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Resilience plays a significant role in buffering the negative effects of parenting stress among custodial grandparents. Using a sample of 76 custodial grandparents, this study aimed to investigate the psychometric properties and factor structure of the 10-item Connor–Davidson Resilience Scale and to examine the predictors at individual level (demographic characteristics and stress management), interpersonal level (positive social support and negative social support), and community level (formal service use). The results of exploratory and confirmatory factor analyses yielded two factors: adaptability and persistence, and positivity. The findings suggest that low levels of stress management and negative social support may undermine resilience in coping with parenting stress. This study emphasizes the significance of both individual and family interventions in fostering resilience among custodial grandparents by aiding them in building stress management skills and improving the quality of social relationships. [ABSTRACT FROM AUTHOR]

Abstract: This manuscript describes the development and psychometric testing of an instrument to assess implementation fidelity of Together Facing the Challenge (TFTC), an evidence‐based approach to treatment foster care (TFC). The development of TFTC utilized a hybrid approach by bringing together components from evidence‐based interventions with data on “what works” in usual care treatment foster care to create an intervention designed to provide enhanced treatment across a wide range of treatment foster care programs. The resulting training/consultation model has shown positive results on practice and youth outcomes in a randomized trial. The TFTC‐FIT was developed during this randomized trial to be used as both a research measure and a quality improvement tool by provider agencies. Findings show that the measure is psychometrically sound and significantly distinguishes agencies trained in TFTC from those that are not. Discussion highlights the potential for such a measure, both in treatment foster care and in other home‐/community‐based interventions and settings for youth. [ABSTRACT FROM AUTHOR]

Group homes are a frequently used but controversial treatment setting for youth with mental health problems. Within the relatively sparse literature on group homes, there is some evidence that some models of treatment may be associated with more positive outcomes for youth. This article explores this possibility by examining differences across time for youth served in group homes utilizing the Teaching Family Model (TFM) and geographically proximate homes using more eclectic approaches. Data come from a longitudinal quasi-experimental study that included 554 youth. Results suggest that youth showed, on average, significant and rapid improvement during initial months in a group home. Improvement did not differ for TFM and non-TFM homes during this initial period. Post-discharge results, though, show that TFM was associated with continued improvement after discharge and significantly better outcomes by 8 months post-discharge. Results also discuss youth-level factors that may influence outcomes as well as need for additional work to more fully understand processes and practices that are key for maximizing and maintaining youths’ positive outcomes during and after group home placements. [ABSTRACT FROM AUTHOR]

This article proposes and examines a parsimonious framework for assessing quality in therapeutic residential care. The synthesized conceptual framework includes four potentially critical domains of quality: setting, staffing, safety, and treatment. Data from a recently completed quasi-experimental study of group homes were used to examine prevalence of various key indicators within each of these domains and to explore relationships between these indicators and youth-level outcomes. Findings suggest that, among this sample of licensed homes in a southeastern state, licensure may be an initial indicator of baseline quality. Beyond this most basic level, utilization of an evidence-informed model (in this case, the teaching family model) was associated with better outcomes. Net of model, findings suggest that positively focused motivational systems, youth’s perceptions of staff’s fairness and helpfulness, provision of age/interest-appropriate toys/books/games, more preservice training, and prohibition of physical restraint were all associated with better outcomes for youth. Additional work is needed to assess the generalizability and utility of this framework for assessing quality in group homes. [ABSTRACT FROM AUTHOR]

There is a gap in understanding how the treatment fidelity aspects of adherence and quality, along with common process factors such as therapeutic alliance, impact outcomes for youth. Few studies have examined both constructs of implementation and process factors simultaneously in regard to their relationship to client outcomes. This study examined the role of (a) youth ratings of implementation quality for a provider of therapeutic residential care, (b) the records of staff ratios of positive to negative statements to youth as reported for a token economy system, and (c) youth ratings of therapeutic alliance in relation to youth emotional and behavioral functioning at 6 months into therapeutic residential services. The study included data collection activities with 112 youth and staff at intake into residential group care through 6 months into residential services. Both youth ratings of therapeutic alliance and the ratio of positive to negative staff interactions with youth were related to improved youth emotional and behavioral functioning, as reported by staff using the Child Behavior Checklist. These findings suggest that it is important to consider both implementation and common process factors when looking to improve the quality of care for youth in therapeutic residential care. [ABSTRACT FROM AUTHOR]

