In the United States, more money is spent on treatment for children's mental health problems than for any other childhood medical condition, yet little is known about usual care treatment for ...children. Objectives of this study were to characterize usual care outpatient psychotherapy for children with disruptive behavior problems and to identify consistencies and inconsistencies between usual care and common elements of evidence-based practices in order to inform efforts to implement evidence-based practices in usual care.
Participants included 96 psychotherapists and 191 children aged four to 13 who were presenting for treatment for disruptive behavior to one of six usual care clinics. An adapted version of the Therapy Process Observational Coding System for Child Psychotherapy-Strategies scale (TPOCS-S) was used to assess psychotherapy processes in 1,215 randomly selected (out of 3,241 collected) videotaped treatment sessions; treatment sessions were recorded for up to 16 months.
Most children received a large amount of treatment (mean number of sessions=22, plus children received other auxiliary services), and there was great variability in the amount and type of care received. Therapists employed a wide array of treatment strategies directed toward children and parents within and across sessions, but on average all strategies were delivered at a low intensity. Several strategies that were conceptually consistent with evidence-based practices were observed frequently (for example, affect education and using positive reinforcement); however, others were observed rarely (for example, assigning or reviewing homework and role-playing).
Usual care treatment for these youths reflected great breadth but not depth. The results highlight specific discrepancies between evidence-based care and usual care, thus identifying potentially potent targets for improving the effectiveness of usual care.
Objective:
Profiles of depressive symptoms were identified among Hispanic, Black, and White parents involved in the child welfare service system, including changes in symptoms over time.
Methods:
...Participants (N=2,109) were parents receiving SafeCare, a home visitation intervention provided in a large, diverse child welfare system. Depressive symptoms were assessed with the Centers for Epidemiological Studies Depression Scale at baseline and at approximately every sixth home visit, up to a total of four times. Univariate tests examined the relationship between baseline symptoms, race-ethnicity, and service participation. Latent class growth analyses identified trajectories of depressive symptoms during participation in child welfare services.
Results:
Participation in services was affected by depressive symptoms. Forty percent of parents did not remain long enough in the program to complete a second CES-D assessment, and those who reported more symptoms at baseline were significantly less likely to do so. Among parents who engaged in services, distinct profiles of depressive symptoms emerged that differed by race-ethnicity. For non-Hispanic Black parents, no changes in depressive symptoms over time were noted, regardless of level of severity at baseline. Parents with the highest levels of symptoms did not improve over time.
Conclusions:
Despite receipt of supportive and recovery-oriented services specifically focused on empowering child welfare–involved parents, many experienced elevated depressive symptoms. Integration of child welfare and community mental health systems may improve both service engagement and mental health among child welfare–involved families.
Objective:Latino families may be at risk of experiencing stressors resulting from the immigration process, such as those related to documentation status and acculturation, that may increase their ...need for mental health services. However, little research exists on the mental health needs and service use of Latino children. This study examined how parental nativity and legal status influence mental health needs and service utilization among children in Latino families investigated by child welfare.Methods:Data from the second National Survey of Child and Adolescent Well-Being, a nationally representative, prospective study of families investigated by child welfare agencies for maltreatment, were used to examine mental health need and service use in a subset of Latino children who remained in the home following a maltreatment investigation (N=390).Results:Although children of immigrants did not differ from children of U.S.-born parents in levels of clinical need, they had lower rates of mental health service receipt. After the analyses accounted for other relevant variables, the odds of receiving services were significantly lower (odds ratio=.09) for children whose parents were undocumented compared with children whose parents were U.S. citizens.Conclusions:This study contributes to growing discourse on Latino family needs within the child welfare system. Analyses support earlier research regarding the effects of parent nativity on mental health service use and advance the literature by identifying parent legal status as a unique barrier to child service receipt.
