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Children and youth with high behavioral health needs can receive care in a psychiatric residential treatment facility (PRTF). Overutilization of PRTFs is concerning because they are highly restrictive and costly residential care settings. Intensive Alternative Family Treatment (IAFT®) is an intensive therapeutic foster care program combined with service implementation strategies that is designed to reduce risk for entry to PRTF among youth with high behavioral health needs. This article presents findings from a quasi-experimental study examining the effectiveness of IAFT services in such a population of youth. In this study, we balanced treatment and comparison groups by first sampling youth with intensive care needs as indicated by having a prior PRTF spell. We then used propensity score weighting and covariate adjustment to estimate the effectiveness of IAFT in preventing PRTF re-entry. We found that receipt of IAFT was associated with a 24% lower risk of PRTF re-entry compared with youth who exited from a PRTF in the same state but did not receive IAFT. Sensitivity tests yielded mixed results regarding the effect of IAFT. Overall, results suggest that IAFT is an effective treatment approach for reducing risk for PRTF entry among youth with high behavioral health needs.

The disengagement that leads to school dropout may start as early as middle school, but may be interrupted by motivational interventions. One approach is to promote the relevance of content through explanations and demonstrations of the value of this content to students' futures. CareerStart is an intervention that provides teachers prepackaged lessons for middle school math, English language arts, science, and social studies, which connects content in these courses to jobs and careers. In this study, we use data from a randomized control trial to report on the impact of CareerStart and career relevant lessons on preventing later drop-out. Event history analysis shows that CareerStart reduced the hazard of drop-out by 23%, and that at the school level, 10 CareerStart lessons was associated with a reduction of 1%. Students who did not change schools experienced the greatest benefit. We discuss implications for practice and research and suggest next steps.

The academic achievement places children on a positive trajectory for their lifespan. The aim of this study was to examine the academic trajectories of children in out-of-home care (OOCH) and whether kinship care has a protective effect relative to nonkin foster care. The sample analyzed for this study consists of 519,306 racially diverse youth in North Carolina schools 8 to 11 years old in the school year 2009-2010 (e.g., 27% African American, 12% Latinx, 53% White). Four longitudinal administrative data sources were merged to create this unique sample. Multilevel modeling revealed no difference between formal and non-OOHC, but showed differences between nonkin foster, informal, and non-OOHC. Children's academic performance who reside in formal kinship care is similar to children in non-OOHC.

This study evaluated the efficacy of School-Based Teen Courts (SBTCs) using a rigorous experimental trial with 24 middle- and high-schools randomly selected to receive SBTCs (n= 12) or to business-as-usual without any SBTC program (n = 12). Analyses examined school-level longitudinal growth models and individual-level pretest-posttest comparisons on school climate, student problems, and suspension rates. Longitudinal growth models revealed that SBTCs were significantly associated with positive changes in school satisfaction and reductions in delinquent friends for high school students, but showed no significant changes on other outcomes. Short-term suspensions decreased more than twice as much in SBTC schools versus comparison schools. There was a 47% reduction in bullying victimization in SBTC schools relative to a 22% reduction in comparison schools. These findings suggest that SBTCs have the potential to positively impact youth development.

Background: Despite documented benefits of Advance Care Planning (ACP), it is still under-utilized in the U.S. Our study aimed to examine whether experiencing a loved one's death is associated with one's own ACP behavior among adults in the U.S. and the potential moderating effect of age. Method: Using a nationwide cross-sectional survey design with probability sampling weights, our study included 1006 adults in the U.S. who participated in and completed the Survey on Aging and End-of-Life Medical Care. Three binary logistic regression models were established to investigate the relationship between death exposure and different aspects of ACP (i.e., informal conversations with family members and doctors and formal advance directives completion). The moderation analysis was subsequently conducted to examine moderating effects of age. Results: The exposure to a loved one's death was significantly associated with higher odds of having conversations with family about end-of-life medical care preferences among the 3 indicators of ACP (OR = 2.03, P <.001). Age significantly moderated the association between death exposure and ACP conversations with doctors (OR =.98, P =.017). The facilitation effect of death exposure on informal ACP engagement in discussing end-of-life medical wishes with doctors is stronger among younger adults than older adults. Conclusions: Exploring an individual's previous experience with a loved one's death might be an effective way to broach the concept of ACP among adults of all ages. This strategy may be particularly useful in facilitating discussions of end-of-life medical wishes with doctors among younger adults than older adults. [ABSTRACT FROM AUTHOR]

