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The Brief Assessment Checklists (BAC-C, BAC-A): Mental health screening measures for school-aged children and adolescents in foster, kinship, residential and adoptive care
Abstract
More than half of children and young people in foster, kinship, and residential care, as well as those subsequently adopted from care, have mental health difficulties that require clinical formulation and intervention. While an increasing number of alternate care jurisdictions are instituting universal mental health screening, existing measures may not adequately screen for a range of attachment- and trauma-related mental health difficulties observed among these populations. The Brief Assessment Checklist for Children (BAC-C), and the Brief Assessment Checklist for Adolescents (BAC-A) are 20-item caregiver-report psychiatric rating scales designed to: 1. screen for and monitor clinically-meaningful mental health difficulties experienced by children and adolescents in various types of care; and 2. be safely administered and interpreted by health and social care professionals other than child and adolescent mental health clinicians. The BAC-C/A were also designed to be used as brief casework monitoring tools by foster care and adoption agencies, and for treatment monitoring in CAMHS. The BAC-C and BAC-A were derived from the Assessment Checklist for Children (ACC, 120 items) and Assessment Checklist for Adolescents (ACA, 105 items) respectively. Internal consistency of BAC-C (N = 347) and BAC-A (N = 230) scores were 0.89 and 0.87 respectively. The BAC-C/A were highly accurate in screening for clinical range ACC and ACA scores (area under the curve (AUC) ranging from 0.96 to 0.99), as well as for CBCL clinical range scores (AUCs: BAC-C = 0.89 to 0.92; BAC-A = 0.93 to 0.94). They were moderately accurate in screening for children that caregivers reported had been referred to mental health services (AUCs: BAC-C = 0.74; BAC-A = 0.79). Initial BAC-C/A psychometric properties compare favourably with that of existing screening instruments, including the Strengths and Difficulties Questionnaire and the Brief Problem Monitor (CBCL short form).
... Most recently, brief screening versions of these scales, the 20-item Brief Assessment Checklists for children and for adolescents (BAC-C, BAC-A) have been developed (Tarren-Sweeney, 2013b). These screening checklists are designed specifically for health and social care professionals as distinct from child and adolescent mental health clinicians, and may be used as casework monitoring tools by foster care and adoption agencies, and also for treatment monitoring in Child and Adolescent Mental Health Services (CAMHS). ...
... These screening checklists are designed specifically for health and social care professionals as distinct from child and adolescent mental health clinicians, and may be used as casework monitoring tools by foster care and adoption agencies, and also for treatment monitoring in Child and Adolescent Mental Health Services (CAMHS). Initial comparisons of their psychometric properties with existing screening instruments, including the SDQ and the CBCL's Brief Report version, suggest the BAC-C and BAC-A compare favourably (Tarren-Sweeney, 2013b). ...
... The review should incorporate mixed methods of research in order to establish not just 'what works' but also 'for whom, in what context, in what circumstances, and why'. 1 2 ESTABLISH A COMMON ASSESSMENT FRAMEWORK AND ONGOING MONITORING OF CHILDREN'S AND YOUNG PEOPLE'S MENTAL HEALTH NEEDS - An agreed assessment framework on entry to care or youth justice is required, as is ongoing monitoring and evaluation of progress as well as an assessment of need for all children currently in the systems. "Specialised assessment of these children requires a shift from a relatively narrow, 'mechanical' focus on identifying children's symptoms and disorders -to seeking a comprehensive understanding of their felt experience, their relationships, family / placement processes, and systemic and care-related pressures on their development" (Tarren-Sweeney, 2013b). This information should be held centrally to avoid multiple assessments and to inform service development. ...
... Trauma-informed assessment of children and youth in child protective services (CPS) out-of-home care (OHC) is an especially growing concern in light of well-documented high levels of traumatic experiences, multiple victimizations, behavior problems, and acute mental health symptoms among this population (Baker, Kurland, Curtis, Alexander, & Papa-Lentini, 2007;Briggs et al., 2012;Collin-Vezina, Coleman, Milne, Sell, & Daigneault, 2011;McMillen et al., 2005;Pecora, Jensen, Romanelli, Jackson, & Ortiz, 2009;Tarren-Sweeney, 2013;Trout et al., 2008). Mental health problems such as anxiety, depression, and attention disorders are reported more frequently among children in OHC than among those receiving in-home CPS services (Kolko et al., 2010;Tarren-Sweeney, 2008). ...
... Intrinsically tied with budgetary constraints are administrative requirements that can impede the ability to properly conduct assessments, interpret findings, and advocate for treatment (Taylor & Siegfried, 2005). Further, CPS agencies may have limited access to psychologists and other trained mental health clinicians to support the assessment process, leading to a lack of knowledge regarding suitable measures for traumatized children and youth that adequately screen or assess for a range of trauma-related mental health difficulties (Tarren-Sweeney, 2013). To compound these difficulties, organizations often have difficulty adapting to change, which can pose a challenge for the adoption of new practices such as standardized trauma assessment (Rivard et al., 2004). ...
Objective: Research confirms that many children and youth in child protective services (CPS) out-of-home care (OHC) have experienced multiple and often traumatic events that can lead to a variety of detrimental outcomes. Few CPS agencies have adopted standardized, trauma-focused assessment procedures, resulting in a gap in the provision of trauma-focused mental health services. The objective of this article is to propose a compendium of trauma-focused, evidence-based measures geared toward children and youth in OHC that can feasibly be incorporated into routine CPS practice. Method: Using a 4-stage search strategy, 9 measures designed to collect information on trauma exposure, trauma-related symptoms, and related behaviors were recommended based on desirable psychometric properties and practical considerations. Results: Although a plethora of measures exist to assess children and youth, a variety of measures geared toward the trauma-specific needs of children and youth in OHC are presented that demonstrate satisfactory psychometric properties and are considered feasible for implementation by CPS. Conclusion: This article fills a gap for children and youth in CPS OHC by proposing a compendium of measures suitable for a standardized, trauma-focused assessment procedure specifically aimed at this vulnerable population, which can serve as a catalyst for the development of specialized, trauma-focused services.
... Four studies collected data at follow-up, the average follow-up period was 13 months (R = 1-36). The most frequently used assessment measures were the Child Behaviour Checklist (CBCL) [89] and versions of the Assessment Checklist measures (Tarren-Sweeney) [90,91] which were each utilised in five studies. Four studies utilised versions of the Trauma Symptom Checklist measures [92,93]. ...
... Further research evaluating interventions for adoptive families should use objective measures. The most prominent outcome measures used throughout this review assessed child psychological well-being and behavioural functioning with the CBCL [89], child mental health via the Assessment Checklist measures [90,91], and trauma symptomatology via the Trauma Symptom Checklist measures [92,93]. However, there is also a need for research to evaluate current assessment measures to provide direction towards the most appropriate measures within this field. ...
Adopted children are often at a risk of experiencing several neurobiological and psychosocial difficulties. Adoptive parents must support these difficulties whilst managing their own idiosyncratic challenges. Family-based psychotherapeutic interventions which promote adoptive family functioning, environments and relationships can mediate these difficulties for adopted families. This review synthesises evidence exploring family-based psychological interventions for adoptive families, appraises the literature’s strengths and weaknesses, and reports characteristics of promising interventions. Included studies recruited domestically adoptive families receiving psychotherapeutic interventions delivered to at least one adoptive parent and child. The authors searched seven electronic information databases, four grey literature databases, two journals and five relevant websites up to 12.12.2022. The quantitative Risk of Bias in Non-Randomised Studies of Interventions tool and the qualitative Critical Skills Appraisal Programme checklist assessed risk of bias. The narrative synthesis presents 20 papers detailing 18 studies involving at least 729 adopted children and 829 adoptive parents. Findings provide preliminary support for integrative interventions which include aspects of sensory activities, attachment-based play, Dyadic Developmental Psychotherapy and Eye Movement Desensitisation and Reprocessing with Therapeutic Input provided to adopted children and adoptive parents separately, alongside the adoptive family. However, risk of bias was high, limiting the conclusions. Future research should examine the feasibility, acceptability and efficacy of integrative therapeutic approaches for adoptive families to further direct clinical practice.
... These experiences influence their development, resulting in decreased psychosocial functioning and well-being (Turney & Wildeman, 2017). Moreover, prior studies have reported extensive developmental issues such as behavioral, psychological and educational problems among foster children both before and during their placement (Goemans et al., 2016Sebba et al., 2015;Tarren-Sweeney, 2013;. ...
... A total score of 7 or higher indicates clinical-level mental health problems. Good psychometric properties and validity were previously reported Tarren-Sweeney, 2013). Foster parents were instructed to fill in the BAC-C/A twice; once for the period prior to the lockdown and once for the present time (during the lockdown). ...
