Sexualized Behaviors in Cohorts of Children in the Child Welfare System

The current retrospective archival study investigated the patterns of normative sexualized behavior (NSB), problematic sexualized behavior (PSB), and sexual perpetration for three age cohorts of boys and girls in a high-risk child welfare sample. All children in the present sample had exhibited some form of PSB in the past. 

We hypothesized that the incidence rates (IR) of NSBs would increase linearly from the early childhood cohort (Ages 2/3-7) to the middle childhood cohort (Ages 8-11) to the preadolescence/adolescence cohort (Ages 12-17), for girls and boys. Although the base rate of sexual behaviors generally increases as children age, children tend to hide sexual behaviors starting at an early age. We therefore hypothesized that a concave quadratic trend would be evident for most PSBs. We further predicted that older children would have a greater incidence of PSB, as well as more victims, compared with younger children. 

We found the predicted upward linear trend for NSB for both girls and boys, with minimal IR differences between the early childhood and middle childhood cohorts. IRs were remarkably high and comparable across age groups for both boys and girls, with respect to the same three PSBs. 

For the two perpetration history variables, there was a concave effect, with girls and boys in the middle childhood cohort exhibiting the lowest IR. Results are explained in the context of previously established patterns of sexualized behavior, as well as the reporting of such behaviors.

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By:  Grossi LM1, Lee AF2, Schuler A3, Ryan JL4, Prentky RA1.

• 1Fairleigh Dickinson University, School of Psychology (T-WH1-01), Metropolitan Campus, 1000 River Road, Teaneck, NJ 07666, USA.
• 2Bentley University, Department of Mathematical Sciences, 175 Forest Street, Waltham, MA 02452, USA; Massachusetts General Hospital, Department of Surgery, 55 Fruit Street, Boston, MA 02114, USA.
• 3Justice Resource Institute, 160 Gould Street, Suite 300, Needham, MA 02494, USA.
• 4William James College, 1 Wells Avenue, Newton, MA 02459, USA. 
• Child Abuse Negl. 2016 Jan 14;52:49-61. doi: 10.1016/j.chiabu.2015.12.014

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A Population-Based Study of the Prevalence and Correlates of Self-Harm in Juvenile Detention

BACKGROUND:

Suicide is the number one cause of death among incarcerated youth. We examined the demographic and forensic risk factors for self-harm in youth in juvenile detention using a Canadian provincial correctional database.

METHOD:

We analyzed data from de-identified youth aged 12 to 18 at the time of their offense who were in custody in a Manitoba youth correctional facility between January 1, 2005 and December 30, 2010 (N = 5,102). Univariate and multivariate logistic regression analyses determined the association between staff-identified self-harm events in custody and demographic and custodial variables. Time to the event was examined based on the admission date and date of event.

RESULTS:

Demographic variables associated with self-harm included female sex, lower educational achievement, older age, and child welfare involvement. Custodial variables associated with self-harm included higher criminal severity profiles, younger age at first incarceration, longer sentence length, disruptive institutional behavior, and a history of attempting escape. Youth identified at entry as being at risk for suicide were more likely to self-harm. Events tended to occur earlier in the custodial admission.

INTERPRETATION:

Self-harm events tended to occur within the first 3 months of an admission stay. Youth with more serious offenses and disruptive behaviors were more likely to self-harm. Individuals with problematic custodial profiles were more likely to self-harm. Suicide screening identified youth at risk for self-harm. Strategies to identify and help youth at risk are needed.

Below:  Time to self-harm event after admission during most recent incarceration

Full article at:   http://goo.gl/bc5wD2

By:  Casiano H1, Bolton SL2, Hildahl K1, Katz LY1, Bolton J1, Sareen J3.