Social work aspires to change social outcomes through policy and practice. Thus, researchers often use quantitative analysis to understand how social phenomena or policy and practice interventions change outcomes, but these causal questions cannot be answered using statistical association only. Directed acyclic graphs (DAGs), also called causal graphs, are a framework for representing assumptions about the causal relations between variables, imbuing statistical associations with causal meaning. This visual language may be more accessible than a math-based approach. We provide social work researchers with clear guidelines for using DAGs. First, we synthesize the current DAG literature and show how many statistical phenomena are represented in DAGs. Second, we describe an ordered process for building a DAG around a causal question about the impact of a treatment on an outcome. Third, we introduce a structured process called "clock and grid" for specifying the confounders that must be accounted for to estimate the unbiased causal effect. Throughout, we use working examples of social work evaluation scenarios to facilitate understanding of these concepts. We argue that DAGs represent an end-to-end conceptual framework for curating subject area knowledge that can advance social work research by informing design and analysis. [ABSTRACT FROM AUTHOR]

Intervention researchers in school settings often implement interventions that involve professional development to schoolteachers or other professional staff to implement school-based interventions. In terms of classroom interventions, teachers are the primary implementation agents; therefore, the fidelity of such interventions depends on teacher adoption and delivery. To understand and meet such fidelity challenges, we set to identify the contextual components and implementation mechanisms that contribute to the variation in teachers' perspectives and methods of implementing an experimental evaluation of CareerStart; an innovative intervention designed to increase student school engagement and achievement by advancing teacher use of career relevant instruction in the middle grades. The results of this study suggest teachers perceive CareerStart in three interrelated ways: their perceptions of the program's effectiveness on student outcomes; the degree to which the program is adaptable and compatible to their roles and responsibilities; and the effects of the school environment on their perceptions of the intervention. We conclude with a discussion of treatment fidelity effectiveness in school-based intervention programs.

We examined the impact of the implementation of The Triple P-Positive Parenting Program in North Carolina (NC) on reducing child maltreatment, a serious public health problem in the US with lasting harmful effects on children. In 2012 and 2013, 34 of 100 counties in NC implemented Triple P. A panel data set with county-level child welfare data and emergency department (ED) discharge data from 2008 to 2015 for 100 counties in NC was constructed. A quasi-experimental design using difference-in-differences analysis estimated the association between the implementation of Triple P and the rate of (1) investigated child maltreatment reports; (2) entry into foster care; and (3) ED visits concerning for child maltreatment. Implementation of Triple P was associated with in a 4% decrease in the county rate of investigated reports of child maltreatment (RR = 0.96, 95% CI [0.93, 0.99]) and a 7% decrease in the county rate of children in foster care (RR = 0.93, 95% CI [0.88, 0.98]). Each of these findings was robust to one but not both sensitivity tests performed. There was no reduction in county-level rates of ED visits with ICD-9-CM codes concerning for child maltreatment. Implementation of Triple P in NC outside of the parameters of scientific study is associated with small reductions in the rates of child maltreatment reports and foster care placements. Additional research is needed to understand whether such small reductions justify the substantial investment communities are making in Triple P., Author(s): Samantha Schilling [sup.1] , Paul Lanier [sup.2] [sup.3] , Roderick A. Rose [sup.2] , Meghan Shanahan [sup.3] [sup.4] , Adam J. Zolotor [sup.3] [sup.5] Author Affiliations: (1) grid.10698.36, 0000000122483208, [...]

