• 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.
    • Assessing the Relationship between Adverse Childhood Experiences and Body Mass Index Trajectory of Children and Adolescents

      Park, Hyeshin; Barth, Richard P., 1952- (2017)
      Background: More than a third of American children and adolescents are overweight or obese. Because childhood obesity is a risk factor for various health, mental health, and socioeconomic problems in adulthood, health practitioners, policy makers, and researchers continue to identify growth trajectories and clarify risk factors for unhealthy growth trajectories. The purpose of this dissertation was to identify subcategories of children who follow different body mass index (BMI) trajectories, describe these groups, and explore whether adverse childhood experiences (ACEs) predict group membership. Methods: A sample of children who participated in the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) study at the Eastern site (Baltimore, MD), and whose demographic and BMI data were collected at age four, were included in the study (n=201). Latent Class Growth Analysis (LCGA) was used to examine longitudinal patterns of BMI growth over a span of 14 years (4 years - 18 years). Data were assessed and the optimal number of classes to describe the growth trajectories was selected. Bivariate and multivariate data analyses were used to describe the children in each group. Multinomial logistic regression was used to examine whether the number of cumulative preschool (age 4) or school-aged ACEs (ages 4 to 14) predicted group membership. Results: Overall, the percentage of overweight/obesity increased with each additional wave. Based on z-BMI score, at age 4, 20.1% were overweight/obese. A marked increase was identified when children were 12 years old (42.0%) and then at 18 years (49.4%). Three BMI growth trajectories were identified: expected growth, emerging overweight, and increasing obesity. Most children followed an expected growth trajectory (73.6%). However, about a fifth followed a trajectory with a steep increase in BMI over time (emerging overweight = 21.9%) and a small percentage of the children exhibited a high initial BMI as well as a high rate of increase (increasing obesity = 4.5%). Ages 8 to 12 and ages 16 to 18 had especially steep slopes when it came to BMI increase in the emerging overweight and increasing obesity trajectories. A higher preschool ACEs score was associated with a low odds ratio of being in the emerging overweight group compared to the expected growth group; school aged ACEs score did not predict membership to a particular class. Female children and those with a higher primary maternal caregiver BMI when the children were 4 years old predicted being in the emerging overweight group compared to the expected growth group. Implications: The time periods that are especially sensitive to steeper weight gain are likely to be the time periods when interventions should be targeted for children in a low income, urban, largely African American community. The current study had results that were divergent from the hypothesis in that children who had higher ACEs at age four were less likely to have an obesity-prone BMI trajectory. Reasons and implications are discussed. The child's gender and the child's maternal caregiver's weight status should provide some guidance in intervention and treatment decisions.
    • The Parent University Program: Factors Predicting Change in Responsive Parenting Behaviors

      Liggett-Creel, Kyla; Barth, Richard P., 1952-; Berlin, Lisa J. (2016)
      There are few evidence-based parenting programs for children under the age of three and even fewer have been rigorously evaluated in comparison to parenting programs for older children (Barth & Liggett-Creel, 2014). Parenting programs such as Child-Parent Psychotherapy, Circle of Security, Promoting First Relationships, Chicago Parent Program, and Attachment and Biobehavioral Catch-up have shown positive outcomes. Common components are beginning to be identified in successful parenting programs for families with children ages birth to three years old. The Parent University Program (PUP) integrates common components of five evidence-based interventions for children birth through three years old. Parent-child dyads (N=86) participated in the parenting program with the goal of increasing responsive parenting skills. This study aims to assess the changes that may occur in responsive parenting behaviors that promote social emotional growth, cognitive growth, sensitivity to cues, and responding to the distress of their child. Results will add to parenting program research on the use of common components, real world implementation and evaluation, and the use of peers as facilitators. Participants of the PUP showed a significant increase in responsive parenting behaviors. Participants who completed pre-test, post-test, and follow-up assessments showed a significant change from clinical to non-clinical status after attending the PUP. Neither the type of facilitator nor the number of hours attended showed an association with changing parenting behaviors. The age of the child was associated with the change in responsive parenting. Older children had higher scores at pre-test and showed less change over time. The results of this research suggest that further evaluation is warranted with more rigorous study design including a randomized clinical trial.
    • Teaching and Learning Motivational Interviewing: Examining the Efficacy of Two Training Methods for Social Work Students

      Hodorowicz, Mary; Barth, Richard P., 1952-; 0000-0001-5542-5733 (2018)
      This study examines the efficacy of two innovative training methods used to teach beginning Motivational Interviewing (MI) skills to social work students in a child welfare training program. The two training methods tested include live supervision (LS), a small group experiential learning interaction with standardized client actors (SCAs), and in-the-moment guidance from a supervisor, and a coding learning method (CL), where students in a classroom setting are introduced to MI skill development via learning core MI concepts as identified in the Motivational Interviewing Treatment Integrity Coding Manual 4.2.1 .Comparison between these methods was enhanced with a randomized controlled trial design. Changes in MI knowledge, attitudes, and MI skill were assessed over three time points through self-report and observational measures. The study also evaluated participant satisfaction and efficiency of training methods via examination of educational resources required by each training method. After participating in pre-test measures, 17 student participants were randomized to receive either the LS or CL training. Both trainings provided 12 hours of MI training instruction over a period of two days. Students were assessed post-training, and at 5 months follow-up, after a semester of learning-as-usual. T-tests and ANOVAs were used to examine efficacy of training methods. Results show that both groups demonstrated an improvement in MI knowledge and attitudes from pre-test to follow-up. MI skill gain within groups varied for specific MI skills. There was no difference between groups in participant training satisfaction for 10 out of 13 satisfaction items. Participants in the LS group endorsed a higher level of satisfaction than the CL training participants for the remaining 3 training satisfaction items. The LS training method is more costly and requires more resources than the CL training method. Findings suggest participants in both groups were satisfied with the training experience, both training methods are effective for improving MI knowledge and attitudes, the LS training method requires more resources than the CL method, and training method effectiveness varied for specific MI skills. Implications for social work education, MI training, and future research are discussed. Keywords: motivational interviewing, social work education, standardized clients, live supervision, MITI coding, training methods