Despite their widespread use as a placement option for youth with mental health problems, there is relatively little research on group homes for youth. Available data highlight concerns with practices and treatment within group homes and mixed results on youth-level outcomes. However, existing research appears to collapse a wide range of group residential settings into a single amorphous category. This article explores potential variations among group homes to examine whether different programs are systematically serving different types of youth. It examines, in particular, placement in homes using the teaching family model (TFM) versus homes that do not. Findings suggest that demographics are not significantly associated with TFM placement. However, custody status, types of mental health problems, and use of psychotropic medications are. Homes appear to be serving distinct niches within a geographic area. Implications for future research and policy/practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives: This article reports the initial findings from a randomized trial to enhance treatment foster care (TFC) in "usual care" agencies. The intervention, Together Facing the Challenge, was built on a combination of practice-based elements from a prior descriptive study of TFC and selected elements from Chamberlain's evidence-based model (multidimensional treatment foster care) to fill conspicuous gaps in usual practice. The study was designed to examine whether additional training and consultation to staff and treatment foster parents improved outcomes for youths.Methods: The study was conducted with 247 youths in TFC and their treatment parents from 14 TFC agencies in a southeastern state in 2003-2008. Half of the agencies were randomly assigned to the intervention condition and received study-provided training and consultation. Agencies in the control group continued to provide training and treatment as usual. Data for the analyses presented here were from interviews with treatment parents at baseline, six months, and 12 months.Results: Compared with youths in the control group, youths in the intervention group showed improvement on the three focal domains--symptoms, behaviors, and strengths. Effects were significant for all outcomes at six months. Effects for behaviors remained significant by 12 months.Conclusions: This study employed a hybrid model to improve practice. It built on current practices in existing agencies and infused additional training and consultation to overcome observed deficits. Such an approach has tremendous potential for moving beyond a singular focus on disseminating evidence-based interventions to a broader view of improving practice in a wide range of agencies. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one on the psychometric properties of the Preschool Behavioral and Emotional Rating Scale (PreBERS), one on the role of teacher-student interactions in effective early intervention, and one on the establishment of effective early intervention and prevention programs.

Recent work suggests that out-of-home placements continue to be relatively common for youth with mental health problems, even within systems of care. The current work examines rates and predictors of movement back home and stability of reunifications. During the focal period, 1,778 youths experienced out-of-home placements; 61% moved back home, and 22% of those reunited were placed out of home again. Race was related to likelihood of reunification and instability: American Indian youth were least likely to return home, whereas Hispanic youth were at increased risk of unstable reunifications. Older youth and boys were more likely to return home, whereas youth from families with higher incomes were slightly more likely to be placed out of home but also most likely to be stably reunited. Higher (i.e., worse) total Child Behavior Checklist score was related to moving back home, whereas decreased strengths and more child-level risk factors predicted instability of reunification. [ABSTRACT FROM AUTHOR]

This article examines out-of-home placements for youth with mental health problems in community-based systems of care. Longitudinal data come from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. One third of youth residing at home when they enrolled in the system of care were placed out of home during the 2-year follow-up period. As expected, youth who were placed out of home displayed more problems, fewer strengths, and more risk factors than youth who remained at home. However, results suggested few differences between youth placed in foster care and those placed in more restrictive settings. In addition, there was increased placement instability for Hispanic and older youth. Findings suggest that out-of-home placements remain a common component in systems of care. This suggests the immediate need for additional work on effectiveness of these settings for youth within systems of care. [ABSTRACT FROM AUTHOR]

