An Integrative Data Analysis of Main and Moderated Crossover Effects of Parent-Mediated Interventions on Depression and Anxiety Symptoms in Youth in Foster Care.

Without preventative intervention, youth with a history of foster care (FC) involvement have a high likelihood of developing depression and anxiety (DA) symptoms. The current study used integrative data analysis to harmonize data across four foster and kinship parent-mediated interventions (and seven randomized control trials) designed to reduce youth externalizing and other problem behaviors to determine if, and for how long, these interventions may have crossover effects on youth DA symptoms. Moderation of intervention effects by youth biological sex, developmental period, number of prior placements, and race/ethnicity was also examined. Youth (N = 1891; 59% female; ages 4 to 18 years) behaviors were assessed via the Child Behavior Checklist, Parent Daily Report, and Eyberg Child Behavior Inventory at baseline, the end of the interventions (4-6 months post baseline), and two follow-up assessments (9-12 months and 18-24 months post baseline), yielding 4830 total youth-by-time assessments. The interventions were effective at reducing DA symptoms at the end of the interventions; however, effects were only sustained for one program at the follow-up assessments. No moderation effects were found. The current study indicates that parent-mediated interventions implemented during childhood or adolescence aimed at reducing externalizing and other problem behaviors had crossover effects on youth DA symptoms at the end of the interventions. Such intervention effects were sustained 12 and 24 months later only for the most at-risk youth involved in the most intensive intervention.

Partner influences on young women's risky drug and sexual behavior.

BACKGROUND: Adolescent girls with a history of maltreatment are at heightened risk for health-risking behaviors, including unsafe sexual behaviors and drug use. However, few studies have examined the views of this population in regard to sexual partner choice, sexual behaviors, and decisions to use drugs with sexual partners. METHODS: We conducted 15 semistructured, open-ended qualitative interviews with young women ages 18-24 with a history of maltreatment and asked them to reflect on their experiences as adolescents. We used the constant comparison method to group the qualitative coded data into themes. RESULTS: Analysis of the interviews suggested that adolescent girls with maltreatment histories often report that they chose partners who are promotive of risky drug and sexual behavior. The interviews also provided insight into why this population is likely to use drugs with their partner and why they might be hesitant to talk about or practice safe sex with their partner. CONCLUSION: The young women's feedback highlighted five areas where adolescent girls with maltreatment histories could benefit: (a) provision of information about partner characteristics that are promotive of both risky behavior and those that are linked to healthy relationships, (b) provision of information about how one's partner can influence one's own drug use,

Young Women's Perspectives of Their Adolescent Treatment Programs: A Qualitative Study.

The perspectives of at-risk adolescent clients can play an important role in informing treatment services. The current study examines qualitative interview data from 15 young women with histories of maltreatment. Using a semi-structured qualitative interview approach, we asked the women to think retrospectively about their treatment experiences as adolescent girls. Results highlight the need for providing adolescent girls with reliable and practical information about risky sexual behavior and drug use from relatable and trustworthy helping professionals. We discuss strategies for developing and maintaining trust and delivering specific content.

Pathways to Preventing Substance Use Among Youth in Foster Care.

Substance use problems are highly prevalent among youth in foster care. Such problems in adolescence have long-lasting implications for subsequent adjustment throughout adulthood and even across generations. Although several programs have demonstrated positive results in reducing substance use in at-risk youth, few studies have systemically examined how such programs work for foster youth and whether they are effective for both genders. This study examined the efficacy of KEEP SAFE, a family-based and skill-focused program designed to prevent substance use and other related health risking behaviors among youth in foster care. We hypothesized that improving the caregiver-youth relationship would lead to later reductions in youths' involvement with deviant peers, which subsequently would lead to less substance use, and that this mechanism would work comparably for both genders. A sample of 259 youth (154 girls, ages 11-17 years) in foster care and their caregivers participated in a randomized controlled trial and was followed for 18 months post-baseline. Results indicated that the intervention significantly reduced substance use in foster youth at 18 months post-baseline and that the intervention influenced substance use through two processes: youths' improved quality of relationships with caregivers at 6 months post-baseline and fewer associations with deviant peers at 12 months post-baseline. This suggests that these two processes may be fruitful immediate targets in substance use prevention programs for foster youth. We also found little gender differences in direct and mediating effects of the intervention, suggesting KEEP SAFE may be effective for both genders in foster care.

Understanding Parent-school Communication for Students with Emotional and Behavioral Disorders.

BACKGROUND: Parents of children with Emotional and Behavioral Disorders (EBD) often face barriers to effective communication with schools. They often feel blamed or stigmatized for their children's behavior and, while advocating, can feel adversarial with the school. OBJECTIVE: The current study aims to describe current communication for parents and teachers of students with EBD, identify parent-school communication barriers, and identify characteristics of effective parent-school communication. METHOD: We conducted 15 semi-structured, qualitative interviews with parents and teachers of students with EBD. Interview questions focused on descriptions of the tone of their current communication, perceived barriers to communication, and ideas for effective approaches to communication. All interviews were audio-recorded, transcribed verbatim, and coded. RESULTS: Results show that parents' feelings about their current parent-school communication varied by the type of school students were attending: day-treatment, neighborhood, military charter, or private treatment school. Both parents and teachers brought up complex issues with parent-school communication related to school culture and the impact of parents' prior negative experiences communicating with schools. Parents and teachers identified barriers to communication and suggestions for effective communication related to technology, institutional issues, time, parents' and teachers' lack of interest in communicating, and school proximity to home. CONCLUSION: Parents and teachers identified parent-school communication as a critical factor to promote children's school success. Three broad recommendations emerged from the interviews targeting malleable factors to increase effective parent-school communication. We also discuss limitations and implications for practice.

