This study compared data from 34 research trials of five empirically supported treatments (ESTs) with one large usual care (UC) sample on child, parent, and family characteristics for children with ...Disruptive Behavior Disorders. Large variations were found within and across ESTs on sample characteristics during the past two decades. Most parent and family characteristics were not reported in EST studies. Statistical comparisons between UC and EST samples revealed that occurrences of child demographics and symptom severity levels were similar, but occurrences of most parent and family characteristics were different, with higher rates of problems for the UC sample. Results indicate that UC clients have complex needs, with multiple child, parent, and family issues. The findings are discussed in relation to the importance of acknowledging parent and family contextual variables in implementation efforts.
To investigate rates of psychotropic medication use by youths served in public service sectors as a function of race/ethnicity.
Logistic regression models were used to examine racial/ethnic ...differences in caregiver report of psychotropic medication use for a random stratified sample of 1,342 children who were served in public service sectors during the second half of fiscal year 1996-97.
Race/ethnicity predicted caregiver report of past-year and lifetime psychotropic medication use when all other factors were held constant. Specifically, caregivers of African-American and Latino children were less likely to report past-year use compared to white children; caregivers of Latino children and "others" were less likely to report lifetime use. Additional factors predictive of medication use in regression models included younger age, male gender, higher household income, insurance type, active to mental health sector at time of enumeration into the study, impairment and diagnosis of mood, and anxiety or attentional disorder.
Racial/ethnic differences in use of psychotropic medication occur in children served in public service sectors and need to be considered in clinical diagnosis and treatment.
•Although the COVID-19 pandemic is unique, collective crises (times of acute difficultly) are common.•Initial responses to the pandemic crises offers lessons that can be applied for future collective ...crises.•Vulnerable populations (low-SES and minorities) are particularly important because they have less resources to buffer against potential hardships.•Crisis-oriented resources can help families maintain their sense of control over their lives during early phases of a collective crisis.•Long-term supports are also needed to buffer against COVID-19-related negative impacts (social inequities and disparities)
To explore minority and low-SES families’ general experiences with the stay-at-home mandate initiated by the COVID-19 pandemic crisis.
Semi-structured qualitative interviews (n = 31) were conducted in May 2020 – six to nine weeks after the stay-at-home mandate was initiated in Chicago Heights, Illinois. Participants were randomly selected from the parent Chicago Heights Early Childhood Center (CHECC) study (N = 2,185). Thematic content analysis of transcribed semi-structured interviews were employed.
During the early phases of the COVID-19 pandemic crisis, ethnic minority and low-SES families were generally comfortable in their homes, but both children and their parents experienced poor wellbeing, such as elevated stress. Families reportedly avoided social resources, despite low-SES. Upon reflection, parents expressed that the pandemic had changed them and, in some ways, the changes were positive.
Readily available crisis-oriented resources, for both children and parents, are needed to help families maintain or rebuild their sense of control over their lives during the early phases of a collective crisis (e.g., pandemic). Although early observations help to contextual families’ initial experiences, examining long-term trends can inform meaningful policies and practices that both support how low-SES families buffer against COVID-19-related negative impacts and mitigate ethnic and SES inequities and disparities.
The study objectives were to examine serious injuries requiring medical attention among children who remain at home after a child welfare/child protective services (CPS) maltreatment investigation in ...the US and to determine whether child/caregiver characteristics and ongoing CPS involvement are related to injuries requiring medical attention. Using the National Survey of Child and Adolescent Well-being, we analyzed data on the subsample of children who remained at home (N = 3,440). A multivariate logistic regression model included child characteristics, chronic illness and disability in the child, level of CPS involvement, subsequent foster care placement, caregiver characteristics, and caregiver/family psychological variables. Injuries requiring medical attention were identified in 10.6% of the in-home population over a15-month period, with no differences in rates by age. Children with a chronic medical condition (OR = 2.07; 95% CI, 1.20–3.58) and children with depressed caregivers (OR = 2.28; 95% CI, 1.45–3.58) were more likely to have an injury that required medical care. Older caregivers (>54 years) were less likely (OR = 0.15; 95% CI, 0.03–0.69) to have a child with an injury requiring care. Injuries were not related to further involvement with CPS after the initial maltreatment investigation. Children with chronic medical conditions who remained in their biological homes or whose caregivers were depressed were likely to experience an injury requiring medical attention. Older caregivers were less likely to report a child injury. Extending existing health policies for foster children to children who remain at home following referral to CPS may encourage more comprehensive injury prevention for this population.
Using longitudinal data from the National Survey on Child and Adolescent Well-Being (NSCAW), this study investigates entry into intensive or restrictive settings during a 36-month study period. ...Specifically, this analysis examines entry into treatment foster care, group homes, residential treatment, and inpatient psychiatric care for youth placed into out-of-home care (n = 981). It aims to determine at what point in their first out-of-home episodes and for what reasons youth entered such settings. As NSCAW used a national probability sampling design,this analysis provides national estimates about entry into intensive or restrictive settings for youth in out-of-home care. Twenty-five percent of youth (n = 280) experienced an intensive or restrictive setting during their first out-of-home care episode; 70% were in either group homes (33.2%) or residential treatment settings (37.0%).About half of the youth with such placements (48.9%) were placed into intensive or restrictive settings as a first placement during their first out-of-home episode.
