Acceptance of medications for opioid use disorder in recovery housing programs in Missouri.

BACKGROUND: Recovery housing plays an important role in supporting individuals in their recovery by building recovery capital and providing stable living environments; however, the extent to which medications for opioid use disorder (MOUD), the gold standard for OUD treatment, are accepted in recovery housing settings is unclear. The purpose of this study, as part of a larger statewide evaluation of Missouri recovery homes, was to identify the extent to which Missouri recovery houses were accepting of methadone, buprenorphine, and naltrexone as well as the extent to which the acceptance of each medication was linked to whether the recovery home encouraged tapering off MOUDs. METHODS: Sixty-four recovery housing managers and/or staff, out of 66 eligible recovery homes in Missouri completed the survey. RESULTS: Results indicated that methadone was the least accepted medication for long-term use followed by buprenorphine and then naltrexone. Recovery houses that had significantly lower overall acceptance of methadone encouraged tapering; however, the overall acceptance for buprenorphine and naltrexone was not significantly related to the encouragement of tapering off MOUDs. CONCLUSION: This work highlights the need to develop reliable instruments to measure and assess MOUD-capable recovery homes and to increase knowledge and acceptance of MOUD within recovery home settings.

Safe From Harm? Youth Self-Report of Physical Assault in Child Welfare Placements.

Although most child welfare placements receive a rigorous assessment and ongoing safety monitoring, it is still unclear which is safest in terms of physical abuse. Our goals for this study were to assess the relative risk of physical assault for different child welfare placements in a national sample of youth and examine that risk within placement types for children with various levels of behavioral problems. Unlike previous studies of assault prevalence, we constrained our analysis to youth self-reports of assaults within a current placement to increase validity. Data from the 2010 National Survey of Child and Adolescent Well-Being (NSCAW II) were used. The final analytic sample included children 8-18 years of age at Wave 3 interview in 2012 (n = 1,302). Physical assault was measured using youth reports of being thrown at, shoved, slapped, beat-up, or stabbed, shot, or threatened with a knife or gun. Multiple bivariate contingency table analyses using Pearson χ2 tests and ordinal logistic regressions were used. Overall, 8% of youth reported a minor assault, 9% a serious assault, and 14% any assault. Ordinal logistic regression models showed that children with more severe behavioral problems were at increased odds of more serious physical assault (odds ratio [OR] = 1.03, 95% confidence interval [CI] = [1.01, 1.05]) and youth in adoptive homes were at decreased odds of assault (OR = 0.22, 95% CI = [0.03, 0.82]). Interaction effects showed that one point increase in behavioral problems resulted in increased odds of more serious assaults only for youth reunified with biological parents (OR = 1.11, p = .01) and youth living with traditional foster parents (OR = 1.06, p = .02). Our results indicate that permanent adoptive homes are the safest child welfare placements irrespective of child characteristics, which is supportive of recent efforts to increase number of youth exiting care to adoption.

A Systematic Review of Bystander Interventions for the Prevention of Sexual Violence.

INTRODUCTION: Bystander interventions have been successful in changing bystander attitudes and behaviors to prevent sexual violence. This systematic review was performed to summarize and categorize the characteristics of sexual violence bystander intervention programs and analyze bystander intervention training approaches for the primary prevention of sexual violence and assault. METHOD: From June to July 2017, the authors searched both published and unpublished American and Canadian studies from 2007 to 2017. The published sources included six major electronic databases and the unpublished sources were Google Scholar and the 40 program websites. From the 706 studies that resulted from this initial search, a total of 44 studies (that included a single bystander intervention program and assessments at both pretest and at least one posttest) were included. RESULTS: Thirty-two percent of studies analyzed bystander behavior postintervention, and most found significant beneficial outcomes. The most frequently used training methods were presentation, discussion, and active learning exercises. Bringing in the Bystander and The Men's Program had the most replicated empirical support for effectiveness. DISCUSSION: There has been a substantive increase in quasi-experimental and randomized controlled trial approaches to assessing the effectiveness of this type of intervention since 2014. The training methods shared between these efficacious programs may translate to bystander interventions for other victimization types, such as child abuse. CONCLUSION: The use of in-person bystander training can make positive changes in attitudes and behaviors by increasing awareness of a problem and responsibility to solve it.

FOOD NEGLECT AND INFANT DEVELOPMENT.

The impact of food insecurity on child development in the general U.S. population is well-established, yet little is known about the harm of food neglect relative to other types of maltreatment. Due to the harmful physiological impact of inadequate nutrients and the social impact of food-related stress, it was hypothesized that food neglect would be more likely to impair infant cognitive and language development than physical abuse, sexual abuse, and other forms of neglect. Families of infants (N = 1,951) investigated by Child Protective Services were studied using the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II; NSCAW Research Group, 2002). Results from multivariable logistic regression models that controlled for likely confounding variables showed that the odds of impairment in cognition and language were significantly greater when food neglect was the most serious form of maltreatment. Considering that both food insecurity and child neglect are associated with poverty and parental mental health problems, it will be important for child welfare and mental health professionals to work collaboratively to better the health of these vulnerable children.

Sexual Abuse of Children With Learning Disabilities.

Although children with a learning disability (LD) are at an increased risk of sexual abuse, it is unclear whether conditions specific to their impairment are associated with sexual assault or if risk derives from other comorbid conditions such as behavioral problems, social skill deficits, or loneliness. Using a national probability study of child maltreatment investigations in the United States ( n = 2,033), we hypothesized that children over the age of 4 with a LD are target congruent to a sexual perpetrator. Seven percent of children were identified as having a LD, and the odds of a sexual abuse allegation was 2.5 times greater for children with a LD relative to children without a LD regardless of confounders. Further, type and severity of assaults varied by group: over 3 times more children with a LD experienced digital or oral copulation compared to those without a LD. Results suggest that children with LDs may require tailored prevention efforts to protect them from sexual abuse.

Subtypes of non-suicidal self-injury based on childhood adversity.

The aim of this study was to examine the latent clusters in non-suicidal self-injury (NSSI) based on childhood adversity. Data were derived from Waves I (2001-2002) and II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of U.S. adults. Individuals engaging in NSSI (N = 672) comprised the analytic sample. Latent class statistical analysis was undertaken to elucidate the latent structure of NSSI based on child experiences of physical and sexual abuse, neglect, and family violence. Four-classes of respondents were identified vis-à-vis childhood adversities. A low abuse/neglect class (35.7% of respondents, 91.1% male) demonstrated less mental health and substance use comorbidity and antisocial behavior. A sexual abuse class (43.1% of respondents, 98.6% female) evinced somewhat lower levels of antisocial behavior than the other classes but similarly high levels of mental health disorder and a non-sexual abuse/neglect class (8.3% of respondents, 91.5% male) characterized by varied and intensive forms of antisocial and externalizing behaviors. Finally, a severe high abuse/neglect/family violence class (12.95% of respondents, 100% female) demonstrated high levels of clinical psychiatric and personality disorders. The current project is a nationally representative study of NSSI latent clusters and extends and validates the existence of NSSI subtypes revealed by prior research.