The measures implemented to contain the COVID-19 pandemic profoundly affected the lives of children and families all around the world, probably affecting children’s psychosocial well-being. The negative consequences of lockdowns are presumed to hit even harder on vulnerable groups such as foster children who already struggle with their psychosocial well-being in normal circumstances and who face specific challenges during lockdowns such as: additional help that is no longer available or only offered digitally and physical contact with birth parents that is forbidden. Nevertheless, some scholars point to the positive side of lockdowns (e.g.: relief due to closure of schools). This study aims to asses the psychosocial well-being of Flemish foster children residing in their foster homes during the COVID-19 lockdown and the factors that are associated with the change in their psychosocial well-being. 888 foster parents reported on the psychosocial well-being of just as many foster children through the Brief Assessment Checklist for Children and Adolescents. The COVID-19 lockdown was not associated with a decreased psychosocial well-being of Flemish foster children residing in their foster homes during the lockdown. Foster parents reported a slight improvement in their relationship with their foster child during the lockdown which points to a positive consequence of the lockdown. In addition, this improvement was positively associated with an increased psychosocial well-being during adverse circumstances and should therefore be enhanced. The type and amount of contact with birth parents is significantly associated with foster children’s changed psychosocial well-being during the lockdown. Foster parents who reported an increase in alternative contact (e.g., (video)calls and messages) between their foster child and his/her birth parent(s) during the lockdown, also reported an increase in their foster child’s psychosocial well-being during that period.
... The BAC (an abbreviated version of the Assessment Checklist for Children and for Adolescents, Tarren-Sweeney, 2007, 2013) is a 20 itemed instrument developed to screen children within care systems on mental health difficulties, including trauma-and attachment related difficulties. The BAC showed good psychometric properties to screen and monitor mental health problems in foster children (among other child welfare populations) (Goemans, Tarren-Sweeney, Van Geel, & Vedder, 2018a;Tarren-Sweeney, 2013). ...
... The BAC (an abbreviated version of the Assessment Checklist for Children and for Adolescents, Tarren-Sweeney, 2007, 2013) is a 20 itemed instrument developed to screen children within care systems on mental health difficulties, including trauma-and attachment related difficulties. The BAC showed good psychometric properties to screen and monitor mental health problems in foster children (among other child welfare populations) (Goemans, Tarren-Sweeney, Van Geel, & Vedder, 2018a;Tarren-Sweeney, 2013). Goemans and colleagues assessed the possible use of the BAC to screen for placements breakdown, whereby the risk for placement breakdown was operationalized as the intention of foster parents to quit with the foster care placement (Goemans et al., 2018a). ...
A significant number of long-term foster placements, intended to provide the child with a stable and safe family rearing environment until the age of 18, end unplanned. This study examined the predictive power of the Strength and Difficulties Questionnaire (SDQ) for predicting foster placement breakdown. It was examined whether the predictive value of the SDQ could be improved by developing a risk classification in which the SDQ scales are combined with foster child and foster family characteristics. The present sample consisted of 526 foster children. Foster parents initially filled out a questionnaire (SDQ and foster child and foster family characteristics). After on average 4 years files were analyzed on whether or not the foster placement broke down and the reason for break down. A CHAID-analysis was performed to develop the risk classification. Results showed that both the SDQ total difficulties score as well as the impact supplement have medium to high predictive power for placement breakdown (AUC = 0.75 and 0.70, respectively). A risk classification based on the SDQ total difficulties score, the age the child was placed with the foster family, the presence of other foster children and the SDQ hyperactivity /attention problems score had high predictive power (AUC = 0.82). Both the SDQ and the newly developed risk classification showed to be valuable tools for predicting placement breakdown. Both tools might help foster care organizations to monitor the placement and assist foster families timely to prevent breakdown.
... There are only a few specialized measures that focus on psychosocial difficulties specifically manifested by children in foster care (Levitt, 2009). Among these are the Brief Assessment Checklists for Children (BAC-C) and Brief Assessment Checklists for Adolescents (BAC-A; Tarren-Sweeney, 2013a), which are twenty item checklists derived, respectively, from the Assessment Checklist for Children (ACC;Tarren-Sweeney, 2007) and the Assessment Checklist for Adolescents (ACA;Tarren-Sweeney, 2013b). The ACC and ACA are empirically derived caregiver-report psychiatric rating scales designed to measure problematic behaviours, emotional states and relational difficulties experienced by children in care (and similar vulnerable populations), in comprehensive clinical/psychosocial-developmental assessments. ...
... In the Australian development samples, the BAC-C and BAC-A were highly accurate in screening for CBCL, ACC and ACA clinical range scores (area under the curve (AUC) >0.88) and moderately accurate in screening for caregiver-reported referrals to clinical services (AUC = 0.74–0.79) (Tarren-Sweeney, 2013b). ...
Children in foster care experience higher levels and rates of psychosocial difficulties than children from the general population. Governments and child welfare services have a responsibility to identify those children in care who have need for therapeutic services. This can be achieved through systematic screening and monitoring of psychosocial difficulties among all children in foster care. However, general screening and assessment measures such as the Strengths and Difficulties Questionnaire (SDQ) and Child Behavior Checklist (CBCL) might not adequately screen for the range of difficulties experienced by foster children. The Brief Assessment Checklists for Children (BAC-C) and Brief Assessment Checklists for Adolescents (BAC-A) are measures designed to screen for and monitor attachment- and trauma-related difficulties among child welfare populations. This article reports psychometric properties of the BAC-C and BAC-A, estimated in a population study of 219 Dutch foster children. The results suggest the BAC-C and BAC-A perform both screening and monitoring functions well. Their screening accuracy, internal reliability and concurrent validity are comparable to those estimated for the SDQ within the same child and adolescent sample. Future research is needed to assess the value of the Brief Assessment Checklists (BAC) compared to other measures and to validate cut-points for the BAC. This study further establishes the BAC-A and BAC-C as valid and useful mental health screening and monitoring measures for use with children and adolescents in foster care.
... Unfortunately, the current state of psychometrically sound, concise, and repeatable psychological symptom assessment for youths in out-of-home care is insufficient (Chambers, Saunders, New, Williams, & Stachurska, 2010). For example, the Assessment Checklist for Children (ACC;TarrenSweeney, 2007) and Assessment Checklist for Adolescents (ACA;Tarren-Sweeney, 2013a) are available in long forms with over 100 items each or short forms with 20 items each (Tarren-Sweeney, 2013b). These short forms may be too lengthy for frequent assessments of youth functioning and different questionnaires are required for different age ranges (4 to 11 years and 12 to 17 years;Tarren-Sweeney, 2013b), which may become cumbersome. ...
... For example, the Assessment Checklist for Children (ACC;TarrenSweeney, 2007) and Assessment Checklist for Adolescents (ACA;Tarren-Sweeney, 2013a) are available in long forms with over 100 items each or short forms with 20 items each (Tarren-Sweeney, 2013b). These short forms may be too lengthy for frequent assessments of youth functioning and different questionnaires are required for different age ranges (4 to 11 years and 12 to 17 years;Tarren-Sweeney, 2013b), which may become cumbersome. Progress monitoring measures are continuous, routine assessments of client change that can help identify a client's response to treatment. ...
BACKGROUND: There is a need for brief progress monitoring measures of behavioral and emotional symptoms for youth in out-of-home care. The Symptoms and Functioning Severity Scale (SFSS; Bickman et al., 2010) is one measure that has clinician and youth short forms (SFSS-SFs); however, the psychometric soundness of the SFSS-SFs with youth in out-of-home care has yet to be examined.
OBJECTIVE: The objective was to determine if the psychometric characteristics of the clinician and youth SFSS-SFs are viable for use in out-of-home care programs.
METHODS: The participants included 143 youth receiving residential treatment and 52 direct care residential staff. The current study assessed internal consistency and alternate forms reliability for SFSS-SFs for youth in a residential care setting. Further, a binary classification test was completed to determine if the SFSS-SFs similarly classified youth as the SFSS full version for low- and elevated-severity.
RESULTS: The internal consistency for the clinician and youth SFSS-SFs was adequate (α = .75 to .82) as was the parallel forms reliability (r = .85 to .97). The sensitivity (0.80 to 0.95), specificity (0.88 to 0.97), and overall accuracy (0.89 to 0.93) for differentiating low and elevated symptom severity was acceptable.
CONCLUSIONS: The clinician and youth SFSS-SFs have acceptable psychometrics and may be beneficial for progress monitoring; however, more research is needed to assess their sensitivity to change over time in out-of-home programs.
... The health and wellbeing of looked after and adopted children and young people (care experienced) is a major contemporary concern across all developed countries. Care experienced children are internationally recognised as a vulnerable social group [1,2] with the cumulative effects of childhood exposure to trauma and adversity known to detrimentally influence outcomes across the life course [3,4,5]. Given the complexity of care experienced children's needs and those of their primary caregivers, multiple services and disciplines are typically involved with individual children. ...
... However, for youth in foster care, more detailed reports of level and pattern of internalizing symptoms and impairment are scarce. Focusing on symptom level instead of diagnosis could provide important information as youth in foster care often show high, but sub-threshold scores on several symptom subscales simultaneously [4,5]. Consequently, they run a higher risk of impairment [6] without meeting criteria for a diagnosis. ...
Among youth in foster care ( N = 303, aged 11–17 years), we investigated prevalence of internalizing symptoms; associations between symptom level and maltreatment types and numbers; and the interaction between gender and maltreatment, on internalizing symptoms. Youth completed Spence Children Anxiety Scale, Short Mood Feelings Questionnaire, and Child and Adolescent Trauma Screen. Compared to community samples, symptom levels above clinical cut-off was more frequent, with social- and generalized anxiety (ES = 0.78–0.88) being most prevalent among youth in foster care. Girls reported more internalizing symptoms (ES = 0.59–0.93). Sexual abuse and neglect were associated with a broader range of internalizing symptoms (ES = 0.35–0.64). Increased incidence of maltreatment was associated with increased levels of symptoms (ES = 0.21–0.22). Associations between maltreatment and symptom level were stronger for girls. This study stresses the importance of broad screening of maltreatment and internalizing symptoms to meet the needs of youth in foster care.
