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Objective: To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Methods: Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients (n = 12). Providers were asked about their experience as mandated reporters working with patients with OUD. Transcripts were independently coded by two staff, and content analysis was used to identify themes. Results: Our analysis resulted in six thematic areas, including CPS-mandated strengths, concerns related to CPS reporting requirements, implementation of mandates, supporting patients after CPS report, communication between stakeholders, and the impact on care. Providers noted that the fear of CPS involvement causes some patients to delay or not engage in care. Other patients are hesitant to accept medications for OUD for fear of CPS involvement. The inconsistencies in how reporting mandates are applied and how CPS handles cases make communication about the policies challenging for providers and create anxiety for patients. Conclusions: The results of this study indicate that mandated reporting requirements and the potential for CPS involvement are perceived to have minimal positive effects on perinatal individuals with OUD and may negatively affect patients and their care. Clinicaltrials.gov number: NCT04240392. [ABSTRACT FROM AUTHOR]

Children with emotional and behavioral disturbance often have difficulties in multiple symptom domains. This study investigates the relationships between child symptoms and caregiver strain and parenting stress among 177 youth and their caregivers participating in a school-based system of care. Youth were grouped by symptom domain and included those with low scores on both internalizing and externalizing symptoms, those with only high internalizing symptoms, those with only high externalizing symptoms, and those with high symptoms levels in both internalizing and externalizing domains. Results revealed significant group differences on measures of caregiver strain and parenting stress. Caregivers of youth with symptoms in both internalizing and externalizing domains reported the highest levels of strain and stress; however, there was some variation in group differences by caregiver outcome. The results of this study emphasize the importance of providing not only services for youth but also support services for their caregivers. (Contains 4 tables)

Community‐based participatory research (CBPR) partnerships strive to promote community capacity building and sustainability, yet initiatives often suffer when grants or relationships with academic partners end. To address these concerns, researchers hoping to develop truly sustainable CBPR partnerships should consider factors that promote the development of community capacity and, ultimately, independence. In this first‐person account, using perspectives gathered from FAVOR, a Connecticut‐based family‐led advocacy organization and an academic researcher, we examine the practices and experiences of the members of a CBPR partnership focused on using community voice to inform changes in the state's children's behavioral health system of care. These practices ultimately led to FAVOR developing the necessary skills to assume full ownership of the community data‐gathering initiative, ensuring that the initiative would be sustained. Through the perspectives of five FAVOR staff and an academic researcher, we describe the factors that contributed to the organization being able to develop the capacity to independently continue their community data‐gathering initiative, including description of the training process and staff members' perspectives on training, autonomy, community value, and lessons learned. We use these stories and experiences to provide recommendations for other partnerships striving to promote capacity building and sustainability through community ownership of the research process. Highlights: Community‐based participatory research (CBPR) should engender capacity‐building and sustainability.CBPR initiatives face sustainability challenges after research partnerships and funding ends.FAVOR's Community Conversations is a unique example of a community‐sustained CBPR initiative.Through the partnership's intentional planning, FAVOR assumed ownership of the research process.CBPR partners should co‐develop a plan to achieve community ownership at partnership outset. [ABSTRACT FROM AUTHOR]

The coronavirus disease pandemic has highlighted significant gaps in community mental health services, placing vulnerable individuals at greater risk for mental health and substance use difficulties via disrupting their wellness journey. Guided by a wellness framework, a needs assessment was conducted among adult consumers of behavioral health services to understand their needs during the pandemic and to help develop and strengthen service delivery strategies. A team of three university researchers and four Consumer Researchers, who receive services at a publicly funded community mental health center, engaged in a community‐based participatory project in which 13 focus groups were conducted with 51 consumers. Several themes emerged from a thematic analysis of transcripts regarding consumer well‐being and healthcare needs, coping strategies employed, and the accessibility, benefits, and perception of clinical and support services during the pandemic. Results highlighted strengths in service delivery and areas in need of enhancement. Findings may inform similar community services that seek to enhance delivery of care among vulnerable populations. [ABSTRACT FROM AUTHOR]

