Assessments Often Miss Mental Health Issues for Youth on Probation

An assessment tool used by many jurisdictions within the juvenile justice system that is intended to help recognize the effects of adversity and trauma in children’s lives is not the best means of evaluating mental health problems faced by at-risk youth, according to new study by a University at Buffalo social work researcher.

The groundbreaking research, which lead author Patricia Logan-Greene believes is among the first studies to connect the adverse childhood experience (ACE) assessment for juveniles on probation to mental health problems, could help improve the justice system’s responses to court-involved youth, especially those who have experienced maltreatment and trauma.

“The United States continues to have a massive juvenile justice system that does not, generally speaking, serve youth well,” says Logan-Greene, an assistant professor in UB’s School of Social Work. “We suspect that the way mental health is often assessed in the juvenile justice system is missing many mental health problems – in particular with disadvantaged youth.”

The number of youth on probation is a far larger group than those who are incarcerated or in treatment facilities. Yet most of the research literature is on that smaller population.

“We may have identified a gap,” says Logan-Greene. “The court assessment asks whether youth have ever been diagnosed with a mental illness.  That question makes a lot of big assumptions like equal access to health care and equal desire to access mental health care, which has a lot to do with stigma.

“A better assessment tool would address symptomology,” she says.

The problems faced by youth on probation are widespread, according to Logan-Greene. The vast majority have histories of child abuse, family dysfunction and social disadvantage.

“Only 25 percent have no history of abuse,” she says. “One of my elevator speeches argues against punitive responses for youth with histories of trauma.”

Although most jurisdictions do assess mental health, these are not necessarily good assessments – and some jurisdictions aren’t assessing for this at all. A single question to capture all aspects of mental health simply isn’t sufficient.

“While the adverse childhood experience tool has done wonderful things to help us recognize the importance of adversity and trauma in children’s lives, there is still room for improvement,” she says. “For instance, there is nothing in the ACE tool about childhood poverty, and we know from previous research that childhood poverty is deeply damaging.”

In the current study, Logan-Greene and her co-authors Robert L. Tennyson and Paula S. Nurius, both from the University of Washington, and Sharon Borja, University of Houston, divided their assessment of childhood adversity into childhood maltreatment, family dysfunction including substance abuse, family history of mental illness, physical health problems with the family, and social disadvantage, using a diverse sample of more than 5,300 youth on probation.

The findings suggest a clear connection between childhood maltreatment and mental health problems.  Although there did not appear to be a relationship between social disadvantage and mental health problems, there was a connection between mental health and the symptoms of social disadvantage such as coping problems, social isolation and what the authors call aspirations or the measure of hope for the future.

“Because social disadvantage did have a negative effect on those indicators we suspect the court assessments are not picking up what are probably undiagnosed and untreated mental health problems among disadvantaged youth,” Logan-Greene says.

How Focusing on Parent-Child Relationships Can Prevent Child Maltreatment

Child abuse and neglect is a widespread and costly problem in the United States. Approximately 3.9 million children were subjects of maltreatment reports to child welfare agencies in 2013. According to the Centers for Disease Control and Prevention, child abuse and neglect cost the U.S. $124 billion in 2012.

In order to help children facing maltreatment, researchers and clinicians first needed to address the heart of the problem. The relationship between the parent and child is key, argues Kristin Valentino, William J. Shaw Center for Children and Families Associate Professor of Psychology at the University of Notre Dame, in an article published recently in a special section of the journal Child Development.

Kristin Valentino  Photo Credit: Credit: Matt Cashore/University of Notre Dame

More than 90 percent of maltreated children are victimized by one or both parents, according to the U.S. Department of Health and Human Services. “My position is that child maltreatment, in most cases, can best be understood as a problem in the parent-child relationship,” Valentino says. “Thus, we should focus on enhancing the parent-child relationship in our intervention efforts.”

Two broad kinds of relational interventions between parents and children are available to researchers and clinicians. In her article, Valentino examines brief models and long-term models, both designed to improve not only how well parents understand their children and how to react to them, but also the child’s attachment security. The latter plays a critical role in supporting positive development, including coping skills, emotional and behavioral functioning, peer relationships and even physical health.

Children who are neglected, abused or otherwise mistreated often develop emotional problems, Valentino says: “Up to 80 to 90 percent of maltreated children develop what is known as disorganized attachment. This classification is one type of insecure attachment and is associated with the worst outcomes including severe problems in emotion regulation, school achievement and the development of psychopathology.”

Valentino reviews the pros and cons of brief and long-term intervention methods, and conclusively recommends a tiered approach wherein families are provided with brief interventions first, and subsequent long-term approaches if needed.

“Given limitations on resources and funds to support treatment in the child welfare system, this approach would allow us to provide services to more families, and to identify families who should be referred to more intensive programs in a targeted manner,” Valentino says.

Valentino is a clinical and developmental psychologist who conducts research with families through Notre Dame’s Shaw Center for Children and Families. Her current research focuses on evaluating the effectiveness of a brief relational intervention for maltreated preschool-aged children and their mothers in a randomized clinical trial design.

The article, titled “Relational Interventions for Maltreated Children,” is featured in a special section of Child Development that addresses how best to address the developmental needs of different at-risk populations of children and families. The special section contains a set of papers from 12 sets of specialists in order to provide expert recommendations that are useful to both clinicians and policymakers.

