Investigating geographic variation in use of psychotropic medications among youth in child welfare

Objectives

Public Law (P.L.) 110-351, the “Fostering Connections to Success Act,” calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors.

Methods

Cross-sectional analysis of Wave 1 data for the 92 child welfare catchment areas participating in the National Survey of Child and Adolescent Well-being, a random probability sample of 2,504 children ages 2-15 years undergoing investigation for abuse and neglect. We employed multilevel regression modeling to examine the impact of catchment-level variables on medication use, controlling for child-level variables.

Results

Fifteen percent of children reported taking psychotropic medications. Rates of medication use across catchment areas ranged widely from 0 to 40%, a 40-fold difference. On multi-level logistic regression modeling, older age (p < .001), male gender (p < .001), emotional and behavioral problems (p < .001), and insurance (p = .05) were associated with psychotropic medication use at the child-level. At the catchment-level, stressful environment within the child welfare system was negatively associated with medication use. No other catchment-level variables examined were found to explain use.

Conclusions

Striking disparities in medication use exist across catchment areas in this national sample. Of the catchment variables examined, only stressful environment was related to medication use.

Practice implications

These findings highlight significant geographic variation in medication use that most likely reflect both under-use and over-reliance on psychotropic medication. The link between child welfare environment and medication use suggests the influence of systemic, as opposed to clinical, causes of variation in medication use. This requires greater implementation of organizational processes governing quality of care for this highly vulnerable population.     

The viralization of online education: Learning beyond the time of the coronavirus

PROSPECTS - In response to the global crisis resulted from the spread of the coronavirus in Brazil, many schools and universities suspended face-to-face classes and began to offer remote classes...     

Missing the Forest for the Trees

This case study examines the alignment between the Intended Curriculum, Implemented Curriculum and Achieved Curriculum of a fourth grade inquiry based unit, Food Chains and Webs. Specifically addressed are how the curriculum was modified to meet state standards, how teachers were trained, and how assessment of curricular implementation was aligned with student performance. Particular focus was placed on measuring how well students connect the findings of inquiry based lessons to larger scientific principles. Implications of this study suggest modifications necessary for effective teacher professional development and classroom practice.     

Unpacking the Treatment Contrast in the Head Start Impact Study: To What Extent Does Assignment to Treatment Affect Quality of Care?

Attending high-quality early childhood care and education (ECCE) is associated with higher cognitive and social-emotional skills, especially for children growing up in poverty, but access to high-quality ECCE is limited. This study capitalizes on the random assignment design of the Head Start Impact Study to better understand whether the randomized offer to attend Head Start, a free comprehensive child development program for low-income and at-risk children, raises the quality of ECCE in which children enroll. Multinomial logistic regression was used to isolate the intent-to-treat impacts of random assignment to Head Start on ECCE quality from impacts on enrollment in formal ECCE. Results indicate that children randomly assigned to receive Head Start (treatment), compared to children in the control group, were more likely to enroll in high-quality and, to a lesser extent, low-quality ECCE. Treatment impacts were largest at the high end of the quality distribution, were driven by increased enrollment in Head Start, and differed for 3- and 4-year-olds. These results highlight the important role of Head Start in providing high-quality ECCE for low-income children.     

Seeking a ‘critical mass’: middle-class parents’ collective engagement in city public schooling

A growing body of literature has begun to explore the individual identities, motivations, and school choices of middle-class, typically white, parents who choose to reside in socioeconomically and racially mixed central city neighborhoods. Drawing on qualitative research in three US cities, we argue that a focus on middle-class parents’ collective engagement in schooling is particularly important in under-resourced urban contexts. In these environments, we show, middle-class parents’ use of social networks often extends beyond basic information-sharing about school quality to encompass a range of activities undertaken with other families ‘like them’ who have also chosen to enroll their children in an urban public school. We find that, in some instances, middle-class parents’ collective actions can benefit an entire class or school. Yet in other instances, their activation of social capital can contribute to processes of social reproduction in urban schooling by excluding or marginalizing low-income students and their families.     

Body physique and proportionality of Brazilian female artistic gymnasts

This study aimed to identify physique characteristics (anthropometry, somatotype, body proportionality) of Brazilian female artistic gymnasts, and to compare them across competitive levels (sub-elite versus non-elite) within competitive age-categories. Two hundred forty-nine female gymnasts (68 sub-elite; 181 non-elite) from 26 Brazilian gymnastics clubs, aged 9–20 years and split into four age-categories, were sampled. Gymnasts were assessed for 16 anthropometric traits (height, weight, lengths, widths, girths, and skinfolds); somatotype was determined according to Heath-Carter method, body fat was estimated by bioimpedance, and proportionality was computed based on the z-phantom strategy. Non-elite and sub-elite gymnasts had similar values in anthropometric characteristics, however non-elite had higher fat folds in all age-categories (P < 0.01). In general, mesomorphy was the salient somatotype component in all age-categories, and an increase in endomorphy, followed by a decrease in ectomorphy across age was observed. Regarding proportionality, profile similarity was found between sub-elite and non-elite within age-categories. In conclusion results suggest the presence of a typical gymnast’s physical prototype across age and competitive level, which can be useful to coaches during their selection processes in clubs and regional/national teams.     

Skeletal maturation,fundamental motor skills and motor coordination in children 7–10 years

Relationships between skeletal maturation and fundamental motor skills and gross motor coordination were evaluated in 429 children (213 boys and 216 girls) 7–10 years. Skeletal age was assessed (Tanner-Whitehouse 2 method), and stature, body mass, motor coordination (Körperkoordinations Test für Kinder, KTK) and fundamental motor skills (Test of Gross Motor Development, TGMD-2) were measured. Relationships among chronological age, skeletal age (expressed as the standardised residual of skeletal age on chronological age) and body size and fundamental motor skills and motor coordination were analysed with hierarchical multiple regression. Standardised residual of skeletal age on chronological age interacting with stature and body mass explained a maximum of 7.0% of the variance in fundamental motor skills and motor coordination over that attributed to body size per se. Standardised residual of skeletal age on chronological age alone accounted for a maximum of 9.0% of variance in fundamental motor skills, and motor coordination over that attributed to body size per se and interactions between standardised residual of skeletal age on chronological age and body size. In conclusion, skeletal age alone or interacting with body size has a negligible influence on fundamental motor skills and motor coordination in children 7–10 years.     

Governance structure and standard setting in educational assessment

ABSTRACT

Seldom have comparative studies of educational assessment systems been undertaken, especially regarding their standard setting procedures. This study examines the effects of governance structures on the power relations in standard setting in the dominant school-leaving or university-entrance examinations. We present acritical analysis of the published research and policy documents, including sense-checking with senior assessment practitioners from 22 jurisdictions. The nature of standard setting systems in three cases of Ireland, the USA and India are described in detail to showcase the differences between the following three models of governance systems: nationalised, commercial market and quasi-market. The contribution of this article, then, is to describe the three models of governance systems, to classify the 22 jurisdictions using the three models, and to generate propositions inductively. Thus, the article provides aconceptual basis for extension of this work to other cases to advance the literature cumulatively by theory-building.