The present study examined how exposure to traumatic events affects children with severe emotional disturbance who are being served in a school-based system of care. Multilevel growth curve models were used to examine the relationships between a child's history of traumatic events (physical abuse, sexual abuse, or domestic violence) and behavioral and emotional strengths, internalizing problem behaviors, and externalizing problem behaviors over 18 months. Results indicate that children receiving services (N = 134) exhibited increased emotional and behavioral strengths and decreased internalizing and externalizing problem behaviors from enrollment to 18-month follow-up. Children with a history of traumatic events improved more slowly than children without such a history on both strengths and internalizing problem behaviors, even after controlling for dosage of services received and other characteristics previously found to predict outcomes. Gender was also related to improvement in internalizing symptoms. Results highlight the continued need to assess the impact of exposure to traumatic events for children served in a system of care. (Contains 4 tables and 3 figures.)s

The Safe Start demonstration projects, funded by the Office of Juvenile Justice and Delinquency Prevention (OJJDP) under the first phase of the Safe Start initiative, are primarily designed to influence change at the systems or macrolevels to reduce the incidence of and impact of exposure to violence for children aged birth to 6 years; direct services are also provided to young children and their families who were exposed to violence. The data presented in this article come from 10 communities that submitted data regarding the characteristics of young children exposed to violence to OJJDP. These data represent families who are typically not represented in the databases of state child protective services programs but instead have been identified by domestic violence advocates, early care and education providers, family members, court personnel, police, and other social service personnel as families with young children in need of intervention due to violence exposure.The purpose of this article is to describe the characteristics of young children and their parents who seek help for psychosocial problems related to exposure to family and community violence. Results indicate that one quarter of the children and nearly half of their parents evidenced clinical levels of stress, suggesting the need to intervene at the family level as well as at the individual level when working with young children exposed to violence. The information presented, including the extent of exposure to violence, the multiple types of violence to which children are exposed, the impact of this exposure on young children and their families, and the multiple ways in which families exposed to violence come to the attention of service providers is useful for policy makers and service providers who are interested in breaking the cycle of violence by meeting the needs of the children exposed to violence and their families. (Contains 3 notes and 8 tables.)

Research supports that office referral data is useful in informing programmatic decisions and planning interventions such as Positive Behavior Supports (PBS). Knowledge of patterns of office referrals may facilitate development of interventions that target specific groups. This study examines patterns in office referrals within an urban district by gender, race/ ethnicity and grade. Findings reveal that there are differences by grade that appear to be related to developmental level, with more referrals for aggression in younger students (grades K-6), disrespectful behavior in middle school students (grades 7-8), and attendance problems in high school students. Gender differences in the rate and type of referrals were found, with significantly more referrals for boys' delinquent/aggressive behavior, which may relate to how schools define unacceptable behavior and the data collection method. Finally, there were significantly more referrals for African American/black students than Hispanic students, suggesting that schools consider racial differences when developing behavioral expectations. (Contains 1 note, 2 tables and 6 figures.)

Objective: Systems of care (SOCs) were developed to increase access to and quality of care for children with emotional and behavioral difficulties and their families through the provision of coordinated, community-based, culturally competent, family-driven services. SOCs focus on wraparound care that is individualized to meet each family's needs. Previous research has illustrated significant disparities in outcomes of nonwraparound care on the basis of youths' race-ethnicity. This study aimed to fill a research gap by examining disparities in outcomes for families receiving wraparound care coordination within an SOC.Methods: This exploratory study examined racial-ethnic disparities in outcomes observed at intake, during service provision, and at 6-month follow-up among 1,138 youths and their caregivers who participated in wraparound care coordination as part of a statewide SOC between 2016 and 2020. Analyses of variance and regression analyses were executed to investigate whether receiving services and/or the youths' racial-ethnic identity predicted differences in behavioral health outcomes and characteristics of or satisfaction with care. Caregiver-reported outcomes were assessed with the Ohio Scales for Youth, the Child Trauma Screen, and the Caregiver Strain Questionnaire.Results: Results revealed few racial-ethnic disparities in the characteristics and outcomes of care coordination among participants at intake or in family involvement in the wraparound process. Participants across groups reported similar and significant improvement in outcomes. However, the results indicated some disparities in satisfaction with care.Conclusions: Results revealed the positive impact of care coordination on the health and well-being of youths and caregivers across racial-ethnic groups. [ABSTRACT FROM AUTHOR]

Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth (Mage = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-months follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed. [ABSTRACT FROM AUTHOR]

Community‐based Participatory Research (CBPR), where consumers participate in the design and execution of an evaluation, holds promise for increasing the validity and usefulness of evaluations of services. However, there is no literature comparing methods and outcomes of studies conducted by professional evaluators with those conducted through a consumer‐driven evaluation process. We attempt to fill this gap by presenting the methods and results from a qualitative evaluation conducted by professional evaluators along with one conducted by a team of consumer researchers who engaged in a CBPR process. This paper includes: (a) methods, and findings that emerged from these evaluations each tasked with examining similar issues within the same community; (b) description of the process used to train the team of consumer researchers whose economic and educational backgrounds are different than most evaluators; and (c) lessons learned about how to prepare for and work with common barriers to implementing a CBPR evaluation. Highlights: Training approach for community‐based participatory research (CBPR) is provided.Data collected by consumer‐research team were seen as more authentic and resulted in greater use.Lessons learned about overcoming common barriers in a CBPR approach are presented. [ABSTRACT FROM AUTHOR]

Families' positive health service-related views and experiences are associated with improvements in physical and psychological well-being. Research has elucidated key differences in the experiences of caregivers and their children. More work is needed to better understand how families experience enrollment in systems of care (SOCs), given their unique service delivery approach. We compared the service-related views and experiences of 77 youth (Mage = 13.5 years, SD = 2.09, Range = 8 to 18) with severe emotional challenges and their caregivers enrolled in a school-based SOC. Youth and their caregivers reported positive views of service characteristics and related youth outcomes. However, caregivers reported significantly higher levels of perceived cultural sensitivity of services, general satisfaction with services, and active participation in services. Qualitative findings indicated that youth primarily reported improvements in their own psychological and behavioral functioning as the most helpful aspect of services, whereas caregivers tended to emphasize specific youth and family services that they received, such as counseling and psychiatric treatment. We discuss limitations and implications for future research. [ABSTRACT FROM AUTHOR]

Systems of care (SOC) have relied on the wraparound care process to individualize community‐based services for children and youth with serious emotional and behavioral difficulties. A core element of wraparound care is Child and Family Team meetings (CFTs), which are designed to give youth and families a leadership role in developing and guiding their plan of care. The National Wraparound Initiative (NWI) has identified Practice Standards regarding CFT implementation. This study examined CFT characteristics and the association between those characteristics and youth and family outcomes in a statewide SOC. Participants were 363 youth (Mage = 10.89, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning and symptoms at enrollment and 6‐month follow‐up. Care coordinators completed a survey assessing CFT implementation and characteristics following each meeting. Multiple regression analyses were used to examine the relationship between CFT characteristics and youth and caregiver outcomes. Results indicated that a higher number of CFTs was associated with poorer outcomes, while a higher percentage of natural supports at meetings was associated with better youth outcomes. Number of days to the first CFT was associated with greater caregiver strain. Implications for CFT implementation within wraparound are discussed. Highlights: Significant relationships were observed between CFT characteristics and youth and family outcomes.A higher number of CFTs was associated with poorer youth and family outcomes.A higher percentage of natural supports was associated with better youth outcomes.SOCs may have difficulty in fully implementing CFTs consistently with NWI Practice Standards. [ABSTRACT FROM AUTHOR]

Abstract The involvement of consumers in the planning and development of health services has been encouraged and, in some cases, mandated. This involvement is viewed by many as a democratic or ethical requirement in that consumers have a right to influence services. Connecticut has been working toward the full implementation of a children's behavioral health system of care since 1997 but has lacked the mechanisms needed for family members to have their voices heard or to be full partners at decision-making tables. This paper is a case study that highlights work that has been done to 1) gather systematic feedback from families through the use of participatory research methods; 2) increase family access to data; and, 3) build the capacity of caregivers with the goal of increasing their involvement and leadership at all levels of the system of care. Highlights • The involvement of consumers in the planning and development of health services is encouraged. • Involvement of consumers is viewed by many ethical as consumers have a right to influence services they receive. • Connecticut has been working to engage family members as full partners at children's behavioral health decision-making tables. [ABSTRACT FROM AUTHOR]

