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Levels of emotional and behavioral problems in children and adolescents demonstrate secular changes over time, warranting ongoing investigation. Prior studies examining secular trends in a range of such problems have been conducted in the U.S. and internationally. Research in this area generally has not fully considered the school setting. This study compared emotional and behavioral problems across two cohorts of students in the U.S. assessed over a 22-year time period as part of measurement development efforts for the Scales for Assessing Emotional Disturbance Rating Scale (SAED-RSRS; Epstein et al., 2020). Specifically, analyses drew from data collected via teacher report on matched cohorts of students for the 1998 (data collected from 1996 to 1997; n = 1,148) and 2020 (data collected from 2016 to 2018; n = 1,148) editions of the SAED-RS. After establishing measurement invariance across cohorts and testing for gender differences, structural equation modeling revealed statistically significant cohort mean differences on two of the five factors of the SAED-RS, suggesting increases over time in Inability to Learn (β = 0.09, p = .024) and Physical Symptoms and Fears (β = 0.14, p = .005) that were comparable for girls and boys. There were no statistically significant differences on the remaining factors: Relationship Problems, Inappropriate Behavior, and Unhappiness/Depression. Supplemental item-level tests revealed differences on 8 of the 39 SAED-RS items. Findings suggest increases in specific problem areas that could benefit from ongoing monitoring and targeted interventions to support contemporary students., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The objective of this study was to assess the measurement invariance of items from the Emotional and Behavioral Screener (EBS) across racial and ethnic groups and assess the impact of differential item functioning (DIF) on test scores from the EBS. Participants were 4,856 first-grade students (49% female) who were diverse with regard to race and ethnicity (45% African American, 41% Hispanic/Latino, and 14% Caucasian). Classroom teachers rated each student on the EBS during the fall semester screening window. Item response theory modeling was combined with ordinal regression to investigate the presence and impact of differential item functioning across 3 race and ethnicity groups. The findings suggest that items from the EBS exhibit small to negligible levels of DIF, and the limited DIF that was present does not significantly impact overall scores. Researchers and practitioners can have confidence that scores from the EBS are relatively unaffected by test bias when measuring the emotional and behavioral risk of young students from African American, Hispanic/Latino, or Caucasian backgrounds. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Background: Food insecurity, uncertainty about the ability to acquire adequate food, is associated with cardiometabolic disease in pregnant women. Whether food insecurity interventions improve cardiometabolic health is unknown., Methods: We conducted a retrospective analysis of women who visited the obstetrics clinic in a community health center from 2013 through 2015. Patients could be referred to the Food for Families (Food for Families) program, which connects food insecure women to food resources. We hypothesized that participation in Food for Families would be associated with better blood pressure and blood glucose trends during pregnancy. We used a propensity score-matched design to reduce bias from differential entry into Food for Families., Results: Eleven percent of women who visited the obstetrics clinic were referred to Food for Families. In propensity score-matched analyses, we found no difference in baseline systolic blood pressure (SBP) between those who were referred and enrolled in Food for Families (113.5 mm Hg), those who were referred and did not enroll in Food for Families (113.9 mm Hg), and those who were not referred to Food for Families (114 mm Hg) (P = .79). However, during pregnancy, women who were referred to and enrolled in Food for Families had a better SBP trend (0.2015 mm Hg/wk lower, P = .006). SBP trends did not differ between women who were referred and did not enroll in Food for Families and those who were not referred. We observed no differences in blood glucose trends between groups (P = .40)., Conclusions: Food for Families participation was associated with better blood pressure trends in pregnant women but no differences in blood glucose trends. Food insecurity reduction programs may improve cardiovascular health for vulnerable pregnant women, and this topic deserves further study incorporating randomized program entry.

Strength-based assessment has been identified as an appropriate approach to use in planning treatment and evaluating outcomes of youth in residential settings. In previous research, the Behavioral and Emotional Rating Scale-2, a standardized and norm-referenced strength-based measure, has demonstrated adequate reliability and validity with youth served in community and educational settings. The purpose of the present study was to examine the internal reliability and convergent validity of the BERS-2 by comparing the test to the Child Behavior Checklist and the Symptoms and Functioning Severity Scale. The results indicate that the scores from the BERS-2 are internally consistent and converge with other behavioral and emotional measures which, taken together, suggest that the BERS-2 could be acceptable for assessing the emotional and behavioral strengths of youth in residential settings. Study limitations and future research directions are identified.

