• Assessing Developmental Pathways of Young Children Investigated for Neglect and Predictors of Persistent Problems

      Woodruff, Kristen; Harrington, Donna; Barth, Richard P., 1952- (2012)
      Background: Young neglected children are at high risk for behavior problems, yet little is known about the diversity of these children or the predictors of behavior problems. The purpose of this dissertation was to identify subgroups of children following different behavioral trajectories, describe these groups and predictors of membership, and explore the association between receipt of child welfare services (CWS) and development. Methods: A sample of 2- and 3-year-olds reported for neglect who remained home (n=236) were selected from the National Survey of Child and Adolescent Well-being (NSCAW). Externalizing and internalizing behaviors, measured by the Child Behavior Checklist (Achenbach, 1991, 1992), were examined over time using latent class growth analysis to assess the optimal number of classes of children following distinct trajectories. Using weighted data, bivariate and multivariate analyses were used to describe the children and identify predictors of group membership from the caregiving environment and CWS. Results: Four subgroups of children following distinct externalizing behavior paths and two subgroups following distinct internalizing behavior paths were identified. Most children scored in normal range, but one in seven (14.7%) exhibited borderline clinical externalizing behaviors at age 2 or 3 and followed a worsening path into clinical range over five or six years. A small group (0.5%) exhibited high levels of externalizing problems that remained in clinical range over time. Two-thirds (66.1%) consistently demonstrate normal-range internalizing behaviors during these five or six years, while the other third (33.9%) exhibit borderline clinical behaviors. Parent-reported physically assaultive behaviors and non-minority status predicted membership in the persistent externalizing problem and borderline clinical internalizing behavior groups. Lower household income predicted membership in the persistent externalizing problem groups. Neither outcome of investigation nor receipt of services predicted membership. Implications: Children reported for neglect should be screened for behavior problems in order to ensure appropriate referral for early intervention, averting persistent problems over time. Two affordable methods of brief screening are discussed. Children most at risk could be referred to early intervention, special education, or early mental health services for more thorough screening, evaluation, and treatment.
    • The System of Care Mental Health Service Experience: Differences in Perceptions between African American and Caucasian Youth and its Impact on Service Use and the Relationship between Receipt of Services and Emotional and Behavioral Symptoms

      Williams, Crystal; Harrington, Donna (2012)
      Racial disparities in adolescent mental health services remain an unrelenting public health problem. The purpose of this study was to understand the differential system of care service utilization patterns and associated symptoms among African American and Caucasian adolescents with serious emotional disturbances (N = 655; M age = 13.7, 60% Caucasian, 63% male). The primary objectives were to: (1) explore differences in perceptions of mental health service experiences at 6-months by race; (2) examine race as a moderator between perceptions of service experiences and receipt of services between 6 and 12 months; and (3) explore mental health symptoms at 12 months as a function of race. Mental health symptoms for a subsample of youth (N = 548) with elevated symptoms were also examined. A secondary data analysis using data from the Comprehensive Community Mental Health Services for Children and Their Families Program (CMHI) and generalized estimating equation (GEE) analyses indicated that (1) African American and Caucasian adolescents did not differ in their overall perceptions of their service experience, (2) race did not moderate perceptions and receipt of services, and (3) race moderated the relationship between receipt of family therapy and externalizing symptoms. The results also showed that use of individual therapy was predicted by race (Caucasian) and greater emotional/behavioral symptoms at baseline, while group therapy was predicated by gender (male) and greater functional impairment at baseline. Adolescents' perceived social support from adults (not peers) predicted fewer internalizing symptoms, and Caucasian adolescents experienced fewer externalizing symptoms. The examination of mental health symptoms for the subsample revealed that race did not moderate receipt of services and symptoms. Instead, perceived social support from adults (not peers) predicted fewer internalizing symptoms, and clinician-client racial match predicted fewer externalizing symptoms. The findings suggest that African American and Caucasian adolescents share similar perceptions of their service experience, yet disparities in service use and symptomatology persist. Further, youth with perceived social support and a clinician-client racial match experience fewer mental health symptoms. Practitioners should assess adolescent's perceived social support upon receipt of treatment, discuss clinician preferences, and explore opportunities to engage African American families in family therapy.