Janet U. Schneiderman

Pediatric Health Assessments of Young Children in Child Welfare by Placement Type.

OBJECTIVES To describe health-related problems across placement types (unrelated foster, kin foster, in-home with birth parent); to examine the association of placement and demographic/child welfare variables (child gender, age, race/ethnicity; caregiver language; type of maltreatment, and length of time receiving services from child welfare) with health-related problems. METHODS This study utilized a retrospective medical chart review of children less than 6 years old (n=449) seen at an outpatient child welfare pediatric clinic. Logistic regression modeling was used to estimate odds of having a weight, medical, or provisional developmental delay problem by placement and demographic/child welfare characteristics. RESULTS Almost 13% of children in the sample were obese (≥95% age-gender specific percentile) and more than a quarter were overweight/obese (≥85%) while only 7% were underweight (≤5%). Most children (78%) had a physical health diagnosis and 25% were provisionally identified with a developmental delay. No differences between weight diagnoses, type of medical diagnoses, and provisional developmental delay by placement type were found, although children with 3 or more medical diagnoses were more likely to be with kin (p<.05). Children 2 years old or older were more likely to be overweight/obese than children under 2 years old (p<.05) and Hispanic children were more likely to be overweight/obese than non-Hispanic children (p<.01). Length of stay in child welfare was positively related with a medical diagnosis or provisional developmental delay (p<.01). CONCLUSIONS Results argue for careful assessment of weight, medical, and developmental problems in children active to child welfare, whether residing in their home of origin, with kin, or with unrelated foster parents. The increasing problem of obesity among young children in child welfare warrants further investigation and intervention. PRACTICE IMPLICATIONS The comprehensive health examination and enhanced health maintenance schedule for children in foster care should be extended to children who remain at home with child welfare services as child welfare involvement rather than placement is related to health-related problems.

Meeting Children's Mental and Physical Health Needs in Child Welfare: The Importance of Caregivers.

Caregivers in the child welfare system are an important element in ensuring that mental and pediatric health services for their children are utilized appropriately. The high prevalence of mental and physical health problems of children in the child welfare system along with the inadequate utilization of health services make the role of caregivers essential for improving health outcomes. This article explores the barriers to meeting the health needs of this vulnerable population of children and how different types of caregivers (unrelated foster, kinship foster, and birth parents) utilize mental and pediatric health services. Child welfare caseworkers need to increase their communication with caregivers, assess adherence to health care recommendations, and help alleviate barriers to care.

Overweight and Obesity among Maltreated Young Adolescents.

PURPOSE (1) To identify and compare rates of body mass index (BMI)≥ 85% (overweight/obesity) and BMI ≥ 95% (obesity) in maltreated versus comparison young adolescents; (2) to determine whether demographic/psychological characteristics are related to high BMI; (3) to determine whether type of maltreatment is related to high BMI in maltreated young adolescents. METHODS We compared a sample of maltreated young adolescents to a comparison sample of adolescents from the same neighborhood. The maltreated sample (n=303) of young adolescents (ages 9-12) came from referrals from the county child welfare department in Los Angeles, CA from new cases of maltreatment opened in specified zip codes. A comparison sample (n=151) was recruited from the same zip codes. The total sample (both maltreated and comparison) was 77% Black or Hispanic and 23% White or biracial with 53% males and 47% females. A stepwise logistic regression was used to examine predictors of high BMI with demographic/psychological covariates and maltreatment group. The maltreated young adolescents were selected and the logistic model included all covariates as well as an interaction between gender and each maltreatment type (neglect, sexual, and physical abuse). RESULTS Maltreated young adolescents were similar to comparison adolescents in obesity prevalence (27.1% and 34.4%, respectively), although comparison young adolescents were 1.7 times more likely to have overweight/obesity than the maltreated young adolescents (95% CI=1.13-2.76). No demographic variables predicted high BMI. For the comparison young adolescents, depression slightly increased the odds of overweight/obesity (OR=1.08, 95% CI=1.01-1.15). Being neglected reduced the odds of being in the overweight/obesity and obesity group when combining genders. For females, but not males, sexual and physical abuse slightly reduced the odds of obesity. CONCLUSIONS Both the maltreated and comparison young adolescents had a high prevalence of overweight and obesity, which puts them at risk for health problems. Maltreatment reduced the odds of having a high BMI for adolescents in this study, which is opposite to research in adults. Further exploration of the mechanism of how maltreatment is related to weight as adolescents age, with specific emphasis on differences between genders, is needed.

Gang youth as a vulnerable population for nursing intervention.

BACKGROUND Gang youth often come from socially and economically marginalized communities. Such youth report significantly higher rates of participation in violence, substance use, and risky sexual behaviors than their nongang peers. AIMS This manuscript argues that gang-identified youth constitute a vulnerable population. MATERIALS AND METHODS Data are drawn from the general research literature and a case example of how a nurse in Los Angeles partnered with law enforcement to provide preventive health care to gang youth and youth at-risk for joining gangs. CONCLUSION Gang youth are a vulnerable population amenable to nursing intervention. Gang youth may have particular health care needs and may need special access to health care.

Health issues of children in foster care.