In this commentary I respond to Lewis (2019 (See CR7)) and Lanier (2019 (See CR6)), building on their critiques and ideas, offering some additional thoughts about the dissemination of the Campbell, Rubin, and Pearl causal frameworks and their potential emergent value to the future of family violence research. I clarify that the central issue to credibility is the plausibility of assumptions, that some widely utilized methods often require researchers to make implausible assumptions, and that there is value to knowing and using all three frameworks., Author(s): Roderick A. Rose [sup.1] Author Affiliations: (Aff1) grid.10698.36, 0000000122483208, School of Social Work, University of North Carolina at Chapel Hill, , 325 Pittsboro St., CB 3550, 27599, Chapel Hill, [...]

Causal questions pervade family violence research, including how and why violence occurs, how it can be prevented, and how to support survivors. Randomization cannot always be used, but in studies of the effects of known causes, regression based observational methods (e.g., propensity score analysis) can be used. Statistical findings are associational only, however, and plausible assumptions are needed to give findings causal meaning. In this review, I suggest two criteria for plausible assumptions that help support credible causal inferences. I then describe and connect three frameworks that provide standards for specifying assumptions in causal inference: the Rubin potential outcomes framework; the Pearl directed acyclic graph framework; and the Campbell framework of validities (e.g., internal validity). These frameworks are widely accepted across the social sciences, facilitating dissemination and critique. Each has strengths and weaknesses, and in studies of the effects of known causes, they may complement each other. Utilizing the standards given to us by these frameworks to select and articulate the assumptions needed for credible causal inference will impact our understanding of family violence and violence prevention more so than studies that cannot be connected as clearly to such standards., Author(s): Roderick A. Rose [sup.1] Author Affiliations: (Aff1) grid.10698.36, 0000000122483208, School of Social Work, UNC Chapel Hill, , 325 Pittsboro Street, 27599-3550, Chapel Hill, NC, USA Family violence research is [...]

Objective: In social service settings, client exposure to an intervention is often facilitated by workers (e.g., case managers, care coordinators) who have some discretion over the services their clients receive. This paper demonstrates how the empirical Bayes residuals (EBRs) of predicted random effects can reliably estimate these workers' latent decision-making tendencies, such as the tendency to refer clients to a particular intervention. As such, in nonexperimental evaluation studies, the EBR can provide a measured value for an unobserved assignment determinant, which can be included in treatment effect models to reduce confounding bias. Method: We used Monte Carlo simulation to generate data for a hypothetical evaluation scenario in which child welfare caseworkers nonrandomly referred youth to a behavioral health intervention. Model variations assessed for bias in treatment effect estimates when instrumenting for nonrandom assignment with the EBR. Results: When caseworker referral effects were evident, the EBR consistently performed well as an instrument to obtain unbiased treatment effects and generally outperformed other methods, such as partially adjusted regression and instrumenting with simple caseworker means. Conclusions: The EBR offers a useful measurement tool when estimating causal effects from nonexperimental data. Study conditions that do not support instrumental variable estimation are also considered. [ABSTRACT FROM AUTHOR]

Introduction:Mental health patients in states without private payer telehealth reimbursement policies before the public health emergency (PHE) may have experienced reduced access to telemental health (TMH). We estimate the association between private payer telehealth policy status in 2019 and the transition to TMH in 2020. Methods:Retrospective cohort study of privately insured individuals 2–64 years old with a mental health disorder and without TMH use in 2019. We examined new telemental use in 2020 by three categories of policy reimbursement status in 2019 (partial parity, full parity vs. no policy), overall (any telemental), and by modality (live video, audio-only, and online assessments) using logistic regression models clustered by state. Results:Among the 34,612 enrollees, 54.7% received TMH for the first time. Relative to no policy states, enrollees in partial or full parity states were equally likely to receive TMH in 2020. However, enrollees in states with a private payer telehealth policy were less likely to receive audio-only (partial parity: odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.39–0.90; full parity: OR: 0.38, 95% CI: 0.26–0.55), but more likely to receive online assessments (full parity: OR: 2.28, 95% CI: 1.4–4.59). Conclusions:Privately insured enrollees similarly transitioned to TMH across states suggesting a broad impact of the PHE policies on access to this care. The differences in audio-only and online assessments suggest that providers were possibly better prepared to implement TMH care via live video or patient portals in states with telehealth policies. [ABSTRACT FROM AUTHOR]

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children's Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs., Author(s): Paul Lanier [sup.1] , Kathryn Maguire-Jack [sup.2] , Brianna Lombardi [sup.1] , Joseph Frey [sup.1] , Roderick A. Rose [sup.1] Author Affiliations: (Aff1) 0000000122483208, grid.10698.36, School of Social Work, [...]