The authors consider school violence from a dynamic systems conceptualization of aggression. This perspective suggests that aggression and school violence involve the contributions of both school social dynamics and the developmental histories of youth who are at risk for involvement in antisocial behavior. The authors present the concept of correlated constraints to describe the systematic alignment of developmental factors and their role in behavioral continuity and realignment. Building from this perspective, the authors present a theoretical framework that complements public health models of prevention to guide the establishment of comprehensive programs for preventing aggressive and violent behavior in schools. This framework suggests that three distinct but complementary levels of intervention are required to effectively reduce school violence: (a) universal strategies to address contextual factors, including the social dynamics of aggression and the activities of "conventional" peers that promote interpersonal conflict; (b) selective strategies for supporting the strengths of at-risk youth to prevent the negative reorganization of their developmental systems; and (c) indicated strategies involving coordinated services from multiple providers to reorganize the developmental systems of high-risk youth (i.e.,youth with emotional and behavioral disorders). [ABSTRACT FROM AUTHOR]

We examined the factor structure and psychometric properties of the Trusting Relationship Questionnaire, a brief measure of relationship quality between youth and community-based service providers involved in their care. Data on youth residing in Therapeutic Foster Care and in Group Homes ( N = 296) were collected. We identified a one-factor solution for the child version of the measure and a two-factor structure for the adult version: child's perception of the relationship and adult's perception of the relationship. Both versions appear to be highly reliable and possess adequate levels of construct, criterion, and discriminative validity. While no statistically significant age differences were noted on the parent version, on the child version, older youth were more likely to report lower relationship scores. Gender differences were found on both versions: Female youth reported higher scores on the child version as did adults reporters of relationships with female youth, but only for the first factor—child's perception of the relationship. Overall, the TRQ appears to capture the quality of the relationship between service providers and youth in their care, thus bridging a gap in assessment measures. [ABSTRACT FROM AUTHOR]

Child welfare service agencies provide parent training as part of their legally mandated responsibility to provide services to assist families to keep their children at home or to achieve reunification. The use of parent-training programs for families in the child welfare system has undergone relatively little examination. Mental health, special education, and juvenile justice have been identifying evidence-based approaches that have demonstrated effectiveness with children and families with conduct disorders and other behavioral problems, although few of these interventions have been tested with child welfare services clientele. This article brings together evidence about the most promising programs from other child service sectors with information about the current parent training approaches in child welfare and generates a range of proposals about next steps to enhance the capacity of parent training and fulfill the high expectations set in law and practice. [ABSTRACT FROM AUTHOR]

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services. [ABSTRACT FROM AUTHOR]

This study examines the experiences of treatment foster mothers. It is part of an ongoing longitudinal study of the use, implementation, and effectiveness of treatment foster care. The study sample is 43 treatment foster mothers. Study data are from in-person interviews with mothers in which each is asked to talk about the youth in her care and her experience of being the youth’s treatment foster mother. Mothers’ responses were analyzed through an inductive and iterative process. The analysis yielded six mutually exclusive categories of experience. Each category was labeled with a name that reflected a critical element of its definition: Strategic, Struggle, Satisfaction, Mothering, Rejection, and ‘Other’. Findings suggest wide variation in how treatment foster mothers experience their role and relationships with youth. Study strengths, limitations, and relevant theoretical frameworks for further work are discussed. [ABSTRACT FROM PUBLISHER]

We examined Treatment Foster Care (TFC) in residential trajectories for youth with. psychiatric disorders and aggressive behavior. We analyzed residential placements of a statewide sample of youth during the 12 months preceding and following admission to TFC. Prior to TFC, the majority of youth were residing in more restrictive settings (group homes or residential treatment). Two-thirds of youth remained in TFC throughout the follow-up year. Of those who left, nearly half returned home, and slightly fewer were discharged to group homes. By the end of the 12-month follow-up period, rates of group home use were similar to those seen in the pre-TFC period. Movement out of TFC during the year was associated with being older at placement and with increased problem behavior (particularly externalizing behaviors). TFC serves as a step-down placement for a substantial number of youth. However, this is not the only way it is used, and models based on short-term transitioning or reunification with families may not be widely implemented or relevant in practice. Additional research is needed to understand current functions of TFC in residential trajectories and to maximize its utility in systems of care. [ABSTRACT FROM AUTHOR]

