Change trajectories of aggressive behavior among children in long-term residential care

This study examined change trajectories of aggressive behaviors among children in long-term residential care in Israel and identified various child-, family-, and placement-related predictors of the change trajectories. Records of 799 children (average age at the beginning of the four years = 10.4, 33.1% female) in their first four consecutive years in care were analyzed using the TRF aggressive behavior subscale (Achenbach, 1991) to measure the outcome variable. Children’s and parents’ characteristics and placement-related factors were used to explain variance in change trajectories. Latent Class Growth Analyses identified four aggressive behavior trajectories: ‘stable-low’ levels of aggressiveness over time (45% of the children), ‘stable-high’ levels (13%), ‘improvement’ (20%), and ‘deterioration’ (22%). Predictors of less resilient trajectories (i.e., stable-high or increasing aggressiveness) included mothers’ difficulties and disabilities, children’s attendance of special education classes, more intensive type of care, and non-immigrant status. The Attachment Theory, Life Course Perspective theories, and the General Strain Theory are used to interpret some of the findings of the study. Identifying the factors that predispose children to certain patterns of change may help direct resources to children at risk of having high or increasing levels of aggression while in residential care.     

Disentangling the effect of out-of-home care on child mental health

BackgroundChildren in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children’s mental health outcomes from the effects of the adverse circumstances that led to their admission to care.ObjectiveThis research investigated the association between care placement and the presence of child mental health problems after controlling for children’s pre-care experiences. It also identified factors associated with mental health problems among children in care.Participants and SettingThe sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159).MethodsThe mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers.ResultsThe odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032).ConclusionsThese findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.     

Children in foster care: factors influencing outpatient mental health service use

OBJECTIVE: To determine factors influencing outpatient mental health service use by children in foster care. METHOD: Detailed survey and administrative data were collected on 480 children who entered long-term foster care in San Diego County from May 1990 through October 1991. These data were linked with claims data from Medicaid and San Diego County Mental Health Services information systems. A Poisson regression model was used to determine whether the following factors influenced outpatient mental health service use: age, race/ethnicity, gender, maltreatment history, placement pattern, and behavioral problems as measured by the Achenbach Child Behavior Checklist (CBCL). RESULTS: Except for maltreatment history, all independent variables included in the multivariate regression model were statistically significant. The total number of outpatient mental health visits increased with age, male gender, and non-relative foster placements. Relative to Caucasians, visits were lower for Latinos, and Asian/Others, but comparable for African-Americans. Concerning maltreatment history, differences were only found in one category; children experiencing caretaker absence received fewer visits compared to children who did not experience caretaker absence. Children with CBCL Total Problem Scale T-scores of 60 or greater had significantly more visits than those with a score less than 60. CONCLUSIONS: Both clinical and non-clinical factors influence outpatient mental health service use by foster children. Limitations imposed by gender, race/ethnicity, and placement setting need to be addressed by child welfare policies. These finding suggest that guidelines are needed to systematically link children in foster care with behavioral problems to appropriate services.     

Education policy and mental weakness: a response to a mental health crisis

Educationalists have been concerned with the labelling and treatment of children with mental health difficulties in the education system in England for some time. These concerns have centred on the role of policy in ‘othering’ such students as deviant learners. The unprecedented number of children suffering from mental illnesses, has forced policymakers to address children’s mental health difficulties. This has involved the identification of a sub-set of the school population experiencing ‘less-severe’ mental health issues, to be addressed through a suite of policy interventions delivered by whole-school approaches, but targeted towards children situated as mentally ‘weak’. Drawing upon a Foucauldian theory of governmentality that addresses children’s behavioural motivations, an in-depth analysis of a number of educational policy initiatives related to mental health is conducted, that it is argued are fundamentally flawed. This analysis is followed by a discussion of the performative culture of High Stakes Testing in contributing to children’s mental health difficulties. Here it is argued that a narrative of mental weakness serves to justify a neoliberal rationality towards the treatment of children for whom the performative logic assumed to motivate all learners, fails.     

