Publications by authors named "Teresa Lind"

23 Publications

  • Page 1 of 1

Strategies that Promote Therapist Engagement in Active and Experiential Learning: Micro-Level Sequential Analysis.

Clin Superv 2021 6;40(1):112-133. Epub 2021 Jan 6.

Department of Psychological and Brain Sciences, University of Delaware.

Therapists' active learning increases treatment fidelity, but research is needed on supervisory strategies to engage therapists in active learning. This study used sequential analysis to examine consultant behaviors associated with increased and decreased probability of eliciting therapists' active learning. The study included 162 consultation sessions from 27 community therapists implementing Attachment and Biobehavioral Catch-up. Consultants' client discussion, information provision, and modeling were associated with reduced likelihood of active learning. Consultants' questions, engagement in active learning strategies, use of video, and silence were associated with greater likelihood of therapist active learning. These findings inform supervisors' attempts to encourage active learning.
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http://dx.doi.org/10.1080/07325223.2020.1870023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262085PMC
January 2021

Train-to-Sustain: Predictors of Sustainment in a Large-Scale Implementation of Parent-Child Interaction Therapy.

Evid Based Pract Child Adolesc Ment Health 2021 8;6(2):262-276. Epub 2021 Jan 8.

University of California, Los Angeles, Department of Psychology.

Sustainment of evidence-based practices is necessary to ensure their public health impact. The current study examined predictors of sustainment of Parent-Child Interaction Therapy (PCIT) within a large-scale system-driven implementation effort in Los Angeles County. Data were drawn from PCIT training data and county administrative claims between January 2013 and March 2018. Participants included 241 therapists from 61 programs. Two sustainment outcomes were examined at the therapist- and program-levels: 1) PCIT claim volume and 2) PCIT claim discontinuation (discontinuation of claims during study period; survival time of claiming in months). Predictors included therapist- and program-level caseload, training, and workforce characteristics. On average, therapists and programs continued claiming to PCIT for 17.7 and 32.3 months, respectively. Across the sustainment outcomes, there were both shared and unshared significant predictors. For therapists, case-mix fit (higher proportions of young child clients with externalizing disorders) and participation in additional PCIT training activities significantly predicted claims volume. Furthermore, additional training activity participation was associated with lower likelihood of therapist PCIT claim discontinuation in the follow-up period. Programs with therapists eligible to be internal trainers were significantly less likely to discontinue PCIT claiming. Findings suggest that PCIT sustainment may be facilitated by implementation strategies including targeted outreach to ensure eligible families in therapist caseloads, facilitating therapist engagement in advanced trainings, and building internal infrastructure through train-the-trainer programs.
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http://dx.doi.org/10.1080/23794925.2020.1855613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259890PMC
January 2021

Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes.

Adm Policy Ment Health 2021 Jul 1. Epub 2021 Jul 1.

Child and Adolescent Services Research Center, San Diego, CA, USA.

Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.
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http://dx.doi.org/10.1007/s10488-021-01144-4DOI Listing
July 2021

A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes.

Adm Policy Ment Health 2021 Apr 21. Epub 2021 Apr 21.

Child and Adolescent Services Research Center, San Diego, CA, USA.

Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.
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http://dx.doi.org/10.1007/s10488-021-01133-7DOI Listing
April 2021

Intervening With Attachment and Biobehavioral Catch-Up to Reduce Behavior Problems Among Children Adopted Internationally: Evidence From a Randomized Controlled Trial.

Child Maltreat 2021 Apr 22:10775595211010975. Epub 2021 Apr 22.

216138Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA.

Children who have been adopted internationally often exhibit persistent behavior problems. The current study assessed the efficacy of the Attachment and Biobehavioral Catch-up intervention (ABC; Dozier & Bernard, 2019) for reducing behavior problems in 122 children adopted internationally. Behavior problems were measured via parent-report using the Brief Infant Toddler Social Emotional Assessment at a pre-intervention visit and after the intervention when children were between 18 and 36 months. Children's behavior problems were also observed using the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) after the intervention when children were 48 and 60 months. Parents who received ABC reported fewer child behavior problems than parents who received the control intervention immediately after the intervention through 1.5 years post-intervention. Additionally, children whose parents received ABC exhibited fewer behavior problems within the parent context of the DB-DOS when they were 48 months old (2 years post-intervention) than children whose parents received the control intervention. There were no significant intervention effects on children's observed behavior problems within the examiner contexts. These results support the efficacy of ABC in reducing behavior problems among children adopted internationally. Trial registration: ClinicalTrials.gov NCT00816621.
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http://dx.doi.org/10.1177/10775595211010975DOI Listing
April 2021

Implementation facilitation strategies to promote routine progress monitoring among community therapists.