Family violence researchers often use an ecological perspective to describe persons nested within groups. Further, family violence researchers frequently investigate whether group characteristics impact individual outcomes. The theoretical orientation and research designs typically used therefore present opportunities to utilize multilevel modeling (MLM) for clustered designs. It is widely understood that MLM corrects standard errors for grouped data, though other approaches can address this issue. Importantly, MLM presents a structured approach to the examination of group differences in outcomes, group differences in the association between the characteristics of persons and these outcomes, and the explanation of group differences using group-level characteristics. This journal frequently receives studies that use MLM for clustered designs, and a set of analytical guidelines may assist authors in preparing such articles so as to properly implement and better leverage the power of MLM to advance family violence research. I describe MLM for the new user, providing guidance on estimation of these models in the context of two examples. In addition, for more experienced users of MLM, I argue for greater attention to between-group and compositional effects that may be prevalent in family violence research, and the opportunities they may raise for a better understanding of the complexities at the group level. In closing I discuss some extensions of MLM and place MLM in the context of research design, providing guidelines for designing, carrying out, and reporting findings from studies that use these methods., Author(s): Roderick A. Rose [sup.1] Author Affiliations: (1) School of Social Work, UNC Chapel Hill, 0000000122483208, grid.10698.36, , 325 Pittsboro Street, 27599-3550, Chapel Hill, NC, USA Multilevel modeling (MLM) is [...]

This article describes the findings from an efficacy trial of a school-based, universal prevention program designed to reduce aggressive behavior of by strengthening emotion regulation and social information-processing (SIP) skills. Three cohorts of third graders (N = 479) participated in this study. The first cohort participated in the Making Choices (MC) program, a second cohort participated in the Making Choices Plus (MC+) program, and a third (lagged) cohort received the standard health education curriculum. Pretest to posttest changes suggest both programs were associated with reduced levels of aggression and improved SIP skills. Gender-moderating effects were observed--boys displayed significant reductions in aggressive behavior and significant increases in positive social goals, whereas girls' aggressive behaviors and social goals showed no significant changes.

The academic impact of the transition from elementary to middle school has significant consequences for many early adolescents. This study examines academic growth across the transition, as well as sociodemographic moderators. Rather than defining the transition effect as a decline in student achievement between fifth and sixth grade, these data demonstrate the transition effect as an interruption in students' growth in achievement during this interval. Results confirm larger interruptions for vulnerable students (e.g., low income, special education) despite closing the gap effect over the third- to eighth-grade interval.

We examined the association between state Medicaid spending for children with disabilities and the financial burden reported by families of children with autism. Child and family data were from the 2005-2006 National Survey of Children with Special Health Care Needs (n = 2,011 insured children with autism). State characteristics were from public sources. The 4 outcomes included any out-of-pocket health care expenditures during the past year, expenditure amount, expenditures as a proportion of family income, and whether additional income was needed to care for a child. We modeled the association between state per capita Medicaid spending for children with disabilities and families' financial burden, controlling for child, family, and state characteristics. Overall, 78% of families raising children with autism had health care expenditures for their child for the prior 12 months; 42% reported expenditures over $500, with 34% spending over 3% of their income. Families living in states with higher per capita Medicaid spending for children with disabilities were significantly less likely to report financial burden. There is a robust relationship between state Medicaid spending for children with disabilities and the financial burdens incurred by families raising children with autism.

