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Mental Health Management Among Older Youth in Foster Care: Service Utilization and Preparedness
Abstract
Purpose
The aim of the study was to document mental health service use (counseling and medication) among youth in foster care, examine how prepared they feel to manage their mental health, and investigate predictors of service use and preparedness.
Methods
The study includes a representative sample of youth in California foster care at age 17 years who participated in in-person, structured interviews (n = 727). Survey measures captured youth characteristics, their mental health service use, and their level of preparedness to manage their mental health. Data from a child welfare worker survey were used to capture county-level service availability, helpfulness, and coordination. Binary and ordered logistic regression were used to predict mental health service use and preparedness.
Results
Youth reported high rates of mental health service use and one-fifth of the sample reported feeling less than prepared to manage their mental health. Youth who screened positive for mental disorders were less prepared than their peers to manage their mental health. Physical (odds ratio [OR] = 1.44; p < .05) and sexual abuse (OR = 2.04; p < .001) predicted past year use of counseling. Sexual abuse also predicted medication use (OR = 1.97; p < .01). Youth who identified as 100% heterosexual were less likely than non-100% heterosexual peers to use counseling (OR = .58; p < .05). The results also suggest geographic variation in use. Finally, caseworkers' perception of greater helpfulness of services in the county they worked predicted greater mental health preparedness (OR = 1.23; p < .05).
Conclusions
Mental health service use remains high among youth in foster care. Youth with particular characteristics may benefit from interventions aimed at preparing them for managing their mental health in adulthood.
... Adolescents in foster care are often quite resilient (Davidson-Arad & Navaro-Bitton, 2015), yet they are also vulnerable to a number of risks including the development of internalizing and externalizing mental health symptoms (e.g., Bronsard et al., 2016;Clausen et al., 1998;Heflinger et al., 2000;Munson et al., 2020). Positive parental relationships have been recognized as central to adolescent mental health for many years, regardless of whether or not youth are in foster care (Steinberg, 2001). ...
... Internalizing and externalizing symptoms are common mental health concerns among youth in foster care (e.g., Bronsard et al., 2016;Clausen et al., 1998;Heflinger et al., 2000;Munson et al., 2020). Internalizing symptoms involve signs of depression, anxiety, and emotional withdrawal. ...
... A meta-analysis examining the prevalence of distinct mental health concerns of youth in foster care indicated that roughly half of the youth represented in the reviewed studies met the criteria for at least one mental health disorder (Bronsard et al., 2016). Indeed, there is a wealth of research documenting the mental health concerns of youth in foster care (e.g., Bronsard et al., 2016;Clausen et al., 1998;Heflinger et al., 2000;Munson et al., 2020). This study adds to the literature by examining multiple mental health symptoms simultaneously and demonstrating that differing mental health symptoms distinguish groups of youth. ...
Adolescents in foster care can be quite resilient, yet they also are at risk for developing internalizing and externalizing mental health concerns. Positive family relationships are central to adolescent mental health, and these relationships can be complex for youth in foster care placements. Accordingly, there can be significant heterogeneity in the mental health symptoms of youth in foster care. The aims of this study were to identify distinct subgroups of youth patterns of internalizing and externalizing symptoms and determine the extent to which positive biological and foster parent relationships predicted profiles of low youth mental health symptoms. Using data from the National Survey of Child and Adolescent Well-being II (N = 343) and a person-centered analytic approach, results revealed four distinct profiles of youths’ mental health symptoms, those with: high internalizing and high externalizing symptoms, high internalizing and moderate externalizing symptoms, moderate internalizing and moderate externalizing symptoms, and low internalizing and low externalizing symptoms. Additionally, youth with better relationships with biological parents were less likely to be in the high symptoms group compared to the low symptoms group. These findings can be used to inform targeted intervention efforts aimed to lessen the mental health symptoms of youth in foster care.
... Previous research gives clear evidence that there is a higher prevalence of mental health problems among children and young people in care than in the majority population without care experiences. Mental health issues could include cognitive problems as well as behavioural problems related to abuse, neglect, and trauma before the child or young person was placed in care (Akister, Owens, and Goodyear 2010;Baidawi, Mendes, and Snow 2014;Cousins, Taggaret, and Milner 2010;Dixon 2008;Kelly et al. 2022;Munson et al. 2020;Okpych and Courtney 2018;Vinnerljung, Hjern, and Lindblad 2005). In a study from Norway, half of the sampled foster children were considered to meet the criteria for a mental illness (Lehmann et al. 2013). ...
... Furthermore, there is often little or no communication between child and adult services, which is yet another complicating factor (Brown, Courtney, and McMillen 2015;McGorry 2009;Osgood, Foster, and Courtney 2010). The loss of support from professional mental health providers makes the journey from care to adulthood even more complicated for young people with mental health problems (Munson et al. 2020). Such a change of mental health services at age 18 is particularly problematic, considering all other changes young people leaving care must handle in the transition from care to independent living (Akister, Owens, and Goodyear 2010;McGorry 2009;Osgood, Foster, and Courtney 2010). ...
... Consequently, studies have found that older youth in foster care are heavy user of mental health services. In a study conducted by Munson et al., (2020) of the CalY-OUTH study where researchers examined mental health service use, results showed that 54% of the sample had used counseling services in the past year, and 29% reported medication use to manage their mental health. However, the rate of mental health service utilization dramatically decreases (50%-60%) once youth leave foster care (Villagrana, 2017;Villagrana et al., 2018). ...
... Having a better understanding of the treatment process can assist in changing negative perceptions of the services provided and in building confidence for self-sufficiency post foster care. For example, Munson et al., (2020) found an association between the social worker's perception of helpfulness of the mental health services provided with a higher perception in the level of preparedness by the foster youth to manage their own mental health. Other studies have also found that knowledge, beliefs, and attitudes about treatment adherence increase when patients understand their illness and the need for preventative treatment (Berk, et al., 2010). ...
