Feasibility and promise of community providers implementing home-based parent-child interaction therapy for families investigated for child abuse: A pilot randomized controlled trial.

BACKGROUND: Despite evidence supporting Parent-Child Interaction Therapy's (PCIT) effectiveness for maltreatment prevention, its integration in child welfare services (CWS) has been challenging. OBJECTIVE: Using a pilot randomized controlled trial design, we evaluated the (1) feasibility of training therapists from CWS providers to implement home-based PCIT (2) feasibility of retaining parent-child dyads at-risk for child abuse in voluntary PCIT services, and (3) promise of PCIT for improving parenting skills. PARTICIPANTS AND SETTING: Between 2015-2017, 23 therapists from CWS providers and 55 caregiver-child dyads who were determined to be at moderate-to-high risk for physical and/or emotional abuse, remained in the same home, and were referred for voluntary parenting services following a child protective investigation participated. METHODS: We trained 14 therapists in home-based PCIT and randomly assigned participating dyads to receive PCIT or services as usual (SAU). Dyads completed baseline and post-treatment assessments, including self-reported and observed parenting skills. RESULTS: All therapists successfully completed the PCIT training; none completed full certification requirements. Of all randomized dyads, 51 % completed at least one treatment session, and the mean number of treatment sessions was 10.83. Caregivers assigned to PCIT used more self-reported (d = .72) and observed (d = .59) positive parenting skills post-treatment than caregivers assigned to SAU. Negative, inconsistent, and punitive parenting strategies and parenting stress did not significantly differ between caregivers assigned to PCIT and SAU. CONCLUSIONS: Despite several challenges to feasibly implementing PCIT in community-based child welfare settings, even a small dose of PCIT improved positive parenting skills among at-risk parent-child dyads.

Risk for substance use among adolescents at-risk for childhood victimization: The moderating role of ADHD.

BACKGROUND: Youth who are victimized by violence are at heightened risk for substance use (SU) during adolescence, a period characterized by elevated impulsivity and risk-taking behavior. This risk may be magnified by attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE: To examine risk/protective factors for adolescent SU among adolescents at-risk for victimization and whether ADHD moderates these associations. PARTICIPANTS AND SETTING: Participants were 1058 caregiver-adolescent dyads in the U.S. who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). METHOD: Binary logistic regression analyses were conducted for each SU type. First-order effects of all variables were tested first and for each SU outcome, followed by tests of two-way interactions between ADHD group and each predictor, after controlling for first-order effects. RESULTS: More externalizing behavior (odds ratio [OR] = 1.38; 95 % confidence interval [CI]:1.12, 1.71) and less parental knowledge (OR = .75; 95 %CI: .60, .95) were associated with greater risk for subsequent tobacco use. Less positive peer affiliation was associated with greater risk for subsequent illicit SU (OR = .59; 95 %CI: .36, .96). More deviant peer affiliation were associated with greater risk for all forms of SU. ADHD moderated the association between deviant peer affiliation and marijuana use [b = .9, p < .05, 95 %CI: .03, 1.77), such that deviant peer affiliation was a significantly stronger predictor of marijuana use among adolescents with ADHD than those without. CONCLUSIONS: Findings suggest risk and protective factors for SU are largely consistent for adolescents at-risk for victimization with and without ADHD, but at-risk adolescents with ADHD may be more susceptible to deviant peer influences.

A Systematic Review of Organizational and Workforce Interventions to Improve the Culture and Climate of Youth-Service Settings.

Both organizational culture and climate are associated with service quality and outcomes across youth-service settings. Increasing evidence indicates capacity of organizational interventions to promote a positive and effective culture and climate. Less is known about common intervention components across studies and service settings. The current systematic review reviewed 9223 citations and identified 31 studies, across six youth-service settings, measuring changes over time in organizational culture and climate following implementation of an organizational or workforce support intervention. Results highlight the promise of organizational interventions, a need for more comparison and randomized designs, and future directions for maximizing capacity of organizations to promote health for frontline providers and the children they serve.

Black and proud: The role of ethnic-racial identity in the development of future expectations among at-risk adolescents.

OBJECTIVES: Research examining factors that foster future expectations has been limited, especially among at-risk ethnic minority adolescents. The present study prospectively examined the protective role of ethnic-racial identity (ERI) in the association between adverse childhood experiences (ACEs) and future family, educational, and occupational expectations among at-risk Black and White adolescents. METHODS: Data were collected from 558 adolescents (73% Black, 27% White) who were at-risk for family violence and participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Information about ACEs was collected prospectively (CPS records and caregiver reports) between birth and age 12. Adolescents reported their ERI, feelings of affirmation and belonging, to their ethnic-racial groups at age 12 and their future expectations at age 14. RESULTS: Structural equation models revealed that in general, ACEs were associated with more negative educational expectations, b = -.04, p < .001, and stronger ERI was associated with decreased expectations for occupational difficulties, b = -.36, p < .001. Tests of moderation revealed that for Black, but not White adolescents, stronger ERI was significantly associated with more positive educational expectations, b = .36, p < .001, and that the negative association between ACEs and educational and occupational expectations was mitigated by stronger ERI, b = .15, p < .001. CONCLUSIONS: Findings underscore the importance of cultivating strong ERI among at-risk Black adolescents as a positive coping strategy to increase their educational and occupational expectations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Potential Protective Role of Peer Relationships on School Engagement in At-Risk Adolescents.

Negative outcomes associated with adverse childhood experiences are well established, but little is known about protective factors that could promote positive adjustment among high-risk youth. This study examined the potential protective role of positive peer relationships in the association between adverse childhood experiences and school engagement among at-risk adolescents. Data were collected prospectively from birth until age 16 from 831 diverse adolescents (52.6% female; 54% African American, 24% Caucasian) who were at-risk for family violence and their caregivers. The significant and negative associations between adversities and school engagement outcomes at age 16 were mitigated by peer intimacy and companionship and exacerbated by peer conflict. The findings underscore the importance of fostering positive peer relationships for improving school engagement among at-risk adolescents.

Unstable child welfare permanent placements and early adolescent physical and mental health: The roles of adverse childhood experiences and post-traumatic stress.

Although researchers have found that child welfare placement disruptions are associated with elevated youth physical and mental health problems, the mechanisms that explain this association have not been previously studied. The present study built on a previous investigation of the physical and behavioral consequences of long-term permanent placement patterns among youth who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). The current investigation (n=251) aimed to (a) report the early adolescent living situations of youth with different long-term placement patterns, and (b) to delineate the roles of adverse childhood experiences (ACEs) and post-traumatic stress (PTS) reactions in the association between unstable long-term placement patterns and physical and mental health problems during the transition to adolescence. Information about youth's living situations, ACEs, and physical and mental health was gathered prospectively from child protective services records and biannual caregiver and youth interviews when youth were 4-14 years old. The majority of youth remained with the same caregiver during early adolescence, but youth with chronically unstable permanent placement patterns continued to experience instability. Path analyses revealed that ACEs mediated the association between unstable placement patterns and elevated mental, but not physical, health problems during late childhood. Additionally, late childhood PTS mediated the association between unstable placement patterns and subsequent escalations in physical and mental health problems during the transition to adolescence. Findings highlight the importance of long-term permanency planning for youth who enter the child welfare system and emphasize the importance of trauma-focused assessment and intervention for these youth.