Dana K. Smith

Placement Disruption in Treatment Foster Care

Rates of placement disruption in traditional and treatment foster care are reviewed. Contextual factors, individual child and caregiver characteristics, and risk factors thought to influence rates of placement disruption are explored. A model for treatment foster care is described, and data are presented on disruption rates for this program. The results indicated that the likelihood of placement disruption is two times higher during the first 6 months (17.8%) compared to the second 6 months (9.2%) of treatment.Taken together across the first and second 6 months of treatment, 23 of 90 youth (25.5%) experienced a placement disruption. Findings indicate that age and gender play a role in disruption, with older girls at the greatest risk for placement disruption. Limitations of the study, future directions,and implications for treatment are discussed.

Child maltreatment and foster care: unpacking the effects of prenatal and postnatal parental substance use

Parental substance use is a well-documented risk for children. However, little is known about specific effects of prenatal and postnatal substance use on child maltreatment and foster care placement transitions. In this study, the authors unpacked unique effects of (a) prenatal and postnatal parental alcohol and drug use and (b) maternal and paternal substance use as predictors of child maltreatment and foster care placement transitions in a sample of 117 maltreated foster care children. Models were tested with structural equation path modeling. Results indicated that prenatal maternal alcohol use predicted child maltreatment and that combined prenatal maternal alcohol and drug use predicted foster care placement transitions. Prenatal maternal alcohol and drug use also predicted postnatal paternal alcohol and drug use, which in turn predicted foster care placement transitions. Findings highlight the potential integrative role that maternal and paternal substance use has on the risk for child maltreatment and foster care placement transitions.

Adolescent Girls’ Offending and Health-Risking Sexual Behavior: The Predictive Role of Trauma

Several studies have highlighted high levels of risk for girls who have been exposed to traumatic experiences, but little is known about the exact relationship between traumatic experiences and problems with delinquency and health-risking sexual behavior (e.g., precipitory and/or exacerbatory roles). However, numerous short- and long-term detrimental effects have been linked to trauma, delinquency, and health-risking sexual behavior. The utility of diagnostic and experiential trauma measures in predicting the greatest risk for poor outcomes for delinquent girls was examined in this study. Results indicate that the experiential measures of trauma (cumulative and composite trauma scores) significantly predicted adolescent offending and adolescent health-risking sexual behavior, whereas the diagnostic measures of trauma (full and partial diagnostic criteria) did not.

Preliminary Support for Multidimensional Treatment Foster Care in Reducing Substance Use in Delinquent Boys.

Although effective outpatient treatments have been identified for the well-documented negative outcomes associated with delinquency and substance use, effective treatments for youths in out-of-home care are rare. In this study, 12- and 18-month substance use outcomes were examined for a sample of 79 boys who were randomly assigned to Multidimensional Treatment Foster Care (experimental condition) or to group care (comparison condition). The boys in the experimental condition had lower levels of self-reported drug use at 12 months, and lower levels of tobacco, marijuana, and other drug use at 18 months. Limitations and future directions are discussed.

Preventing Internalizing and Externalizing Problems in Girls in Foster Care as They Enter Middle School: Impact of an Intervention

Girls in foster care have been shown to be at risk for emotional and behavioral problems, especially during the preadolescent and adolescent years. Based on these findings and on the lack of research-based preventive interventions for such youths, the current study examined the impact of an intervention targeting the prevention of internalizing and externalizing problems for girls in foster care prior to middle school entry. Study participants included 100 girls in state-supported foster homes who were randomly assigned to an intervention condition or to a control condition (foster care services as usual). The intervention girls were hypothesized to have fewer internalizing problems, fewer externalizing problems, and more prosocial behavior at 6-months post-baseline compared to the control girls. The results confirmed the hypotheses for internalizing and externalizing problems, but not for prosocial behavior. Limitations and future directions are discussed.