In a previous study with a nationally representative sample, researchers found that the items of the Preschool Behavioral and Emotional Rating Scale can best be described by a four-factor structure model (Emotional Regulation, School Readiness, Social Confidence, and Family Involvement). The findings of this investigation replicate and extend these previous results with a national sample of children (N = 1,075) with disabilities enrolled in early childhood special education programs. Data were analyzed using classical tests theory, Rasch modeling, and confirmatory factor analysis. Results confirmed that for the most part, individual items were internally consistent within a four-factor model and showed consistent item difficulty, discrimination, and fit relative to their respective subscale scores., (© 2015 Michigan Association for Infant Mental Health.)

Tests that measure the emotional and behavioral problems of children and youth are typically not normed and standardized on youth diagnosed with disruptive behavior, particularly those youth in residential care. Yet professional standards mandate that before instruments are used with a specific population the psychometric properties need to be studied and re-established: specifically, psychometric properties, including validity, need to be evaluated (AERA, APA, and NCME, The standards for educational and psychological testing. AERA, Washington, DC, 1999). The purpose of the present study was to assess the validity characteristics of the Symptoms and Functioning Severity Scale (SFSS; Bickman et al., Manual of the Peabody Treatment Progress Battery, Vanderbilt University, Nashville, TN, 2010), a widely used test developed for use in outpatient clinics, with youth in a residential care program. The convergent validity of the SFSS was established with the large correlations (0.78-0.86) with the CBCL. Several binary classification analyses including specificity, area under the receiver operating characteristic curve, positive and negative likelihood ratios, and the Youden Index supported the validity of the SFSS. However, the sensitivity index was somewhat low indicating the test may produce a high level of false negatives. Limitations, future research and implications are discussed.

Background: There is a need for brief progress monitoring measures of behavioral and emotional symptoms for youth in out-of-home care. The Symptoms and Functioning Severity Scale (SFSS; Bickman et al., 2010) is one measure that has clinician and youth short forms (SFSS-SFs); however, the psychometric soundness of the SFSS-SFs with youth in out-of-home care has yet to be examined., Objective: The objective was to determine if the psychometric characteristics of the clinician and youth SFSS-SFs are viable for use in out-of-home care programs., Methods: The participants included 143 youth receiving residential treatment and 52 direct care residential staff. The current study assessed internal consistency and alternate forms reliability for SFSS-SFs for youth in a residential care setting. Further, a binary classification test was completed to determine if the SFSS-SFs similarly classified youth as the SFSS full version for low- and elevated-severity., Results: The internal consistency for the clinician and youth SFSS-SFs was adequate (α = .75 to .82) as was the parallel forms reliability ( r = .85 to .97). The sensitivity (0.80 to 0.95), specificity (0.88 to 0.97), and overall accuracy (0.89 to 0.93) for differentiating low and elevated symptom severity was acceptable., Conclusions: The clinician and youth SFSS-SFs have acceptable psychometrics and may be beneficial for progress monitoring and additional research should clarify their potential for progress monitoring of youth in out-of-home programs.