Transition Supports for At-Risk Students: A Case Example.

Middle school students with emotional and behavioral disorders are at risk for myriad negative outcomes. Transitioning between schools may increase risk for students being reintegrated into their neighborhood school. The current study seeks to inform supports for students and their families during these transitions. Students With Involved Families and Teachers (SWIFT) is an initiative being conducted in a small urban area in the Pacific Northwest, USA. Parent, student, and school-based supports were provided across a yearlong transition for students receiving special education services in a behavioral day-treatment program. A case example is used to describe the essential features of SWIFT, illustrate the experience of a student and his family, and outline lessons learned for successful home-school collaboration.

Stakeholders' Voices: Defining Needs of Students with Emotional and Behavioral Disorders Transitioning between School Settings.

Students with emotional and behavioral disorders (EBD) too often do not receive adequate services or care in their school settings, particularly during transitions in educational placements. In addition, school support teams often struggle with creating transition plans that honor the needs of students with input from key stakeholders responsible for supporting student success. This article presents findings from the information-gathering phase of an iterative project that aims to develop a support program for students with EBD transitioning from day-treatment schools to district schools. We conducted 5 semistructured, qualitative focus groups with parents and teachers to explore needs during students' transitions between school settings. Five themes emerged from the focus groups: (a) consistent, behavior-specific feedback and positive reinforcement are vital to sustaining learned prosocial skills; (b) students benefit from regular opportunities to learn and practice social skills; (c) transition programming should emphasize communication between school and home; (d) routines at home and school should be coordinated; and (e) parents need support at school meetings. We will use findings from this study to develop a multifaceted intervention that aims to support students, their caregivers, and their teachers during transitions between the aforementioned types of schools.

Adverse Consequences of School Mobility for Children in Foster Care: A Prospective Longitudinal Study.

Few prospective studies have examined school mobility in children in foster care. This study described the school moves of 86 such children and 55 community comparison children (primarily Caucasian), living in a medium-sized metropolitan area in the Pacific Northwest who were approximately 3 to 6 years old at the study start. Additionally, the effects of moves from kindergarten through Grade 2 on academic and socioemotional competence in Grades 3 through 5 were examined. A greater number of early school moves was associated with poorer later socoemotional competence and partially mediated the effects of maltreatment and out-of-home placement on socioemotional competence. This was the case only for children with poorer early learning skills in kindergarten. Implications for preventive intervention are discussed.

Refining an intervention for students with emotional disturbance using qualitative parent and teacher data.

Intensive supports are needed for students with emotional disturbance during high-risk transitions. Such interventions are most likely to be successful if they address stakeholder perspectives during the development process. This paper discusses qualitative findings from an iterative intervention development project designed to incorporate parent and teacher feedback early in the development process with applications relevant to the adoption of new programs. Using maximum variation purposive sampling, we solicited feedback from five foster/kinship parents, four biological parents and seven teachers to evaluate the feasibility and utility of the Students With Involved Families and Teachers (SWIFT) intervention in home and school settings. SWIFT provides youth and parent skills coaching in the home and school informed by weekly student behavioral progress monitoring. Participants completed semi-structured interviews that were transcribed and coded via an independent co-coding strategy. The findings provide support for school-based interventions involving family participation and lessons to ensure intervention success.

Examining the equivalence of fidelity over two generations of KEEP implementation: A preliminary analysis.

PROBLEM: In order to obtain and maintain positive outcomes garnered from evidence-based practice (EBP) models, it is necessary to implement them effectively in "real world" settings, to continually monitor intervention fidelity to prevent drift, and to train new staff due to turnover. The fidelity monitoring processes that are commonly employed in research settings are labor intensive and probably unrealistic to employ in community agencies given the additional burden and cost that they represent over and above the cost of implementing the EBP. Efficient strategies for implementing fidelity monitoring and staff training procedures within the inner context of agency settings are needed to promote agency self-sufficiency and program sustainability. METHOD: A cascading implementation model was used whereby agencies who achieved proficiency in KEEP, an EBP designed to prevent placement disruptions in foster and kinship child welfare homes, were trained to take on fidelity management roles to improve the likelihood of program sustainability. Agency staff were trained to self-monitor fidelity and to train internal staff to achieve model fidelity. A web-based system for conducting fidelity assessments and for onsite/internal and remote program quality monitoring was utilized. RESULTS: Scores on fidelity ratings from streamed observations of intervention sessions showed no differences for foster parents treated by first generation interventionists trained by model developers compared to a second generation of interventionists trained by the first generation. CONCLUSION AND RELEVANCE TO CHILD WELFARE: Development of the local intra-agency capacity to manage quality intervention delivery is an important feature of successful EBP implementation. Use of the cascading implementation model appears to support the development of methods for effective monitoring of fidelity of the KEEP intervention, for training new staff, and ultimately for the development of internal methods for maintaining program sustainability and effectiveness.