... The "Pediatric Symptoms Checklist" (PSC; Jellinek et al., 1979;Jellinek et al., 1988) and the "Strengths and Difficulties Questionnaire" (SDQ; Goodman, 1997Goodman, , 2001 are two brief questionnaires which obtain information on some psychopathological areas: attention, internalizing, externalizing problems, the PSC; emotional, conduct, hyperactivity/inattention, and peer relationship problems the SDQ. Approaching these is the "Brief Assessment Checklist," in the versions for children and adolescents (BAC-C and BAC-A), specifically aimed at identifying problems in subjects particularly at risk such as those in foster, kinship, residential, and adoptive care (Goemans et al., 2018;Tarren-Sweeney, 2013). ...
Background
The questionnaires completed by the parents give a first general information on the behavioral problems of the child–adolescent, as a useful orientation to the clinical evaluation. The Child and Adolescent Behavior Inventory (CABI) is a 75-item parent questionnaire, which explores a large number of problem areas. The study of its predictive validity for the clinical diagnosis, in comparison with the Diagnostic and Statistical Manual of Mental Disorders ( DSM)-oriented scales of the Child Behavior Checklist (CBCL), can assess whether its use may be advantageous.
Material and Methods
Parents/caregivers of 462 children and adolescents responded to both CABI and CBCL as a preliminary routine investigation. The results were compared with those of diagnoses obtained after the completion of the usual clinical procedure.
Results
Accuracy values (probability of correct classification) resulted high for both instruments and significantly better for CABI anxiety and attention-deficit hyperactivity disorder (ADHD) scales, and for CBCL oppositional defiant disorder (ODD) and conduct disorder (CD) scales; no significant difference was found for depression scales. All the areas under the curve (AUC) of the receiver operating characteristic analysis reached excellent values, suggesting a very good predictive ability of the five scales of the two instruments. The comparison of AUC showed the CABI’s anxiety and ADHD scales to give significantly higher values than those of CBCL, indicating that these two scales have a better predictive ability.
Conclusion
The study indicates a very good comparative (vs CBCL) and predictive validity of the CABI, suggesting an advantage in the use of this shorter questionnaire, available for free use both for clinical practice and supposedly for screening and epidemiological evaluations.
... The theoretical frameworks underpinning the SDQ and BACs questionnaires are different. The SDQ is underpinned by a developmental theoretical framework (Goodman, 1997) while the BACs was developed with attachment and trauma theories in mind (Tarren-Sweeney, 2013a). From the participants' perspective, neither questionnaire was able to provide the necessary and sufficient profile of the young person to be able to develop an effective care plan. ...
Looked after children often experience greater mental health challenges than children in the general population. Consequently, there has been a call for greater focus on early preventive interventions and priority access to specialist mental health support for them. Brief mental health screening tools often provide the gateway to services and yet there is a lack of suitable assessment tools available for looked after children. The current study is the first to explore the perspectives of foster carers and clinicians working in Child and Adolescent Mental Health Services (CAMHS) in relation to the use of two brief screening tools: the Strengths and Difficulties Questionnaire (SDQ) and the Brief Assessment Checklists (BACs). Qualitative data were collected via semi-structured telephone interviews and face-to-face focus groups with 13 female foster carers and 19 clinicians working in a CAMHS setting. Thematic analyses generated six themes which were organised into three superordinate ones centred around: (1) relevance to looked after children; (2) using measures to inform care planning; and (3) current problems when using psychometric measures within the looked after children population. Foster carers and clinicians emphasised the need for a comprehensive understanding of these children given the complexity of their difficulties. There was acknowledgement that psychometric measures could facilitate and contribute to this by highlighting difficulties, providing accurate feedback to carers and clinicians, and enabling access to support. However, both groups seldom felt that current measures were nuanced enough to adequately capture the children’s needs. Yet screening tools play a crucial role in identifying the mental health needs of looked after children and facilitating access to services. Further research is needed to establish the ability of such measures to increase the sensitivity of their complex needs assessment. A number of clinical recommendations are also discussed in relation to the assessment of mental health in this population.
... While screening disagreement is partly a consequence of measurement error, the SDQ and BAC may each be more accurate (than the other) at detecting particular types of psychopathology. In the Australian study, the BAC was slightly more accurate at identifying children who have clinically significant attachment-and trauma-related difficulties, as measured by the ACC and ACA total scores, while the SDQ proxy was slightly more accurate at identifying more common internalizing, externalizing, and attentional difficulties, as encapsulated within the CBCL total problems score (Tarren-Sweeney, 2013a). This suggests that overall screening accuracy might be improved by employing both screening measures within a single screening procedure. ...
Although children residing in statutory out-of-home care and those adopted from care are more likely than not to have mental health difficulties requiring clinical intervention or support, their difficulties often remain undetected. Children's agencies have a duty of care to identify those child clients who require therapeutic and other support services, without regard to the availability of such services. The present article proposes a first-stage mental health screening procedure (calibrated for high sensitivity) for children and adolescents (ages 4-17) in alternative care, which children's agencies can implement without clinical oversight using the Strengths and Difficulties Questionnaire (SDQ) and Brief Assessment Checklists (BAC). The screening procedure was derived from analyses of BAC, SDQ, and "proxy SDQ" scores obtained in three national studies of children and adolescents residing in alternative care (Australia, the Netherlands, and England). The SDQ and BAC demonstrated moderate to high screening accuracy across a range of clinical case criteria-the SDQ being slightly better at predicting general mental health problems and the BAC
... In contrast, adopted and non-adopted children scored similarly on the internalising symptoms scale (5.13 AE 2.85 vs 4.74 AE 3.57 respectively); 6 this was unexpected because previous research has indicated higher levels of emotional problems in adopted children (Sanchez-Sandoval and Palacios, 2012). While the SDQ is validated for use with both community and clinical samples (Goodman, et al., 2000), it does not specifically address behaviours that are apparent in children who have experienced early trauma and severe adversity, including attachment-related difficulties, anxiety and dissociative responses to trauma, ageinappropriate sexual behaviour and self-harm (Tarren-Sweeney, 2013) and this may partly explain this disparity. Similar scores between the two groups (adopted 14.23 AE 3.89; nonadopted 13.16 AE 4.83) 7 on the General well-being scale (coupled with equivalent internalising symptom scores) might suggest that the challenges for adopted children in school may be primarily of an externalising nature, at least for this age group. ...
Much is hypothesized but little is known about the effects of early adversity on school experience, academic attainment and career aspiration for children and young people adopted from care. Drawing on data from Wave 1 of the Youth (10-15 years old) Questionnaire (n=4899) from the United Kingdom Household Longitudinal Survey (UKHLS), also known as Understanding Society (US), this study explored differences between young people adopted (n=22) and a matched comparison group (n=110) on measures of educational and occupational aspirations and also psychological well-being. Adopted young people reported higher externalising and total difficulties scores (based on the SDQ, Goodman, 1997) than the general population comparison group, but equivalent internalising symptoms. Adopted children were more likely to show an intention to seek full-time work at the end of compulsory schooling. These findings align with previous research regarding the psychological well-being of adopted children, contribute new knowledge about the aspirations of young people adopted from care and highlight methodological issues when utilising large scale panel survey data for narrowly defined subgroups .
... Adopted and non-adopted children scored similarly on the internalising symptoms scale (5.13 ± 2.85 vs 4.74 ± 3.57 respectively) 5 , this was unexpected because previous research has indicated higher levels of emotional problems in adopted children (Sanchez-Sandoval and Palacios, 2012). Whilst the SDQ is validated for use with both community and clinical samples (Goodman et al., 2000), it does not specifically address behaviours that are apparent in children that have experienced early trauma and severe adversity, including attachment-related difficulties, anxiety and dissociative responses to trauma, age-inappropriate sexual behaviour and self-harm (Tarren-Sweeney, 2013) and may partly explain this disparity. Similar scores between the two groups (adopted 14.23 ± 3.89; non-adopted 13.16 ± 4.83 6 ) on the General Well-being Scale (coupled with equivalent internalising symptom scores) might suggest that the challenges for adopted children in school may be primarily of an externalising nature, at least for this age group, but internalising symptoms and externalising behaviour often co-occur (Sanchez-Sandoval and Palacios, 2012) and further investigation utilising purposeful research design is called for. ...
Much is hypothesized but little is known about the effects of early adversity on school experience, academic attainment and career aspiration for children and young people adopted from care. Drawing on data from Wave 1 of the Youth (10-15 years old) Questionnaire (n=4899) from the United Kingdom Household Longitudinal Survey (UKHLS), also known as Understanding Society (US), this study explored differences between young people adopted (n=22) and a matched comparison group (n=110) on measures of educational and occupational aspirations and also psychological well-being. Adopted young people reported higher externalising and total difficulties scores (based on the SDQ, Goodman, 1997) than the general population comparison group, but equivalent internalising symptoms. Adopted children were more likely to show an intention to seek full-time work at the end of compulsory schooling. These findings align with previous research regarding the psychological well-being of adopted children, contribute new knowledge about the aspirations of young people adopted from care and highlight methodological issues when utilising large scale panel survey data for narrowly defined subgroups .
