cigarette smokers and nonsmokers in 2 public colleges, 2 high schools, and 1 middle school in Connecticut between November 2012 and April 2013. Participants discussed cigarette smoking cessation in relation to e-cigarettes. Verbatim transcripts were analyzed using thematic analysis.

RESULTS

All participants, regardless of age and smoking status, were aware that e-cigarettes could be used for smoking cessation. College and high school participants described different methods of how e-cigarettes could be used for smoking cessation: (a) nicotine reduction followed by cessation; (b) cigarette reduction/dual use; and (c) long-term exclusive e-cigarette use. However, overall, participants did not perceive that e-cigarette use led to successful quitting experiences. Participants described positive attributes (maintenance of smoking actions, "healthier" alternative to cigarettes, and parental approval) and negative attributes (persistence of craving, maintenance of addiction) of e-cigarettes for cessation. Some college students expressed distrust of marketing of e-cigarettes for smoking cessation.

CONCLUSIONS

Adolescent and young adult smokers and nonsmokers perceive that there are several methods of using e-cigarettes for quitting and are aware of both positive and negative aspects of the product. Future research is needed to determine the role of e-cigarettes for smoking cessation in this population.

Relationship of risk assessment to placement characteristics in a statewide child welfare population

Risk assessments allow child and youth services to identify children who are at risk for maltreatment (e.g., abuse, neglect) and help determine the restrictiveness of placements or need for services among youth entering a child welfare system. Despite the use of instruments by many agencies within the U.S. to determine the appropriate placements for youth, research has shown that placement decisions are often influenced by factors such as gender, age, and severity of social-emotional and behavior problems. This study examined ratings of risk across multiple domains using a structured assessment tool used by caseworkers in the Rhode Island child welfare system. The relationship between ratings of risk and placement restrictiveness was also examined. Risk levels varied across placement settings. Multivariate analyses revealed that lower caseworker ratings of parent risk and higher ratings of youth risk were associated with more restrictive placements for youth. Implications for the child welfare system are discussed.

The moderating effect of family involvement on substance use risk factors in adolescents with severe emotional and behavioral challenges

OBJECTIVE

The current study longitudinally examined the moderating effects of family involvement, which previous research has shown to be a protective factor against adolescents' substance use involvement, on the associations between internalizing and externalizing problems, respectively, and substance use (alcohol, marijuana, and tobacco) and problems in a unique sample of adolescents with severe emotional and behavioral problems.

METHOD

Adolescents (n=4786) and their parents were assessed at three waves over a 1-year period as part of the SAMHSA funded Comprehensive Community Mental Health Initiative (CMHI). Multilevel growth curve models were estimated using Hierarchical Linear Modeling (HLM) to examine the associations between time-varying internalizing and externalizing problems, respectively, and substance use involvement over time as a function of family involvement at baseline.

RESULTS

Results supported the hypothesis that family involvement protects against adolescent substance use involvement by buffering the adverse effects of both internalizing and externalizing problems. Specifically, for alcohol use, family involvement buffered the negative effects of high externalizing problems. For tobacco use, family involvement buffered the negative effects of both internalizing and externalizing problems, respectively. For substance use problems, family involvement buffered the effects of only internalizing problems. Family involvement did not moderate effects of emotional and behavioral problems on marijuana use, however, a significant main effect was observed such that family involvement was negatively related to marijuana use.

CONCLUSIONS

Results suggest that the beneficial effects of family involvement on at-risk adolescents' substance use involvement are dependent on the type of emotional and behavioral problems the adolescent experiences as well as the type of substance the adolescent uses. Implications for family- and adolescent-focused treatment are discussed.

Racial/ethnic differences in patterns of sexual risk behavior and rates of sexually transmitted infections among female young adults

OBJECTIVES

We examined patterns of sexual behavior and risk for sexually transmitted infections (STIs) in young adulthood for Black, Hispanic, and White females.

METHODS

We used a nationally representative sample of 7015 female young adults from wave III of the National Longitudinal Study of Adolescent Health. Sexual risk items assessed behaviors occurring in the previous 6 years and past year to determine classes of sexual risk and links to STIs in young adulthood.