Relationship between out-of-home care placement history characteristics and educational achievement: A population level linked data study

Studies generally show children who have entered out-of-home care have worse educational outcomes than the general population, although recent research suggests maltreatment and other adversities are major contributing factors. Children’s out-of-home care experiences vary and may affect their outcomes. This study examined the influence of placement stability, reunification, type of care, time in care and age at entry to care on children’s educational outcomes. We conducted a population-based record-linkage study of children born in Western Australia between 1990 and 2010 who sat State or national Year 3 reading achievement tests (N = 235,045 children, including 2160 children with a history of out-of-home care). Children’s educational outcomes varied with many aspects of their care experience. Children placed in residential care were particularly likely to have low scores, with an unadjusted OR 6.81, 95% CI[4.94, 9.39] for low reading scores, which was partially attenuated after adjusting for background risk factors but remained significant (OR = 1.50, 95% CIs [1.08, 2.08]). Reading scores were also lower for children who had experienced changes in care arrangements in the year of the test. A dose-response effect for multiple placements was expected but not found. Older age at entering care was also associated with worse reading scores. Different characteristics of a child’s care history were interwoven with each other as well as child, family and neighbourhood characteristics, highlighting a need for caution in attributing causality. Although the level of educational difficulties varied, the findings suggest a widespread need for additional educational support for children who have entered care, including after reunification.     

‘Push on through’: Children’s perspectives on the narratives of resilience in schools identified for intensive mental health promotion

Child mental health is a growing concern for policymakers across the global north. Schools have become a key site for mental health interventions, with new programmes aimed at promoting ‘resilience’, through which children may maintain or regain mental health during adversity. As one of the first studies to explore the early impact of intensive mental health promotion in schools from children’s perspectives, we adopt a governmentality approach to consider the logic and techniques of such programmes with a specific focus on England. An innovative visual methodology was used to focus on student perspectives of mental health interventions in school. Young peoples’ photo representations of mental health were collected and used to stimulate focus group discussions with 65 students aged 12–14, across seven schools. ‘Resilience’ was seen to be the key organising concept for mental health interventions in schools. The concept was viewed as narrowly focused on attitude towards—and performance in—school work, with individuals being encouraged to ‘push on through’ difficulties to achieve success. Young people were critical of this approach, suggesting several alternatives. These included increased access to independent mental health professionals, safe spaces within schools and mental health education that addressed the social and affective dimensions of mental health difficulties.     

Association between psychosocial stressors with emotional and behavioral problems among children of low-income addicted families living in Brazil

BackgroundChildren exposed to substance use in their families are vulnerable to multiple risk factors in their development and at increased risk for emotional and behavioral problems. The aims of the study were as follows 1) estimate the prevalence of emotional and behavioral problems among children aged 6–11 years old, living with addicted family members in a low-income urban community of São Paulo, Southeastern Brazil; 2) evaluate the children’s exposure to family psychosocial stressors and substance use; and 3) investigate the factors related to the increased risk of emotional and behavioral problems and substance use.MethodsA cross-sectional study was conducted among 101 children aged 6–11 years old (M = 9.16 years, SD = 1.61). The instruments used were a sociodemographic questionnaire, the Child Behavior Checklist (CBCL) and the Psychosocial Stress Factors (PSF).ResultsHigh prevalence of problems was found for this sample: the CBCL showed 26.7% of clinical scores for Internalizing Problems, 40.6% for Externalizing Problems, and 40.6% for Total Problems. Exposure to family psychosocial stressors was also high, including severe disease (33%), physical aggression (28.9%), death (27.8%), psychiatric hospitalization (16.7%), suicide attempts (15.5%), and suicide (9.3%). Exposure to these family stressors was associated with an increase of two to four times in the prevalence of internalizing and externalizing problems.ConclusionsChildren exposed to substance abusers have more mental health problems than general population, even when compared to peers living in similar low-income areas. This is a group that should be target of a selective preventive intervention.     

Child sexual abuse victims as witnesses: The influence of testifying on their recovery

Victims of child sexual abuse (CSA) are likely to show a wide range of adaptation difficulties. In addition, some children and their families are involved in legal proceedings following the child’s disclosure. However, little is known about the effects of legal involvement on CSA victim’s mental health and recovery. In this longitudinal study, the effects of testifying were examined in a sample of 344 children at initial assessment (67% of girls) receiving services in a Child Advocacy Centre, of which 130 children testified. The participants’ age ranged from 6 to 14 years old (M = 9.42 SD = 2.14). Children and their parents completed a series of measures to evaluate the child’s mental health (e.g. depression, anxiety, PTSD) at four points in time over a 2-year period. Multilevel analysis indicates that all the children showed significant improvement over time but the group who testified more than once shows higher levels of emotional distress 2 years after the initial assessment. This study highlights the importance of documenting the experience of CSA victims in the justice system in order to establish the adequate conditions to support child witnesses.     