... It turns out that there are only a few specialised measures that focus on psychosocial difficulties specifically manifested by children in foster care (Levitt, 2009). Among these instruments is the Brief Assessment Checklist (BAC) (Tarren-Sweeney, 2013) for which we studied the psycho- metric properties in a Dutch sample of foster children (Goe- mans, Tarren-Sweeney, Van Geel, & Vedder, 2017). Our study showed that both the child and adolescent versions of the BAC measures perform both screening and monitor- ing functions well. ...
This article focuses on the variability in developmental outcomes of foster children and the implications for foster care research and practice. We first provide a brief overview of our previous work, where we have shown by means of meta-analysis and a longitudinal study that foster children greatly vary with respect to their developmental functioning. We then discuss that it is both the heterogeneity of developmental trajectories and the lack of an accurate model for predicting foster children's development that make the screening and monitoring of foster children's development important. We provide suggestions for screening and monitoring, and discuss the Brief Assessment Checklist as an example of a specific instrument available for screening and monitoring of vulnerable children exposed to severe social adversity. We conclude our article with directions to improve foster care and research on foster care, including a discussion of the effectiveness of and foster children's susceptibility to interventions, support for foster parents and the potential of large national and international studies.
... Intrinsically tied with budgetary constraints are administrative requirements that can impede the ability to properly conduct assessments, interpret findings, and advocate for treatment (Taylor & Siegfried, 2005). Further, CPS agencies may have limited access to psychologists and other trained mental health clinicians to support the assessment process, leading to a lack of knowledge regarding suitable measures for traumatized children and youth that adequately screen or assess for a range of trauma-related mental health difficulties (Tarren-Sweeney, 2013). ...
... Very few studies have been conducted to examine the psychometric properties of emotional behavioral measures with youth in out of home care. The convergent validity of the Behavioral and Emotional Rating Scale-2 (BERS-2; Epstein, 2004), was examined with youth in residential care (Duppong Hurley, Lambert, Epstein, & Stevens, 2013;) the Brief Assessment Checklist was explored with youth in foster and kinship care (Tarren-Sweeny, 2013), and the diagnostic capabilities of the Strengths and Difficulties Questionnaire was examined with out-of-home populations (Goodman et al., 2004;Goodman & Goodman, 2012;Mason et al., 2012). As a whole, this area of examining the psychometric properties of existing emotional and behavioral assessments with high-needs sub-populations is critical to understand which measures can be successfully utilized in different settings. ...
Youth in residential care have significant mental health needs which require regular progress monitoring; however, very few emotional or behavioral assessments have been examined with this unique, high-risk population. This study examined the psychometrics of the Symptom Functioning and Severity Scale, a brief 24-item measure designed to assess the emotional and behavioral status of youth. This study examined the SFSS ratings from 143 youth with a disruptive behavior diagnosis living in a group-home facility in the Midwest and 52 of their service providers. Overall, the findings suggest that the psychometrics of the SFSS, when rated by staff or youth were similar to the original outpatient clinical samples. More specifically, the Rasch analyses indicate that the SFSS items and the overall scale is performing adequately, and the confirmatory factor analyses replicated the two-factor structure for staff. However, the fit of the two-factor model was less compelling for youth ratings. In all, the brief SFSS seems a promising measure for assessing problem severity for youth in residential care.
... Furthermore; one cannot rule out the possibility that false positives in this high risk group are children with substantial mental health problems, just below the requirements of diagnostic criteria. For example, in a newly reported study on mental health screening in a foster-care sample from New Zealand (N = 577), Tarren-Sweeny [36] found that a majority of false-positive children had at least one mental health score in clinical range as measured with Child Behaviour Checklist [37]. Post-hoc analyses of our data support this finding. ...
Background
High prevalence of mental disorders among foster children highlight the need to examine the mental health of children placed out of home. We examined the properties of the Strengths and Difficulties Questionnaire (SDQ) in screening school-aged foster children for mental disorders.Methods
Foster parents and teachers of 279 foster children completed the SDQ and the diagnostic interview Developmental and Well-Being Assessment (DAWBA). Using the diagnoses derived from the DAWBA as the standard, we examined the performance of the SDQ scales as dimensional measures of mental health problems using receiver operating characteristic (ROC) analyses. Recommended cut-off scores were derived from ROC coordinates. The SDQ predictive algorithms were also examined.ResultsROC analyses supported the screening properties of the SDQ Total difficulties and Impact scores (AUC = 0.80-0.83). Logistic regression analyses showed that the prevalence of mental disorders increased linearly with higher SDQ Total difficulties scores (X2 = 121.47, df = 13, p
Considering the importance of mapping family interventions practices aimed specifically to adoption, this study sought to identify through a systematic review, how family intervention models for adoptive families are structured in initial adaptation with children from 0 to 6 years old. Four databases were consulted, which led to 9.143 results: Google Scholar (n=8.056), Science Direct (n=814), SciELO (n=43) and PsycINFO (n=230). Seven articles considered pertinent to the proposal of this study were included. As a result, it was identified that most part of the interventions were not systematically described. Although promising results were indicated, replication would not be viable due to the lack of detailing of the performed practices. There was no hegemony in the choice of intervention models. Also, it was indicated that the specificity for adoption in the interventions analyzed is not clear.
Mentalization refers to the capacity to understand and interpret one’s own and others mental states. There is good evidence for individualised treatments aimed at increasing this capacity with children and adolescents. However, there has been no focused synthesis of the literature concerning specifically group delivered mentalization-based parenting interventions. The current study aimed to systematically review the literature in relation to group delivered mentalization-based parenting interventions. Three databases were searched to identify N=515 studies that were screened and reported according to PRISMA guidelines. Inclusion criteria were met by N=10 studies. Interventions varied in terms of content, but often included psychoeducation, experiential group exercises and homework tasks. The length and setting of interventions did not appear to influence outcomes. Significant improvements in parental reflective functioning were found in eight of the ten studies. There was mixed evidence for the efficacy in terms of other parental and child outcomes. This may be due to the lack of high quality studies and the absence of longer-term follow-ups. There is a need for future research to conduct high quality studies with greater diversity in participating parents and long-term follow-up.
This article reports on a pilot study of a parent-only cognitive behavioural therapy (CBT) programme for parents of children with autism spectrum disorders (ASD) and anxiety difficulties. Twenty-one parents of anxious children with ASD (5–11 of age) completed the From Timid to Tiger intervention. Parent outcome measures were assessed at post-intervention and at 3-month follow-up. Analysis indicated significant reductions in both parent and clinician reports of child anxiety symptoms. Specifically, 38% of children were free of their primary diagnosis at treatment end and this increased to 57% when measured at 3-month follow-up. Positive gains were evidenced regarding parents’ ability to manage their child's anxiety without accommodating to it. The results provide preliminary evidence of parent-only CBT programs for children with ASD
Literature review and exploration of stakeholder views regarding the need for Allied Health Professional support and intervention for Looked After Children.
Childhood trauma is associated with a wide array of neurodevelopmental, physiological, psychosocial, and emotional challenges beyond those captured by posttraumatic stress disorder (PTSD)—especially in instances of multiple and/or repeated traumas and traumas that occur in the context of a caregiving relationship. As a result, children who have experienced complex developmental trauma often receive multiple diagnoses concurrently and across their lifespan. Indeed, childhood trauma has been identified as a central transdiagnostic risk factor in the etiology of numerous mental disorders and in research examining the existence of a general psychopathology factor (p-factor) (Caspi et al., 2014). However, recent criticisms of p-factor modelling have questioned the interpretation and cross-study comparability of work in this area, calling for a more theory-driven approach to defining the general factor. Emotion dysregulation has been identified as a potential mediator in the relationship between childhood trauma and the transdiagnostic risk of psychopathology, and some researchers interpret the general factor as emotion dysregulation. However, researchers have yet to test emotion dysregulation as a reference domain for the p-factor or the structure of psychopathology within a Developmental Trauma Disorder (DTD) framework. This study attempted to address these gaps in a sample of (N = 555) children involved in the Ontario child welfare system who have experienced maltreatment. In the first part of the study, I assessed the degree to which the Assessment Checklist for Children (ACC) captures the proposed DTD diagnostic criteria. In the second part, I tested the factorial structure of DTD symptoms using Confirmatory Factor Analysis, including a single factor, correlated factors, second-order, fully symmetrical bifactor, and bifactor(s-1) model with emotion dysregulation as the general factor reference domain. The results identify gaps in the ACC when applied to the DTD framework. Further, the results suggest that the bifactor(s-1) model fits the data best and provides the most interpretable results with meaningful clinical practice and research implications.
Parent management training has demonstrated effectiveness in the treatment of child behavioural issues and associated conduct difficulties. Anger, aggression, and irritability are common symptoms amongst children presenting with disruptive mood dysregulation disorder. Currently, there are no well-established evidence-based interventions for children presenting with symptoms of disruptive mood dysregulation disorder. This pilot study aims to assess if a standard, well-established, parent management training program (group Triple P) may be effective in addressing disruptive mood dysregulation disorder symptoms. Thirteen parents of children who presented with disruptive mood dysregulation disorder or subthreshold symptoms completed the Triple P behavioural management program (Level 4). Post-treatment, parents reported no significant change on childhood irritability. However, parents noted significant improvement on child overt aggression, behavioural difficulties and an increase in child pro-social behaviours. Despite the many limitations inherent in this pilot study, results suggest that standard parent management training may be useful in addressing overt aggression but not irritability.