• 1Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
• 2Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
• 3Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 

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Maltreatment, Child Welfare, and Recidivism in a Sample of Deep-End Crossover Youth

Although research has oft-documented a maltreatment-delinquency link, the effect of involvement in-and timing of-child welfare system involvement on offending has received less attention. We examine whether the timing of child welfare involvement has differential effects on recidivism of deep-end juvenile offenders (youth who have been adjudicated delinquent by the court and placed in juvenile justice residential programs). 

The current study uses a large, diverse sample of 12,955 youth completing juvenile justice residential programs between 1 January 2010 and 30 June 2013 in Florida (13 % female, 55 % Black, 11 % Hispanic). Additionally, we explore the direct effects of childhood traumatic events on delinquency, as well as their indirect effects through child welfare involvement using structural equation modeling. 

The findings indicate that adverse childhood experiences fail to exert a direct effect on recidivism, but do exhibit a significant indirect effect on recidivism through child welfare involvement, which is itself associated with recidivism. This means that while having exposures to more types of childhood traumatic events does not, in and of itself, increase the likelihood of re-offending, effects of such experiences operate through child welfare placement. 

Differences in the effects of maltreatment timing and of adverse childhood experiences are observed across sex and race/ethnicity subgroups. Across all racial subgroups, exposures to adverse childhood experiences have a significant effect on the likelihood of child welfare placement, yet child welfare placement exerts a significant effect on recidivism for White and Hispanic youth, but not for Black youth. Only Hispanic female and White male youth with overlapping child welfare and juvenile justice cases (open cases in both systems at the same time during the study period) were more likely to recidivate than their delinquent-only counterpart youth. 

Crossover status (child welfare and juvenile justice involvement, whether prior or open cases) was essentially irrelevant with respect to the re-offending of Black youth completing juvenile justice residential programs. 

The findings indicate the effects of exposure to adverse childhood experiences, and child welfare system and juvenile justice system involvement on re-offending are not uniform across subgroups of youth but that earlier child welfare involvement is more detrimental than concurrent child welfare system involvement when it does matter.

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By:   Baglivio MT1, Wolff KT2, Piquero AR3, Bilchik S4, Jackowski K5, Greenwald MA6, Epps N7.

• 1G4S Youth Services, LLC, 6302 Benjamin Rd., Suite 400, Tampa, FL, 33625, USA. Michael.Baglivio@us.g4s.com.
• 2John Jay College of Criminal Justice, 524 West 59th St., New York, NY, 10019, USA. kwolff@jjay.cuny.edu.
• 3University of Texas at Dallas, 800 W. Campbell Rd., GR31, Richardson, TX, 75080, USA. apiquero@utdallas.edu.
• 4Center for Juvenile Justice Reform, 3300 Whitehaven St. NW, R. 5045, Washington, DC, 20007, USA. Shay.bilchik@gmail.com.
• 5G4S Youth Services, LLC, 6302 Benjamin Rd., Suite 400, Tampa, FL, 33625, USA. Katherine.Jackowski@us.g4s.com.
• 6Florida Department of Juvenile Justice, 2737 Centerview Drive, Tallahassee, FL, 32399, USA. Mark.Greenwald@djj.state.fl.us.
• 7Florida Department of Juvenile Justice, 2737 Centerview Drive, Tallahassee, FL, 32399, USA. Nathan.Epps@djj.state.fl.us.

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Chronic Neglect and Aggression/Delinquency: A Longitudinal Examination

Neglect is the most common form of maltreatment in the United States, yet its impact on development remains understudied, especially for chronic neglect. Chronic neglect is also one of the most costly burdens on child welfare systems. 

This study examines the effects of chronic neglect, including two subtypes (Failure to Provide and Lack of Supervision) on adolescent aggression and delinquency using a diverse longitudinal sample of youth. Chronic neglect and chronic failure to provide (ages 0-12) predicted aggression/delinquency (age 14) even after controlling for the effects of other maltreatment (ages 0-12). Chronic lack of supervision, however, did not. 