Understanding the financial well-being of single mothers who care for children with developmental disabilities is important to ensure that public policies can be effectively targeted to support these vulnerable families. The authors analyze data from the Survey of Income and Program Participation to describe income poverty, asset poverty, income, net worth, and liquid assets of U.S. single, working-age mothers (n = 242) of children and adult children with developmental disabilities. The well-being of these mothers was compared to the situation of married mothers of children with developmental disabilities (n = 345) and of single mothers who did not have children with developmental disabilities (n = 6,547). Compared with both married mothers of children with developmental disabilities and single mothers without children with developmental disabilities, single mothers of children with developmental disabilities had markedly worse financial well-being across a range of income- and asset-based measures. Single mothers caring for children with developmental disabilities face adverse financial well-being as compared with other mothers. Policy makers should consider targeted measures to improve the financial well-being of these parents.

Student engagement is a critical aspect of the learning process and a known predictor of school success. We report on an evaluation of a classroom intervention, CareerStart, designed to promote engagement through the use of career-relevant instruction whereby teachers use examples to tie the lesson material to knowledge and skills students can see as relevant to potential future careers. Evidence from a randomized control trial indicates that among math teachers, CareerStart increases the use of career-relevant instruction. We discuss research and policy implications of these findings. We argue that CareerStart should be investigated further, and that policymakers and educators should consider this program or similar relevance-based efforts when looking to reform teaching practice. (Contains 2 tables and 1 figure.)

We examined racial and ethnic disparities in quality of care for children with autism and other developmental disabilities and whether disparities varied for children with autism compared to children with other developmental disabilities. Analyzing data from the National Survey of Children with Special Health Care Needs (N = 4,414), we compared Black and Latino children to White children. We found racial and ethnic disparities on 5 of 6 quality outcomes. The interaction between race and disability status indicated that disparities in quality indicators were exacerbated among families of children with autism. These analyses suggest that children with autism, particularly those who are Latino and Black, face greater challenges in receiving high-quality health care.

This study examines access to, utilization of, and quality of health care for Latino children with autism and other developmental disabilities. We analyze data from the National Survey of Children with Special Health Care Needs (N = 4,414 children with autism and other developmental disabilities). Compared with White children, Latino children with autism and other developmental disabilities had a consistent pattern of worse health care access, utilization, and quality. We then test mediation models to determine if health care quality mediates the relationship between ethnicity and health care utilization disparities. Three of four quality indicators (provider does not spend enough time with child, provider is not culturally sensitive, and provider does not make parent feel like a partner) were significant mediators. These analyses suggest that interventions targeted at improving providers' cultural sensitivity and behavior during the clinical encounter may reduce disparities in the health care utilization of Latino children with autism and other developmental disabilities.

We examined the association between states' legislative mandates that private insurance cover autism services and the health care-related financial burden reported by families of children with autism. Child and family data were drawn from the National Survey of Children with Special Health Care Needs (N = 2,082 children with autism). State policy characteristics were taken from public sources. The 3 outcomes were whether a family had any out-of-pocket health care expenditures during the past year for their child with autism, the expenditure amount, and expenditures as a proportion of family income. We modeled the association between states' autism service mandates and families' financial burden, adjusting for child-, family-, and state-level characteristics. Overall, 78% of families with a child with autism reported having any health care expenditures for their child for the prior 12 months. Among these families, 54% reported expenditures of more than $500, with 34% spending more than 3% of their income. Families living in states that enacted legislation mandating coverage of autism services were 28% less likely to report spending more than $500 for their children's health care costs, net of child and family characteristics. Families living in states that enacted parity legislation mandating coverage of autism services were 29% less likely to report spending more than $500 for their children's health care costs, net of child and family characteristics. This study offers preliminary evidence in support of advocates' arguments that requiring private insurers to cover autism services will reduce families' financial burdens associated with their children's health care expenses.