Studies have shown that once youth emancipate from foster care, there is a dramatic drop (60%) in the utilization of services. Reasons for mental health service disruption are unclear, but studies in the general population have consistently found that a person’s perception, knowledge, and attitudes toward mental health services are significant in the utilization of services. This qualitative study sought to examine the perceptions formed by former foster youth about the mental health services received while in foster care, and whether these perceptions might have an impact on the utilization of mental health services post foster care. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Qualitative content analysis with a deductive approach was used to analyze the data. Results show that lack of self-determination, no explanation given for referral to mental health services, and mandated mental health services, increased the negative perceptions youth formed about services. Perception of helpfulness of services also impacted the discontinuation of services post foster care. Findings from this study suggest that self-determination in the referral to services and treatment can significantly impact a youth’s perception of the services received and subsequent use of these services post foster care. Similarly, a hesitation to engage in mental health services was due to an inconsistency in the receipt of services due to placement instability, which lead to negative perceptions of services.
... Munson and colleagues (2020) similarly found that compared to youth in Los Angeles County, youth in rural counties were more likely to receive counseling in the last 12 months. The authors explained that smaller provider pools characteristic of rural counties may streamline referral processes and increase access to mental health services (Munson et al., 2020) ...
The Transition-Age Youth Research and Evaluation Hub (TAY-Hub) is a university-based research collaborative housed in the California Child Welfare Indicators Project at the University of California, Berkeley. The TAY-Hub specializes in research related to policies and practices affecting transition-age youth by monitoring outcomes and through applied research. This work is grounded in engagement with members of the child welfare services community, including those with lived experience of foster care.
... They are notably more likely than their same-age peers without a history of child welfare involvement to experience psychiatric illness [7,8] and suicidal behavior [9]. Recent research has also suggested that older youth may need more support to prepare them to manage their own health, mental health, and housing needs once they have left the system [10,11]. ...
Youth who age out of foster care face a constellation of challenges associated with navigating the transition to adulthood and often do not have opportunities to express their perspectives. The purpose of this project was to partner with these youth to develop a trauma-informed photovoice program that can be freely utilized in child welfare programming. This youth participatory action research (yPAR) project engaged youth and young adults with child welfare experience in a long-term partnership to co-develop and pilot test a trauma-informed photovoice program called Photovoice for Change (P4C). P4C evolved into a three-meeting structure: (1) orientation and launch; (2) preparation for sharing; and (3) share back. Youth participants revealed photographs of “places and spaces” that impacted their lives, sharing their meaning with other youth and supportive adults in a group setting. The project concluded with a gallery showing, featuring a video highlighting the program participants’ experiences. Trauma-informed photovoice may be an important program to embed within the child welfare system, as it can provide youth with an opportunity to: (a) strengthen within-group relationships and (b) express important aspects of their lives in a supportive and safe environment.
... They also reported that care leavers discussed not having opportunities to make decisions, lacking independent living skills and also lacking multiple forms of social support. Recent studies have also focused on how prepared older youth leaving care feel related to particular aspects of their lives, such as managing their mental health (Munson et al., 2020), and finances, financial planning and housing (Katz & Courtney, 2015). ...
Young adults with histories of out-of-home care (OOHC) have poor early adult outcomes. Transitioning to adulthood takes preparation, coupled with support and resources. Few studies have examined these young adults’ perceptions of what helped them prepare for adulthood and how prepared they perceived they were to make the developmental transition to adulthood. This convergent mixed methods study builds knowledge surrounding preparedness among a sample of young adults with histories in OOHC ( N = 204). The study progressed in three phases. First, quantitative measures of preparedness were examined related to five critical areas of young adulthood: (1) employment, (2) education/training, (3) health care, (4) housing and (5) managing money. Results indicated that youth felt more prepared to manage their money and pursue employment than they felt prepared in the other areas. The second phase focused on qualitative interview data. Participants were asked, “What has been the most helpful thing in preparing you to live as an adult?” Open-ended responses were audiotaped, listened to by analysts, transcribed, and de-identified. Qualitative analysis followed a series of steps, centering constant comparison. Six themes (with sub-themes) emerged from the analysis of the data, namely (1) Forced independence; (2) The instructive role of mistakes; (3) Programs and services; (4) Family support; (5) Structure; and (6) Role models. Finally, analysts compared results of the quantitative and qualitative data and noted the data were convergent in suggesting that young adults feel somewhat more prepared around employment, managing money, and finances, in comparison to other areas. Implications are discussed.
... At age 17, 68 % have behavioral health needs and more than a third have depression or substance dependence; yet, only half of these youth receive services (Vaughn et al., 2007;Brown et al., 2015;Courtney et al., 2014). Additionally, those who meet criteria for mental health disorder at age 17 are half as likely to feel prepared to manage their mental health in young adulthood (Munson et al., 2020). Thus, youth in foster care are likely to be less prepared to cope with emergent challenges impacting mental health in young adulthood, and more likely to have both limited informal social support resources and negative perceptions of formal mental health services. ...
This study articulates the iterative development of an intervention called Strengthening Youth Networks and Coping (SYNC), which is designed to target coping self-efficacy and help-seeking intentions and behaviors among youth in foster care. The overarching goal is to design an intervention that will be a feasible and acceptable enhancement to existing child welfare services, and that will address modifiable determinants among adolescents involved in child welfare system that are related to elevated risk for mental health challenges, limited support network capacity, and service disengagement after exiting foster care. In this paper, we describe our initial needs assessment, explain how we selected proximal intervention mechanisms (i.e., intermediate outcomes) to target, and outline the preliminary intervention development process, including ongoing insights we received from a research advisory group including members with lived experience. Next, we report and discuss the initial acceptability pre-testing data collected from youth (N = 30) as well as feasibility data collected from providers (N = 82), results from which were used to refine the SYNC intervention framework prior to robust efficacy testing. Findings highlight the need and importance of targeting youth coping and help-seeking, integrating programming within existing transition services, delivering this content in a group-based format that includes near-peer mentors and facilitators with lived experience, and developing options that work for the heterogeneous population of young people in foster care. The results also highlight the key objective of capturing youth's interests prior to enrolling in the program (e.g., language used in recruitment materials), holding their interest throughout the program (e.g., creating opportunities for youth to engage with other youth with similar experiences), and suggestions to encourage youth's engagement and participation. This paper articulates the value of this intervention development approach, and the sequential phases of this intervention development process as well as the results, which may be useful to applied researchers and practitioners working with youth in foster care and other priority populations.
