Hewitt B. Clark

Children lost within the foster care system: Can wraparound service strategies improve placement outcomes?

The proportion of children with emotional and behavioral disturbances within the foster care system in the United States is continuing to increase. Many of these children experience numerous placement changes each year, often into extremely restrictive settings. The Fostering Individualized Assistance Program (FIAP) study examined the feasibility of applying a wraparound strategy to these children and their foster, biological and/or adoptive families. This FIAP wraparound strategy paralleled the foster care system and involved the clinical case management of a broad range of individually tailored services, driven by a wraparound team of adult key players in each childs life. This was a controlled study which involved the random assignment of 132 children (ages 7–15 years) to the FIAP wraparound group or to a group that received usual foster care services. We provide a description of the FIAP wraparound intervention and findings that support the efficacy of this strategy in improving the placement outcomes for children lost in the foster care system. Discussion focuses on systemic and intervention factors that may be improved upon to strengthen future individualized wraparound processes and evaluation/research efforts.

Improving Adjustment Outcomes For Foster Children With Emotional And Behavioral Disorders Early Findings From A Controlled Study On Individualized Services

This study was a community-based, controlled experiment to evaluate the efficacy of the Fostering Individualized Assistance Program (FIAP), which was driven by permanency (i.e., a stable placement in a supportive family) and family-focused values and involved the wrapping of services around children, based on their individual needs and those of their families. The services and supports were intensely case managed to ensure that these could be adjusted as childrens situations and needs changed. The study involved a comparison of 132 children in foster care with, or at risk for, emotional and behavioral disorders, who were randomly assigned to the FIAP program or to a group that received standard-practice foster care. A description of the FIAP intervention and a report of preliminary results that support the efficacy of the FIAP strategy in improving the emotional and behavioral adjustment of children in foster care are presented.

Preventing relapse in obesity through posttreatment maintenance systems: comparing the relative efficacy of two levels of therapist support.

The present study compared the relative effectiveness of a therapist-supported maintenance condition with a minimal contact maintenance condition in preventing relapse following an obesity treatment program. Thirty-two subjects who completed an initial 12-week cognitive/behavioral plus aerobic exercise treatment program were matched on absolute weight loss and randomly assigned to one of two maintenance conditions. Subjects were assessed at pretreatment, posttreatment, and 3, 6, and 12 months following posttreatment using measures of weight, blood pressure, and depression. Three- and six-month follow-up results indicated that subjects who participated in the therapist-supported maintenance group continued to lose weight and/or maintained therapy-induced weight loss to a greater degree than control subjects. At the 12-month follow-up assessment therapist-supported subjects maintained therapy-induced weight loss better than the control subjects. These findings suggest that maintenance programs which provide continued contact emphasizing relapse prevention training may be an important adjunct in the maintenance of therapy-induced weight loss.

Transition from School to Adult Life: Empowering Youth Through Community Ownership and Accountability

The evolution of transition services for youth with disabilities illustrates the transformation that has occurred from a systems-driven to a youth-centered support approach. This article documents how this shift has occurred. We review research that has influenced the direction of national policies and practices. A chronology of the policies that best represent the seminal foundation for current transition best practices for youth with emotional disturbance (ED) is presented. The field of special education led the way toward articulating the new vision for providing transition support by defining services as the coordination of multiple systems to address life domains (e.g., post-secondary education, employment, independent living, and community adjustment). Promising practices, within the context of the conversion to an ecological model of support that contributes to youth self-determination, include utilization of a youth-centered, strengths-based approach to transition planning, beginning in the middle school years. There remain significant barriers to adoption of the practices that may best support the successful transition of youth. These include lack of coordinated efforts across systems, socioeconomic, and community factors. Committed actions by government, the business sector, and private citizens are essential to address these challenges.

