Samantha M. Brown

Multiple Victimizations Before and After Leaving Home Associated With PTSD, Depression, and Substance Use Disorder Among Homeless Youth

Exposure to multiple forms of maltreatment during childhood is associated with serious mental health consequences among youth in the general population, but limited empirical attention has focused on homeless youth—a population with markedly high rates of childhood maltreatment followed by elevated rates of street victimization. This study investigated the rates of multiple childhood abuses (physical, sexual, and emotional abuse) and multiple street victimizations (robbery, physical assault, and sexual assault) and examined their relative relationships to mental health outcomes (meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for post-traumatic stress disorder [PTSD], depression, and substance use disorder) among a large (N = 601) multisite sample of homeless youth. Approximately 79% of youth retrospectively reported multiple childhood abuses (two or more types) and 28% reported multiple street victimizations (two or more types). Each additional type of street victimization nearly doubled youths’ odds for meeting criteria for substance use disorder. Furthermore, each additional type of childhood abuse experienced more than doubled youths’ odds for meeting criteria for PTSD. Both multiple abuses and multiple street victimizations were associated with an approximate twofold increase in meeting depression criteria. Findings suggest the need for screening, assessment, and trauma-informed services for homeless youth who consider multiple types of abuse and victimization experiences.

Does Parent-Child Interaction Therapy Reduce Future Physical Abuse? A Meta-Analysis.

Objective: To use meta-analytic techniques to evaluating the effectiveness of parent–child interaction therapy (PCIT) at reducing future physical abuse among physically abusive families. Methods: A systematic search identified six eligible studies. Outcomes of interest were physical abuse recurrence, child abuse potential, and parenting stress. Results: Parents receiving PCIT had significantly fewer physical abuse recurrences and significantly greater reductions on the Parenting Stress Index than parents in comparison groups. Reductions in child abuse potential were nonsignificant, although 95% confidence intervals suggest clinically meaningful treatment effects. The studies examining physical abuse recurrence had a medium treatment effect (g = 0.52), while results from pooled effect size estimates for child abuse potential (g = 0.31) and parenting stress (g = 0.35) were small. Conclusions: PCIT appears to be effective at reducing physical abuse recurrence and parenting stress for physically abusive families, with the largest treatment effects seen on long-term physical abuse recurrence. Applications to social work practice are discussed.

An exploratory factor analysis of coping styles and relationship to depression among a sample of homeless youth

The extent to which measures of coping adequately capture the ways that homeless youth cope with challenges, and the influence these coping styles have on mental health outcomes, is largely absent from the literature. This study tests the factor structure of the Coping Scale using Exploratory Factor Analysis (EFA) and then investigates the relationship between coping styles and depression using hierarchical logistic regression with data from 201 homeless youth. Results of the EFA indicate a 3-factor structure of coping, which includes active, avoidant, and social coping styles. Results of the hierarchical logistic regression show that homeless youth who engage in greater avoidant coping are at increased risk of meeting criteria for major depressive disorder. Findings provide insight into the utility of a preliminary tool for assessing homeless youths’ coping styles. Such assessment may identify malleable risk factors that could be addressed by service providers to help prevent mental health problems.

Challenges facing families of sexually abusive youth: what prevents service engagement?

Abstract Although it is becoming increasingly important to integrate families of sexually abusive youth in treatment, there are many families who resist engagement. Little is known about why families are not more involved and what factors prevent service engagement. In collaboration with a state sex offender management board, this qualitative study analyzed the perspectives of approved treatment providers (N = 19) on factors that deter family engagement. Findings revealed engagement is determined by detailed contexts and circumstances such as stress, preparedness, and subjective barriers. Pragmatic recommendations are offered to procure and sustain family engagement in treatment.

Prospective Associations Between Peer Victimization and Dispositional Mindfulness in Early Adolescence

Peer victimization is associated with several mental health and behavioral problems during childhood and adolescence. Identifying prospective associations between victimization and factors known to protect against these problems may ultimately contribute to more precise developmental models for victimization’s role in behavioral and mental health. This study tested prospective associations between peer victimization and dispositional mindfulness, defined by non-judgmental and accepting awareness of the constant stream of lived experience, during early adolescence. It was hypothesized that victimization would predict lower levels of mindfulness over a 4-month period. Study participants were 152 seventh and eighth grade students (female = 51%, Caucasian = 35%, Hispanic/Latino = 34%, African-American = 13%, and multi-ethnic or other = 18%) participating in a social-emotional learning intervention feasibility trial. A structural equation model tested associations between mindfulness, victimization, and covariates at baseline, and mindfulness and victimization at 4-month posttest. As hypothesized, baseline victimization predicted significantly lower levels of mindfulness at 4-month posttest. Baseline mindfulness did not predict victimization. Results may reflect victimized youths’ mindful awareness being recurrently diverted away from the present moment due to thoughts of prior and/or impending victimization. Study implications may include implementing mindful awareness practices as an intervention strategy for victimized youth to enhance and/or restore this promotive factor.