... As adolescence and young adulthood are vulnerable age stages for the development of mental disorders, early identification and tailored intervention planning should be an integral part of a placement and admission process in which the resources and strengths of these adolescents should be adequately assessed [73]-especially by offering continuity in evidence-based psychotherapy and well-prepared transitions [15,[74][75][76]. For example, primary treatment modalities (e.g., family-based therapies and multicomponent interventions) have been suggested as primary strategies for treating substance-use disorders among adolescents, and a dialectical-behavioral therapy plus milieu approach demonstrated sustained positive treatment outcomes [77,78]. ...
Background:
Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood.
Methods:
Seventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed.
Results:
In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples.
Conclusions:
Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.
... However, young parents in our sample had limited access to both formal and informal mental health supports, making it harder to address these challenges. The absence of mental health supports is concerning, as youth with foster care backgrounds are vulnerable to emotional problems (McMillen et al., 2005;Munson et al., 2020), due to a history of child maltreatment and the trauma of child welfare involvement. ...
Background
The COVID-19 pandemic has brought unique challenges to parents of young children, due to the closure of schools and childcare centers, and increased caregiver burden. These challenges may be especially pronounced for youth with foster care backgrounds, as they lack critical support and resources to rely on during emergency situations.
Objective
The purpose of the present study was to examine the experiences of these vulnerable young parents since the beginning of the pandemic.
Participants and setting
Our study included 17 young parents ages 18–26, who had recently aged out of foster care or were currently in extended care. Participants were predominantly female, and Black, Indigenous, or people of color (BIPOC).
Methods
Youth participated in virtual focus groups or individual interviews and described their experiences and challenges during the COVID-19 pandemic. A structured thematic analysis approach was employed to examine key themes in youths` accounts.
Results
Analysis resulted in five major themes: (a) employment disruptions and economic hardships, (b) educational challenges for parents and children, (c) parental and child mental health concerns, (d) insufficient resources and barriers to service receipt, and (e) “silver linings”.
Conclusions
Young parents with foster care backgrounds faced numerous challenges due to COVID-19 and struggled to access critical resources and supports. Implications for policy, practice, and research are discussed.
... LGBTQ youth may face additional stigmatization both on campus and off (such as less support from family) that can contribute to feelings of isolation, increased prevalence of mental health issues, increased risk of discrimination and physical harm, homelessness, and resource gaps (Forge et al., 2018;Munson et al., 2020;Paul, 2020). This study contributes to a growing body of work on difficulties LGBTQ foster youth face during the transition to adulthood and underscores the need for protective supports and services. ...
Graduating from college is a life-transforming achievement for young people with foster care backgrounds. This memo provides an early look at factors that promote or stymie college degree completion by around age 23 of youths transitioning to adulthood from the foster care system.
What we did
The outcome investigated in this memo is whether or not youth completed a college degree, drawing on data from the Wave 4 CalYOUTH interviews and from National Student Clearinghouse data. The sample included 719 participants from the longitudinal study. Additionally, we ran separate analyses on the subset of youth who had enrolled in college (n = 446). Several groups of factors were analyzed as potential predictors of degree completion, including youths’ demographic characteristics, personality traits, educational background characteristics, maltreatment and foster care history characteristics, involvement in foster care planning and information they received about extended foster care, behavioral health problems, social support, and postsecondary education services in their county (based on caseworker perceptions). Additionally, in the analysis involving just college enrollees, we also analyzed several characteristics of the college the youth first enrolled in, as well as whether youth were involved in a campus support program (CSP) at any point in college and whether they had received an Education and Training Voucher (ETV).
What we found
Among all CalYOUTH participants (n = 719), the majority of youth had enrolled in college (61.8%). Overall, just about one in ten youth (9.6%) had completed a college degree, including 6.0% who completed a 2-year degree and 3.6% who completed a 4-year degree. Males, youth who identified as not being 100% heterosexual, and youth who had ever repeated a grade in elementary or secondary education had lower expected odds of completing a degree compared to their counterparts. In the full sample of CalYOUTH participants (n = 719), higher reading proficiency, better high school grades, prior placement in kinship foster care, and having received a lot of encouragement to continue their education from foster care professionals increased the youths’ expected odds of degree completion. In the sample of just youth who had enrolled in college (n = 446), Black youth were more likely than White youth to complete a degree, as were youth who received an ETV (versus those who did not) and youth who first enrolled in a 4-year college (versus youth who first enrolled in a 2-year college).
What it means
A key finding of this memo is that the majority of CalYOUTH participants had enrolled in college, and nearly 10% had attained a 2- or 4-year college degree by around age 23. These rates are generally higher than rates reported in other studies of transition-age foster youth, and may be a result, at least in part, of the investments made in the past two decades in California aimed at increasing college access and persistence for foster youth (for example, extended foster care, ETVs, campus-based support programs, community college tuition fee waivers). Several factors (for example, markers of youths’ academic achievement, postsecondary education encouragement, and the role they played in transition planning meetings) were significant predictors of degree completion in the full sample, but the magnitude of these factors generally became smaller and nonsignificant in the college enrollee sample. This suggests that part of these predictors’ influence on degree completion has to do with increasing the odds that youth enroll in college. The findings suggest that youth who had ever repeated a grade will benefit from extra support as they make their way to a college degree. LGBTQ youth may face additional stigmatization both on campus and off that affect their chances of completing a degree, and underscores the need for protective supports and services. The finding that degree completion rates were higher for Black college enrollees than White college enrollees is a promising finding as it counters general trends in college outcomes, and future analyses should more closely examine potential contributors to this outcome. Degree completion was higher for youth who first enrolled in 4-year colleges, which is also consistent with national trends, yet it is important to note that only about 11% of youth in this study first enrolled in a 4-year college. Finally, ETV receipt was found to increase the odds of completion, as it may provide critical funding that helps reduce financial strain and increase youths’ economic stability as they pursue a college degree.