Individuals who report everyday experiences of discrimination are at heightened risk for adverse health outcomes and tend to report underutilization of health services. Systems of care (SOCs) have the potential to engage members of minority groups and to reduce health disparities. We examined the service‐related experiences of predominantly Latinx caregivers enrolled in a SOC for their children with severe psychological health needs. We used independent samples t‐tests and regression analyses to compare relations among service access, perceived service characteristics, and caregiver stress according to whether caregivers reported frequent or infrequent discrimination. The frequent discrimination group scored significantly higher on dimensions of stress and had greater dosage than the infrequent group. There were no differences in relations between service characteristics and outcomes by group. Findings indicated important differences in the service‐related experiences and outcomes of caregivers who reported frequent and infrequent discrimination. We discuss limitations and implications. [ABSTRACT FROM AUTHOR]

Participation in community-based family interventions characterized by an integrated service approach is linked to enhanced caregiver and child outcomes. However, more research is needed that examines the developmental impacts of interventions serving young children and their families, given that adversity in early childhood may predict problematic developmental trajectories. We examined potential relations among perceived characteristics of an early childhood system of care serving children with severe emotional and behavioral challenges and their families, dimensions of family involvement, and changes in child and caregiver functioning from intake to 6 months. We analyzed data from 158 caregivers of children under age 6 ( M = 3.9 years, SD = 1.11, Range = 1.4-5.9 years) who were primarily White and boys. Results indicated, for instance, that perceived cultural competence and general satisfaction were positively associated with active caregiver participation in services. Although multiple path models tested via path analyses were not statistically significant, the model that assessed the potential mediating effect of active caregiver participation on the relation between cultural competence and caregiver stress approached significance ( z = −1.89, SE = .03, p = .06). Qualitative results indicated that caregivers primarily viewed receiving family support as the most helpful aspect of the SOC, followed by learning enhanced parenting skills and observing positive changes in their children's behaviors. Our findings highlight important facets of an early childhood SOC linked to positive participant experiences and outcomes. We discuss limitations of our study and implications for future research. [ABSTRACT FROM AUTHOR]

Exposure to potentially traumatic events (PTEs) significantly impacts outcomes for children in behavioral health systems of care (SOCs). The present study built on previous research that found parenting stress influences outcomes for children exposed to PTEs. The sample included 184 young children and their families who were enrolled in an early childhood SOC. Path analyses demonstrated that parenting stress mediated the relationship between the number of PTEs a child experienced and caregiver-reported internalizing/externalizing problem behaviors at baseline. Parenting stress also mediated PTEs and internalizing problem behaviors at 6 months. In response to the culmination of these studies, we discuss ways SOCs can support parents to help alleviate parenting stress. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

The 50th anniversary of the Swampscott Conference offers an opportunity to reflect on a community psychology setting, The Consultation Center at Yale, that was formed in response to the 1963 Community Mental Health Act and the 1965 Swampscott Conference. The Center has flourished as a community psychology setting for practice, research, and training for 39 of the 50 years since Swampscott. Its creation and existence over this period offers an opportunity for reflection on the types of settings needed to sustain the field into the future. [ABSTRACT FROM AUTHOR]

Children may be exposed to numerous types of traumatic events that can negatively affect their development. The scope to which studies have examined an array of events among young children has been limited, thereby restricting our understanding of exposure and its relationship to behavioral functioning. The current cross-sectional study describes traumatic event exposure in detail and its relationship to behavioral health among an at-risk sample of young children ( N = 184), under 6 years of age, upon enrollment into an early childhood, family-based, mental health system of care. Caregivers completed home-based semistructured interviews that covered children's exposure to 24 different types of traumatic events and behavioral and emotional functioning. Findings indicated that nearly 72% of young children experienced 1 or more types of traumatic events. Multiple regression model results showed that exposure was significantly associated with greater behavioral and emotional challenges with children's age, gender, race/ethnicity, household income, and caregiver's education in the model. These findings highlight the prevalence of traumatic exposures among an at-risk sample of young children in a system of care and suggest that this exposure is associated with behavioral and emotional challenges at a young age. [ABSTRACT FROM AUTHOR]