Background: Each year a number of youth with a school identified disability are placed in residential care. It has been well documented that these youth enter with elevated rates of behavioral, emotional, educational, mental health, and familial challenges. However, the physical and medical condition of these youth remains unstudied., Objective: The purpose of the present study was to determine the prevalence of health and medical problems among a group of youth with school identified disabilities at entrance to a residential care center., Methods: Archival medical, demographic, and disability status data were obtained for 346 youth served in a large residential care center in the Midwest. Chi-square and correlation tests, and relative risk ratio estimates, were used to evaluate the relationship between medical condition and hypothesized correlates., Results: Findings revealed that over one-third of the sample had at least one medical condition, with asthma being the most prevalent (15.6%). Rates of medical condition differed by disability type and prevalence of asthma differed by race/ethnicity., Conclusions: Youth with a school identified disability in care demonstrate health care needs that need to be addressed while in care and following community reintegration. Intervention programs and targeted curriculum are needed to teach youth how to manage their health specific needs and how to independently navigate the health care system., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The purpose of this article is to describe the health-related quality of life (HRQoL) of adolescents in residential care and to examine selected correlates. A sample of 229 adolescents (mean age=17 years) living in a residential care setting completed a validated measure of HRQoL (PedsQL 4.0 Generic Scales). Mean-level scores for Total HRQoL, Physical HRQoL, and Psychosocial HRQoL were examined, and the percentage of youth scoring below a clinical cutoff value was reported. Demographic and psychotropic medication data for each youth were accessed from an electronic database maintained by the residential care program and used to examine correlates of HRQoL. Approximately 25% of youth had at least 1 HRQoL score in the "at risk" range, indicating a significant proportion of youth in residential care have significant impairments in HRQoL. Younger age and female gender were associated with poorer HRQoL. Psychotropic medication prescriptions were associated with poorer HRQoL. A significant percentage of adolescents in residential care may experience suboptimal HRQoL, and certain demographic and clinical factors appear to be associated with greater risk. Systematic assessment of HRQoL is recommended for youth in residential care, and interventions to promote better HRQoL among youth at particularly high risk may be beneficial., (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Purpose: The Pediatric Quality of Life assessment (PedsQL™) is the most widely used measure for assessing adolescent health-related quality of life (HRQoL). While youth in residential treatment facilities face many physical and mental health, behavioral, education, and familial challenges that could impact their HRQoL, no research has sought to assess the factor structure of the PedsQL™ among youth receiving residential care., Methods: High school-aged youth (N = 229) attending a large residential treatment center in Omaha, NE were recruited to complete a data collection packet comprised of various health assessments including the PedsQL. Four competing confirmatory factor analysis models were used to test the hypothesized internal structure of the PedsQL™ 4.0 Teen Report., Results: Models A, B, and C had acceptable CFI (≥.90), TLI (≥.90), and RMSEA (≤.08) fit indicators. However, factor loadings for items 5 and 6 were problematic. After removing the two problematic items, Model D was fit to the data and proved to be the superior of the four models. This model included two first-order factors (physical health problems; school attendance problems) and one second-order factor (psychological health problems)., Conclusions: The findings suggest that researchers and practitioners studying youth in residential settings can reliably use the PedsQL™ to assess their HRQoL.

Rising health care costs have led to an emphasis on identifying factors that contribute to medical service utilization. Previous research has suggested an association between youth psychopathology and service utilization; however, prospective studies among high-risk populations are needed. The current study examined youth psychopathology as a predictor of subsequent medical service utilization among a large sample (N = 536) of youth entering residential treatment. Youth psychopathology and medical status were assessed at intake, and medical service utilization was tracked across the duration of the residential placement. Results indicated that higher levels of psychopathology predicted greater youth medical service utilization, even after controlling for the presence of a diagnosed medical condition. Internalizing problems was a significant independent predictor of utilization, but externalizing problems was not. These findings highlight the association between mental health and medical service utilization and suggest that effective behavioral health services may be helpful in reducing costly medical service needs.

This study compares the On the Way Home (OTWH) aftercare program to traditional aftercare supports on placement and school stability for 82 youth (43 treatment, 39 control) with disabilities discharging from residential care. One-year-post-discharge results revealed that negative event occurrence (i.e., returning to care or discontinuing enrollment in the community school) was three to over five times less likely for OTWH youth compared to youth in the control condition.

Objective: To examine the prevalence of physical health problems among youth entering residential treatment., Patients and Methods: The sample included 1744 youth (mean age: 14.6 ± 1.8 years) entering a large residential treatment program between 2000 and 2010. Youth received an intake medical evaluation, including a review of available records, detailed medical history, and physical examination. Medical conditions present at the time of the evaluation were recorded by the examining physician and later coded by the research team. Only diagnoses recognized by the International Classification of Diseases, 10th Revision, were included in the analyses. To maintain the focus on physical health problems, behavioral and emotional disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were excluded. Obesity, acne, and allergies were also excluded., Results: Approximately one-third (33.7%) of youth had a physical health diagnosis at the time of intake. Asthma was the most prevalent condition diagnosed (15.3% of the sample). Girls were significantly more likely to have a diagnosis than were boys (37.1% vs 31.5%). Age was not associated with diagnostic status. Rates of physical health conditions differed significantly by ethnicity: black (36.4%) and white (35.4%) youth had the highest rates, and Hispanic youth (23.2%) had the lowest., Conclusions: Youth who enter residential treatment have high rates of physical health conditions. These problems could complicate mental health treatment and should be considered in multidisciplinary treatment planning.