... Future studies on the development of mental disorders in care systems may help to identify protective factors among individuals with mental disorders, so as to further support a successful transition to an independent adult life. For instance, future studies should investigate the effect of close cooperation between child and adolescent psychiatric services and care systems in offering a combination of environment-orientated and evidence-based treatments for individuals leaving care (i.e., liaison services; [24,[99][100][101][102]). Such results would be important for shaping interventions that support a successful transition to an independent adult life. ...
While children and adolescents placed in child welfare or juvenile justice out-of-home care show higher prevalence rates of mental disorders compared to the general population, it remains unclear whether this pattern persists into adulthood. A quantitative synthesis of existing studies is lacking. The aim of this meta-analysis was to estimate the prevalence rates for mental disorders among adults with a foster or residential child welfare or juvenile justice care history, comparing them where possible to rates among the general population. PubMed, PsycInfo, EMBASE, and Web of Science were systematically searched for epidemiological studies published up to 28 October 2020. Nineteen studies, totaling 604,257 participants, met our inclusion criteria. Random-effects models were used for prevalence rates and odds ratios (OR) of mental disorders, and study quality was rated. A prevalence rate of 30% [95% CI (23.36, 37.36)] for any mental disorder in adults with a child welfare care history was found (3–17% for specific disorders). A prevalence rate of 45% [95% CI (42.38, 47.38)] for any mental disorder was found in adults with a juvenile justice care history (6–66% for specific disorders). For out-of-home placement history, adult mental disorders were significantly higher than in the general population (OR = 1.33–2.76). Studies differed in terms of methodology and the disorder groups considered, so heterogeneity between effect sizes ranged from low to high. Our findings suggest that the high risk that mental health issues will persist in adults with an out-of-home placement history needs to be taken seriously in the transition from adolescence to adulthood. The care systems involved need to collaborate and to be aware of these risks.
A high percentage of homeless youth have a history of foster care placement; this population faces high rates of behavioral health problems. No research has focused on the predictors of service use among homeless former foster youth. This analysis seeks to determine what foster care and homeless experiences are associated with service use among this population. Data were collected via convenience sample from 184 homeless former foster youth at a drop-in center in Hollywood, California. A series of logistic regressions were conducted for network engagement behaviors that may be impacted by foster care experiences. Knowledge from prior empirical results form the basis for this analysis.
Findings
Number of foster care placements and age at first foster care placement, overall time spent homeless, age at first homelessness, and being kicked out of housing as a cause of homelessness were associated with decreased service use. Time spent in foster care and homeless experiences during foster care were associated with increased service use.
Application
Results can be used to aid in understanding which foster care and homeless experiences aid or hinder service use. From a policy level, findings from this study can aid child welfare agencies in further understanding which foster care experiences present as risk factors after transition from care.
Youth involved in the child welfare system and specifically those in foster care disproportionately experience concerns related to their psychosocial needs compared to youth who are not in care; consequently, assessment of those needs and referral to appropriate services is critical. The purpose of this study was to examine whether needs (i.e. behaviors) of youth involved in the child welfare and foster care systems and organizational culture and climate are associated with caseworkers’ recommendations for services, considering youth and caregiver report, as well as other individual and family factors. The sample came from Wave 2 of the National Survey of Child and Adolescent Well-Being II and weighted data were used for the analyses (n = 462). Logistic regression was used to analyze factors, such as youth behavior and organizational culture and climate, that predict a referral for various youth services for youth who experienced maltreatment and remained in home or were placed in foster care. Results indicate that youth behavior was most likely to predict referral services, as well as other youth characteristics, but organizational culture and climate of agencies did not influence referral recommendations. These findings highlight the need for more research examining the decision-making and assessment practices of child welfare caseworkers and use of appropriate assessments for youth involved in the child welfare system.
Youth who exit foster care often have mental health treatment histories, but they commonly discontinue treatment after exiting the system. The purpose of this study was to adapt an intervention designed to improve engagement/investment in mental health treatment, specifically to be delivered to youth aging out of foster care. An iterative process that incorporated focus groups with both youth and providers was used to adapt the original intervention curriculum, then the feasibility of implementation of the adapted intervention in settings for older foster youth was explored. Language of the intervention manuals was modified so terms resonated more with youth and was simplified to be accessible to low reading levels. Two new sessions were added to provide skills for talking with providers and to assist in incorporating mental health into broader transition goals for foster youth. The adapted intervention was implemented on an ongoing basis at a transition drop-in center. The adapted intervention was found to be acceptable by facilitators and youth participants. The most feasible and acceptable content and setting for the group to be implemented in an ongoing way emerged from the results. Future efficacy studies are needed to determine whether outcomes such as attitudes toward mental health services and engagement are changed by the intervention. Preliminary testing supports the potential for integrating the adapted engagement intervention into broader transition planning efforts since mental health has strong connections with other transition domains.
Drawing from the National Survey on Drug Use and Health (NSDUH; N = 611,880), a nationally representative survey of U.S. adolescents and adults, we assess age, period, and cohort trends in mood disorders and suicide-related outcomes since the mid-2000s. Rates of major depressive episode in the last year increased 52% 2005-2017 (from 8.7% to 13.2%) among adolescents aged 12 to 17 and 63% 2009-2017 (from 8.1% to 13.2%) among young adults 18-25. Serious psychological distress in the last month and suicide-related outcomes (suicidal ideation, plans, attempts, and deaths by suicide) in the last year also increased among young adults 18-25 from 2008-2017 (with a 71% increase in serious psychological distress), with less consistent and weaker increases among adults ages 26 and over. Hierarchical linear modeling analyses separating the effects of age, period, and birth cohort suggest the trends among adults are primarily due to cohort, with a steady rise in mood disorder and suicide-related outcomes between cohorts born from the early 1980s (Millennials) to the late 1990s (iGen). Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people, creating a cohort effect. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
The prevalence of psychotropic medication use among children and adolescents in foster care has received increasing attention from policymakers and scholars and led to responses from government. Most research has focused on school-age foster children; less is known about psychotropic medication use among foster youth transitioning to adulthood from care. Using data from a longitudinal study of transition-age foster youth (n = 611), this study examines the prevalence of psychotropic medication use over time, evaluates youths’ perceptions of the benefits of medication, and assesses associations between medication use and behavioral health problems. The overall rate of psychotropic medication use dropped from age 17 to age 19. Among youth with at least one behavioral health problem, rates of psychotropic medication use also declined over time. Decreases in psychotropic medication use between age 17 and 19 were found among youth with the following disorders: mania, an alcohol use disorder, and a non-alcohol drug use disorder. Behavioral health status and youths’ living arrangements were associated with the likelihood of psychotropic medication use at age 17, whereas only behavioral health status was associated with the likelihood of psychotropic medication use at age 19. Most youth reported either a positive or neutral view of the relative benefits of using medications. Among youths who had used medications, those in relative foster homes were less likely than those in non-relative foster homes to report negative views of their medications. The findings have implications for child welfare and health care professionals and policymakers.