Psychol Serv 2021 Apr 1. Epub 2021 Apr 1.

Department of Psychology, University of California.

Despite substantial support for the importance of routine progress monitoring (RPM) as part of evidence-based practice, few providers utilize measurement-based care. This study sought to identify the relative importance of facilitation strategies viewed as most helpful for increasing intention to use RPM among 388 ethnically diverse community therapists serving children and families. Four types of facilitation strategies were examined: language/interpretability, automation, staffing/access, and requirements. Mixed analyses of variance found that therapists' reported intentions to use RPM were more influenced by strategies of automating assessment administration, provision of clerical assistance, and agency requirements than by making linguistically appropriate measures available. However, the importance of strategies differed depending on therapist race/ethnicity and current RPM use. Language/interpretability of RPM assessments was less emphasized for non-Hispanic White therapists and therapists who have not yet or only minimally adopted RPM compared with ethnic minority therapists and therapists who regularly use RPM, respectively. Furthermore, therapists who were not current RPM users emphasized automation more than staffing/access. Results may inform prioritization of implementation facilitation strategies for agencies to encourage RPM. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/ser0000456DOI Listing
April 2021

Characterizing therapist delivery of evidence-based intervention strategies in publicly funded mental health services for children with autism spectrum disorder: Differentiating practice patterns in usual care and AIM HI delivery.

Autism 2021 Aug 28;25(6):1709-1720. Epub 2021 Mar 28.

Child and Adolescent Services Research Center, University of California, San Diego, USA.

Lay Abstract: This study was conducted to identify patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder receiving publicly funded mental health services and compare strategy use for therapists delivering usual care to those trained to deliver AIM HI ("An Individualized Mental Health Intervention for ASD"), an intervention designed to reduce challenging behaviors in children with autism spectrum disorder. For therapists trained in AIM HI, intervention strategies grouped onto two factors, and , while strategies used by usual care therapists grouped onto a broader single factor, . Among usual care therapists, were related to an increase in child behavior problems, whereas for AIM HI therapists, were related with reductions in child behavior problems over 18 months. Findings support the use of active teaching strategies in reducing challenging behaviors in children with autism spectrum disorder and provide support for the effectiveness of training therapists in evidence-based interventions to promote the delivery of targeted, specific intervention strategies to children with autism spectrum disorder in mental health services.
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http://dx.doi.org/10.1177/13623613211001614DOI Listing
August 2021

Strengthening capacity for implementation of evidence-based practices for autism in schools: The roles of implementation climate, school leadership, and fidelity.

Am Psychol 2020 11;75(8):1105-1115

Department of Speech and Hearing Sciences, University of Washington.

Understanding the factors that influence the use of evidence-based practices (EBPs) for autism spectrum disorder (ASD) in schools is critical to the selection of effective implementation strategies to support their sustained use. The current study has 2 aims: (a) evaluate the association between school leadership profiles (undifferentiated and optimal) and fidelity of EBP implementation and (b) examine the role of implementation climate as a mediator in this association. Participants included 56 principals, 90 special education teachers, and 133 classroom staff from 66 elementary schools. Participants completed the Multifactor Leadership Questionnaire and Implementation Climate Scale. Teachers and staff reported on intensity (frequency) of EBP delivery, and the research team rated the accuracy (adherence) to the components of the EBP. Schools were required to implement at least 1 of 3 EBPs for ASD (discrete trial training, pivotal response training, or visual supports). Using structural equation modeling, we found that schools with optimal leadership had higher observed ratings of teacher and staff fidelity for pivotal response training accuracy (p < .05), but not for discrete trial training or visual supports. However, this association became nonsignificant with the introduction of implementation climate into the models. Optimal leadership profiles were linked to more positive teacher/staff-reported implementation climate, compared with undifferentiated profiles (p < .01), but found no association between implementation climate and fidelity. Overall, the results of this study indicate that the role of principal leadership in EBP implementation is complex, which has implications for fostering a conducive organizational implementation context in schools. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/amp0000649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202724PMC
November 2020

Improving social-emotional competence in internationally adopted children with the Attachment and Biobehavioral Catch-up intervention.