The purpose of this study is to test the validity of the Assessment Checklist measures in assessing complex mental health and behavioural difficulties of children and young people in care attending a specialist mental health service in Queensland, Australia. Fifty-eight consumers (53% male) with an average age of 8 years were assessed by carers on the Assessment Checklist for Children—Short Form and Strengths and Difficulties Questionnaire, and 44 consumers (36% male) with an average age of 13 years were assessed by carers on the Assessment Checklist for Adolescents—Short Form and Strengths and Difficulties Questionnaire. Results showed that the Assessment Checklist for Children—Short Form total score correlated with the Strengths and Difficulties Questionnaire total score. There were some correlations between subscales on both the measures. The Assessment Checklist for Adolescents—Short Form and Strengths and Difficulties Questionnaire correlated on very few domains. Domains of the Assessment Checklist measures that assess emotional dysregulation, trauma, interpersonal/attachment styles, sexual behaviour and food maintenance appear to provide additional clinical information about consumers that the standard Child and Youth Mental Health Service carer-report measure (Strengths and Difficulties Questionnaire) does not. It is recommended that the Assessment Checklist measures be used as an additional measure to assess the complexity of the children and young people in care who attend specialist mental health services.
Foster children often had negative experiences in the past, which can contribute to attachment problems. In their meta-analysis, van den Dries et al. found that foster children were more often disorganized attached when compared to the general population. It is to be expected that the quality of attachment between the foster children and their foster parents is related to various factors. However, research into which factors are associated with the development of secure attachment is scarce. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, a total of 13 articles were included in this review. This review provides an overview of the associated characteristics with the quality of attachment between foster carers and foster children. In the articles included in this review, the foster carers’ characteristics were often described as more important than characteristics of the foster child and placement when it comes to developing a secure attachment. The most consensus, although not unanimous, existed on the finding that a positive, sensitive parenting style of foster parents was positively related to a secure attachment between the foster children and their foster carers.
Working to improve the welfare of children in care is a priority shared by all French child protection services. However, the means to measure and improve well‐being are limited (Fergeus et al., 2019). Although the trend today is towards a more comprehensive understanding of the point of view of adults involved in the socioeducational process, too little is done to include the children's own perception of their situation and conditions of care. The purposes of this study are to document and analyse the point of view of children in foster families on their subjective well‐being and also to identify contextual factors that influence it. Ninety‐one children living in foster care, aged 13.5 years on average, completed the French version of the Multidimensional Students' Life Satisfaction Scale developped by Huebner, Zullig Runa in 2012. The multidimensional evaluation of well‐being (family, school, self, friends, and living conditions) reveals a moderate life satisfaction within the foster family and a weak one at school. Total life satisfaction levels are directly linked to the number of care orders the child has experienced, their duration, and the type of education received. The implications of these results for professional practices related to children in care will be discussed.
Evidence-based assessment (EBA) is foundational to high-quality mental health care for youth and is a critical component of evidence-based practice delivery, yet is underused in the community. Administration time and measure cost are barriers to use; thus, identifying and disseminating brief, free, and accessible measures are critical. This Evidence Base Update evaluates the empirical literature for brief, free, and accessible measures with psychometric support to inform research and practice with youth. A systematic review using PubMed and PsycINFO identified measures in the following domains: overall mental health, anxiety, depression, disruptive behavior, traumatic stress, disordered eating, suicidality, bipolar/mania, psychosis, and substance use. To be eligible for inclusion, measures needed to be brief (50 items or less), free, accessible, and have psychometric support for their use with youth. Eligible measures were evaluated using adapted criteria established by De Los Reyes and Langer (2018) and were classified as having excellent, good, or adequate psychometric properties. A total of 672 measures were identified; 95 (14%) met inclusion criteria. Of those, 21 (22%) were "excellent," 34 (36%) were "good," and 40 (42%) were "adequate." Few measures had support for their use to routinely monitor progress in therapy. Few measures with excellent psychometric support were identified for disordered eating, suicidality, psychosis, and substance use. Future research should evaluate existing measures for use with routine progress monitoring and ease of implementation in community settings. Measure development is needed for disordered eating, suicidality, psychosis, and substance use to increase availability of brief, free, accessible, and validated measures.
The number of children in need of out-of-home care (OOHC) continues to increase in Australia, and numbers of kin carers (relatives of the cared-for) match or exceed those of foster carers. Like foster carers, kin carers have a vital role in OOHC, yet kin carers typically receive less training and fewer support services. The carer role is complex and demanding, and the wellbeing of foster and kin carers is vital to the ongoing provision of OOHC to children who cannot live with their parents. The current research explores the perceived wellbeing of foster and kin carers, with attention to the different experiences of the two groups. A cohort of 210 foster and 116 kin carers completed an online survey that assessed stress, role satisfaction, mental health, perceptions of the child in their care, and access to services that support their role. While overall wellbeing was similar for the two groups, kin carers reported greater stress and mental health concerns than foster carers. The two groups also differed on demographic variables, including the age of the carers, training for the caring role and the length of time they have been in the caregiving role. Furthermore, kin carers reported accessing fewer services, training, and support; and had significantly less contact with service providers as compared to foster carers. In response to the increased number of children placed with kin, government and private service providers need to consider their foster and kin care policies and service delivery practices to include training, support, and access to services for all carers, with specific attention to improving carer wellbeing and satisfaction.
This systematic review analyzes findings from all identified studies measuring traumatic stress in child welfare specific samples in order to explore how the existing literature informs trauma screening and assessment practices in child welfare systems. Most prior research involving measures of traumatic stress in children has been conducted with clinical samples that are not child welfare specific or entirely limited to this population. The aims of this review are to describe the child welfare samples screened for traumatic stress, their reported traumatic stress outcomes, other important variables investigated that could assist with the identification of high risk sub-groups, and to review trauma related implications for child serving systems. Searches of all relevant databases identified 14 studies for the analysis. Implications are provided regarding the mental health and trauma recovery needs of maltreated children, high risk sub-groups within this population, systemic challenges and considerations regarding how the child welfare system might collect and utilize trauma information to enhance decision making.
This article draws on an evaluation of the effectiveness of the Nurturing Attachments group work program provided by AdoptionPlus for adoptive families in England. Twenty-nine adoptive families participated in a longitudinal quantitative study, completing questionnaires and validated measures before and after group attendance. The Nurturing Attachments program, informed by Dyadic Developmental Psychotherapy, was developed to help foster and adoptive parents strengthen their relationships with the child and support children who had experienced developmental traumas. Most parents were caring for children who were late placed and who had complex and overlapping difficulties. Post-training, parents reported increased confidence in their own parenting and statistically significant positive changes in self-efficacy and in their capacity for reflective functioning. However, unexpectedly, adoptive parents identified more children as having greater emotional and peer difficulties and fewer with symptoms of conduct disorders. This article focuses on the relationship between perceptions of adopted children’s behavior and parental reflective functioning (PRF) and self-efficacy. It explores whether improved reflective functioning, particularly curiosity, led to a better understanding of their child’s behaviors and thus an increased recognition of emotional distress. Recommendations for supporting adoptive parents, including the importance of supporting PRF, within a wraparound package of support during childhood and adolescence are made.
This study presents the feasibility and pilot evaluation of the Reflective Fostering Programme (RFP), a recently developed, group-based program to support foster carers, based on the concept of “reflective parenting.” This innovative development follows calls by the National Institute for Health and Clinical Excellence and other organizations to help improve outcomes for children in care by providing better support to their carers. This study aimed to establish whether it is possible to implement the RFP and to gather preliminary data on the acceptability and effectiveness of the program. Twenty-eight foster carers took part in the study. Results indicate that training and delivery of the RFP were feasible; the program was felt to be relevant and meaningful to both foster carers and social care professionals delivering it. Preliminary pre-post evaluation showed a statistically significant improvement in foster carers’ stress, their achievement of self-defined goals and child’s emotion lability and overall strengths and difficulties. There were no statistically significant changes in carers’ reflective functioning, although some foster carers reported on changes in reflective capacity during focus groups. Preliminary findings about the feasibility of training and delivery of the RFP, as well as the acceptability and effectiveness of the program, are encouraging, but further impact evaluation is needed.
Background
Routine screening to identify mental health problems in English looked-after children has been conducted since 2009 using the Strengths and Difficulties Questionnaire (SDQ).
Aims
To investigate the degree to which data collection achieves screening aims (identifying scale of problem, having an impact on mental health) and the potential analytic value of the data set.
Method
Department for Education data (2009–2017) were used to examine: aggregate, population-level trends in SDQ scores in 4/5- to 16/17-year-olds; representativeness of the SDQ sample; attrition in this sample.
Results
Mean SDQ scores (around 50% ‘abnormal’ or ‘borderline’) were stable over 9 years. Levels of missing data were high (25–30%), as was attrition (28% retained for 4 years). Cross-sectional SDQ samples were not representative and longitudinal samples were biased.
Conclusions
Mental health screening appears justified and the data set has research potential, but the English screening programme falls short because of missing data and inadequate referral routes for those with difficulties.
Declaration of interest
None.
Adopted children and adolescents are at an increased risk of experiencing emotional, behavioural and relational difficulties compared to their non-adopted peers. This systematic review aimed to establish the effectiveness of interventions with adoptive parents on adopted children and adolescents' psychological well-being, behavioural functioning and parent-child relationship. A systematic search was performed adhering to PRISMA, including studies that assessed the effects of interventions with adoptive parents on adopted child and adolescent outcomes. Electronic databases, key journals, grey literature sources, reference and citation lists were searched and published authors in the field were contacted. Nineteen papers describing 15 interventions were included. The findings from this review provide preliminary support for the use of interventions with adoptive parents for improving adopted children's emotional and behavioural outcomes. However, overall, the studies were found to have a high risk of bias and the significant heterogeneity across the studies limits the conclusions that can be drawn. Further research is required to provide conclusive recommendations regarding the effectiveness of interventions with adoptive parents on the outcomes of adopted children.