Gender significantly moderated these effects, suggesting that males are more likely to respond to neglect by becoming aggressive/delinquent. Finally, social problems (age 12) partially mediated for boys, and fully mediated for girls, the connections between chronic neglect and aggression/delinquency, bolstering theorizing that neglect impairs social functioning broadly. 

Implications include the need for further research on chronic neglect, especially in providing guidance for child welfare systems. Interventions for chronically neglected youth should include social skill development.

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By:  Logan-Greene P1, Semanchin Jones A1.

• 1School of Social Work, University at Buffalo, USA. 

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From Placement to Prison Revisited: Do Mental Health Services Disrupt the Delinquency Pipeline among Latino, African American & Caucasian Youth in the Child Welfare System?

Racial and ethnic disparities in delinquency among child welfare-involved youth are well documented. However, less is known about the mechanisms through which these disparities occur. 

This study explores the extent to which sets of variables predict the occurrence of juvenile delinquency and whether race/ethnicity moderates the strength of the relationships between (1) social, emotional, and behavioral (SEB) problems and delinquency and (2) mental health service use and delinquency. 

We used a nationally representative sample of 727 African American, Caucasian, and Latino youth between the ages of 12-17 who were referred to the child welfare system. Controlling for age, gender, placement instability, maltreatment history, poverty, and urbanicity, linear regression analyses revealed that African American and Latino youth engaged in more delinquent acts than Caucasian youth did. However, service use decreased the likelihood of engaging in more delinquent acts for African Americans. 

Additional efforts are needed to illuminate and address the contextual and organizational barriers to delivering effective mental health services as a strategy to reduce racial disparities in delinquent behavior.

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By: Garcia AR1, Greeson JK2, Kim M3, Thompson A2, DeNard C2.

• 1School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA. Electronic address: antgar@sp2.upenn.edu.
• 2School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA.
• 3Department of Social Work, The Chinese University of Hong Kong, Hong Kong. 

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Intergenerational Transmission of Maltreatment: A Multilevel Examination

Despite the commonly held belief that there is a high degree of intergenerational continuity in maltreatment, studies to date suggest a mixed pattern of findings. One reason for the variance in findings may be related to the measurement approach used, which includes a range of self-report and official indicators of maltreatment and both cross-sectional and longitudinal designs. 

This study attempted to shed light on the phenomenon of intergenerational continuity of maltreatment by examining multiple indicators of perpetration of maltreatment in young adults and multiple risk factors across different levels within an individual’s social ecology. The sample included 166 women who had been placed in out-of-home care as adolescents (>85% had a substantiated maltreatment incident) and followed into young adulthood, and included three waves of adolescent data and six waves of young adult data collected across 10 years. 

The participants were originally recruited during adolescence as part of a randomized controlled trial examining the efficacy of the Treatment Foster Care Oregon intervention. Analyses revealed weak to modest associations between the three indicators of perpetration of maltreatment in young adulthood, i.e., official child welfare records, self-reported child welfare system involvement, and self-reported maltreatment (r = .03–.51). Further, different patterns of prediction emerged as a function of the measurement approach. Adolescent delinquency was a significant predictor of subsequent self-reported child welfare contact, and young adult partner risk was a significant predictor of perpetration of maltreatment as indexed by both official child welfare records and self-reported child welfare contact. In addition, women who were originally assigned to the intervention condition reported perpetrating less maltreatment during young adulthood. 

Implications for measurement and interventions related to reducing the risk for intergenerational transmission of risk are discussed.

Full article at: http://goo.gl/JXehc5

By: Leslie D. Leve, Atika Khurana, and Emily B. Reich

University of Oregon

Correspondence concerning this article should be addressed to Leslie Leve, Prevention Science Institute, 6217 University of Oregon, Eugene, OR 97403-6217; direct inquiries regarding clinical aspects of Treatment Foster Care Oregon and its implementation to Patricia Chamberlain, Oregon Social Learning Center, 10 Shelton McMurphey Boulevard, Eugene, OR 97401. Email: ude.nogerou@evel or ; Email: gro.clso@cittap.

