Heather N. Taussig

Interventions to prevent child maltreatment and associated impairment

Although a broad range of programmes for prevention of child maltreatment exist, the effectiveness of most of the programmes is unknown. Two specific home-visiting programmes-the Nurse-Family Partnership (best evidence) and Early Start-have been shown to prevent child maltreatment and associated outcomes such as injuries. One population-level parenting programme has shown benefits, but requires further assessment and replication. Additional in-hospital and clinic strategies show promise in preventing physical abuse and neglect. However, whether school-based educational programmes prevent child sexual abuse is unknown, and there are currently no known approaches to prevent emotional abuse or exposure to intimate-partner violence. A specific parent-training programme has shown benefits in preventing recurrence of physical abuse; no intervention has yet been shown to be effective in preventing recurrence of neglect. A few interventions for neglected children and mother-child therapy for families with intimate-partner violence show promise in improving behavioural outcomes. Cognitive-behavioural therapy for sexually abused children with symptoms of post-traumatic stress shows the best evidence for reduction in mental-health conditions. For maltreated children, foster care placement can lead to benefits compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefits for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures.

Risk behaviors in maltreated youth placed in foster care: a longitudinal study of protective and vulnerability factors

OBJECTIVE Few studies have examined the impact of placement in foster care prospectively to determine what early responses might predict later functioning. The current study examined protective and vulnerability factors in a longitudinal study of youth placed in foster care. METHODOLOGY A cohort of 214 ethnically-diverse youth, ages 7-12, who entered foster care between May 1990 and October 1991 were recruited for the Time 1 study if they remained in foster care for at least 5 months. For the Time 1 study, youth and their caregivers were interviewed and assessed approximately 6 months following their initial placement. Six years later, as adolescents, the youth were re-interviewed regarding their involvement in four domains of risk behavior. RESULTS Bivariate analyses indicated that several Time 1 control variables (e.g., age, ethnicity, type of maltreatment, behavior problems) and Time 1 psychosocial predictor variables (i.e., dimensions of social support and self-perception) were related to the Time 2 risk behavior outcomes. Regression analyses with all variables accounted for between 33 and 46% of the variance, with the psychosocial predictor variables, as a group, significant over and above the control variables. CONCLUSIONS The results suggest that there are some modifiable protective and vulnerability factors present shortly after maltreated youth are placed in foster care that predict their engagement in adolescent risk behaviors 6 years later.

Impact of a Mentoring and Skills Group Program on Mental Health Outcomes for Maltreated Children in Foster Care

OBJECTIVE To evaluate the efficacy of the Fostering Healthy Futures program in reducing mental health problems and associated problems. DESIGN Randomized controlled trial. SETTING Denver metropolitan area. PARTICIPANTS Children aged 9 to 11 years who were maltreated and placed in foster care. INTERVENTION Children in the control group (n=77) received an assessment of their cognitive, educational, and mental health functioning. Children in the intervention group (n=79) received the assessment and participated in a 9-month mentoring and skills group program. MAIN OUTCOME MEASURES Children and caregivers were interviewed at baseline prior to randomization, immediately following the intervention, and 6 months after the intervention. Teachers were interviewed 2 times after baseline. Measures included a multi-informant index of mental health problems, youth-reported symptoms of posttraumatic stress, dissociation, and quality of life, and caregiver- and youth-reported use of mental health services and psychotropic medications. RESULTS After adjusting for covariates, intent-to-treat analyses demonstrated that the treatment group had fewer mental health problems on a multi-informant factor 6 months after the intervention (mean difference, -0.51; 95% confidence interval, -0.84 to -0.19), reported fewer symptoms of dissociation 6 months after the intervention (mean difference, -3.66; 95% confidence interval, -6.58 to -0.74), and reported better quality of life immediately following the intervention (mean difference, 0.11; 95% confidence interval, 0.03 to 0.19). Fewer youths in the intervention group than in the control group had received recent mental health therapy 6 months after the intervention according to youth report (53% vs 71%, respectively; relative risk=0.75; 95% confidence interval, 0.57 to 0.98). CONCLUSIONS A 9-month mentoring and skills group intervention for children in foster care can be implemented with fidelity and high uptake rates, resulting in improved mental health outcomes. Trial Registration clinicaltrials.gov Identifier: NCT00809315.

Cumulative risk exposure and mental health symptoms among maltreated youth placed in out-of-home care

OBJECTIVE Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study was to elucidate the relation between cumulative risk and mental health symptomatology. METHODS The study consisted of a sample of 252 maltreated youths (aged 9-11) placed in out-of-home care. RESULTS Analyses confirmed the high-risk nature of this sample and identified seven salient risk variables. The cumulative risk index comprised of these seven indicators was a strong predictor of mental health symptoms, differentiating between children who scored in the clinical range with regard to mental health symptoms and those who did not. Finally, the data supported a linear model in which each incremental increase in cumulative risk was accompanied by an increase in mental health problems. CONCLUSION This is the first known study to examine cumulative risk within a sample of youths in out-of-home care.

Emotional Maltreatment and Psychosocial Functioning in Preadolescent Youth Placed in Out-of-Home Care

This article examines the impact of emotional maltreatment on the psychosocial functioning of youth placed in out-of-home care as a result of maltreatment. Participants included 243 children participating in a randomized controlled trial of a preventive intervention for preadolescent youth placed in out-of-home care. This study analyzed baseline data collected prerandomization from interviews with children and their out-of-home caregivers and data from child welfare records. Bivariate and regression analyses were used to explore the relationships between emotional maltreatment and interpersonal functioning, self-perception, mental health, and behavioral problems for the total sample and by gender. Findings suggest that subtypes of emotional maltreatment are associated with different outcomes and that males are more negatively impacted by emotional maltreatment than are females.