“For me context is the key – from that comes the understanding of everything.” Kenneth Noland, American painter, April 10, 1924–January 5, 2010
Children placed for adoption often face unique challenges and are at higher risk of mental health problems compared to the general population. Yet despite some important clinical developments, there is still a lack of evidence related to effective therapeutic interventions for this population. This study reports on the preliminary evaluation of a mentalization-based family therapy service, Adopting Minds, offered as part of a post-adoption support service. Thirty-six families who had adopted 42 children were referred to the service between September 2015 and December 2016. Demographic information was collected and assessments undertaken on the families at baseline and at the end of therapy, using a range of validated measures. Five families who had completed therapy were also interviewed about their experience of the approach. For those families on which data were available, positive outcomes in mental health and parental self-efficacy were identified, and adoptive parents reported high levels of satisfaction with the mentalization-based family therapy service. Analysis of the interviews revealed that the families found it a containing space that was supportive and non-judgemental. They felt able to express their fears and worries to a therapist who was friendly and knowledgeable and reported that the service helped them to deal with and link struggles they were facing to their own as well as their child's past experiences. However, some adoptive families felt that this short-term, six-session service alone was not enough to address all the difficulties that had brought the family to seek help, and would have preferred a longer-term intervention or therapy in combination with other types of support.
Background
A significant proportion of children in the social care system in England present with mental health problems, with the majority experiencing some form of emotional and behavioural difficulties. The most effective treatments for these children are currently unknown, partly due to a lack of robust, controlled studies. Researchers have identified a number of obstacles to conducting well-designed research with this population, making the need to test the feasibility of a randomised controlled trial especially important.
Methods/design
This protocol outlines a two-arm, randomised control feasibility trial to explore the acceptability and credibility of mentalization-based treatment (MBT) as a treatment for reducing emotional and behavioural difficulties in looked after children and to test the possibility of addressing a number of methodological challenges to conducting high-quality research with this population. MBT is a relatively new intervention which, in the adaptation of the model tested here, includes many of the features of therapy identified in NICE guidelines as necessary to support children in care. The two arms are MBT and usual clinical care (UCC). The study will take place in Hertfordshire Partnership University NHS Foundation Trust with follow-up at 12 and 24 weeks.
Discussion
This study will aim to ascertain whether it is worthwhile and feasible to progress to testing the intervention in a full-scale definitive randomised controlled trial (RCT). This study therefore has the potential to improve our understanding of the obstacles to conducting high-quality research with this very vulnerable population, and in the medium term, could help to improve the stability of foster placements and the emotional well-being of children in care.
Trial registration
ISRCTN90349442
Library Fellowship Paper presented to the Parliament of Victoria March 2016
Background:
The assessment of children and young people with history of complex developmental trauma presents a significant challenge to services. Traditional diagnostic categories such as post-traumatic stress disorder (PTSD) are argued to be of limited value, and while the proposed 'Developmental Trauma Disorder' definition attempts to address this debate, associated assessment tools have yet to be developed. This review builds on a previous review of assessment measures, undertaken in 2005.
Aim:
To identify trauma assessment tools developed or evaluated since 2004 and determine which are developmentally appropriate for children or adolescents with histories of complex trauma.
Method:
A systematic search of electronic databases was conducted with explicit inclusion and exclusion criteria.
Results:
A total of 35 papers were identified evaluating 29 measures assessing general functioning and mental health (N = 10), PTSD (N = 7) and trauma symptomatology outside, or in addition to, PTSD (N = 11). Studies were evaluated on sample quality, trauma/adversity type, as well as demographic and psychometric data. Distinction was made between measures validated for children (0-12 years) and adolescents (12-18 years).
Conclusion:
Few instruments could be recommended for immediate use as many required further validation. The Assessment Checklist questionnaires, designed with a developmental and attachment focus, were the most promising tools.
Background: The Brief Problem Monitor (BPM) is a short version of the Child Behavior Checklist (CBCL) and its derived questionnaires and has already been psychometrically tested and approved in its English original version. The German translation likewise comprises three subscales (Internalizing-INT, Attention Problems-ATT, and Externalizing-EXT) and is available for multiple informants (parent, teacher, and youth report). Method: The psychometric characteristics (reliability and validity) of the German translation were examined by means of clinical as well as population-based samples of children aged 6–18 years. Results: The results indicate good reliability and, with some constraints, good validity. Conclusion: The German translation of the BPM can be judged as a reliable and valid instrument.
Foster-care programs are beginning to use standardized assessment methods consistently as part of pro gram and case planning, as well as for documenting the clinical status of children in care. A number o studies have now been published that describe the psychosocial functioning of children in foster care using the Child Behavior Checklist (CBCL). This article reports findings on intake CBCL scores for a group of children 4 to 18 years old served in long-term family foster care by The Casey Family Program an agency serving children in 13 states.These CBCL scores are compared with scores reported for other samples of children in family foster care and residential treatment. Overall rates of serious behavior prob lems for children in care are estimated from the available data.The implications of the findings for clinical and program planning and future research using the CBCL are discussed.
The aim of this review is to map the literature on the adoption of children from public care, to identify the extent of research-based knowledge and to note gaps in the evidence. Adoption research has grown over the last 40 years but, as the methodological quality has increased, so has the complexity of the questions to be answered. This review covers research on the problem profiles of placed children and the challenges to new parents, matching and preparation, contact arrangements, medium and long-term outcomes and interventions with adoptions in difficulty. The article recommends that adoption research needs to be considered as an integral part of general research into placement choices for children. Looking to the future, the commissioning of large-scale studies is recommended to gain a life-long perspective on adoption, to identify predictors of outcome, the consequences of contact arrangements for all the parties, and the cost-effectiveness of different types of adoption support. Many smaller scale studies need to be commissioned to monitor the progress of the various policy initiatives and legislative changes designed to increase the use of adoption as a placement choice in the UK.
Children in out-of-home care (OOHC) present with high levels of physical, developmental and emotional and behavioural difficulties, yet often fail to receive appropriate services. This article describes a joint health and welfare service specifically developed to provide comprehensive physical, developmental and mental health assessments to a cohort of children entering long-term care in one region of Sydney, New South Wales (NSW), Australia. Paediatric, allied health, dental and psychosocial assessments were co-ordinated from a single referral from the child's welfare case manager. Follow-up appointments were held 6-12 months later to assess the outcomes of recommendations. Physical, mental health and developmental difficulties in the children are reported, the implications for service requirements are presented and process blocks described. There is a need for a specific co-ordinating service to overcome the inherent fragmentation of this group (related both to transience and change in the welfare sector, and levels of comorbidity and chronicity in health presentations). Health and Welfare services must operate together, with an awareness of the processes and resource constraints in each sector, if they are to deliver sustainable and reliable health care to this vulnerable group.
Since its development, the Strengths and Difficulties Questionnaire (SDQ) has been widely used in both research and practice. The SDQ screens for positive and negative psychological attributes. This review aims to provide an overview of the psychometric properties of the SDQ for 4- to 12-year-olds. Results from 48 studies (N = 131,223) on reliability and validity of the parent and teacher SDQ are summarized quantitatively and descriptively. Internal consistency, test-retest reliability, and inter-rater agreement are satisfactory for the parent and teacher versions. At subscale level, the reliability of the teacher version seemed stronger compared to that of the parent version. Concerning validity, 15 out of 18 studies confirmed the five-factor structure. Correlations with other measures of psychopathology as well as the screening ability of the SDQ are sufficient. This review shows that the psychometric properties of the SDQ are strong, particularly for the teacher version. For practice, this implies that the use of the SDQ as a screening instrument should be continued. Longitudinal research studies should investigate predictive validity. For both practice and research, we emphasize the use of a multi-informant approach.
The Best Practices for Mental Health in Child Welfare Consensus Conference focused on developing guidelines in five key areas (screening and assessment, psychosocial interventions, psychopharmacologic treatment, parent engagement, and youth empowerment) related to children's mental health. This paper provides an overview of issues related to the first three areas, presents the guidelines developed in these areas, and discusses the implications these guidelines have for the field of child welfare.
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.
Knowledge of the emotional and behavioural problems of children in kinship foster care is scarce. No data on such problems in European countries have been published. This study compares child psychiatric problems and placement characteristics of children living in kinship and nonkinship foster care.
A total of 214 children in kinship and nonkinship foster care, aged 4-13, participated in the study. The Child Behavioral Checklist (CBCL) was completed by their foster parents and demography and placement information was collected.
Of the nonkinship group, 51.8 % scored above the borderline on the CBCL Total Problem score, as did 35.8% of the kinship group. The kinship group had fewer previous placements, were more often fostered within their local community and had more contact with their biological parents. Kinship foster parents had lower social status, in terms of educational level. Variables significantly related to high level of the CBCL Total problems score were male gender and location of foster home outside community of birth family. Positive outcome was significantly associated with placement within the child's own community, which in turn was related to kinship placement.
Placement in kinship foster care should be considered as a viable possibility.