Introduction:
In 2015, an estimated 43.4 million Americans aged 18 and older suffered from a behavioral health issue. Accurate estimates of the number of psychiatrists, psychologists, and psychiatric nurse practitioners are needed as demand for behavioral health care grows.
Methods:
The National Plan and Provider Enumeration System National Provider Identifier data (October 2015) was used to examine the supply of psychiatrists, psychologists, and psychiatric nurse practitioners. Providers were classified into three geographic categories based on their practicing county (metropolitan, micropolitan, and non-core). Claritas 2014 U.S. population data were used to calculate provider-to-population ratios for each provider type. Analysis was completed in 2016.
Results:
Substantial variation exists across Census Divisions in the per capita supply of psychiatrists, psychologists, and psychiatric nurse practitioners. The New England Census Division had the highest per capita supply and the West South Central Census Division had among the lowest supply of all three provider types. Nationally, the per capita supply of these providers was substantially lower in non-metropolitan counties than in metropolitan counties, but Census Division disparities persisted across geographic categories. There was a more than tenfold difference in the percentage of counties lacking a psychiatrist between the New England Census Division (6%) and the West North Central Census Division (69%). Higher percentages of non-metropolitan counties lacked a psychiatrist.
Conclusions:
Psychiatrists, psychologists, and psychiatric nurse practitioners are unequally distributed throughout the U.S. Disparities exist across Census Divisions and geographic categories. Understanding this unequal distribution is necessary for developing approaches to improving access to behavioral health services for underserved populations.
Supplement information:
This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
This report presents findings from the Child Welfare Worker Survey, an on-line survey of 235 California child welfare workers and their perceptions of key characteristics of the service delivery context of extended foster care, including: the availability of transitional living services; coordination between the child welfare system and other service systems such as county courts; and youth attitudes toward extended care. This report provides a valuable snapshot of how youths’ caseworkers, central players in the implementation of extended foster care, perceive young people making the transition to adulthood out of care and the service context for that transition.
This report presents findings from the Baseline Youth Survey, providing the most comprehensive view to date of young people approaching the transition to adulthood from foster care in the wake of the federal Fostering Connections Act. Information gathered during interviews with 727 youths who were an average of 17 years old at the time, offers insight into the needs and aspirations of transition-age foster youth. Study findings can help inform efforts to improve policies and services for foster youths’ transitioning to adulthood.
Objective:
During the transition to adulthood, youths face challenges that may limit their likelihood of obtaining services for psychiatric problems. The goal of this analysis was to estimate changes in rates of service use and untreated psychiatric disorders during the transition from adolescence to adulthood.
Methods:
In a prospective, population-based study, participants were assessed up to four times in adolescence (ages 13-16; 3,983 observations of 1,297 participants, 1993-2000) and three times in young adulthood (ages 19, 21, and 24-26; 3,215 observations of 1,273 participants, 1999-2010). Structured diagnostic interviews were used to assess service need (participants meeting DSM-IV diagnostic criteria for a psychiatric disorder) and use of behavioral services in 21 service settings in the past three months.
Results:
During young adulthood, 28.9% of cases of psychiatric disorders were associated with some treatment, compared with a rate of 50.9% for the same participants during adolescence. This decrease included a near-complete drop in use of educational and vocational services as well as declines in use of specialty behavioral services. Young adults most frequently accessed services in specialty behavioral or general medical settings. Males, African Americans, participants with substance dependence, and participants living independently were least likely to get treatment. For cases of psychiatric disorders among young adults, insurance and poverty status were unrelated to likelihood of service use.
Conclusions:
Young adults were much less likely to receive treatment for psychiatric problems than they were as adolescents. Public policy must address gaps in service use during the transition to adulthood.
Childhood sexual abuse (CSA) histories are prevalent among adolescent girls in the juvenile justice system (JJS) and may contribute to their high rates of suicidal behavior. Among 166 JJS girls who participated in an intervention trial, baseline CSA and covariates were examined as predictors of suicide attempt and nonsuicidal self-injury (NSSI) reported at long-term follow-up (7–12 years later). Early forced CSA was related to lifetime suicide attempt and NSSI history and (marginally) to postbaseline attempt; effects were not mediated by anxiety or depressive symptoms. Findings suggest that earlier victimization and younger entry into JJS are linked with suicide attempt and NSSI.
This study examined the prevalence of mental health and substance abuse disorders and service utilization among a racially and ethnically diverse group of foster youth. Self-report data on symptoms and service receipt were used to identify whether groups of adolescents defined by their race and ethnicity were equally likely to receive services given the presence of a mental health or substance use disorder. Study findings showed that Caucasians are more likely to receive mental health services than African Americans. Race was not a significant predictor of accessing substance abuse services. Hispanic ethnicity was not a predictor of receipt of mental health or substance abuse treatment services. Implications for future research, practice, and policy are discussed.
This study examined lifetime, 12-month, and current mental health service use among older youths in the foster care system and examined variations in mental health care by race, gender, maltreatment history, living situation, and geographic region.
The Service Assessment for Children and Adolescents, the Child Trauma Questionnaire, and the Diagnostic Interview Schedule were used in interviews with 406 youths in Missouri's foster care system who were aged 17 years.
Ninety-four percent of the youths had used a mental health service in their lifetime, 83 percent used a mental health service in the past year, and 66 percent were currently receiving a mental health service. Lifetime rates for inpatient psychiatric care (42 percent) and other residential programs (77 percent) were exceptionally high. A quarter of the youths received mental health services before they entered the foster care system. Among youths who received residential services, half did not receive community-based services before receiving residential services. After the analyses controlled for need, predisposing characteristics, and enabling characteristics, youths of color were less likely to receive outpatient therapy, psychotherapeutic medications, and inpatient services, and they were more likely to receive residential services. Youths who had been neglected and youths in kinship care were less likely to receive some types of services. Geographic differences in service use were common and sometimes mediated the effect of race on service use.