Abstract Community health nurses provide care to children in foster care. Nurses who understand the health needs of the foster care population are better prepared to assess health status, provide appropriate services and evaluate the care. The health needs of these children are related to the reason for their placement in foster care, the lack of continuity of caregivers, and the health care systems available. The health issues are especially acute in the United States where the number of children in foster care has reached over 500,000. (Leslie et al., 2000) The health issues include chronic physical problems, developmental delays, and especially, mental health issues.

Characterizing the sexual abuse experiences of young adolescents

The purpose of this descriptive study was to: (a) compare the demographics of maltreated youth initially labeled as sexually abused by the Department of Child and Family Services (DCFS) to maltreated youth classified as sexually abused using current and past case records, (b) identify differences in sexual abuse experiences and types of perpetrators between boys and girls, and (c) provide a detailed description of the sexual abuse experiences for boys and girls. Participants were youth ages 9-12 years old with a recent maltreatment allegation. The Maltreatment Case Record Abstraction Instrument (MCRAI) was used to code child welfare records of 303 maltreated youth of whom 60 experienced sexual abuse. Perpetrators were classified by gender into four categories (biological parent, parental figure, relative, and unrelated) and type of abuse was classified into three categories (penetrative, contact without penetration, and non-contact). Using Chi-Square tests, perpetrator categories and sexual abuse types were compared by child gender for significant differences. Only 23 (38.3%) of the 60 sexually abused youth were labeled as sexually abused in the most recent DCFS report when they entered the study. About three-quarters of the sexually abused youth experienced non-penetrative physical contact, 40% experienced penetration, and 15% experienced sexual abuse without physical contact. Most youth (91.7%) were victimized by a male, and 21.7% were abused by a female. Youth experienced a large range of sexual abuse experiences, the details of which may be important for exploration of consequences of childhood sexual abuse.

Child Maltreatment and Sexual Risk Behavior: Maltreatment Types and Gender Differences.

Objective: To compare sexual risk behaviors in maltreated male and female sexually active adolescents with a comparison population and examine whether specific maltreatment experiences were associated with sexual risk behaviors and teen pregnancy. Method: Data came from the fourth assessment (M = 7.2 years after baseline) of an ongoing longitudinal study with case-control design. The sample was restricted to only the sexually active adolescents, leaving a sample of 251 (n = 82 comparison, n = 169 maltreated, mean age = 18.49 years, SD = 1.46). Maltreatment type was coded from case records, and sexual behaviors were assessed via computerized questionnaire. Results: Maltreated youth were significantly younger at first consensual intercourse than comparison youth, and males were younger than females. Maltreated males reported significantly higher number of lifetime sexual partners than maltreated females. Neglected, sexually abused, and physically abused youth were more likely to have had a one-night stand than comparison youth. Sexually abused females were at higher risk of having sex under the influence than other maltreated females. Neglected females were more likely to have ever been pregnant than females with other maltreatment types or comparison females. A higher number of maltreatment victimizations predicted a younger age at first pregnancy involvement for both sexes. Conclusion: Many maltreated youth continue to be at high risk for engaging in behaviors that may initiate a trajectory of problematic sexual behaviors. The findings highlight maltreated males and neglected females as vulnerable groups that should be targeted in prevention efforts to curtail sexual risk behaviors and prevent teenage pregnancy.

The Health of Children in Foster Care

This qualitative study of school nurses describes what the nurses want to do for school children in foster care, what they are actually doing, and how the school organization affects the provision of care. The study looked at the nurses’ practice through the lens of the Social Ecological Model of Health, identified interventions using the Minnesota Public Health Intervention Model, and analyzed the school organization using the Bolman-Deal Model (Bolman & Deal, 1997). A purposive sample of nurses was chosen to participate in interviews, and observations of their work and a survey on the frequency of their interventions was implemented. Interviews were analyzed using a phenomenological approach. Four themes derived from the data included structural barriers to client access, nonrecognition of the broad determinants of health, isolationism, and lack of political power. School nurses are aware of foster children’s increased health care needs, yet increased services are not provided as a result of a lack of organizational support.

Body mass index trajectory throughout adolescence: a comparison of maltreated adolescents by maltreatment type to a community sample

Childhood maltreatment is associated with adult obesity, but there is conflicting evidence regarding the relationship between childhood maltreatment and obesity during adolescence.

Overweight and obesity among Hispanic children entering foster care: a preliminary examination of polyvictimization.

This retrospective medical chart review examined the prevalence of overweight/obesity (≥85th percentile) and obesity (≥95th percentile) in Hispanic foster children aged 2–18 years in Los Angeles, California. Logistic regression was used for boys and girls separately to analyze polyvictimization (i.e., one vs. two or more types of maltreatment), type of maltreatment (abuse vs. neglect), and age-group as risk factors for overweight and obesity. Almost 40% of participants were overweight/obese, with the highest prevalence (47.7%) observed among children aged 12–18. Children aged 6–18 were at an increased risk of overweight/obesity and obesity compared with children aged 2–5. Although polyvictimization has been shown to have adverse health effects, in this study, it was related to slightly lower odds of obesity for boys but was unrelated to high weight for girls. Addressing the obesity epidemic among Hispanic foster children is vital to preventing continued obesity and the development of obesity-related health problems, especially by focusing on important community and family influences.