New Beginnings: evaluation of a short social–emotional intervention for primary‐aged children

We report on an effectiveness trial of ‘New Beginnings’, a short social–emotional intervention for primary‐aged children. The sample comprised 253 children (aged 6–11) attending 37 primary schools across England. Data on social and emotional competence and mental health difficulties were collected using child self‐report, and parent‐ and teacher‐informant report questionnaires in a pre‐test–post‐test control group design. One hundred and fifty‐nine children took part in the intervention, and 94 children acted as a comparison group. Children in the intervention group attended weekly 45‐minute small group sessions for seven weeks. Child self‐report data indicated that the intervention was successful in promoting social and emotional competence, and that improvements were sustained at seven‐week follow‐up. However, this finding was not replicated in either the teacher or parental data. We conclude that future iterations of the intervention may need to be more intensive and lengthy in order to produce changes in behaviour that are salient to teachers and parents.     

American Revolution in Mental Health Care Delivery

Abstract

The American health care system is in the midst of unprecedented changes under the name of “managed care,” including preauthorizations for care, cost and outcome accountability, formulary regulations and restrictions, and corporation of multi-professional collaboration. How to prepare practitioners for new responsibilities in such a time of exponential change while preserving professional values and priorities is the rightful concern of mental health educators. This paper identifies and examines some fundamental professional skills as essential criteria for assessing the preparation of social work professionals for the new mental health care environment. They are (1) communication skills, (2) cultural competency, and (3) state-of-the-art treatment. The paper also discusses the manner in which rapid scientific advance, managed-care environments, and changing patterns of practice might test, extend and alter traditional pillars of professional competence. Finally, it is stressed that social work education should prepare professionals to distinguish between constructive and destructive aspects of managed care and should teach the moral imperative to confront harmful practices.     

Children's attitudes towards ADHD,depression and learning disabilities

Attention deficit hyperactivity disorder (ADHD), depression and general learning disabilities (LD) are common difficulties for British primary school children. It has been found that characteristics associated with these difficulties can result in negative attitudes and stigma from other children, causing problems with peer relationships. Furthermore, problematic peer relations can intensify the difficulties associated with these disorders. Packages such as ‘Tackling Stigma: A Practical Toolkit’ aim to combat stigma in schools. However, these packages have not been based on evidence regarding children's attitudes towards different disorders. This study aims to explore children's attitudes towards ADHD, depression and LD from a conative (measure of social distance) and cognitive (measure of positive or negative attributes ascribed to a person) perspective. Participants were 273 children (M= 9.2 years). Vignettes were used to describe a child with ADHD, depression, or LD or a ‘normal’ child. The Shared Activities Questionnaire was utilised to assess conative attitudes, and the Adjective Checklist was utilised to assess cognitive attitudes. Results showed that children generally displayed more negative attitudes to vignettes describing mental health difficulties (MHD) (ADHD and depression) than LD. Children had more negative attitudes towards the ADHD (externalising disorder) vignette than the depression vignette (internalising disorder). Younger children had more positive conative attitudes than older children. Those who had previous contact with children with ADHD, depression and LD had more positive attitudes. These findings can enhance current stigma reduction interventions through contributing a deeper understanding of children's attitudes towards the most common MHD and LD in childhood.     

Do regulable features of child-care homes affect children’s development?

Data from the NICHD Study of Early Child Care were used to assess whether regulable features of child-care homes affect children’s development. Child-care homes selected were those in which there were at least two children and the care provider received payment for child care (ns=164 when the study children were 15 months old, 172 at 24 months, and 146 at 36 months). Caregivers who were better educated and had received more recent and higher levels of training provided richer learning environments and warmer and more sensitive caregiving. Caregivers who had more child-centered beliefs about how to handle children also provided higher quality caregiving and more stimulating homes. In addition, when settings were in compliance with recommended age-weighted group size cut-offs, caregivers provided more positive caregiving. Quality of care was not related to caregivers’ age, experience, professionalism, or mental health, or to the number of children enrolled in the child-care home or whether the caregivers’ children were present. Children with more educated and trained caregivers performed better on tests of cognitive and language development. Children who received higher quality care, in homes that were more stimulating, with caregivers who were more attentive, responsive, and emotionally supportive, did better on tests of language and cognitive development and also were rated as being more cooperative. These findings make a case for regulating caregivers’ education and training and for requiring that child-care homes not exceed the recommended age-weighted group size.     

Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey

Despite good reason to believe that children in foster care are disproportionately exposed to adverse childhood experiences (ACEs), relatively little research considers exposure to ACEs among this group of vulnerable children. In this article, we use data from the 2011–2012 National Survey of Children’s Health (NSCH), a nationally representative sample of non-institutionalized children ages 0–17 in the United States, to estimate the association between foster care placement and exposure to an array of ACEs. In adjusted logistic regression models, we find that children placed in foster care or adopted from foster care, compared to their counterparts, were more likely to experience parental divorce or separation, parental death, parental incarceration, parental abuse, violence exposure, household member mental illness, and household member substance abuse. These children were also more likely to experience ACEs than children across different thresholds of socioeconomic disadvantage (e.g., children in households with incomes below the poverty line) and across different family structures (e.g., children in single-mother families). These results advance our understanding of how children in foster care, an already vulnerable population, are disproportionately exposed to ACEs. This exposure, given the link between ACEs and health, may have implications for children’s health and wellbeing throughout the life course.     

Child safeguarding practices in light of the Deserving/Undeserving paradigm: A historical & contemporary analysis

BackgroundContemporary child protection systems in the UK need to be seen in light of the late nineteenth century child rescue movement, at a time of curbs in public spending, shifts in attitudes towards children’s welfare and the development of social work. There are similarities in the social, institutional and legal contexts, between the nineteenth century and today, centralising ‘deservedness’, that determined and determines children’s access to services.ObjectiveThe current article compares historical data and practices of children in care in the UK, encompassing 1881–1918, with contemporary data and practices, through the lens of the deserving/undeserving paradigm, inherited from the Poor Law of 1834.Participants and SettingDrawing on two data sets, namely historic children’s case files (N = 108), 1881–1918 from the Children’s Society (a philanthropic institution) highlighting the perception of custodians, doctors, professionals, as well as children and parents, and current data from interviews with young care leavers and safeguarding practitioners (N = 42), our research focuses on the most disadvantaged children with complex needs and damaging (pre)care experiences.MethodsData is analysed using thematic content analysis, framed within critical realist ontology, taking account of stratified non-linear dynamics of processes at different levels.Results and ConclusionIn both data sets the inability to support certain children is justified by referring to their complex needs and mental health and behavioural problems., Here, the child is held accountable and placed in the ‘undeserving’ category and consequently misses out on help and support, highlighting a need for awareness, and reflective and reflexive practice among practitioners/professionals.     

An examination of child protective service involvement among children born to mothers in foster care

ObjectiveThis study identified children born to mothers in foster care and documented Child Protective Service (CPS) involvement among children.MethodsProbabilistically linked birth and CPS records from California (2009–2012) were used to identify all mothers in foster care on or after conception. Children were followed prospectively using linked records to identify CPS involvement occurring during the first three years of life. Differences between reported and unreported children were examined using χ2 tests. The Latent Class Analysis (LCA) identified classes of children born to mothers in care who were at increased risk of CPS involvement. Model fit was assessed using the Bayesian Information Criterion, entropy, and likelihood ratio tests. For each of the classes, the relationship to the distal outcome (i.e., a maltreatment report by age three), was examined.ResultsFindings indicate that 53% of children born to mothers in care were reported. The proportion of children reported to CPS for maltreatment declined over time, from 63% of children born to mothers in foster care in 2009, to 46% in 2012. The LCA documented three distinct classes of mother-child dyads with varying risk of report. More than one third of children in Class 1 and nearly 70% of children in Class 3 were reported.ConclusionsThis study was the first to develop multi-dimensional class profiles of two-generation CPS involvement among mother-child dyads. This study documents that mothers’ experiences in care and mental health conditions vary widely, underscoring the importance of providing services that fit the needs of dyads.     