Objective: To examine the prevalence/predictors of mental health (MH) problems and services use in 12- to 36-month-old children who had been investigated for maltreatment. Method: Data came from the ...second National Survey of Child and Adolescent Well-Being (NSCAW II), a longitudinal study of youth ages 0 to 17.5 years referred to U.S. child welfare agencies. These analyses involved 1117 children 12 to 36 months of age. Sociodemographic, social services, developmental and health data were collected on the children and caregivers. Outcomes were scores over the clinical cutoffs on the Brief Infant Toddler Social and Emotional Assessment (BITSEA) Scales for 12- to 18-month-olds and the Child Behavior Checklist (CBCL) for 19- to 36-month-olds. Results: In all, 34.6% of 12 to 18 month-olds scored high on the Problem Scale of the BITSEA, and 20.9% on the Competence Scale, whereas 10.0% of 19- to 36-month-olds scored over the CBCL clinical cut-off. Children of black ethnicity were less likely to have elevated scores on the BITSEA Problem Scale, whereas children who lived with a never-married caregiver were five times more likely to have elevated scores. Competence problems were associated with prior child welfare history. Elevated CBCL scores were associated with living with a depressed caregiver. Few children with identified MH problems, 2.2%, received an MH service. When we added parenting skills training that might be related to the treatment of child problems, 19.2% received a service. Conclusions: Identifiable MH problems are common, but few children receive services for those problems. The lack of services received by these young, multi-challenged children is a services systems and social policy failure. (Contains 4 tables.)
Little is known of how low-income residents of urban heat islands engage their knowledge, attitudes, behaviors, and resources to mitigate the health impacts of heat waves. In this qualitative study, ...we conducted semi-structured interviews with 40 adults in two such neighborhoods in Los Angeles California to explore their adaptation resources and behaviors, the impacts of heat waves on physical and mental health, and threat assessments of future heat waves. Eighty percent of participants received advanced warning of heat waves from television news and social media. The most common resource was air conditioning (AC) units or fans. However, one-third of participants lacked AC, and many of those with AC engaged in limited use due primarily to the high cost of electricity. Adaptation behaviors include staying hydrated, remaining indoors or going to cooler locations, reducing energy usage, and consuming certain foods and drinks. Most of the participants reported some physical or mental health problem or symptom during heat waves, suggesting vulnerability to heat waves. Almost all participants asserted that heat waves were likely to increase in frequency and intensity with adverse health effects for vulnerable populations. Despite limited resources, low-income residents of urban heat islands utilize a wide range of behaviors to minimize the severity of health impacts, suggesting they are both vulnerable and resilient to heat waves.
Background: Maternal depression has been linked to substance use in adolescents, but the mechanisms of the relationship between maternal depression and adolescent substance use are less clear. ...Specifically, previous literature has overlooked the role of fathers as a potential protective or exacerbating factor in buffering this relationship. Objectives: The goal of this study was to investigate the association between maternal depressive symptoms and adolescent substance use, exploring father's residential status as a moderator for adolescents living with a mother with depressive symptoms. Method: Paper-and-pencil surveys were administered to a sample of 176 mothers and their adolescent daughters aged 14-18, predominantly identifying as African American/Black. Participants included a subset of mothers with HIV. Results: The results revealed that maternal depressive symptoms were not directly associated with adolescent substance use. However, father's residential status was found to be a significant moderator in the relationship between maternal depressive symptoms and adolescent substance use. Specifically, when fathers were involved in the daughter's life (residential or non-resident), substance use was higher in adolescents of mothers with high depressive symptoms than in those of mothers with low depressive symptoms. Conclusion: The results suggest that varied family dynamics are critical to understanding engagement in substance use among adolescent girls, including the influence of both mothers and fathers.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The study objective was to examine the likelihood and magnitude of child abuse and neglect (CAN) re-reports for young children (0–71 months) with delays in cognitive, language, and adaptive ...development, compared to typically developing children. The National Survey of Child and Adolescent Well-Being (NSCAW II), a nationally representative and longitudinal survey, was used to examine CAN re-reports at two follow-up waves, 18- and 36-months post baseline assessments. Logistic regression models were employed to determine the correlation between number of developmental delays and a CAN re-report at waves 2 and 3. Results indicate that children with three or more domains of delays had odds 4.73 times higher than children without developmental delays of re-report to CPS at wave 2 but not at wave 3. In this study, children with multiple developmental delays have elevated rates of CAN re-reports when compared to typically developing children. Allocation of child welfare resources should include strategies for preventing maltreatment risk among children with developmental delays.
Abstract This study investigated the association between maternal depressive symptoms and adolescent engagement in sexual intercourse in a non-clinical sample of mothers and their adolescent ...daughters from minority families. The current study explores ways in which maternal depression, family factors, and adolescent sex interact. Data were from a cross-sectional study of 176 mother–daughter dyads, including a subset of mothers with HIV. Logistic regression analyses revealed that among mothers who were not current marijuana users, more maternal depressive symptoms was associated with daughters' engagement in sexual intercourse. Neither parent-child conflict nor parental involvement significantly mediated the relationship between maternal depressive symptoms and adolescent sex. This study provides the first empirical evidence that non-clinical depressive symptoms in mothers are associated with adolescent engagement in sexual intercourse.