The child welfare system was actively engaged in arranging mental health services for youths in the foster care system, but the system was unable to maintain many youths in less restrictive living situations. The variations by race and geography indirectly indicate quality concerns.
This study assessed the relationship between the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment.
Data were collected at study entry into the National Survey of Child and Adolescent Well-Being and were weighted to provide population estimates.
Nearly half (47.9%) of the youths aged 2 to 14 years (N = 3,803) with completed child welfare investigations had clinically significant emotional or behavioral problems. Youths with mental health need (defined by a clinical range score on the Child Behavior Checklist) were much more likely to receive mental health services than lower scoring youth; still, only one fourth of such youths received any specialty mental health care during the previous 12 months. Clinical need was related to receipt of mental health care across all age groups (odds ratio = 2.7-3.5). In addition, for young children (2-5 years), sexual abuse (versus neglect) increased access to mental health services. For latency-age youths, African-American race and living at home significantly reduced the likelihood of care. Adolescents living at home were also less likely to receive services, whereas having a parent with severe mental illness increased (odds ratio = 2.4) the likelihood of service use.
Routine screening for mental health need and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system.
To estimate the lifetime and past year prevalence rates of major psychiatric disorders in a sample of older youths in the foster care system, to examine the timing of disorder onset and system entry, and to explore variations in past year prevalence rates.
Using the Diagnostic Interview Schedule for DSM-IV, interviews were conducted with 373 17-year-old youths (90% of those eligible) in one state's foster care system between December 2001 and June 2003.
: Sixty-one percent of the youths qualified as having at least one psychiatric disorder during their lifetime; of these youths, 62% reported onset of their earliest disorder before entering the foster care system. In addition, 37% of youths met criteria for a psychiatric disorder in the past year. The number of types of maltreatment experienced was the most robust predictor of psychiatric disorder among several maltreatment variables. There were no differences in prevalence rates for youths in kinship care and those in nonkin foster families.
Older youths in the foster care system have disproportionately high rates of lifetime and past year psychiatric disorders. Results support recommendations for initial and periodic mental health assessments for these youths and mechanisms to continue mental health services for young adults transitioning out of the foster care system.
This study examined the relationship between initiation of outpatient mental health service use and level of child welfare involvement.
Three levels of child welfare involvement were examined: in-home care and no child welfare services beyond an initial investigation, in-home care and additional child welfare services, and placement in out-of-home care (foster care). Longitudinal data were collected for a subsample of children (N=3,592) aged two through 14 years who were enrolled in the National Survey of Child and Adolescent Well-Being, a nationally representative sample of children undergoing investigation for abuse or neglect. Event history analysis was used to model relative risk of initiation of mental health service use over time.
Hazard functions revealed a large increase in onset of mental health services immediately after the time of the initial contact with child welfare, varying by level of child welfare involvement and leveling off by three months after the initial contact. The multivariate Cox proportional-hazards model indicated that compared with children who were placed in out-of-home care, those in in-home care who did not receive any further child welfare services were about one-third as likely to use mental health services and those in in-home care who received additional child welfare services were one-half as likely to use mental health services. Other covariates in the model predicted mental health service use, including being older, being Caucasian, having a history of maltreatment (specifically, physical abuse, physical neglect, or abandonment), being uninsured, and need for mental health services, as measured by the Child Behavior Checklist.
Contact with child welfare functions as a gateway into mental health services for children in child welfare, even when need for such services is controlled for.
• Despite the high prevalence of mental health problems and disorders that develop in adolescence and early adulthood, young people tend to not seek professional help. Young men and young people from Indigenous and ethnic minority groups tend to be those most reluctant to seek help.
• Young people are more inclined to seek help for mental health problems if they:
• have some knowledge about mental health issues and sources of help;
• feel emotionally competent to express their feelings; and
• have established and trusted relationships with potential help providers.
• Young people are less likely to seek help if they:
• are experiencing suicidal thoughts and depressive symptoms;
• hold negative attitudes toward seeking help or have had negative past experiences with sources of help; or
• hold beliefs that they should be able to sort out their own mental health problems on their own.
• Young people may seek help through talking to their family and friends, with family being more important for younger adolescents, and friends and partners becoming more influential later on.
• The professionals most likely to act as gatekeepers to mental health services for young people are school counsellors, general practitioners, and youth workers.
• Increasingly, Internet‐based information and interventions are being used to engage young people in the help‐seeking process.
This research examined linkages between exposure to childhood sexual abuse (CSA) and childhood physical punishment/abuse (CPA) and mental health issues in early adulthood.
The investigation analyzed data from a birth cohort of over 1,000 New Zealand young adults studied to the age of 25.
Exposure to CSA and CPA was associated with increased risks of later mental disorders including depression, anxiety disorder, conduct/anti-social personality disorder, substance dependence, suicidal ideation, and suicide attempts at ages 16-25. Control for social, family, and individual factors reduced the associations between CPA and mental health outcomes to the point of statistical non-significance. However, there was a consistent finding for CSA to remain associated with increased risks of later mental health problems. After adjustment, those exposed to CSA including attempted or completed sexual penetration had rates of disorder that were 2.4 times higher than those not exposed to CSA. Those exposed to harsh or abusive physical punishment had rates of disorder that were 1.5 times higher than those exposed to no or occasional physical punishment. It was estimated that exposure to CSA accounted for approximately 13% of the mental health problems experienced by the cohort. Findings showed that exposure to CPA had only weak effects on later mental health. It was estimated that exposure to CPA accounted for approximately 5% of the mental health problems experienced by the cohort.
Exposure to CSA was associated with consistent increases in risks of later mental health problems. Exposure to CPA had weaker and less consistent effects on later mental health. These findings suggest that much of the association between CPA and later mental health reflects the general family context in which CPA occurs, whereas this is less the case for CSA.