The relationship between time spent living with kin and adolescent functioning in youth with a history of out-of-home placement

OBJECTIVE Many children in the US who are court-ordered to live in out-of-home care are placed with kinship caregivers. Few studies have examined the impact of living with kin on child well-being. This study examined the relationship between length of time living with kin and indices of adolescent well-being in a cohort of children who were initially court-ordered into out-of-home care. METHODS Prospective cohort design with 148 youth, ages 7-12, who entered out-of-home care between May, 1990, and October, 1991. Seventy-five percent of those interviewed at T1 (6 months following placement) were interviewed at T2 (5 years later). RESULTS Bivariate analyses did not demonstrate significant relationships between length of time living with kin and the outcome variables. In multivariate analyses, longer length of time living with kin was related to: (1) greater involvement in risk behaviors including: delinquency (β=.22, p<.05), sexual risk behaviors (β=.31, p<.05), substance use (β=.26, p<.05), and total risk behaviors (β=.27, p<.05), and (2) poorer life-course outcomes including: Tickets/Arrests (OR=1.4, p<.05) and lower grades (β=-.24, p<.05). Time living with kin was not related to total competence, or self-destructive, internalizing, externalizing, or total behavior problems. There were trends (p<.10) for time living with kin to predict greater trauma symptomatology (β=.17) and suspensions (OR=1.1). CONCLUSIONS There were no significant bivariate findings. The multivariate findings suggested a pattern of poorer functioning for youth who spent more time living with kin. No differences were found in current symptomatology. PRACTICE IMPLICATIONS Although findings from a single study should not dictate changes in practice or policy, the current studys findings do suggest that the field needs to conduct more methodologically sophisticated research on the impact of kinship care.

Does community violence exposure predict trauma symptoms in a sample of maltreated youth in foster care

Previous studies find that childhood exposure to family and community violence is associated with trauma symptoms. Few studies, however, have explored whether community violence exposure (CVE) predicts trauma symptoms after controlling for the effects associated with family violence exposure (FVE). In the current study, CVE and FVE were examined in a sample of 179 youth with a recent history of maltreatment. CVE was associated with trauma symptoms after controlling for FVE, but FVE was not associated with trauma symptoms after controlling for CVE. In addition, negative coping strategies (e.g., self-harm, interpersonal aggression) partially mediated the association between CVE and trauma symptoms. These findings are discussed in terms of their implications for interventions aimed at addressing the needs of children exposed to violence.

RCT of a mentoring and skills group program: placement and permanency outcomes for foster youth.

OBJECTIVE: To examine the impact of a mentoring and skills group intervention for preadolescent children in foster care on placement stability and permanence at 1-year postintervention. METHODS: A randomized controlled trial was conducted with 9- to 11-year-old children who were maltreated and placed in foster care (n = 54 control; n = 56 intervention). State child welfare records provided information on number of placement changes, placement in residential treatment, and case closure (ie, permanency). Rates of adoption and reunification were also examined. Analysis was by intention to treat. RESULTS: After controlling for baseline functioning and preintervention placement history, intervention youth were 71% less likely to be placed in residential treatment (odds ratio [OR] = 0.29, 95% confidence interval [CI] 0.09–0.98). There were no significant treatment differences in predicting placement changes or permanency for the total sample. Among a subsample of children living in nonrelative foster care at baseline, intervention youth had 44% fewer placement changes (incidence ratio = 0.56, 95% CI 0.34–0.93), were 82% less likely to be placed in a residential treatment center (OR = 0.18, 95% CI 0.03–0.96), and were 5 times more likely to have attained permanency at 1 year postintervention (OR = 5.14, 95% CI 1.55–17.07). More intervention youth had reunified 1-year postintervention [χ2(1, N = 78) = 3.99; P < .05], and the pattern of findings suggested that intervention youth had higher rates of adoption. A significant interaction [χ2(1, N = 110) = 5.43; P = .02] demonstrated that the intervention attenuated the impact of baseline behavior problems on placement changes. CONCLUSIONS: The findings suggest that participation in a 9-month mentoring and skills group intervention leads to greater placement stability and permanence, especially for children in nonrelative foster care.

Self- and other-directed destructive behaviors: assessment and relationship to type of abuse

An accumulation of empirical evidence suggests that abused children are more likely to engage in destructive behaviors than are their nonmaltreated peers. This study explored whether type of abuse experienced (i.e., sexual vs. physical) was related to the type of destructive behavior displayed by children who had been placed in foster care. Results indicated that physically abused youth reported engaging in more other-directed destructive behaviors than did sexually abused youth. Sexually abused children reported engaging in more self-than other-directed destructive behaviors. Although non-significant, this same pattern of findings was observed in parental reports. When examining these relationships within gender, similar results were obtained. The results suggest that the type of destructive behavior is differentially related to the type of abuse experienced. Further study is needed to clarify the relationship between the type of abuse and the type of destructive behaviors.

Suicidality Among Preadolescent Maltreated Children in Foster Care

This study sought to determine the prevalence of suicidal ideation, plans, and attempts among 515 preadolescent (aged 9–11 years) maltreated children who entered foster care within the prior year. Over a quarter (26.4%) of the children had a history of suicidality according to their own and/or their caregiver’s report, 4.1% of whom were imminently suicidal. In bivariate analyses, children at higher risk of suicidality tended to be younger, non-Hispanic, abused, and to have experienced multiple types of maltreatment, more referrals to child welfare, more household transitions, and a longer length of time in foster care. There were no gender differences. Multiple regression analyses found physical abuse and chronicity of maltreatment to be the most robust predictors of suicidality. It is critically important that these high-risk children are screened for suicidality before adolescence and that caregivers and professionals are informed of their risk status so that they may implement mental health treatment, monitoring, and harm reduction measures.