Complex health concerns among child welfare populations and the benefit of pediatric medical homes

Children referred to child welfare have higher-than-average rates of physical, mental, and developmental health conditions, yet coordinating medical care to address their complex needs is challenging. This study investigates complex health characteristics of child welfare-involved children to inform evolving patient-centered medical homes that incorporate multidisciplinary care and social health determinants. Study questions include: (1) To what degree do child welfare-involved children present with complex physical, behavioral, and developmental conditions? (2) How does the clustering of complex health concerns vary according to developmental stage? (3) What demographic factors relate to complex health concerns? Data are from 5873 children (birth to 18) who participated in the National Survey of Child and Adolescent Well-being II. Latent class analyses were conducted for children in four developmental groups (infants, preschool-age, elementary school-age, and adolescents), including up to 11 indicators from standardized health measures. For all developmental groups, the best fitting model indicated a complex health concern class and a class with fewer health concerns. Multivariate logistic regressions revealed that membership in the complex health concerns class was associated with: increased age, poverty, poor caregiver health, out-of-home placement, gender, and race/ethnicity; although some developmental differences in predictors were observed. Results suggest that for younger children, preventive approaches and integration of developmental specialists in primary care is needed, while school-age children and adolescents demonstrate greater need for integrated behavioral health. All developmental groups would benefit from multidisciplinary teams that address complex health issues related to environmental risks common among children involved in child welfare.

Systematic Review of Social–Emotional Screening Instruments for Young Children in Child Welfare:

Purpose: The Child Abuse Prevention and Treatment Act requires child welfare agencies to have provisions in place to refer young children to early intervention services, yet the socioemotional health needs of children are often challenging to recognize and treat effectively. This study reviews the substantive and psychometric properties of screening instruments designed for children ages 10 and younger. Methods: Major social science databases, websites of national organizations, and the Mental Measurements Yearbook were used to identify instruments for review. Results: Twenty-four instruments met review criteria, and eight show above-average measurement properties and testing, tap children’s strengths and concerns, and have evidence of validity with families similar to child welfare–involved families. Discussion: It is important to effectively screen for children showing concerns in early childhood, so that treatment and prevention can be prioritized. This study indicated several tools with adequate testing and with emerging evidence and applicability to child welfare.

Feasibility, Acceptability, and Clinical Trends of a Mindfulness-Informed Child Welfare Intervention: Implications for Trauma-Focused Practice

Exposure to stress and early life trauma have been linked to child maltreatment and parental substance misuse. These issues often co-occur, yet few child welfare services target their shared underlying causes in a single intervention. Teaching mindfulness-informed strategies to substance-misusing families in the child welfare system may be one promising trauma-informed approach. As part of a larger pilot study testing the initial efficacy of a mindfulness-informed intervention for parents in public child welfare, this study explored the feasibility, acceptability, and clinical trends of the intervention using weekly reports of stress, coping, and mindfulness. Findings show support for the feasibility and acceptability of the intervention as well as positive responses to the intervention on measures of stress and mindfulness. However, the impact of the intervention varied with regard to improving weekly coping among participants. Implications for the integration of mindfulness into child welfare practice as a trauma-informed approach are discussed.

Social Connectedness, Self-Efficacy, and Mental Health Outcomes Among Homeless Youth Prioritizing Approaches to Service Provision in a Time of Limited Agency Resources

Homeless youth frequently meet diagnosis criteria for depressive and/or substance use disorder(s). Although prior research has established that both social connectedness and self-efficacy buffer vulnerable youth’s adverse health outcomes, few studies have compared the potential of these protective factors on homeless youth’s mental well-being. The current study analyzes comparative effects of social connectedness and self-efficacy on meeting criteria for major depressive disorder, substance use disorder, and the co-occurrence of both disorders among a sample of 601 service-seeking homeless youth in Austin, Denver, and Los Angeles. Hierarchical logistic regressions indicate that while both social connectedness and self-efficacy constructs are valuable protective factors, social connectedness may offer greater utility, particularly in buffering against more complex mental health outcomes, such as the co-occurrence of depressive and substance use disorders. Accordingly, resource-strapped homeless youth service providers and researchers may benefit from tailoring mental health intervention strategies to further emphasize social connectedness in future efforts.

Mindfulness Intervention with Homeless Youth

Objectives: Mindfulness-based interventions demonstrate promise in helping individuals cultivate awareness of risks, thereby decreasing likelihood of revictimization; however, mindfulness-based approaches with homeless youth have received little empirical attention. This mixed-methods study investigates a mindfulness-based intervention for homeless youth, investigating (a) quantitatively—to what extent is the intervention effective in increasing youths’ mindfulness over time? and (b) qualitatively—in observing homeless youths’ participation in the mindfulness groups, what strategies appear most helpful in engaging them in this mindfulness intervention and what challenges are encountered? Methods: Using a randomized experimental design, the current study pilot tests an intensive (3 day), skill-building intervention to train homeless youth (N = 97, ages 18–21 years) to practice mindfulness and avoid risks. Youths’ mindfulness was assessed via standardized self-report instruments at baseline and post-intervention (1 week post baseline for youth in the control condition). Results: Repeated-measures ANOVA results indicate that although no effect was found on total mindfulness, a significant effect was found for mindfulness subscales. Intervention youth improved in their observation skills significantly more than control youth (F[1] = 3.88, p < .05, partial-η2 = .05). Qualitatively, certain intervention strategies (i.e., facilitating, personal sharing, teaching, and peer activation) demonstrated notable utility in actively engaging youth in mindfulness material, whereas challenges (meeting basic needs, a fight or flight instinct, and a generalized distrust of service providers) created challenges in implementing mindfulness skills. Conclusion: The intervention improved youths’ attention to internal and external stimuli yet future iterations will need to continue to modify to meet the unique needs of this population.