Transition to Adult Roles for Students With Emotional/Behavioral Disturbances A Follow-Up Study of Student Exiters From Steps-to-Success

Transition from adolescence to adulthood is especially challenging for youth and young adults with emotional/behavioral disturbances (EBD). The Transition to Independence Process (TIP) model serves to prepare and facilitate youth and young adults with EBD in their transition into adulthood roles through a person-centered and developmentally appropriate process. Using existing state and program data, this study compared the postsecondary outcomes (e.g., employment, postsecondary education, incarceration) of exiters from the Steps-to-Success Program, a TIP-based system serving secondary school students, to those of matched comparison groups of (a) other young adults with EBD who had services as usual and (b) young adults with no previous classification. Our results demonstrated the efficacy of the Steps-to-Success Program in improving postsecondary outcomes for youth with EBD.

Predicting Improvement of Transitioning Young People in the Partnerships for Youth Transition Initiative: Findings from a Multisite Demonstration

Prior research has indicated that young people with serious mental health conditions show poorer progress and greater challenges in the transition to adulthood, as reflected by lower rates of employment and postsecondary education, higher rates of criminal justice involvement, and greater interference in daily activities from mental health and substance use disorders. Little knowledge exists, however, regarding improvement on these indicators among young people enrolled in community-based transition support programs and individual characteristics that might moderate this improvement. This study describes rates of improvement on indicators of transition progress and challenges among young people enrolled in a multisite demonstration of transition support programs. Young people in the study showed increased rates of progress and decreased rates of challenges over four quarters of enrollment. Moderation of these changes by individual characteristics including demographic, historical, and diagnostic variables suggested ways of improving transition support programs and avenues for future research.

Social Problem-Solving Training for Severely Emotionally and Behaviorally Disturbed Children

A 15-lesson social problem-solving training program was developed and implemented with 25 severely disturbed children enrolled in a special day treatment school. Trained children generated significantly more alternative solutions at posttesting than did matched control youngsters. Follow-up analyses indicated a larger number of antisocial responses from trained as opposed to untrained children. No adjustment differences were found at posttesting. Issues related to generalization of skill acquisition from the cognitive to behavioral domain are discussed.

Employment and Social Outcomes Associated with Vocational Programming for Youths with Emotional or Behavioral Disorders

The authors examined the different types and amounts of vocational programming received by secondary students with emotional or behavioral disorders (E/BD) and their postschool outcomes, including graduation status, earnings, use of public assistance, and contact with the Department of Corrections. Generic vocational education and on-the-job-training had significant positive relationships with total earnings, whereas occupationally specific vocational education did not have any significant relationships with total earnings. All types of vocational education had inverse significant relationships with the dropout rate. Vocational education had no beneficial relationships with the use of public assistance or with contact with the Department of Corrections. The authors conclude that students with E/BD should be encouraged to have some type of vocational education in secondary school, although occupationally specific vocational education did not appear to have as many significant relationships as the other two types of vocational education.

Case management of pregnant and parenting female crack and polydrug abusers

The increasing use of crack-cocaine among addicted women and subsequent births of polydrug-exposed infants prompted the State of Florida to undertake initiatives to seek solutions to these problems. This study, focused on one of these initiatives, explored the relationship between service components of a comprehensive treatment program and substance-free time among 120 African American and Caucasian crack-cocaine addicted women. Findings from a multiple regression analysis indicated that aftercare management (p < .0001), vocational services (p < .02), and residential treatment (p < .03) were statistically significant services associated with substance-free time. Although these findings are not conclusive, they are supportive of a growing body of literature that suggests that crack-using and polydrug-using women can be responsive to treatment when it is tailored to their individual needs and includes long-term community support.

The effects of feedback and contingent reinforcement on the exercise behavior of chronic pain patients.

&NA; The purpose of this study was to increase knowledge through research in the area of operant management of chronic back pain, using a strong experimental design. Reinforcement was made contingent on rate of walking, and feedback about progress was provided at certain intervals during each observation session. The changing criterion experimental design for a single subject indicated important systematic increases in walking rate, while the no‐reinforcement and non‐contingent reinforcement procedures produced no systematic effect. Pre‐post ratings showed an average decrease in reported pain.