LGBTQ youth are largely overrepresented in the child welfare system. The experiences of LGBTQ youth have largely been overlooked. LGBTQ youth often encounter a number of challenges and disparities as they navigate the child welfare system. Many report experiences of discrimination, marginalization, and an overall lack of acceptance. The permanency and placement options have historically been limited for many LGBTQ youth, often leading to an over reliance on congregate settings and aging out of foster are. The current article provides a synthesis of the existing research on the experiences and outcomes of LGBTQ youth in care, as well as an exploration of the policy and practice initiatives aimed at creating a more inclusive system of care.
This paper is the first study to use a multi-state sample to longitudinally explore the relationship between remaining in foster care beyond age 18, behavioral health needs, and receipt of behavioral healthcare services. The study began with a sample of 732 older youth in foster care and followed them longitudinally for six years, after all had aged-out of care. Indicators of behavioral health and receipt of behavioral healthcare services were measured, as well as whether or not remaining in foster care after one's 18th birthday made a difference in receiving behavioral healthcare services. We found a high need for behavioral healthcare services in the years following their 18th birthdays and a significant drop-off in service use after exiting foster care. We also found a strong relationship between remaining in care after one's 18th birthday and receipt of behavioral healthcare services among those in need. Policy implications discussed highlight the possible role of Medicaid on young adults who have aged-out of foster care with behavioral healthcare service needs, and the potential impact of the Patient Protection and Affordable Care Act. Among the treatment implications are the need for highly effective behavioral healthcare services for older youths in foster care and the need for receipt of ongoing services upon exiting foster care.
This study examined the relationship of emotion regulation to multiple forms of child abuse and subsequent posttraumatic stress. Particular consideration was given to emotional abuse, which has received less attention in the literature. Results from a survey of 912 female college students revealed that women who reported a history of sexual, physical, or emotional abuse endorsed greater emotion regulation difficulties compared to women without abuse histories. Notably, emotional abuse was the strongest predictor of emotion deregulation. Mediation analyses indicated that emotion dysregulation partially explained the relationship between physical and emotional abuse and symptoms of posttraumatic stress, suggesting that intervention efforts aimed at improving emotion regulation strategies might be beneficial in decreasing posttraumatic stress among women with child maltreatment histories.
This paper describes the well-being of participants in the Midwest Evaluation of the Adult Functioning of Former Foster Youth (n = 603), a study of youth leaving out-of-home care in the USA, at the point where they have been ‘young adults’ for about 1 year. Although some of these young adults are in stable situations and either moving forward with their education or employed in promising jobs, more of them are having significant difficulties during the early stages of the transition to adulthood. Too many are neither employed nor in school, have children that they are not able to parent, suffer from persistent mental illness or substance use disorders, find themselves without basic necessities, become homeless, or end up involved with the criminal justice system. They are doing worse than other young adults across a number of important dimensions. Most of these young adults continue to maintain relations with members of their family of origin, with many finding themselves living with family at age 19. Importantly, those young people who chose to remain under the care and supervision of the child welfare system experienced better outcomes than those who either chose to or were forced to leave care.
Public Law (P.L.) 110-351, the “Fostering Connections to Success Act,” calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors.
To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents.
Participants were 226 children and adolescents (190 outpatients and 36 controls) aged 6 to 17 years. To assess the concurrent validity of the MINI-KID, participants were administered the MINI-KID and the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) by blinded interviewers in a counterbalanced order on the same day. Participants also completed a self-rated measure of disability. In addition, interrater (n = 57) and test-retest (n = 83) reliability data (retest interval, 1-5 days) were collected, and agreement between the parent version of the MINI-KID and the standard MINI-KID (n = 140) was assessed. Data were collected between March 2004 and January 2008.
Substantial to excellent MINI-KID to K-SADS-PL concordance was found for syndromal diagnoses of any mood disorder, any anxiety disorder, any substance use disorder, any ADHD or behavioral disorder, and any eating disorder (area under curve [AUC] = 0.81-0.96, kappa = 0.56-0.87). Results were more variable for psychotic disorder (AUC = 0.94, kappa = 0.41). Sensitivity was substantial (0.61-1.00) for 15/20 individual DSM-IV disorders. Specificity was excellent (0.81-1.00) for 18 disorders and substantial (> 0.73) for the remaining 2. The MINI-KID identified a median of 3 disorders per subject compared to 2 on the K-SADS-PL and took two-thirds less time to administer (34 vs 103 minutes). Interrater and test-retest kappas were substantial to almost perfect (0.64-1.00) for all individual MINI-KID disorders except dysthymia. Concordance of the parent version (MINI-KID-P) with the standard MINI-KID was good.
The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.
This study analyzed patterns of outpatient mental health service use from adolescence into early adulthood among young adults who were reported as victims of maltreatment in adolescence.
Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children for whom maltreatment was investigated by the child welfare system. The sample consisted of 616 young adults aged 12 to 15 at baseline. Analysis used descriptive statistics to determine need for and use of outpatient mental health services across time. Logistic regression was used to examine predictors of use of outpatient mental health services in young adulthood.
Almost half of the young adults in this sample had one or more indicators of mental health problems. There was a significant decrease in use of specialty mental health services from adolescence to young adulthood, declining from 47.6% at baseline, to 14.3% at the five- to six- year follow-up. Among young adults with mental health problems, less than a quarter used outpatient mental health services. Logistic regression results indicated that having mental health problems, having Medicaid, and being white were positively associated with use of outpatient mental health services in young adulthood.
Mental health problems were prevalent among young adults who were suspected of being maltreated when they were adolescents, but only about a quarter of those in need used outpatient mental health services. Interventions to improve access to outpatient mental health services for this vulnerable population should particularly support outreach and engagement of young adults who are uninsured and from racial or ethnic minority groups with a history of involvement with the child welfare system in order to meet their unique developmental needs.
To assess and predict changes in mental health service use as older youth leave the foster care system.
Participants were 325 19-year-olds participating in a longitudinal study of older youth leaving the foster care system in Missouri. All were in the foster care system at age 17. Participants were interviewed nine times between their 17th and 19th birthdays using the Service Assessment for Children and Adolescents and a history calendar to improve recall of service history. Analyses included Cox proportional hazards regression to predict time to service stoppage and McNemar's test to assess difference in rates of service use between age 17 and 19.
