Norín Dollard

The Use of Flexible Service Dollars in Rural Community-based Programs for Children with Serious Emotional Disturbance and Their Families

It is commonly agreed that flexible service dollars are a crucial aspect of tailoring services to meet the unique and changing needs of children with serious emotional disturbance and their families. This is particularly true in isolated rural areas. The need for a common terminology that distinguishes among the philosophy of individualized care, the programmatic components of such systems, and the types of flexible-funding mechanisms that facilitate such approaches are discussed. The uses of flexible service dollars in North Idaho and upstate New York, along with some case studies, are presented to highlight the similarities in the needs of families in both states; namely, economic supports, transportation, social-recreational, and respite services. Finally, the elements that contributed to successful use of service dollars are identified, and a call for additional research on outcomes associated with individualized care is made.

Adolescent Girls’ Use of Avoidant and Approach Coping as Moderators Between Trauma Exposure and Trauma Symptoms

High rates of child maltreatment demand attention, as exposure to child maltreatment substantially increases the risk of developing PTSD. Some evidence exists that the presence of coping skills may reduce the likelihood that victims of childhood maltreatment will develop PTSD (Agaibi & Wilson, Trauma Violence Abuse 6:195–216, 2005). This study examined whether avoidant and/or approach coping skills moderated the relationship between childhood trauma exposure and trauma symptoms among adolescent females with a history of complex trauma. Results suggest that the use of avoidant coping moderates the relationship between trauma exposure and trauma symptoms. More specifically, girls with higher levels of trauma exposure demonstrated lower levels of trauma symptoms if they reported using higher levels of avoidant coping. Clinical implications for these results are discussed.

Mental Health Needs of Poor Suburban and Rural Children and Their Families

The inverse relationship between economic status and mental illness is well established. Less is known, however, about the nature of this relationship. A comparison of poor suburban and rural youth receiving services for their emotional and behavioral problems revealed more similarities than differences. Family income increased during the first year of service for a small percentage of families. A small but significant relationship was found between increased income and caregiver strain as well as child outcomes. For families who are poor and have a child with a disability, highly individualized services and support that reduce caregiver strain are necessary to improve child outcomes.

Family Involvement in Treatment Among Youth in Residential Facilities

Youth treated in a residential treatment center (RTC) receive an array of services to address their mental health and behavioral issues, including psychotherapy and medication. Prior studies have shown that youth continue to receive a considerable number of services after discharge from a RTC. This study describes the characteristics of children and youth served in Florida’s Medicaid-funded residential treatment facilities, examines whether family involvement in treatment is associated with discharge to a family-like setting, and assesses continuity of treatment after discharge. Data for this study were obtained from the SIPP Provider Monthly Report Database from January 2005 through December 2011. These data contain information on family involvement during treatment. Post-discharge data were from Medicaid enrollment/claims files and Prepaid Mental Health Plan encounters. Results of this study suggest that family contacts for interventions and treatment planning are associated with a greater likelihood of discharge to a family-like setting. Among youth discharged to a family-like setting, family involvement during treatment was associated with receiving follow-up outpatient care. Results support the continued emphasis on including family members in the treatment of youth with mental health needs to ensure better outcomes and continuity of treatment.

Arrests among youth after out-of-home mental health treatment: Comparisons across community and residential treatment settings: Arrests among youth after out-of-home treatment

BACKGROUND There are three options in Florida for young people with mental health needs who require out-of-home treatment: community-based group homes, foster families and inpatient group facilities. Prior research has suggested that young people in group settings have poorer criminal justice outcomes, perhaps attributable to negative peer effects in group environments. AIMS To compare arrest rates during and after out-of-home treatment for youth across the three settings. To test the hypothesis that arrest rates during treatment are independently related to arrest rates after treatment, after allowing for pre-treatment characteristics and placement type. METHODS Florida Medicaid claims data were used to identify children and adolescents in out-of-home mental health care from 2003-2007. These were then matched with Florida Department of Juvenile Justice and Law Enforcement records. Propensity score matching was used to allow for observed differences between youth in different treatment settings. Multinomial logistic regression models were used to test relationships between arrest rates. RESULTS Unadjusted arrest rates for youth in therapeutic group home care were higher than in psychiatric inpatient units or foster care during and after treatment. Arrests during the treatment episode accounted for a substantial proportion of the difference in arrests after out-of-home treatment. After accounting for differences in arrest rates during treatment, the group versus non-group nature of the treatment setting per se was not a strong determinant of arrest after the treatment episode. CONCLUSIONS AND IMPLICATIONS FOR PRACTISE Attention to the causes of higher arrest rates in group homes, which may include peer contagion and staff policies, could improve outcomes. For youths without a major psychiatric disorder, therapeutic foster care may be better than community-based group care.

Profile of children placed in residential psychiatric program: association with delinquency, involuntary mental health commitment, and reentry into care

This study examined characteristics and profiles of youth receiving services in 1 of Floridas Medicaid-funded residential mental health treatment programs--State Inpatient Psychiatric Program (SIPP)--between July 1, 2004, and June 30, 2008 (N=1,432). Latent class analysis (LCA) was used to classify youth, and 3 classes were identified: Children With Multiple Needs, Children With No Caregivers, and Abused Children With Substantial Maltreatment History. The results of LCA showed that Children With Multiple Needs experienced the greatest risk for adverse outcomes. Compared with youth in the other 2 classes, these children were more likely to get readmitted to SIPP, more likely to become involved with the juvenile justice system, and more likely to experience involuntary mental health assessments. Implications of the findings are discussed.

Age, Race, and Gender Differences in Antipsychotic Medication Use Among Children Prior to Entry to Out-of-Home Care

There is growing literature examining the use of psychotropic medications and specifically antipsychotic medications among youth in the United States. This study uses administrative claims data to assess antipsychotic medication use among children prior to being served in therapeutic out-of-home care settings and whether there are utilization differences by age, race, or gender. Florida Medicaid claims data were analyzed for children and adolescents receiving out-of-home care between July 2003 and June 2006. The majority of children and adolescents in out-of-home treatment settings received antipsychotic medications prior to the therapeutic care episode, but differences existed in treatment patterns across age, gender, and racial groups. Utilization was higher among youth ages 6–12 compared to those 13–18, and was higher among males than females. Blacks are less likely to be prescribed antipsychotics, but those prescribed antipsychotics receive them for the same number of days, and for the same number of months as Whites and Hispanics. Such differences require further investigation to determine whether they result from inadequate treatment and whether treatment differences are related to outcomes.

Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program

ABSTRACT Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors’ experiences working with this population.