Abstract Objectives To examine emergency department (ED) use among children involved with child protective services (CPS) in the US but who remain at home, and to determine if ED use is related to ...child, caregiver and family characteristics as well as receipt of CPS services. Method We analyzed data on 4,001 children in the National Survey of Child and Adolescent Well-being. Multivariate models compared rates of ED use for whether the family received CPS services or did not receive CPS services as well as child characteristics, caregiver characteristics and caregiver/family psychological variables. Results ED use among children who remained at home receiving CPS services was similar to that of children who did not receive CPS services (35.6% and 37.4%, respectively). In multivariate modeling, children with families who received CPS services, children 6 years or older, and children without a chronic health problem were less likely to use the ED. Children who remained at home in families identified with numerous stressors and, therefore, likely at high risk for future abuse and neglect were 1.73 times (95% CI, 1.14–2.63) more likely to have repeat ED use than children in low risk families. Conclusion Children who remain at home after a CPS evaluation are at high risk for ED use. Future research should focus on the health problems that precipitate an ED visit as well as the relationship between primary care and ED use.
To compare the prevalence and agreement of diagnoses based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) and clinician assignment for youths receiving public mental health ...services between 1996 and 1997 and to examine potential predictors of diagnostic agreement.
Participants included 240 youths aged 6-18 years. Past-year prevalence rates and kappa statistics were calculated for four diagnostic categories: anxiety, mood, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBD). Potential predictors of diagnostic agreement were examined with logistic regression analysis.
The prevalence of ADHD, DBD, and anxiety disorders was significantly higher based on the DISC-IV, while the prevalence of mood disorders was significantly higher based on clinician assignment. Diagnostic agreement was poor overall. The kappa values ranged from -0.04 for anxiety disorders to 0.22 for ADHD. Significant predictors of agreement varied by diagnosis and included symptom severity, comorbidity, youth age and gender, and school-based problem identification.
Consistent with previous findings of poor diagnostic agreement between structured interviews and clinicians, these results call for a better understanding of factors affecting diagnostic assignment across different methods. This is especially important if researchers continue to use structured interviews to determine prevalence, establish diagnosis-based treatment guidelines, and disseminate evidence-based treatments to community mental health settings.
Extremes of heat and particulate air pollution threaten human health and are becoming more frequent because of climate change. Understanding the health impacts of coexposure to extreme heat and air ...pollution is urgent.
To estimate the association of acute coexposure to extreme heat and ambient fine particulate matter (PM
) with all-cause, cardiovascular, and respiratory mortality in California from 2014 to 2019.
We used a case-crossover study design with time-stratified matching using conditional logistic regression to estimate mortality associations with acute coexposures to extreme heat and PM
. For each case day (date of death) and its control days, daily average PM
and maximum and minimum temperatures were assigned (0- to 3-day lag) on the basis of the decedent's residence census tract.
All-cause mortality risk increased 6.1% (95% confidence interval CI, 4.1-8.1) on extreme maximum temperature-only days and 5.0% (95% CI, 3.0-8.0) on extreme PM
-only days, compared with nonextreme days. Risk increased by 21.0% (95% CI, 6.6-37.3) on days with exposure to both extreme maximum temperature and PM
. Increased risk of cardiovascular and respiratory mortality on extreme coexposure days was 29.9% (95% CI, 3.3-63.3) and 38.0% (95% CI, -12.5 to 117.7), respectively, and were more than the sum of individual effects of extreme temperature and PM
only. A similar pattern was observed for coexposure to extreme PM
and minimum temperature. Effect estimates were larger over age 75 years.
Short-term exposure to extreme heat and air pollution alone were individually associated with increased risk of mortality, but their coexposure had larger effects beyond the sum of their individual effects.
Objective:The purpose of this study was to identify the mechanisms through which different aspects of leadership affect mental health practitioners’ attitudes toward supervisory feedback.Methods:Data ...were collected from 363 practitioners nested in 68 treatment teams in public-sector mental health organizations. A multilevel path analysis was conducted to examine the associations of transformational leadership (supervisor’s ability to inspire others to follow a course of action) and leader-member exchange (quality of the supervisor-practitioner relationship) with practitioner attitudes toward feedback.Results:Transformational leadership and leader-member exchange were directly and positively associated with practitioners’ attitudes toward feedback. Transformational leadership was also indirectly associated with practitioners’ attitudes toward feedback through the quality of supervisor-practitioner relationships.Conclusions:Study results contribute to the growing body of evidence suggesting that leaders play a key role in shaping mental health service delivery. Both leadership behavior and high-quality supervisor-practitioner relationships are important in supporting practitioners in delivering evidence-based mental health care. Policymakers, administrators, and researchers should consider an integrative approach when developing leadership training interventions.
Child abuse and neglect (CAN) is a complex issue that is subject to both under- and overreporting; yet, research into the underlying neighborhood-level drivers of these practices remains limited. The ...current study gathered perspectives from 30 child protective service (CPS) workers and agency leaders in Southern California neighborhoods to identify perceptions of social and contextual neighborhood factors that might influence over- and underreporting of CAN. The data were analyzed using a grounded theory approach, which revealed five themes: (a) neighborhood conflict, (b) neighborhood fear and mistrust, (c) neighborhood norms, (d) poor CAN reporting knowledge, and (e) mandated reporters’ discretion. These themes highlight the potential impact of neighborhood contexts and social dynamics on CAN reporting practices, emphasizing the need for prevention and early intervention neighborhood-level initiatives that improve CPS relationships within their local community.
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