RESULTS

Latent class analysis revealed 3 sexual risk classes for Black and Hispanic youths and 4 sexual risk classes for White youths. The moderate and high risk classes had the highest probabilities of risky sexual partners, inconsistent condom use, and early age of sexual initiation, which significantly increased odds for STIs compared with recent abstainers.

CONCLUSIONS

We found different classes of sexual behavior by race/ethnicity, with Black and Hispanic young women most at risk for STIs in young adulthood. Preventive efforts should target younger adolescents and focus on sexual partner behavior.

Psychological distress and substance use among community-recruited women currently victimized by intimate partners: a latent class analysis and examination of between-class differences

Latent class analysis was used to examine patterns of victimization among a community sample of 212 women experiencing intimate partner violence (IPV). Results identified three classes of women characterized by victimization history (recent IPV, childhood victimization); classes were further differentiated by IPV-related posttraumatic stress disorder symptoms, other indicators of psychological distress, and substance use. Differentiating levels of victimization and their associated patterns of psychosocial functioning can be used to develop intervention strategies targeting the needs of different subgroups of women so that mental health and substance use problems can be reduced or prevented altogether. Implications for treatment and future research are presented here.

The role of ethnic pride and parental disapproval of smoking on smoking behaviors among minority and white adolescents in a suburban high school

BACKGROUND

Adolescence is a critical developmental period when tobacco use is initiated and progression to regular smoking occurs. Another growing concern is the mounting evidence of ethnic/racial disparities in the smoking rates and adverse health consequences related to smoking. To reduce ethnic/racial disparities in smoking behaviors, understanding the protective influences against smoking behaviors among minority adolescents is important. Therefore, we examined the role of ethnic pride and parental disapproval of smoking on a wide range of smoking behaviors in ethnic/racial minority and White adolescents attending a suburban high school in Connecticut.

METHODS

A total of 870 adolescents (ethnic/racial minority: n= 202) completed questions on susceptibility to smoking, ever trying a cigarette, smoking at least one cigarette daily in the past 30 days, as well as parental disapproval of smoking and ethnic pride in a school-wide survey.

RESULTS

Logistic regression analyses indicated that perceived parental disapproval of adolescent smoking and ethnic pride were associated with susceptibility to smoking, ever trying a cigarette, and daily smoking differently for minority and White adolescents. For White youth, high parental disapproval of smoking was protective against all three smoking behaviors whereas ethnic pride was not. For minority youth, the combined protective effect of higher ethnic pride and higher parental disapproval of smoking was protective against all smoking behaviors.

CONCLUSION

The protective role of parental disapproval of smoking and ethnic pride on smoking behaviors may inform culturally sensitive smoking interventions aimed at diverse, multi-ethnic youth, and future studies are needed to examine this.

Exposure to traumatic events and the behavioral health of children enrolled in an early childhood system of care

Children may be exposed to numerous types of traumatic events that can negatively affect their development. The scope to which studies have examined an array of events among young children has been limited, thereby restricting our understanding of exposure and its relationship to behavioral functioning. The current cross-sectional study describes traumatic event exposure in detail and its relationship to behavioral health among an at-risk sample of young children (N = 184), under 6 years of age, upon enrollment into an early childhood, family-based, mental health system of care. Caregivers completed home-based semistructured interviews that covered children's exposure to 24 different types of traumatic events and behavioral and emotional functioning. Findings indicated that nearly 72% of young children experienced 1 or more types of traumatic events. Multiple regression model results showed that exposure was significantly associated with greater behavioral and emotional challenges with children's age, gender, race/ethnicity, household income, and caregiver's education in the model. These findings highlight the prevalence of traumatic exposures among an at-risk sample of young children in a system of care and suggest that this exposure is associated with behavioral and emotional challenges at a young age.