Validated questionnaires can support the identification of psychosocial problems by the Preventive Child Health Care (PCH) system. This study assesses the validity and added value of four scoring methods used with the Strengths and Difficulties Questionnaire (SDQ) for the identification of psychosocial problems among children aged 7-12 by the PCH.
We included 711 (of 814) children (response: 87%) aged 7-12 undergoing routine health assessments in nine PCH services across the Netherlands. Child health professionals interviewed and examined children and parents. Prior to the interview, parents completed the SDQ and the Child Behaviour Checklist (CBCL), which were not shown to the professionals. The CBCL and data about the child's current treatment status were used as criteria for the validity of the SDQ. We used four SDQ scoring approaches: an elevated SDQ Total Difficulties Score (TDS), parent-defined difficulties, an elevated score for emotional symptoms, conduct problems or hyperactivity in combination with a high impairment score, and a combined score: an elevated score for any of these three methods.
The Cohen's Kappa ranged from 0.33 to 0.64 for the four scoring methods with the CBCL scores and treatment status, generally indicating a moderate to good agreement. All four methods added significantly to the identification of problems by the PCH. Classification based on the TDS yielded results similar to more complicated methods.
The SDQ is a valid tool for the identification of psychosocial problems by PCH. As a first step, the use of a simple classification based on the SDQ TDS is recommended.
This study examined the criterion-related validity of score inferences from the Behavioral and Emotional Screening System Parent Form (BESS Parent) for the detection of symptoms of prevalent mental health disorders of childhood. The BESS Parent was administered to 99 parents of first- through fifth-grade students, along with the Child Behavior Checklist (CBCL). Correlations were computed between the BESS Parent total and researcher-calculated subscale scores, and Diagnostic and Statistical Manual (DSM)-oriented scales of the CBCL. Moderate correlations were obtained between the BESS Parent total score and CBCL DSM-oriented conduct problems, oppositional defiant, attention deficit/hyperactivity disorder, and affective problems scales, and with the CBCL externalizing, internalizing, and total problems composite scores. Results support interpreting the BESS Parent as a measure of risk and as an indicator of the potential presence of one of the common mental health disorders of childhood.
The Assessment Checklist for Adolescents — ACA is a 105-item carer-report mental health rating scale, measuring behaviours, emotional states, traits, and manners of relating to others, as manifested by adolescents (ages 12 to 17) residing in various types of alternate care, as well as those adopted from care. The ACA was designed for population and clinical research with these young people, and for use as a clinical assessment measure. The ACA's content was largely derived from the Assessment Checklist for Children (ACC). Fifteen ACC items were modified to better reflect adolescent difficulties, and 25 additional items were derived using a combination of inductive and deductive strategies. Item and factor analyses were carried out on scores from a 136-item research instrument, obtained for 230 young people residing in long-term care (as part of the NSW Children in Care study). These data were supplemented by ACC scores obtained for 142 adolescents residing in treatment foster care in Ontario, Canada. A robust 7-factor model was identified among a core of 73 clinical item scores, accounting for 51% of score variance. Four of the factors replicate ACC clinical scales (non-reciprocal interpersonal behaviour; sexual behaviour problems; food maintenance behaviour; and suicide discourse), and three are unique to the ACA (social instability/behavioural dysregulation; emotional dysregulation/distorted social cognition; and dissociation/trauma symptoms). The ACA also contains two empirically-derived low self-esteem scales (low confidence; negative self-image) that are shared with the ACC. Initial data indicate that the ACA has good content, construct and criterion-related validity, as well as high internal reliability.
This article describes a combined quantitative and qualitative approach to assessing the need for mental health services of looked after children. We interviewed 48 children and young people who were accommodated by one local authority in foster care, children’s homes and residential schools. Fifty-six per cent of our sample were suffering from significant psychological morbidity. Forty-four per cent had a definite, probable or resolving diagnosis of at least one psychiatric disorder with impaired psychosocial functioning. Self-esteem was preserved to a variable extent across different domains. In most cases, problems in psychological development had been identified at a young age and the majority had previously been assessed, and some treated, by the local psychiatric service. Most of the participants had strategies for managing distress, made good use of available support networks and were happy with the level of care they were receiving. We concluded that a majority of children and young people looked after by our local authority suffer from chronic and disabling mental health problems despite early recognition of their difficulties, attempts at solutions and supportive care settings. The need we identified wasnot for improved recognition of mental health problems, but rather for more effective interventions.
The paper reports an investigation into the nature, patterns and complexity of mental health symptomatology reported for a large (N = 347) population sample of children in foster and kinship care. Cluster analyses were performed on caregiver-reported Child Behavior Checklist (CBCL) and Assessment Checklist for Children (ACC) scores. The derived profile types are characterized more by symptom complexity than specificity, and are delineated more by elevation than shape. The analyses indicate that social and interpersonal relationship difficulties are hallmark features of clinical presentations of children in care; that anxiety is more often observed as a component of felt insecurity than as generalized or trauma-specific anxiety; and that attention-deficit hyperactivity is rarely manifested in isolation from other difficulties. Whereas 35 % of children had clinical difficulties that could plausibly be construed as discrete mental disorders or comorbidity, another 20 % displayed complex attachment- and trauma-related symptomatology that is not adequately conceptualized within DSM or ICD classifications.
The Rutter scales for completion by parents (A scale) and teachers (B scale) were developed in a series of studies in the UK as screening and research instruments to detect emotional/behavioral disturbances in children aged 9–13 yrs. In this article, the findings from research conducted since then are considered, reviewing the research results in terms of the psychometric properties of the scales and their suitability for different types of investigation. Reliability and validity are found to be generally positive, especially for the B scales and the conduct disorder subscale. The scales are found to be best suited for screening populations, for large group comparisons, for assessment of change over the long term rather than the short term, and for studies on disturbed behavior rather than narrowly defined disorder. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined mental health and attachment problems in children in foster care. This study also obtained data concerning the validity of the Randolph Attachment Disorder Questionnaire (RADQ). Children were selected according to length of time in placement and age and screened for mental health symptoms using the Child Behavior Checklist and the RADQ. The findings showed that children in foster care have reported symptoms within the range typical of children not involved in foster care. The conclusion is that the RADQ has limited usefulness due to its lack of specificity with implications for treatment of children in foster care.
One-hundred and fifty-six children were randomly evaluated at an inner-city juvenile/family court. These children were removed from their parent's custody subsequent to a finding of severe child maltreatment. From our original sample of 156 children, 62 met strict criteria for Post Traumatic Stress Disorder (PTSD). Fifty-two of these 62 were successfully recruited and participated in the 2 year re-examination. Each PTSD diagnosis was conferred by the Diagnostic Interview for Children and Adolescents (DICA). From our sample of 52 PTSD children re-examined after 2 years, 17 (32.7%) retained the full PTSD diagnosis, while 67.3% did not meet criteria.
Population and clinical surveys of the mental health of children in foster, kinship and residential care have failed to account for a range of problems manifested by such children, largely because measurement has been restricted to standard parent-report checklists. These under-researched problems include attachment-related difficulties, anxiety and dissociative responses to trauma, age-inappropriate sexual behavior and self-harm. The Assessment Checklist for Children (ACC) was developed to measure such problems in a prospective epidemiological study of children in long-term care. The ACC is a 120-item carer-report psychiatric rating instrument, measuring behaviors, emotional states, traits, and manners of relating to others, as manifested by children in care. Content was developed systematically, with a view to measuring all clinically significant problems experienced by children in alternate care that are not adequately measured by standard parent-report checklists. Ten clinical and two low self-esteem scales were empirically derived via factor analysis, and labeled: Sexual behavior; pseudomature interpersonal behavior; non-reciprocal interpersonal behavior; indiscriminate interpersonal behavior; insecure interpersonal behavior; anxious–distrustful; abnormal pain response; food maintenance; self-injury; suicide discourse; negative self-image; and low confidence. Initial data indicate that the instrument has good content, construct and criterion-related validity.
This manuscript reviews information on past use of the CBCL to describe the clinical status of children in state custody and the results of a recent study of a representative statewide sample. The sample included a random sample of children in state custody, including those in foster care, kinship care, group residential facilities, and state institutions. One third (34%) of the children in state custody were reported as having significant behavior problems. The narrow band scales reflecting greatest difficulties included Aggressive, Delinquent, and Withdrawn behavior. The youngest teenage group was significantly more likely to have Internalizing problems in the clinical level, and those living in family homes were more likely to have scores in the non-clinical range than those in foster homes or group placements. There were no effects of gender, race, adjudication status, or length of time in custody. Implications for policy makers, caseworkers, and researchers are discussed.
To review the scale, symptomatology and determinants of mental health problems of children in alternate care, and to consider the need for specialized knowledge and clinical competence for assessment and treatment of these problems.
The scale of mental health problems among children in care is exceptional for a nonclinical population, approaching that of clinic-referred children. Children in residential care have more mental health problems than those in family-type foster care, while those in kinship care have fewer problems. Children manifest complex psychopathology, characterized by attachment difficulties, relationship insecurity, sexual behaviour, trauma-related anxiety, conduct problems, defiance, inattention/hyperactivity, and less common problems such as self-injury and food maintenance behaviours.
Children in care have complex symptomatology that is not well represented in present classification systems. There is a need for research into the characteristics and meaning of these complex presentations, and some re-appraisal of present taxonomies. Clinicians should consider these difficulties in their entirety, rather than as discrete disorders. It is recommended that assessment and intervention are provided by clinical teams that have specialist knowledge of children in care, and that use an ecological approach to assessment.
