William Ganger

Mental Health Problems of Children in Foster Care

We compared the rates of mental health problems in children in foster care across three counties in California. A total of 267 children, ages 0 to 17, were assessed two to four months after entry into foster care using a behavioral screening checklist, a measure of self-concept and, in one county, an adaptive behavior survey. Results confirmed previous research and indicated consistently high rates of mental health problems across the three counties. Behavior problems in the clinical or borderline range of the CBCL were observed at two and a half times the rate expected in a community population. Fewer children fell within the clinical range on the self-concept measure. No significant differences in rates between the three county foster care cohorts were observed, despite the different demographic characteristics of the counties. On the adaptive behavior scale, the mean scores for children in foster care were more than one standard deviation below the norm. Our findings suggest that the most important mental health screening issue with children in foster care is to identify what specific mental health problems need to be addressed so that the most effective treatment services can be provided.

Impact of child psychosocial functioning on reunification from out-of-home placement

Abstract This study examined the impact of child psychosocial functioning on the probability of reunification over an eighteen month period for 669 children, ages 2–16, who had been removed from their birth home and placed in either kinship care or foster care. Psychosocial functioning was measured from two sources, a standardized measure of behavior problems, and information abstracted from case files on emotional/behavioral problems, developmental/learning problems, and physical handicap or acute medical problems. Results indicated a separate and significant negative impact of externalizing behavior problems and behavioral/emotional problems on reunification from out-of-home placement. Children with problems were one-half as likely to be reunified as children without problems, even after controlling for background characteristics and type of maltreatment. The impact of externalizing behavior problems was observed in foster care but not in kinship care. Developmental and medical problems were not significantly related to reunification.

Mental Health Care for Children With Disruptive Behavior Problems: A View Inside Therapists' Offices

OBJECTIVES In the United States, more money is spent on treatment for childrens mental health problems than for any other childhood medical condition, yet little is known about usual care treatment for children. Objectives of this study were to characterize usual care outpatient psychotherapy for children with disruptive behavior problems and to identify consistencies and inconsistencies between usual care and common elements of evidence-based practices in order to inform efforts to implement evidence-based practices in usual care. METHODS Participants included 96 psychotherapists and 191 children aged four to 13 who were presenting for treatment for disruptive behavior to one of six usual care clinics. An adapted version of the Therapy Process Observational Coding System for Child Psychotherapy-Strategies scale (TPOCS-S) was used to assess psychotherapy processes in 1,215 randomly selected (out of 3,241 collected) videotaped treatment sessions; treatment sessions were recorded for up to 16 months. RESULTS Most children received a large amount of treatment (mean number of sessions=22, plus children received other auxiliary services), and there was great variability in the amount and type of care received. Therapists employed a wide array of treatment strategies directed toward children and parents within and across sessions, but on average all strategies were delivered at a low intensity. Several strategies that were conceptually consistent with evidence-based practices were observed frequently (for example, affect education and using positive reinforcement); however, others were observed rarely (for example, assigning or reviewing homework and role-playing). CONCLUSIONS Usual care treatment for these youths reflected great breadth but not depth. The results highlight specific discrepancies between evidence-based care and usual care, thus identifying potentially potent targets for improving the effectiveness of usual care.

Parental visiting and foster care reunification

Abstract Parental visiting has long been a crucial factor in reunification decisions for children in foster care. The purposes of the present study, part of a larger follow-up investigation of permanency planning for children in foster care, were to correlate parental visiting with permanency planning outcomes and to develop a logistic regression model predicting family reunification. Findings show that the majority of children with maternal and paternal visits at the level recommended by the court were reunified, but no association was found between parental visiting and recidivism of reunified children at a 12 month follow-up. Maternal visiting at the recommended level was the strongest predictor of reunification among the five study variables included in the regression model, indicating that a child visited by the mother as recommended was approximately 10 times more likely to be reunified. The paper also includes information on parental visiting in traditional and kinship foster homes and across three ethnic groups. Implications of study findings for child welfare practice and future research are discussed.

Racial and Ethnic Variations in Mental Health Care Utilization Among Children in Foster Care

Although children placed in foster care have an elevated need for mental health services, little is known about the extent to which their needs are met and the factors associated with their utilization of such services. In this study we examined racial and ethnic differences in caregiver-reported mental health service utilization rates among a sample of 659 youth ages 2-17 years in foster care. Results indicate that White American youth were significantly more likely to receive services compared to African American and Latino youth, even when the effects of possible confounding variables were controlled. Possible explanations and implications for racial and ethnic disparities in service utilization are discussed.

Use of the public mental health system by children in foster care: Client characteristics and service use patterns

This study examined client crossover from the social services (DSS) to the mental health (SDMHS) system in San Diego County. Public mental health service use was examined in 1,352 subjects participating in a longitudinal study of children in foster care. Overall, 17.4% (n=235) of the children in DSS were also served in SDMHS. Children in DSS who also received services from SDMHS (multiple-system youth) were compared with children only served in DSS (single-system youth). Multiple-system youth were significantly older and had different removal and placement histories than single-system youth. Within multiple-system youth, analyses compared demographic and diagnostic data of subgroups defined by the number of episodes and/or the levels of mental health care received. These analyses revealed that a small group of multiple-system youth (16.6%) were the most severely disturbed and received the most services. Methodological issues related to tracking clients across service sectors are discussed.

Dissociation in Foster Preschoolers: A Replication and Assessment Study

ABSTRACT This study replicated the Child Behavior Checklist factor structure of traumatic sequelae in maltreated children that was established by A. C. Hulette and colleagues (in press; see also A. Cholankeril et al., 2007). The factors represent dissociation and posttraumatic stress disorder symptomatology. The present study also examined the extent to which these 2 factor scores varied depending on specific maltreatment experiences. Results indicated that children who experienced both physical and sexual abuse in addition to neglect had significantly higher levels of dissociation than children who experienced (a) sexual abuse alone or with neglect, (b) physical abuse alone or with neglect, or (c) only neglect. The current study provides evidence that children who experience multiple forms of maltreatment are more likely to be dissociative, perhaps due to a greater need for a coping mechanism to manage the distress of that maltreatment.

Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services

Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.

The Parent Participation Engagement Measure (PPEM): Reliability and Validity in Child and Adolescent Community Mental Health Services

Parent participation in community-based child mental health services is an important yet understudied process associated with treatment effectiveness. This paper describes the development and psychometrics of the Parent Participation Engagement Measure in a sample of 1374 parents and 563 youth receiving publicly-funded mental health services. Analyses indicated excellent internal consistency, and model fit indices/factor loadings supported a one-factor model. Convergent and discriminant validity were supported, although some coefficients were modest in magnitude. Psychometric results were consistent for Caucasian versus Hispanic, parent versus youth, and English versus Spanish-language respondents. The clinical and research utility of this measure are discussed.