Mental health service use dropped dramatically across the study period for all services. Service rates dropped most steeply for youth who left the foster care system. Service use rates declined by roughly 60% from the month prior to leaving the foster care system to the month after leaving the system. Most young adults who stopped pharmacotherapy following discharge from foster care reported they did so of their own volition.
Practitioners should be aware of the possibility of patient-initiated mental health service discontinuation following exit from the foster care system and plan accordingly.
Effective means of transitioning adolescent patients with chronic illness from paediatric to adult medical care are poorly documented and supported by limited evidence. The purpose of this study is to describe expectations and concerns of adolescents with chronic illness regarding transition from subspecialty paediatric to adult-centred care during the transition process in order guide effective programme design and implementation.
Qualitative content and thematic analysis of semi-structured individual interviews with 22 adolescents with chronic illness, including cystic fibrosis, sickle cell disease, juvenile rheumatoid arthritis, and inflammatory bowel disease. Interviews took place at 1-3 time points over an 18-month study period.
Transition topics included: timing of transfer to adult care, the transition process, attitudes about transition, and factors that might aid transition. During the study period, one-third of participants made the transition to adult-oriented health care. All participants who had transitioned to adult-oriented care reported participating in a structured transition programme. Concerns of those who had not initiated the transition process centred on re-establishing relationships and bringing a new team 'up to speed'. Most adolescents anticipating transfer to adult care identified only downsides and felt unprepared to transition at the time of the interview. Subjects who had transitioned noted benefits of the adult-oriented system, even if they had been ambivalent prior to transfer of care. Participants suggested that earlier discussions about transition, opportunities to meet new healthcare teams and visits to adult-oriented venues prior to transition might aid in the transition process.
Subspecialty paediatric providers should anticipate common fears and concerns of adolescents and discuss the benefits of transfer to adult-oriented care. Further evaluation of existing transition programmes is an area for future study and is necessary for improvement of the continuum of care for adolescents with chronic medical conditions.
The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.
This study examined predictors of utilization of mental health services among children and adolescents in foster care. Of particular interest was whether the type of maltreatment was related to utilization of services. Subjects were 662 children ages 2-17 who were in foster care for at least 5 months. Service utilization, demographic, and behavioral data were collected through interviews with the subjects' caretakers. Type of maltreatment data were collected from Child Welfare case records. Fifty-six percent of the subjects had received mental health services. Children removed from their homes due to sexual and/or physical abuse were more likely to receive services than were those who were removed due to neglect and caretaker absence. Clinically significant behavior problems were associated with greater likelihood of receiving services, except for the sexually abused group who were very likely to receive services regardless of their behavior problem score. Sexually abused youth also received a higher number of outpatient visits than did neglected youth. In sum, youth who have experienced "active" types of maltreatment are more likely to receive mental health services than are those with "passive" types of maltreatment, even when the effect of severity of mental health problems is controlled.
To determine factors influencing outpatient mental health service use by children in foster care.
Detailed survey and administrative data were collected on 480 children who entered long-term foster care in San Diego County from May 1990 through October 1991. These data were linked with claims data from Medicaid and San Diego County Mental Health Services information systems. A Poisson regression model was used to determine whether the following factors influenced outpatient mental health service use: age, race/ethnicity, gender, maltreatment history, placement pattern, and behavioral problems as measured by the Achenbach Child Behavior Checklist (CBCL).
Except for maltreatment history, all independent variables included in the multivariate regression model were statistically significant. The total number of outpatient mental health visits increased with age, male gender, and non-relative foster placements. Relative to Caucasians, visits were lower for Latinos, and Asian/Others, but comparable for African-Americans. Concerning maltreatment history, differences were only found in one category; children experiencing caretaker absence received fewer visits compared to children who did not experience caretaker absence. Children with CBCL Total Problem Scale T-scores of 60 or greater had significantly more visits than those with a score less than 60.
Both clinical and non-clinical factors influence outpatient mental health service use by foster children. Limitations imposed by gender, race/ethnicity, and placement setting need to be addressed by child welfare policies. These finding suggest that guidelines are needed to systematically link children in foster care with behavioral problems to appropriate services.
To investigate links between child sexual abuse (occurring before 13 years), later mental health, family organization, parenting behaviors, and adjustment in offspring.
The present study investigates a subsample of the Avon Longitudinal Study of Parents and Children an ongoing study of women and their families in the area of Avon, England. A sample of 8292 families met inclusion criteria for identifiable family type and completed self-report data on prior sexual assault. Further data were collected on life course variables, socioeconomic variables, psychological well-being, relationship quality, parent-child relationship quality, and children's adjustment.
After adjustment for other childhood adversity, prior child sexual abuse was associated with a range of outcomes in adulthood, including current membership of a nontraditional family type (single mother and stepfather) poorer psychological well-being, teenage pregnancy, parenting behaviors, and adjustment problems in the victim's later offspring. The relationship of child sexual abuse with aspects of the parent-child relationship in later life and with the offspring's adjustment difficulties were mediated in part by mother's mental health--chiefly anxiety.
Findings indicate that child sexual abuse has long-term repercussions for adult mental health, parenting relationships, and child adjustment in the succeeding generation.
Mental health and substance use problems and service utilization by transition-age foster youth: Early findings from CalYOUTH
- M E Courtney
- P Charles
Courtney ME, Charles P. Mental health and substance use problems and
service utilization by transition-age foster youth: Early findings from
CalYOUTH. Chicago, IL: Chapin Hall at the University of Chicago; 2015.
Small area variations in health care delivery
- J E Wennberg
- A Gittelsohn
Wennberg JE, Gittelsohn A. Small area variations in health care delivery.
Science 1973;182:1102e8.
The lifetime experiences Questionnaire: A measure of history of emotional, physical, and sexual maltreatment
- D T Rose
- L Y Abramson
- C A Kaupie
Rose DT, Abramson LY, Kaupie CA. The lifetime experiences Questionnaire:
A measure of history of emotional, physical, and sexual maltreatment.
Madison, WI: University of Wisconsin-Madison; 2000.