Profiles of Maltreatment in the Child Welfare System: Predicting Mental Health Outcomes and Examining Age as a Moderator.

This longitudinal study explored the unique profiles of maltreatment among youth in the child welfare system and examined their relation to mental health outcomes over time. We additionally examined the moderating role of age. Participants included 316 youth in the foster care system (age range: 6-13 years). Data were collected through the Department of Children and Family Services upon youths' entry into foster care, then quarterly for the duration of care. A latent profile analysis identified five profiles of maltreatment, categorized as primary neglect (PN), neglect and physical abuse (PA), complex trauma, complex trauma with severe sexual abuse (SA), and neglect with SA. A hierarchical general linear model applied to the data revealed that all four classes predicted higher internalizing symptom trajectories compared with the PN reference class, event rate ratios (eRRs) = 1.19-1.37, but none of these associations were significantly moderated by age. Membership in the two classes categorized by complex trauma predicted higher externalizing behavior trajectories as compared to the PN reference class, eRRs = 1.11-1.13. The relation between membership in the neglect with SA class and externalizing behaviors was moderated by age, eRR = 0.83. Finally, membership in all four classes predicted higher posttraumatic stress symptoms as compared with the reference group, eRRs = 1.84-2.45, and with all associations moderated by age, eRRs = 0.51-0.53. These findings provide insight into the maltreatment experiences of youth in the child welfare system and have important implications for treatment needs.

The Impact of Health Care Education on Utilization Among Adolescents Preparing for Emancipation From Foster Care.

PURPOSE: As teens in foster care prepare for emancipation, health care navigation is often overlooked, as caseworkers address other social needs. This study examined the impact of health care education materials designed for foster youth, called ICare2CHECK. It was hypothesized that ICare2CHECK would increase nonurgent ambulatory health care use and decrease emergency/urgent care use. METHODS: Adolescents (N = 151; aged 16-22 years) were enrolled in ICare2CHECK and received health education materials at their baseline study visit. Surveys were repeated every 3 months to assess health care utilization. After 12 months of enrollment, health care data for all eligible youth and matched comparison youth (N = 151) over the previous 24 months were extracted from the electronic health record (N = 302). Electronic health record data were coded as counts of completed nonurgent ambulatory care encounters (i.e., primary and preventative care and specialty care), completed urgent or emergency encounters (i.e., urgent and emergency department visits and hospitalizations), completed foster care clinic visits, and total completed visits. RESULTS: Health care use significantly decreased over time for both enrolled and comparison youth. Females, youth engaging in health risk behaviors, and those with a mental health or chronic condition diagnosis used significantly more health care. Receipt of educational materials was associated with a smaller decline in health care use and nonurgent ambulatory care use, controlling for covariates. Self-reported use of educational materials was associated with increased utilization in the enrolled condition. CONCLUSIONS: Results suggest that ICare2CHECK is associated with increased engagement in health care generally and nonurgent ambulatory care specifically (e.g., outpatient primary and specialty care).

Strategies for Assessing and Modeling Depressive Symptoms in Longitudinal Studies of Adolescents.

Studying age-related change in psychosocial behavior is difficult because manifestation differs with development. While the use of age-appropriate measurement instruments addresses developmental differences, changes in measurement also challenge researchers' ability to study developmental trajectories. Leveraging 8-occasion data from 262 girls (baseline ages 11 and 17 years) participating in a cross-sequential study spanning childhood to adulthood, this paper (1) highlights the needs of developmental researchers seeking to measure change across large swaths of development, (2) forwards an initial formula to convert Beck Depression Inventory-II scores into Children's Depression Inventory scores and facilitate longitudinal analysis and understanding of how depression develops across adolescence, and (3) suggests collection and analysis of new data that would better facilitate researcher's linking of child-, adolescent-, and adult-oriented measurement instruments.

Childhood Adversity and Associated Psychosocial Function in Adolescents with Complex Trauma.

BACKGROUND: Childhood adversity is linked to a number of adult health and psychosocial outcomes; however, it is not clear how to best assess and model childhood adversity reported by adolescents with known maltreatment exposure. OBJECTIVE: This study sought to identify an empirically-supported measurement model of childhood adversity for adolescents in child protective custody and associations among childhood adversity and adolescent outcomes. METHODS: Self-report survey data assessed childhood adversity and adolescent outcomes, including psychological wellbeing, quality of life, and substance use, in 151 adolescents ages 16 to 22 in protective custody with a documented maltreatment history. RESULTS: Findings suggest that, among youth with complex trauma histories, it is important to distinguish among risk related to unexpected tragedy (e.g., natural disaster, parental divorce), family instability (e.g., parental substance abuse or mental health concerns), and family violence (e.g., physical or sexual abuse). Family violence was associated with poorer psychological wellbeing and quality of life, while family instability was associated with cigarette and marijuana use. CONCLUSIONS: Among adolescents with complex trauma histories, childhood adversity assessments reflect multiple domains of adversity, each of which are differentially related to adolescent risks. Properly assessing childhood adversity in adolescents with complex trauma histories may help target interventions for specific risks (e.g., substance use) based on which types of childhood adversity youth have been exposed to.