Adolescent mothers and their children are at risk for a myriad of negative outcomes. This study examined risk and protective factors and their impact on a sample (N = 172) of impoverished adolescent mothers. Multiple regression analyses revealed that depressed adolescent mothers report higher levels of parenting stress and that their children are more at risk for maltreatment and are developmentally behind other babies. In addition, adolescent mothers with restricted social support have babies who are at higher risk for maltreatment. Finally, mothers who were older during pregnancy were more likely to stay in school. Implications for program development are discussed. [ABSTRACT FROM AUTHOR]

This study examines the relationship between the number of types of traumatic events experienced by children 3 to 6 years old, parenting stress, and children's posttraumatic stress (PTS). Parents and caregivers provided data for 154 urban children admitted into community-based mental health or developmental services. By parent and caregiver report, children experienced an average of 4.9 different types of potentially traumatic events. Nearly one quarter of the children evidenced clinically significant PTS. Posttraumatic stress was positively and significantly related to family violence and other family-related trauma exposure, nonfamily violence and trauma exposure, and parenting stress. Additionally, parenting stress partially mediated the relationship between family violence and trauma exposure and PTS. This study highlights the need for early violence and trauma exposure screening in help-seeking populations so that appropriate interventions are initiated. [ABSTRACT FROM AUTHOR]

This chapter describes the framework and implementation of a program accountability system in a statewide initiative (South Carolina First Steps to School Readiness), which was developed (1) to enable practitioners to provide evaluation information required by legislative mandate and (2) to develop the capacity of practitioners to systematically plan their program, implement with quality, and self-evaluate. The components of this program are reflected in its name: Planning, Implementation, and Evaluation (PIE). The chapter describes PIE in relation to program theory, usage, and efforts to mainstream. [ABSTRACT FROM AUTHOR]

Exposure to adverse events during childhood and adolescence is associated with problematic outcomes across the life span, including the development of posttraumatic stress disorder (PTSD). A growing body of research examining the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy in treating PTSD among young people has yielded mixed findings. More work is needed that elucidates whether EMDR is linked to positive and sustained reductions in symptoms among youth who experience potentially traumatic events. For this open trial, we analyzed data from 143 youth (Mage = 12.9, standard deviation [SD] = 3.4, Range = 6-18) who received outpatient behavioral health clinic services, including EMDR. We assessed whether the number of types of exposure to family-related and non-family-related traumatic events, as well as differences in severity of PTSD symptomatology, was associated with changes in internalizing and externalizing problem behaviors from intake to 6 months. Results indicated that youth with (a) fewer exposures to non-family-related potentially traumatic events and (b) more severe PTSD symptoms, showed greater improvements in externalizing problem behaviors. We discuss limitations of the present study and implications for future research. [ABSTRACT FROM AUTHOR]

The purpose of this article is to present a new brief measure for efficiently and effectively identifying children who have been exposed to violence. The tool was derived from an epidemiological survey of children's experiences completed by parents and was designed to be practical and nonthreatening. The instrument was completed by the parents of 215 children ages six years old and younger. Psychometric evidence indicates satisfactory internal reliability (Cronbach's alpha = 0.82), and the measure also yields consistent results over time. In addition, it relates appropriately and as expected to another measure of violence and trauma exposure, which indicates validity. While the new measure is still under development, it has implications for use by service providers of young children and their families. [ABSTRACT FROM AUTHOR]

Numerous programs have been established to help children who have experienced or are experiencing family violence, but few of these programs have been systematically evaluated. To contribute to the field's understanding of interventions for young children exposed to family violence and their families, we evaluated an intervention that offers comprehensive assessment, targeted caregiver-child intervention, individualized service planning, and care coordination. Baseline-to-discharge results revealed (1) a significant decrease over time in the number of potentially traumatic events that children experienced, including family and nonfamily violence events, (2) significant decreases over time in children's post-traumatic stress-intrusive thoughts and post-traumatic stress-avoidance behaviors, (3) significant decreases in self-reported stress associated with the parenting role among caregivers, (4) favorable ratings of services by caregivers, and (5) high levels of service receipt. [ABSTRACT FROM AUTHOR]