Purpose: Undiagnosed language impairment (LI) for youth in residential care is a concern as similar populations have shown elevated levels of language delays. Therefore, the purposes of this study were to identify the percentage of youth in residential care who are at risk for LI and to compare the demographic, academic achievement, and functional academic skills of youth with or without possible LI., Method: Participants were 80 youth in residential care. Risk for LI was determined using the Clinical Evaluation of Language Fundamentals-4 Screening Test (E. Semel, E. H. Wiig, & W. A. Secord, 2004). Independent-samples t tests and chi-square analyses were conducted to assess the differences between groups. Measures used included the Woodcock-Johnson Test of Achievement (R. W. Woodcock, K. S. McGrew, & N. Mather, 2001) and the Kaufman Functional Academic Skills Test (A. S. Kaufman & N. L. Kaufman, 1994)., Results: More than half of the sample (54%) were identified as being at risk for LI. Statistically significant differences between youth with and without LI were found on academic variables. Specifically, youth who were at risk for LI presented academic achievement and functional academic scores in the low to low-average ranges., Conclusion: Findings suggest that there is a need to screen youth entering residential programs for possible LI. Implications for treatment and program planning are discussed.

While estimates suggest that 10% to 31% of children in residential care are identified as with a disability, little is known about their characteristics or functioning as compared to nondisabled peers. This study evaluated data of 123 children with (n=34) and without (n=89) disabilities in residential care to determine demographic, behavioral, mental health, and educational characteristics. Data included demographic, behavior checklist, and standardized mental health and academic measures. Results indicated that both groups presented elevated risks; however, scores for children with disabilities revealed even greater levels of need. Primary risks were found on indicators of behaviors (e.g., social functioning), mental illness (e.g., anxiety), and academic performance (e.g., general knowledge and reading). Implications, limitations, and recommendations for future research are discussed.

Research and evaluation of the wraparound process has typically focused on outcomes, service providers, and costs. While many of these studies describe a process that is consistent with the wraparound approach, few studies have reported attempts to monitor or measure the treatment fidelity of the wraparound process. The purpose of this study was to assess the fidelity of the wraparound process in a community-based system of care using the Wraparound Observation Form-Second Version. Results from 112 family planning meetings indicated some strengths and weaknesses within the current system. Families and professionals were frequently involved in the planning and implementation of the wraparound process. However, informal supports and natural family supports were not present in a majority of the meetings. Given the significant number of youth served in wraparound programs, the benefits of using the Wraparound Observation Form-Second Version as an instrument to monitor the fidelity of the wraparound approach should not be ignored.

The push to rapidly implement the wraparound approach for families of children with serious emotional disturbance (SED) has resulted in a number of service models that may or may not be in accordance with its theoretical foundation. Given the number of wraparound programs being implemented nationwide, the need to develop instruments that can measure the fidelity of wraparound services in a reliable manner should not be ignored. The purpose of this study was to examine the interobserver agreement of the Wraparound Observation Form--Second Version (WOF-2), an observation system designed to assess the fidelity of wraparound services. Observations were conducted across 30 family planning meetings where wraparound services were provided. The mean percentage agreement across the 48 items was 96.7% (range 83.3-100%) and the average kappa statistic was 0.886 (range = 0.318-1.0). On the basis of these results, the WOF-2 appears to be a reliable instrument for assessing the delivery of wraparound services.

The present study reports on the standardization of the Behavioral and Emotional Rating Scale and examines its factor structure, reliability, and criterion validity. Data on a national sample of children without disabilities (n = 2,176) and children with emotional and behavioral disorders (n = 861) were collected. Analysis of the data from the first sample identified five factors: interpersonal strengths, family involvement, intrapersonal strength, school functioning, and affective development. The factors appeared to be highly stable and reliable (.79 to .99). No statistically significant age or gender differences were noted, although females were rated higher on each factor and the overall score. The second sample was rated significantly lower than the first across the factors and total score. The article discusses future research issues and practical implications.