Outpatient mental health services for children in foster care: a national perspective

OBJECTIVE: To determine factors influencing the use of outpatient mental health services provided by mental health professionals (OMHS) for children in foster care using a national probability sample in the United States. METHOD: As part of the National Survey of Child and Adolescent Well-being, detailed survey data were collected on 462 children, ages 2-15, who had been in out-of-home care for approximately 12 months at the time of sampling. A multivariate logistic regression model was used to determine how clinical need, as measured by a Total Problem, Externalizing, or Internalizing Scale T-score of 64 or greater on the Achenbach Child Behavior Checklist (CBCL), and non-clinical factors affected OSMHS use. RESULTS: Over half of the children in the sample received at least one OMHS. Need, older age, and history of sexual abuse history all positively predicted OMHS. A history of physical neglect negatively predicted OSMHS. African-Americans used fewer services than children of Caucasian ancestry at all values on the CBCL. This finding was particularly salient at lower levels of CBCL scores; at higher levels, the discrepancy in the use of services diminished but the proportion of children receiving services remained lower for African-American children. CONCLUSIONS: This national study confirms previous findings regarding the use of mental health services based on regional data. Limitations in the use of services imposed by non-clinical factors, specifically, age, race/ethnicity and type of abuse, need to be examined in order to address implicit and explicit policies and practices that may result in inequitable distribution of services.     

The relation between dimensions of maltreatment,placement instability,and mental health among youth in foster care

Youth in foster care with maltreatment experiences often demonstrate higher rates of mental and behavioral health problems compared to youth in the general population as well as maltreated youth who remain at home. Previous research has demonstrated that dimensions of maltreatment (type, frequency, and severity) and placement instability are two prominent factors that account for high rates of psychopathology (e.g., depression, anxiety, and disruptive behavior disorders). The present study sought to clarify the relation between maltreatment and mental health among youth in foster care by studying both the isolated dimensions of maltreatment and cumulative maltreatment, and to determine whether the effects of maltreatment on mental health operated indirectly through placement instability. Information on youth in foster care’s (N = 496, M_age = 13.14) mental and behavioral health, maltreatment history, and placement changes were obtained from state records and primary caregivers. Using a SEM framework, the results suggest that maltreatment and placement instability each independently relate to mental and behavioral health problems. Further, none of the maltreatment types predicted greater placement instability in the current models. These findings suggest that placement stability is critical for mental health for youth in foster care, regardless of the type, severity, or frequency of their maltreatment experiences. Results also indicated that, although cumulative maltreatment predicted both internalizing and externalizing symptoms, maltreatment frequency and severity had direct relations to externalizing symptoms only. These findings underscore the utility of comprehensive maltreatment assessment, encouraging researchers and clinicians to assess and carefully consider the relation between maltreatment dimensions and outcomes.     

Adopted and permanently placed children in education: from rainbows to reality

Children who leave care into adoption and special guardianship are often considered by schools and local authorities to have found their “happy ending.” Yet there is growing evidence that the impact of prenatal and early trauma, abuse and neglect does not disappear upon placement in a permanent family. Rates of social, emotional and mental health difficulties remain high, and the group has pronounced educational needs. Whilst having high levels of involvement with education and health services, families report significant difficulties in mobilising understanding, support and provision. In the context of growing numbers of children in England finding permanence through adoption and special guardianship, and the Department for Education’s increasing focus on addressing the needs of this group, this paper highlights the key role of Educational Psychology Services in supporting adopted and other permanently placed children by providing training, consultation, assessment, intervention and research for children and their families, their schools, and the local authorities.     

Exploring children’s perspectives of engagement with their carers using factor analysis

Positive engagement between a child and carer in out-of-home care is understood to have long-term benefits for children who have experienced abuse or neglect. This study analysed data from the ‘Views of Children and Young People in Foster Care 2009′ survey of 937 children in out-of-home care in Queensland, Australia, to identify factors that supported or hindered engagement between a child and carer. Exploratory and confirmatory factor analysis and structural regression were used. Findings suggest that children’s engagement with their carer is influenced by a range of internal and external factors including child characteristics, the care experience, contact with biological parents, and placement trajectory. Child engagement is important because it is central to positive outcomes such as placement stability in out-of-home care. Implications for policy and practice include the need for a structural response that supports building and maintaining positive child-carer relationships.