 

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Problem-Specific Racial/Ethnic Disparities in Pathways from Maltreatment Exposure to Specialty Mental Health Service Use for Youth in Child Welfare

The authors examined racial/ethnic differences in pathways from maltreatment exposure to specialty mental health service use for youth in contact with the Child Welfare system. Participants included 1600 non-Hispanic White, African American, and Latino youth (age 4–14) who were the subjects of investigations for alleged maltreatment and participated in the National Survey of Child and Adolescent Well-Being. Maltreatment exposure, internalizing, and externalizing problems were assessed at baseline and subsequent specialty mental health service use was assessed one year later. Maltreatment exposure predicted both internalizing and externalizing problems across all racial/ethnic groups, but non-Hispanic White youth were the only group for whom maltreatment exposure was linked with subsequent service use via both internalizing and externalizing problem severity. Only externalizing problems predicted subsequent service use for African American youth and this association was significantly stronger relative to non-Hispanic White youth. Neither problem type predicted service use for Latinos. It is likely that individual, family, and system-level factors converge to link African American youth with externalizing problems to services, but not as responsive in linking African American and Latino youth with internalizing problems to services...

For all racial/ethnic groups, we hypothesized that maltreatment exposure would be a strong predictor of both internalizing and externalizing problems, which was supported by our findings. We also expected that there would be a strong correlation between internalizing and externalizing problem severity in this high-risk population, which was also supported by our data. While our model considered the potential direct association between maltreatment exposure and MHS use, we predicted that maltreatment exposure would be indirectly linked to MHS via child emotional/behavior problems. Given the foregoing evidence suggesting racial/ethnic disparities in MHS use as a function of problem type for youth in contact with CW, we further hypothesized that these indirect pathways to care would differ for racial/ethnic minority youth, which also supported by our data. Specifically, although maltreatment exposure significantly predicted both internalizing and externalizing problem severity across all racial/ethnic groups, non-Hispanic White youth were the only group for whom both types of problems significantly predicted subsequent specialty MHS use. Only externalizing problems predicted subsequent specialty MHS use for African American youth and neither type of MH problem predicted service use for Latinos. Thus, we found evidence of disparities in pathways from maltreatment exposure to mental health service use that varied by problem-type and youth race/ethnicity. Furthermore, while externalizing problem severity was a predictor of specialty MHS use for both non-Hispanic White and African American youth, it was a much stronger predictor for African American compared to non-Hispanic White youth. Conversely, internalizing problem severity was a stronger predictor of specialty MHS use for non-Hispanic White youth compared to African American and Latino youth.

Taken together, these findings suggest a more complicated association between race/ethnicity and MHS use than what is suggested by research examining disparities without considering the type of MH problem in question. These differential patterns may be explained by individual, family, and system-level factors that lead to the particular visibility of racial/ethnic minority youth with disruptive behavior as compared to internalizing problems. However, the data and design of the current study does not enable us to discern whether these racial/ethnic disparities are due to differences in responsiveness on the part of the CW system in linking certain youth with certain needs to specialty MHS, or whether individual and family factors deter families from following through with MHS receipt.

It is likely that individual, family, and system-level factors converge to influence problem-specific disparities in pathways from maltreatment exposure to MH care for different racial/ethnic groups. Ethnic minority youth are overrepresented in CW and juvenile justice (Crane & Ellis, 2004; Morton, 1999), where externalizing problems are closely scrutinized. Disruptive behavior is also a robust predictor of placement instability in CW (James, Landsverk, & Slymen, 2004), thus more resources may be directed towards youths with externalizing problems to support placement stability. CW workers may attend particularly to addressing the externalizing behaviors of African American youth who, in general, are at greater risk of placement instability and other negative CW outcomes. Data from NSCAW I suggest that externalizing problems are systematically associated with placement disruption for African American children but not for non-Hispanic White children (Foster, Hillemeier & Bai, 2011). Perhaps stronger linkages to effective care for disruptive behavior problems are all the more important for African American children who are more vulnerable to adverse system outcomes.