Objective: This study examined points of entry into the mental health service system for children and adolescents as well as patterns of movement through five service sectors: specialty mental health services, education, general medicine, juvenile justice, and child welfare. Methods: The data were from the Great Smoky Mountains Study, a longitudinal epidemiologic study of mental health problems and service use among youths. The sample consisted of 1,420 youths who were nine, 11, or 13 years old at study entry. Each youth and a parent were interviewed at baseline and every year thereafter about the use of services for mental health problems over the three-year study period. Results: Population estimates indicated that 54 percent of youths have used mental health services at some time during their lives. The education sector was the most common point of entry and provider of services across all age groups. The specialty mental health sector was the second most common point of entry for youths up to age 13 years, and juvenile justice was the second most common point of entry for youths between the ages of 14 and 16. Youths who entered the mental health system through the specialty mental health sector were the most likely to subsequently receive services from other sectors, and those who entered through the education sector were the least likely to do so. Conclusions: The education sector plays a central role as a point of entry into the mental health system. Interagency collaboration among three primary sectors--education, specialty mental health services, and general medicine--is critical to ensuring that youths who are in need of mental health care receive appropriate services. [ABSTRACT FROM AUTHOR]

Background: The Caring for Children in the Community Study examined the prevalence of DSM-IV psychiatric disorders and correlates of mental health service use in rural African American and white youth. Methods: Four thousand five hundred youth aged 9 to 17 years from 4 North Carolina counties were randomly selected from school databases. Parents completed telephone questionnaires about their children's behavior problems. A second-stage sample of 1302 was identified for recruitment into the interview phase of the study, and 920 (70.7%) of these were successfully interviewed at home using the Child and Adolescent Psychiatric Assessment and related measures of service use. Results: Weighted back to general population estimates, 21.1% of youth had 1 or more DSM-IV psychiatric disorders in the past 3 months. Prevalence was similar in African American (20.5%) and white (21.9%) youth. The only ethnic difference was an excess of depressive disorders in white youth (4.6% vs 1.4%). Thirteen percent of participants (36.0% of those with a diagnosis) received mental health care in the past 3 months. White youth were more likely than African American youth to use specialty mental health services (6.1% vs 3.2%), but services provided by schools showed very little ethnic disparity (8.6% vs 9.2%). The effect of children's symptoms on their parents was the strongest correlate of specialty mental health care. Conclusions: In this rural sample, African American and white youth were equally likely to have psychiatric disorders, but African Americans were less likely to use specialty mental health services. School services provided care to the largest number of youths of both ethnic groups. [ABSTRACT FROM AUTHOR]

This article compares mental health service need and use among three groups of children: those with a history of foster care placement, those in contact with departments of social services but never in placement, and those from impoverished families who have not been in contact with social services. Data come from a longitudinal epidemiologic study of mental health problems and service use. All three groups show very high rates of mental health problems, but children in foster care or in contact with social services are significantly more likely than children living in poverty to receive mental health services. [ABSTRACT FROM AUTHOR]

Current views of the role of social relations in the development of aggressive and disruptive behavior are presented, and advances in social development research are summarized. The primary points of the articles in this special issue are considered against this backdrop and synthesized with regard to implications for the development of preventative interventions and positive behavioral supports for aggressive youth with or at risk of emotional and behavioral disorders. Together these articles suggest that the social growth of such youth is highly complex and involves multiple factors, including the social goals and characteristics of the student, the affiliative patterns and social roles of the student, and the interactional dynamics among students and between students and teachers. School-based interventions should focus not only on the behavior of the student, but also on social-cognitive processes and social contextual factors that support aggressive and disruptive behavior. [ABSTRACT FROM AUTHOR]

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research. [ABSTRACT FROM AUTHOR]

Background. Dietary intervention to reduce fat consumption and increase fiber consumption has been recommended by the National Cancer Institute, but there is little evidence concerning the effectiveness of self-help materials. The purpose of this study was to evaluate such self-help materials, introduced by a nurse in a primary care setting. Methods. A randomized controlled trial involving 242 subjects was conducted in two primary care clinics in Chapel Hill, NC, in 1987. Changes in fat and fiber consumption in the intervention and control groups during the 3-month interval between interviews were compared using analysis of covariance. Results. The estimated reduction in fat 3.8g larger for the intervention group than for the control group, but the confidence interval included zero. For those individuals who had some responsibility for meal preparation there was a larger difference (-6.9g) in favor of the intervention group, although the difference using calorie-adjusted values was -3.8g with a 95% confidence interval (-7.1, -0.4). The differences for fiber change were smaller. Conclusions. We found significant small but consistent differential changes associated with a minimal self-help intervention, but we cannot rule out the possibility of some response bias. Nonetheless, this study demonstrates that the use of self-help materials for dietary change is feasible, and may be effective. [ABSTRACT FROM AUTHOR]