An Examination of Exposure to Traumatic Events and Symptoms and Strengths for Children Served in a Behavioral Health System of Care

The present study examined how exposure to traumatic events impacts children with severe emotional disturbance who are being served in a school-based system of care. Multilevel growth curve models were used to examine the relationships between a child's history of traumatic events (physical abuse, sexual abuse, or domestic violence) and behavioral and emotional strengths, internalizing problem behaviors, or externalizing problem behaviors over 18 months. Results indicate that children receiving services (N = 134) exhibited increased emotional and behavioral strengths and decreased internalizing and externalizing problem behaviors from enrollment to 18 months follow-up. Children with a history of traumatic events improved more slowly than children without such a history on both strengths and internalizing problem behaviors, even after controlling for dosage of services received and other characteristics previously found to predict outcomes. Gender was also related to improvement in internalizing symptoms. Results highlight the continued need to assess the impact of exposure to traumatic events for children served in a system of care.

Tobacco use and suicidality: latent patterns of co-occurrence among black adolescents

INTRODUCTION

Tobacco use is responsible for a considerable portion of the health disparities experienced by Blacks. In addition to its physiological effects, tobacco use has consistently been shown to be associated with suicidality among adolescents. The purpose of the present study is to describe the association between specific patterns of tobacco use behavior and those of suicidality among a nationally representative sample of Black high school students.

METHODS

Responses from Black adolescents (N = 2,931) who completed the 2007 Youth Risk Behavior Surveillance Survey were included. Latent class analysis was utilized to identify typologies based on two domains: (a) lifetime and recent tobacco use and (b) suicidality. The association between tobacco use class membership and suicidality class membership as well as the direct effects of age and gender on class membership was also investigated.

RESULTS

A significant proportion of Black youth reported smoking and suicidal behaviors. A 4-class model provided the best overall fit to the data for tobacco use behavior (nonsmokers, former smokers, light current smokers, and frequent current smokers); a 3-class model provided the best overall fit to the data for suicidality (not suicidal, mild suicidality, suicidal). Smoking status was associated with suicidality class membership, with more intense patterns of smoking related to increased probability of identification with both mild suicidality and being classified as suicidal compared with not suicidal.

CONCLUSIONS

The results of this study indicate that any current smoking status increases the likelihood of suicidality at least 5-fold and provides incentive to target this specific portion of the population of Black adolescent smokers.

Parental Knowledge and Substance Use among African American Adolescents: Influence of Gender and Grade Level

Parental knowledge is defined as parental awareness and information about a child's activities, whereabouts, and associations that is obtained through parental monitoring, parental solicitation, or self-disclosure. Increased parental knowledge is generally associated with lower adolescent substance use; however, the influence of various contextual factors, such as adolescent gender and grade level is not well understood, particularly for different racial or ethnic groups. In the present study, we used Hierarchical Generalized Linear Modeling (HGLM) analyses to examine the longitudinal relationship of parental knowledge to adolescent substance use in the context of adolescent gender and grade level among 207 urban African American adolescents in grades 6-11. Results indicated that increased parental knowledge is associated with a concurrent lower likelihood of substance use across all types of substances examined (alcohol, tobacco, marijuana, other drug use, and any drug use), but it did not predict changes in substance use one year later for the entire sample. However, analyses by gender and grade level showed that for boys and middle school youth, parental knowledge was a protective factor for increases in substance use across one year. Findings are discussed in terms of their implications for prevention and health promotion interventions for adolescent substance use among African American youth.

The impact of youth and family risk factors on service recommendations and delivery in a school-based system of care

The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a personal or family history of substance use had more services recommended than youth without these risk factors, while youth with a family history of substance use received more services. Youth with a history of substance use received a significantly higher dosage of services overall. Finally, history of family mental illness was associated with receiving mental health and operational services (e.g., family advocacy, emergency funds). Implications and limitations are discussed.