Yet, it may also be the case that individual and family factors work to amplify system-level determinants of MHS use. Even if a referral for MHS is made on the part of the CW system, racial/ethnic minority parents may hold culturally-influenced perceptions of child MH problems (e.g., beliefs about causes) and MHS (e.g., mistrust, stigma,) that may dissuade or encourage help-seeking (Cauce et al., 2002). These barriers may be more pronounced in the identification of and help-seeking for internalizing problems compared to externalizing problems in ethnic minority families (Gudiño et al., 2009). While child behavior that is disruptive, oppositional, or defiant may run counter to cultural values that emphasize respect, obedience, and deference to adults, internalizing problems may not necessarily be at odds with such cultural values. The adult distress threshold model of cultural influence (Weisz et al., 1988) suggests that culture may influence perceptions of how serious a problem is and decisions about what should be done. Because internalizing problems are already less likely to lead to MHS use, relative to externalizing problems (Wu et al., 1999), the presence of internalizing problems in racial/ethnic minority children may not lead to sufficient distress to overcome a higher threshold for concern and the aforementioned barriers to accessing mental health services.

Examining specialty MHS use prospectively, use of a nationally representative sample of children in contact with the CW, and the application of analytic methods to examine moderation and indirect effects are notable strengths of this study. However, our results should be interpreted in light of study limitations. First, we relied on parent-report for all study variables and it would be important to replicate these results with multi-informant methods. Second, while the use of a general maltreatment latent variable is a strength in that it accounts for the complexity of exposure to such adversity, the current study does not examine potential differences related to specific forms of maltreatment. Third, although paths from internalizing and externalizing problems to MHS use were in the predicted direction, they were not statistically significant predictor of MHS use for Latino youth. Despite the large nationally representative sample, uneven group sizes could have impacted significance levels. For example, the relatively smaller sample of Latino youth and the resulting larger standard errors for estimates may have limited our ability to identify significant effects. Additional research examining specific determinants of MHS use for Latino youth in contact with child welfare is warranted. Fourth, we were unable to verify the Missing at Random (MAR) assumption from our missing data estimation used in Mplus. However, this concern is mitigated by the fact that there were few missing data. Fifth, we defined service use as any contact with an outpatient specialty MH provider and cannot comment on the effectiveness or quality of services. Furthermore, although we assessed child behavior problems, we are unable to specify the reasons families sought services. Lastly, while we examined overall racial/ethnic group disparities in specialty MHS use, we were unable to examine more proximal indicators of culture in our model due to limitations of the NSCAW data set. Research is needed to refine our understanding of enthnocultural factors impacting MHS use. Despite these limitations, these results highlight concerning patterns of disparities that require further study.

Gatekeepers of MHS, including those within the family and the broader CW system, may be more likely to direct attention to racial/ethnic minority youth with externalizing problems who are also at risk of having poor CW system outcomes. Yet, this greater responsiveness to disruptive behavior among African American children occurs in the context of disparities whereby racial/ethnic minorities are less likely to receive services overall. It stands to reason that racial/ethnic minority youth with clinical need that does not include disruptive behavior may be driving the overall pattern of disparities (Gudiño et al., 2012). Increased awareness of these disparities as a function of problem type and increased awareness of the negative impact of untreated internalizing problems is needed within CW. While information provided to CW staff and families of children who come into the system may be one important avenue for targeting disparities, efforts must also focus on improving methods for identifying need and facilitating referral to MHS. Efforts to support the implementation of evidence-based MH assessment within CW and to examine the impact of these methods on disparities may help ensure equitable linkage of vulnerable youths to MHS.

  

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By: Jonathan I. Martinez, Omar G. Gudiño, and Anna S. Lau

University of California, Los Angeles

  

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