Boy Held Captive Teaches Us About Good Child Protection Practice

Canadian media have been covering the story of a 10 year old boy who was rescued by child protection workers in London, Ontario. They boy, who cannot be named in accordance with typical Canadian child protection legislation, had been locked in a bedroom of his aunt and uncle’s house for between 18-24 months. The room, like the rest of the house, police and social workers described as squalid. As the Globe and Mail newspaper reports, he was found in the master bedroom. His bed and his pajamas were soiled with urine and the room had left overs of his fast food diet. Feces were also found in the room.

For this boy, his confinement must have been even more confusing as he had a 9 year old cousin, the daughter of the aunt and uncle, who was not confined. But somehow, she must have been ingratiated into the need for secrecy as she went about her life outside the home.

The boy is not originally from Canada and has limited English. He has not been registered in school and thus was not known to educational officials. Therefore, his absence from school did not ring any bells – he just wasn’t known.

Media have also interviewed neighbors who also did not know of the boy, adding to his invisibility. Yet, somehow, child protection received a tip that he existed and went out to investigate. Knocks on the door went unanswered but the social worker noted a shadow moving. Police were summoned and the boy was found.

The good child protection practice here is being inquisitive and paying attention to what you see. The boy has been severely neglected bot physically and emotionally. He reportedly now wants normal food and the chance to go to school. This suggests that he had a connection to the average life experience of a child prior to being imprisoned by the aunt and uncle who now face criminal charges.

His case also reminds us of how powerful families can be in keeping abuse hidden. One has to imagine how isolated the boy was but knowing that just on the other side of the window were children and families going about their day. The home was in a typical residential neighborhood that might be seen anywhere in Canada or the USA. Children lived in the homes around this boy and he would have heard him them out playing. What power existed with the aunt and uncle that he would have remained so invisible? This is a lesson for child protection.

But so too is the apparent strength of his early life. Trauma informed therapy can build upon that helping him to realize the dream of going to school. Inside that dream will be many chapters that might range from connecting to other kids on up to building a future for himself.

No doubt in the weeks to come we will learn more about this story but it reminds us of the need to act, be alert to the data as it comes to you and to think critically about what the data means.

Prevent Child Abuse America: Interview with Ben Tanzer

Earlier in April, VetoViolence and Students Against Violence Everywhere (SAVE) recognized National Youth Violence Prevention Week through an “Ask the Expert” forum on Facebook. The event ignited a conversation about the importance of preventing youth violence before it starts. This week, to continue raising awareness and sharing resources on preventing violence before it starts, VetoViolence and Prevent Child Abuse America are hosting a second Ask the Expert forum on Facebook focused on child maltreatment prevention in honor of Child Abuse Prevention Month.

PFPLogo2011I had the opportunity to interview Ben Tanzer, Senior Director of Strategic Communication for Prevent Child Abuse America, who is also a trained social worker. Ben talks about his work at Prevent Child Abuse America, their awareness campaign on child maltreatment, as well as the challenges they face in improving outcomes for children.

SWH: Tell us about your background and the work you do with Prevent Child Abuse America.

PCAA: I am a trained social worker who always wanted to work on children’s issues and always had a love for words. At Prevent Child Abuse America I get to play a role in our efforts to tell the story of early child development. How a programming and policy focus on enhancing a child’s brain, and their social-emotional life, has long-term positive impacts for both the individual and society. But that exposure to violence, poverty, and child abuse and neglect can undermine all of that. We try to tell this story through traditional means, press releases, statements, and interviews, as well as, new media, Twitter, blogging, Facebook, and the like.

SWH: What are the primary goals and objectives of Prevent Child Abuse America, and what activities help you work towards the achievement of those goals?

PCAA: Our primary goals and objectives are to create a society in which all children are given the support they need and the healthy childhood they deserve. A society in which all adults realize they play a role in the lives of all children, and in which no child is ever abused or neglected. We work to build awareness of the different ways that people can affect the lives of children and families in their communities as well as working to increase knowledge and understanding of our primary prevention program, Healthy Families America (HFA).

SWH: What are the biggest barriers and challenges your organization faces in reducing child abuse in America today?

PCAA: One of the largest barriers that we face is a communications challenge: that people are aware that child abuse and neglect is an issue and want to do something about it, but don’t know how. Many of us  are conditioned to believe that the only way we can help a child in need is by calling CPS if we suspect something is wrong. While this action is critically important, we know that there is much more that can be done to help prevent child abuse as opposed to intervening in an abusive situation, including everything from knocking on a neighbor’s door to see if they want a break from parenting to volunteering at local child-serving organizations to advocating for the expansion of innovative prevention and family support programs that may already exist in the communities we live in

SWH: How does your work engage or incorporate social workers in helping to improve outcomes for children?

PCAA: Healthy Families of America employs home visitors in communities across the nation, who may or may not be trained social workers, but who are providing support to families modeled on the core tenets of social work, for example, meeting people where they’re at, be that geographically, culturally, or emotionally. Further, many of the staffers in our chapters and at our national office are social workers by training. Social workers are critical to the success of our organization and our mission.

SWH: What do you hope to accomplish with the Facebook Ask the Expert awareness event, and how can regular, everyday people help prevent child abuse?

PCAA: We hope that the Ask the Expert event will help those who are interested in learning more about early child development and prevention better understand the various ways they can help play a role in promoting healthy child development and the prevention of abuse and neglect before it starts. If we’re able to spread the word to just a few interested people, and they in turn are able to help their friends and family understand that they, too, play a role, then we’re one big step closer to the kind of society we’re working towards.

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