Risk, Reinforcement, Retention in Treatment, and Reoffending for Boys and Girls in Multidimensional Treatment Foster Care

In this study, the author examined the impact of youth and family preplacement risk factors on multidimensional treatment foster care (MTFC) parent—youth interactions,youth treatment completion, and outcomes for boy and girl adolescents who have problems with chronic delinquency. In particular, she looked at (a) how levels of preplacement youth and family risk factors for chronically delinquent boys and girls who were treated with MTFC affect parent—youth interactions during treatment, (b) how these interactions and preplacement youth and family risk factors relate to treatment completion for boys and girls, and (c) how treatment completion for girls and boys affects reoffending behavior during the 12 months postplacement. As hypothesized, results indicated higher levels of preplacement youth and family risk for girls compared with boys; however, contrary to the authors hypothesis, levels of preplacement youth and family risk were not found to have a significant impact on MTFC parent—youth interactions.As expected, MTFC parent—youth interactions were significantly related to treatment completion, and treatment completion was significantly related to lower rates of reoffending behavior for both boys and girls.Treatment components specific to MTFC are reviewed and directions for future research are suggested.

Multidimensional Treatment Foster Care as an Intervention for Juvenile Justice Girls in Out-of-Home Care

In the last decade, service providers are increasingly aware of the need for interventions to address the unique service challenges of girls referred from the juvenile justice system that male-oriented treatments are not particularly well-suited to address (see Part III). The focus of this chapter is on a family-based intervention, Multidimensional Treatment Foster Care (MTFC; Chamberlain 2003), that was originally developed for males from juvenile justice as an alternative to group and residential care. During the last 15 years, MTFC was adapted to fit the treatment needs of girls and was tested in two continuously run randomized clinical trials. In this chapter, we present (a) an overview of the MTFC model, focusing on modifications made for girls; (b) a description of two studies focused on evaluating the efficacy of MTFC with girls in the juvenile justice system; and (c) a summary of results from the completed trials demonstrating the efficacy of MTFC as compared to treatment in group/residential care (representing services as usual for girls with severe delinquency referred from the juvenile justice system). A range of results are presented, including re-offending rates, time spent in locked settings, self-reported delinquency, and pregnancy rates. Clinical implications for the treatment and prevention of delinquency in girls are discussed.

Adapting Multidimensional Treatment Foster Care for the Treatment of Co-occurring Trauma and Delinquency in Adolescent Girls

Girls in the juvenile justice system have been found to experience high rates of traumatic childhood events. Despite the well-documented coexistence of trauma and delinquency, few programs integrate the treatment of both disorders. Because of the lack of intervention studies addressing co-occurring trauma and delinquency and the lack of data about how these disorders impact each other, there is limited information about how to best treat these disorders when they co-occur. The current article provides a theoretical rationale for adapting a community-based intervention, Multidimensional Treatment Foster Care, to treat adolescent girls with co-occurring trauma and delinquency, describes the intervention approach, and presents outcomes from a small-scale pilot study.

Adolescent Onset of Maternal Substance Abuse: Descriptive Findings From a Feasibility Trial

Although maternal substance abuse in child welfare populations is a well-documented occurrence, little is known about the onset of these behaviors or the substance abuse histories of these mothers. Descriptive data from a small feasibility trial of mothers referred for substance abuse and child neglect suggest adolescent onset of hard substance use. Age of onset was associated with family history of use. The majority of mothers reported polysubstance abuse starting at an early age and quickly escalating patterns of behavior, including intravenous drug use. Implications for prevention efforts for children of families identified with substance abuse problems are discussed.

Female Juvenile Offenders

Over the last decade, there has been increasing recognition by researchers and policymakers of the serious problem of antisocial and criminal behavior committed by adolescent females (Pepler et al. 2005; Prescott 1998; Putallaz and Bierman 2004). This is largely due to a recent increase in the prevalence of arrest rates among this population. According to the most recent data, females make up 30% of all juvenile arrests (Puzzanchera 2009), which is nearly a 50% increase from the 1 in 5 rate of the early 1990s (Snyder 2008). The poor outcomes associated with girls’ offending behavior are significant, and include behaviors such as ongoing engagement in criminal offending, drug use, adolescent childbearing, and mental health problems (Chamberlain et al. 2007; Kerr et al. 2009; Miller-Johnson et al. 1998; Underwood et al. 1996; Teplin et al. 2002). It is therefore of high public health significance to better understand the characteristics and outcomes of female juvenile offenders, and to develop and rigorously test intervention approaches for these young women.