This paper examines the relationships between insurance coverage, need, and mental health services in a community-based sample of 1,015 youths who were 9, 11, and 13 years old at the beginning of the study. They were followed over a two-year period. A strong measure of need based on a standardized diagnostic interview was available and repeated over three annual waves. Data on service use was collected quarterly across two years. Major findings included: (a) high need (serious emotional disturbance [SED]) was strongly related to use of any mental health services; (b) services use was much more likely to occur with public (Medicaid) insurance coverage than either private or no insurance; (c) considerable unmet need was observed even for youths with SED; (d) school-based mental health services potentially substituted for professional mental health services; and (e) there was little unnecessary use of mental health services in the low need group. The major policy implication of these findings is that the regulation of insurance benefits should be based on level of need, rather than on arbitrary limits which are likely to either reduce the probability of or appropriate amount of care for youths who most need mental health services. [ABSTRACT FROM AUTHOR]

This paper reports on the reliability of children's responses on the Child and Adolescent Services Assessment (CASA)—a self-report instrument for use with 8- to 18-year-olds that gathers information about services used to address mental health problems. Findings were based on interviews completed by 77 children at a one week test-retest interval. Results showed that reports of lifetime service use were as reliable as were reports of service use in the preceding three months. Children reported restrictive and intrusive services more reliably than services that were provided in their natural environment. Reliability appeared to be associated more strongly with characteristics of the type of service than with characteristics of the child. Children also could report reliably on some details about their encounters with service providers (e.g., length of stay, number of visits, and onset of service use). [ABSTRACT FROM AUTHOR]

Objectives. Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family caretakers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. Methods. A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. Results. Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. Conclusions. Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use. [ABSTRACT FROM AUTHOR]

Objectives. This study examined prevalence of psychiatric disorders, social and family risk factors for disorders, and met and unmet needs for mental health care among Appalachian youth. Methods. All 9-, 11-, and 13-year-old American Indian children in an 11-county area of the southern Appalachians were recruited, together with a representative sample of the surrounding population of White children. Results. Three-month prevalences of psychiatric disorders were similar (American Indian, 16.7%; White, 19.2%). Substance use was more common in American Indian children (9.0% vs 3.8% in White children), as was comorbidity of substance use and psychiatric disorder (2.5% vs 0.9%). American Indian poverty, family adversity (e.g., parental unemployment, welfare dependency), and family deviance (parental violence, substance abuse, and crime) rates were higher, but the rate of family mental illness, excluding substance abuse, was lower. Child psychiatric disorder and mental health service use were associated with family mental illness in both ethnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian children used fewer mental health services. Conclusions. This study suggests that poverty and crime play different roles in different communities in the etiology of child psychiatric disorder. [ABSTRACT FROM AUTHOR]

Data from the National Child Development Study were used to explore the relationship between extremity of externalizing behavior problems during childhood and employment-related outcomes in young adulthood. Analyses focused on four heuristic dimensions of extremity (age at onset, density, persistence, and pervasiveness) and three outcomes (school-leaving age, level of qualifications at labor force entry, and social class of job al age 23). Persistence was associated with the most substantial deficits across all outcomes, and temporal proximity was more influential than early onset. The data suggest that school-based and home-based situational behavior problems should not be combined into a single nonpervasive category. [ABSTRACT FROM AUTHOR]

The article discusses how the interrelation between psychiatric research and mental health care system reforms in the U.S. can be improved. It highlights various issues discussed at the conference titled "Child and Adolescent Mental Health Services: Issues and Solutions," held in September 2009. It offers suggestions including federal funding for collaboration of research with mental health policy, developing sabbatical programs, and creating an information network of research and practice.

The author reflects on different views, techniques and researches on therapeutic residential care (TRC) conducted by several researchers.