Self-report data from 2,088 sixth-grade students in 11 middle schools in North Carolina were combined with administrative data on their eighth-grade end-of-the-year achievement scores in math and reading to examine the influence of students' perceived parental school behavior expectations on their academic performance. Through use of multilevel modeling and control for the influence of students' demographics, trouble avoidance, and perceived support from adults and peers, we found that students' perceptions of their parents' expectations of their school behavior had a small but positive and statistically significant influence on their math and reading scores approximately 3 years later. Implications for the implementation of evidence-based interventions in schools are discussed.

Background: Women with developmental disabilities are much less likely than nondisabled women to receive cervical and breast cancer screening according to clinical guidelines. One barrier to receipt of screenings is a lack of knowledge about preventive screenings. Method: To address this barrier, we used a randomized control trial (n = 175 women) to test "Women Be Healthy," an intervention designed to promote cervical and breast cancer screening for women with developmental disabilities. Women assigned to the experimental group participated in weekly health education program for 8 weeks. Women assigned to the control group participated in their regular vocational training or educational activities. Results: Unadjusted findings indicated modest gains for both groups in knowledge related to cervical and breast cancer screening. Regression results indicated statistically significant but modest knowledge gains for the experimental group related to breast cancer screening. Implications: These findings indicate that the "Women Be Healthy" curriculum is promising but needs to better address cervical cancer. (Contains 4 tables.)

This article examines the analysis of the psychometric properties, including the validity and reliability, of the Empathy Index (EI), a new instrument designed to measure empathy deficits of sex offenders. The EI was tested with a sample of 158 sex offenders incarcerated in North Carolina prisons. An exploratory factor analysis yielded three subscales: social aggression; instrumental (proactive) aggression; and justification. Social aggression was an unexpected finding, given this type of aggression is more commonly found in young females rather than adult male sex offenders. The instrument demonstrates promising construct and concurrent validity as well as strong internal reliability. Implications for future research and practice are discussed. (Contains 4 tables.)

Background: Understanding how financial well-being changes through the life course of caregiving parents of children with developmental disabilities is critically important. Methods: We analyse SIPP (U.S. Census Bureau) data to describe income poverty, asset poverty, income, net worth, and liquid assets of US parents (N = 753) of children with developmental disabilities. Results: Income and asset poverty was greatest for the youngest and oldest parents. Liquid assets were relatively flat across cohorts, while net worth declined sharply for elderly parents. Income was highest among parents aged 45-54. Conclusion: These findings signal significant financial vulnerability among parents of children with developmental disabilities. Policy makers should consider targeted measures to improve the financial well-being of these parents, particularly the youngest and oldest. (Contains 2 figures and 1 table.)

The school dropout rate in America is too high, especially for low-income students and those from nondominant racial or ethnic groups. For many students, the social-psychological and behavioral disengagement from school that leads to dropping out often begins in middle school. Research on early adolescents confirms that increasing the perceived future career relevance of schooling is associated with higher levels of student engagement. This article describes the value of promoting future career relevance in middle school education and the CareerStart program, which can be implemented in schools to promote this type of learning. CareerStart is a whole school engagement program that responds to current education reform initiatives and supports more comprehensive efforts to promote school-based professional collaborations that benefit at-risk students.

In this study, we examined longitudinal, person-centered trajectories of acculturation, internalizing symptoms, and self-esteem in 349 Latino adolescents. We compared acculturation measures (time in the US, culture-of-origin involvement, US cultural involvement, for both parents and adolescents); acculturation stressors (perceived discrimination, acculturation conflicts); and family dynamics (parent-adolescent conflict, familism). Results indicated that, over time, Latino adolescents' internalizing problems decreased and their self-esteem increased. However, we showed that increased length of time living in the US was significantly related to lower self-esteem among adolescents. Parent-adolescent conflict was a strong risk factor, which not only directly heightened internalizing symptoms and lowered self-esteem, but also mediated the effects of acculturation conflicts and perceived discrimination on these outcomes. Our findings revealed familism as a cultural asset associated with fewer internalizing symptoms and higher self-esteem. Internalizing symptoms were also minimized by the adolescent's involvement in the US culture whereas bicultural adolescents with high culture-of-origin involvement reported higher self-esteem. We discussed the limitations and implications of this study for future research and practice.