The current classification system, DSM-IV, inadequately captures the range and type of psychopathology seen in the "in care" population of children. A combination of pre-natal influences, early interpersonal trauma involving the primary caregiving relationship, disturbed and disrupted attachment relationships and other significant losses and adverse environmental effects produce a complex constellation of symptoms and a pervasive impact on development that is difficult to categorize. The challenges facing DSM-V are illustrated, highlighting unresolved topics such as quasi-autism, reactive attachment disorder and complex trauma.
The literature on psychopathology among children in family foster care published in the last 20 years was reviewed to estimate prevalence and types of psychopathology in this population.
A comprehensive computerized database was searched for the period 1974 through 1994, with emphasis on recent literature.
Available evidence suggests that the prevalence of psychopathology among children in family foster care is higher than would be expected from normative data, even when this population is compared with children who have backgrounds of similar deprivation. As for the types of psychopathology in this population, the only apparent trend is the predominance of externalizing disorders, such as disruptive behavior disorders. A combination of social, psychological, and biological factors may render children in family foster care highly vulnerable to psychopathology.
This paper examines psychiatric symptoms and disorders in children in the care of a Children's Aid Society. Youth, caretaker and teacher scores on the Standardized Clinical Information System questionnaire were correlated with demographic and maltreatment data gathered from the files of children from a Children's Aid Society. Mean externalizing and internalizing scores for the study group were significantly elevated above the norm on the youth, caretaker and teacher reports; externalizing more so than internalizing. Forty-one percent to 63% of the children studied scored in the pathological range for one or more disorders. Conduct disorder was the most common disorder (30% to 50%). Within the study sample, temporary wards and children with a history of having been abused had more elevated scores. The authors conclude that children in foster care have significant psychiatric morbidity reflective of the extreme adversity and maltreatment they have experienced.
Considerable debate exists regarding the possible relationship between child abuse and posttraumatic stress disorder (PTSD). In this study, 3 groups of foster care children were compared. The groups included 50 sexually abused, 50 physically abused, and 50 nonabused foster care children. Participants completed the Child Post-Traumatic Stress Reaction Index, the Childhood PTSD Interview, and the Modified Stroop Procedure (MSP), which included sexual abuse and nonsexual abuse stimuli. The MSP has not been previously used in child abuse research. Results indicated that sexually and physically abused children demonstrated PTSD at a high level. The MSP discriminated between the sexually abused children with PTSD and those without PTSD. Responses to the MSP sexual abuse stimuli resulted in significantly longer color-naming times than responses to nonsexual abuse stimuli. Preadolescents demonstrated more severe PTSD than early adolescent children.
Risk and protective factors of psychosocial development in children in different residential care settings need to be further studied internationally, in order to develop working methods for social and health care services. Standardized methods of the CBCL, TRF, and CGAS, were used to evaluate psychosocial functioning of children in children's homes in Finland. Further, data on sociodemographic situations and traumatic events in their lives were assembled. The percentage of behavioural and emotional problems within clinical or borderline range in the different ratings was 55-80%. Combined traumatization, sexual abuse, school difficulties, male sex, older age (> 11 years) and older age at first and on-going placement (> 7 years), as well as difficulties in relationships with parents are likely to be associated with more severe behaviour problems and lower general functioning. The results of this study show that children and adolescents in social service residential settings are a highly vulnerable group and that these children have extensive mental health needs.
To describe the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a brief measure of the prosocial behavior and psychopathology of 3-16-year-olds that can be completed by parents, teachers, or youths.
A nationwide epidemiological sample of 10,438 British 5-15-year-olds obtained SDQs from 96% of parents, 70% of teachers, and 91% of 11-15-year-olds. Blind to the SDQ findings, all subjects were also assigned DSM-IVdiagnoses based on a clinical review of detailed interview measures.
The predicted five-factor structure (emotional, conduct, hyperactivity-inattention, peer, prosocial) was confirmed. Internalizing and externalizing scales were relatively "uncontaminated" by one another. Reliability was generally satisfactory, whether judged by internal consistency (mean Cronbach a: .73), cross-informant correlation (mean: 0.34), or retest stability after 4 to 6 months (mean: 0.62). SDQ scores above the 90th percentile predicted a substantially raised probability of independently diagnosed psychiatric disorders (mean odds ratio: 15.7 for parent scales, 15.2 for teacher scales, 6.2 for youth scales).
The reliability and validity of the SDQ make it a useful brief measure of the adjustment and psychopathology of children and adolescents.
This study assessed continuity of problematic sexualized behaviors (PSB) over a 1-year period. Ninety-seven 10-12-year-olds in either foster boarding homes or a residential treatment center participated at Time 1. Twelve months later, 78 youth were available for a second data collection assessment. At both data collection phases, researchers interviewed foster parents or primary therapists about the youths' sexual behavior. Findings revealed significant continuity in PSB over time, with children who at Time 1 exhibited PSB significantly more likely to exhibit PSB at Time 2. The reverse was also true in that the absence of PSB at Time 1 was associated with the absence of PSB at Time 2. In addition, a subset of specific PSB behaviors was noted to be most stable, although this varied across the groups. Youth with PSB exhibited several patterns of persistence in specific behaviors over time, including continuity, a mix of continuity and change, and complete discontinuity. The persistence of PSB over time was most true for the children living in a residential treatment center, the more disturbed group studied. We conclude that the persistence of PSB is more likely when the child has other problematic behaviors.
To report baseline mental health measures from the Children in Care study, a prospective epidemiological study of children in court-ordered foster and kinship care in New South Wales, Australia.
Mental health, socialization and self-esteem were assessed in 347 children in a statewide mail survey, using two carer-report checklists, the Child Behavior Checklist (CBCL) and the Assessment Checklist for Children (ACC).
Children in the study had exceptionally poor mental health and socialization, both in absolute terms, and relative to normative and in-care samples. Levels and rates of disturbance for children in foster care exceeded all prior estimates. Rates of disturbance for children in kinship care were high, but within the range of prior estimates. Boys presented with higher scope and severity of mental health problems than girls on the CBCL, while gender-specific patterns of disturbance were shown on the ACC. A moderate age effect was accounted for by children's age at entry into care.
Children in care are at high risk of mental health problems. Psychological support for the children and their carers is an essential secondary prevention strategy. Implications for service delivery are discussed.
The paper reports epidemiological and phenomenological investigations of aberrant eating among 347 pre-adolescent children in court-ordered foster and kinship care, in New South Wales, Australia. A quarter of children displayed clinically significant aberrant eating problems, with no evidence of gender or age effects. Two distinct patterns were identified. The first is a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity (termed Food maintenance syndrome), resembling the behavioral correlates of Hyperphagic Short Stature (Psychosocial Dwarfism). Various data suggest this pattern is primarily triggered by acute stress, including maltreatment in care, against a background of complex psychopathology and developmental disabilities. The second is a cluster of pica-type eating behaviors that correlates with self-injurious behavior, and is closely associated with developmental disabilities. The paper includes recommendations for clinicians working with pre-adolescent children in care.
Exploratory analyses of sexual behavior problems (SBP) were conducted within a larger epidemiological study of 347 preadolescent children in foster and kinship care. SBP was estimated from carergiver-reported scores on the Assessment Checklist for Children. The study simultaneously examined a large number of discrete and cumulative influences on the development of children at high risk for SBP. Most children with SBP had corresponding psychopathology, most notably conduct problems, inattention, and interpersonal behavior problems suggestive of attachment disturbances. Several correlates identified in previous studies were not associated with SBP. High concordance of SBP was found among 52 sibling dyads. Independent predictors of SBP were older age at entry into care, female gender, placement instability, and contact sexual abuse. The findings emphasize the significance of cumulative risk among children exposed to multiple adversities. The findings generated several hypothesized mechanisms involving attachment disturbances.
Manual for ASEBA school-age forms and profiles VT: University of Vermont, Research Center for Children, Youth, & Families Policy statement: AACAP/CWLA policy statement on mental health and use of alcohol and other drugs, screening and assessment of children in foster care
- T Rescorla
, T., & Rescorla, L. (2001). Manual for ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families. American Academy of Child and Adolescent Psychiatry, & Child Welfare League of America (2003). Policy statement: AACAP/CWLA policy statement on mental health and use of alcohol and other drugs, screening and assessment of children in foster care. (Retrieved 18th October, 2012).
Department for Children, Schools and Families and Department of Health
- London
London: Department for Children, Schools and Families and Department of Health.
Emotional and behavioural problems in children: The Revised Rutter Scales
- C Hogg
- M Rutter
- N Richman
Hogg, C., Rutter, M., & Richman, N. (1997). Emotional and behavioural problems in children: The Revised Rutter Scales. In I. Schlare (Ed.), Child psychology portfolio. Windsor, UK: NFER-elson.
Costs and outcomes of non-infant adoptions
- Selwyn
- Julie
- Sturgess
- Wendy
- Quinton
- David
- C Baxter
Selwyn, Julie, Sturgess, Wendy, Quinton, David, & Baxter, C. (2006). Costs and outcomes of non-infant adoptions. London: BAAF.
The mental health of children in fos-ter and kinship care in New South Wales
- Tarren
- Sweeney
- Michael
Tarren-Sweeney, Michael, & Hazell, Philip (2006). The mental health of children in fos-ter and kinship care in New South Wales, Australia. Journal of Paediatrics and Child Health, 42, 91–99.