Risk and protective factors associated with patterns of antisocial behavior among nonmetropolitan adolescents

This study used latent class analysis (LCA) to identify patterns of antisocial behavior (ASB) in a sample of 1,820 adolescents in a nonmetropolitan region of the Northeast. Self-reported ASBs including stealing, fighting, damaging property, and police contact were assessed. LCA identified four classes of ASB including a non-ASB class, a mild, a moderate, and a serious ASB class. Multinomial logistic regression indicated that parent-child relationships served as a protective factor against engaging in ASB and peer, school, and community risk and protective factors differentiated mild patterns of ASB from more intense patterns of involvment. These findings suggest utility in using the LCA to better understand predictors of adolescent ASB to inform more effective prevention and intervention efforts targeting youth who exhibit different patterns of behavior.

Substance use among Asian American adolescents: Influence of race, ethnicity, and acculturation in the context of key risk and protective factors

This study examines the relative influence of race/ethnicity, acculturation, peer substance use, and academic achievement on adolescent substance use among different Asian American ethnic groups and U.S. racial/ethnic groups. Data from the Wave 1 in-home sample of the National Longitudinal Study of Adolescent Health was used to examine lifetime use of alcohol, tobacco, and marijuana in a full adolescent sample of all racial/ethnic groups (N=20,745) and a subsample of Asian American adolescents (N=1,248). Path analysis examined the hypothesized relationships of peer substance use and acculturation as risk factors and academic achievement as a protective factor for racial/ethnic groups. The results indicated that when Asian American adolescents were compared to other major U.S. racial/ethnic groups, peer use and acculturation were both significant mediators of smoking, drinking, and marijuana use, and academic achievement mediated each type of use at a trend level. For Asian American ethnic groups, peer use is a risk factor and, to a lesser extent, academic achievement a protective factor for substance use. Also, although acculturation is a predictor of substance use, when peer use and academic achievement are taken into account, acculturation -- like ethnicity -- no longer predicts use. Mediation analyses indicated that: peer substance use mediates smoking, drinking, and marijuana use; academic achievement does not; and acculturation mediates substance use for some substances and some Asian American ethnic groups. The results are discussed for their implications for understanding how culturally-specific approaches can inform preventive interventions.

Low-dose paclitaxel synergizes with oncolytic adenoviruses via mitotic slippage and apoptosis in ovarian cancer

The microtubule-stabilizing drug paclitaxel has activity in relapsed ovarian cancer. dl922-947, an oncolytic adenovirus with a 24-bp deletion in E1A CR2, replicates selectively within and lyses cells with a dysregulated Rb pathway and has efficacy in ovarian cancer. In the aggressive A2780CP xenograft, combination treatment with weekly dl922-947 and paclitaxel has significantly greater efficacy than either treatment alone and can produce complete tumor eradication in some animals. We investigated the mechanisms of paclitaxel's synergy with dl922-947 in ovarian cancer. The host-cell microtubule network is grossly rearranged and stabilized following adenovirus infection, but paclitaxel does not increase this significantly. Paclitaxel does not synergize by increasing infectivity, viral protein expression or virus release. However, destabilizing the microtubule network with nocodazole reduces viral exit, revealing a novel microtubule-dependent pathway for non-lytic adenoviral exit. dl922-947 can override multiple cell cycle checkpoints but induces cell death by a non-apoptotic mechanism. In combination, dl922-947 and low-dose paclitaxel induces aberrant, multipolar mitoses, mitotic slippage and multinucleation, triggering an apoptotic cell death.

Social-ecological influences on patterns of substance use among non-metropolitan high school students

Patterns of substance use are examined in a sample of over 1,200 youth in a non-metropolitan region of New England. Self-reported history and frequency of alcohol, tobacco, marijuana, inhalants, pain medications, and other hard drug use was assessed for 9th and 10th grade students. Latent class analyses identified four patterns of substance use: non-users (22%), alcohol experimenters (38%), occasional polysubstance users (29%), and frequent polysubstance users (10%). Contextual risk and protective factors in the individual, family, peer, and community domains predicted substance use patterns. Youth report of peer substance use had the largest effects on substance use class membership. Other individual characteristics (e.g., gender, antisocial behavior, academic performance, perceived harm from use), family characteristics (e.g., parental drinking, parental disapproval of youth use), and community characteristics (e.g., availability of substances) demonstrated consistent effects on substance use classes. Implications for prevention are discussed from a social-ecological perspective.