To examine the rates and predictors of mental health services use for a nationally representative cohort of youths who had been investigated for alleged maltreatment.
Data came from caregiver and ...caseworker baseline and 18-month interviews in the second National Survey of Child and Adolescent Well-being. These interviews took place from March 2008 to September 2008 and September 2010 to March 2011. Data on family and child characteristics and service use were gathered and examined by using weighted univariate and multivariate analyses.
Children had numerous challenges: 61.8% had a previous report of maltreatment, 46.3% had poor socialization skills, and 23.9% had a mental health problem measured by the Child Behavior Checklist (CBCL). At baseline, 33.3% received some mental health service and this varied by age, with younger children receiving fewer services. This percentage decreased to 30.9% at the 18-month follow-up, although the youngest children had increases in services use. For younger children, race/ethnicity, out-of-home placement, chronic physical health problems, low adaptive behaviors, and CBCL scores in the clinical range were related to use. For children ≥ 11, out-of-home placement, high CBCL scores, and family risk factors predicted services use at 18 months.
Mental health services utilization increases as young children come into contact with schools and medical providers or have more intensive involvement with child welfare. Minority children receive fewer services adjusting for need. Over the 18-month follow-up, there was a decrease in service use that may be a result of the tremendous financial challenges taking place in the United States.
Guided by structural family systems theory, this study explored the relationship between parentification and adolescent daughters' sexual risk engagement and substance use. We also explored how ...adolescent reports of parental monitoring moderated the relationship between parentification and adolescent risk. Data were from a cross‐sectional, cross‐generational study of 176 mother–daughter dyads from low‐income, inner‐city, ethnic minority families. In this sample, which included a subset of mothers with HIV, parental physical symptoms were associated with slightly higher levels of parentification. Parentification was associated with adolescent daughters' intention to have sex (but not substance use) in a direction opposite to prediction. Higher parentification was associated with lower intention to have sex. Parental monitoring did not moderate relationships between parentification and adolescent risk. These findings highlight that despite the negative influence hypothesized in structural family systems theory, parentification was not associated with risk engagement of high‐risk adolescent daughters in ethnic minority families with low income.
摘要
本研究以结构化家庭系统理论为指导,探索亲职化同青春期女儿性风险与物质滥用之间的关系;文章还探索了青少年对家长监管的报告如何调节亲职化与青少年风险之间关系。我们的研究数据来自一项对176名内城区少数民族低收入家庭母女组合进行的横断面、跨世代研究。研究样本包含一组携带HIV病毒的母亲。在样本中,家长的身体症状与稍高水平的亲职化相关。亲职化在预测相反方向与青春期女儿的性意图相关(而非物质滥用)。较高的亲职化与较低的性意图相关。家长监管并未调节亲职化与青少年风险之间的关系。这些结果表明,尽管在结构化家庭系统理论中被认为有消极影响,亲职化与低收入少数民族家庭中高风险青春期女儿的风险涉入没有关联。
Resumen
Guiados por la teoría familiar estructural de sistemas, en este estudio analizamos la relación entre la padrificación, el comportamiento de riesgo sexual de las hijas adolescentes y el consumo de sustancias. También estudiamos cómo los informes de las adolescentes acerca del control de los padres moderaron la relación entre la padrificación y el riesgo de dichas adolescentes. Los datos se tomaron de un estudio transversal e intergeneracional de 176 díadas madre‐hija de familias de minorías étnicas de bajos recursos que viven en zonas marginales. En esta muestra, que incluyó un subconjunto de madres con VIH, los síntomas físicos de los padres estuvieron asociaron con niveles de padrificación un poco más altos. La padrificación estuvo asociada con la intención de las hijas adolescentes de tener relaciones sexuales (pero no de consumir sustancias) en dirección opuesta a la predicción. Un mayor nivel de padrificación estuvo asociado con una menor intención de tener relaciones sexuales. El control de los padres no moderó las relaciones entre la padrificación y el comportamiento de riesgo de las adolescentes. Estos resultados ponen de manifiesto que, a pesar de la influencia negativa propuesta como hipótesis en la teoría familiar estructural de sistemas, la padrificación no estuvo asociada con la participación en comportamientos de riesgo de las hijas adolescentes con alto riesgo de familias de minorías étnicas con bajos recursos.
PDF