Dev Psychopathol 2020 Jul 16:1-13. Epub 2020 Jul 16.

Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA.

Children adopted internationally experience adverse conditions prior to adoption, placing them at risk for problematic social-emotional development. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help internationally adoptive parents behave in ways that promote young children's social-emotional competence. Participants included 131 parent-child dyads randomly assigned to receive either ABC (n = 65) or a control intervention (n = 66). In addition, 48 low-risk biologically related parent-child dyads were included as a comparison group. At follow-up assessments conducted when children were 24 to 36 months old, internationally adopted children who received the ABC intervention had higher levels of parent-reported social-emotional competence than children who received a control intervention. In addition, observational assessments conducted when children were 48 and 60 months of age showed that internationally adopted children who received ABC demonstrated higher social-emotional competence than children who received a control intervention. Adopted children who received the control intervention, but not the ABC intervention, displayed more difficulties with social-emotional competence than low-risk children. Finally, postintervention parent sensitivity mediated the effect of ABC on observed child social-emotional competence in parent interactions, controlling for preintervention parent sensitivity. These results demonstrate the efficacy of a parenting-focused intervention in enhancing social-emotional competence among children adopted internationally.
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http://dx.doi.org/10.1017/S0954579420000255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854831PMC
July 2020

Therapist-Observer Concordance in Ratings of EBP Strategy Delivery: Challenges and Targeted Directions in Pursuing Pragmatic Measurement in Children's Mental Health Services.

Adm Policy Ment Health 2021 01;48(1):155-170

Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.

Pragmatic measures of therapist delivery of evidence-based practice (EBP) are critical to assessing the impact of large-scale, multiple EBP implementation efforts. As an initial step in the development of pragmatic measurement, the current study examined the concordance between therapist and observer ratings of items assessing delivery of EBP strategies considered essential for common child EBP targets. Possible EBP-, session-, and therapist-levels factors associated with concordance were also explored. Therapists and independent observers rated the extensiveness of therapist (n = 103) EBP strategy delivery in 680 community psychotherapy sessions in which six EBPs were used. Concordance between therapist- and observer-report of the extensiveness of therapist EBP strategy use was at least fair (ICC ≥ .40) for approximately half of the items. Greater therapist-observer concordance was observed in sessions where a structured EBP was delivered and in sessions where therapists reported being able to carry out planned activities. Findings highlighted conditions that may improve or hinder therapists' ability to report on their own EBP strategy delivery in a way that is consistent with independent observers. These results can help inform the development of pragmatic therapist-report measures of EBP strategy delivery and implementation efforts more broadly.
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http://dx.doi.org/10.1007/s10488-020-01054-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722101PMC
January 2021

Emotion Regulation among Children in Foster Care Versus Birth Parent Care: Differential Effects of an Early Home-Visiting Intervention.

J Abnorm Child Psychol 2020 08;48(8):995-1006

Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA.

Children involved with Child Protective Services (CPS) often show worse emotion regulation than non-involved children, with downstream effects on adaptive functioning. The current study uses two randomized control trials, one conducted with foster caregivers and one conducted with birth parents, to investigate the longitudinal effects of caregiver type (foster versus birth parent) and a home-visiting parenting intervention on emotion regulation among young children referred to CPS. Participants were 211 children referred to CPS during infancy or toddlerhood, of whom 120 remained with their birth parents and 91 were placed in foster care. Caregivers were randomly assigned to receive Attachment and Biobehavioral Catch-Up (ABC), a 10-session intervention designed to promote nurturing, sensitive, and non-intrusive caregiving, or a control intervention. Caregiver type moderated the effects of ABC on young children's observed anger dysregulation during a frustrating task at age 2 to 3 years. Among children remaining with their birth parents, children whose caregivers received ABC showed lower anger dysregulation than children whose caregivers received the control intervention. Children placed in foster care showed lower anger dysregulation than children with birth parents regardless of parenting intervention, and additionally showed higher adaptive regulation than children remaining with their birth parents. Adaptive regulation was not significantly associated with parenting intervention or the caregiver by intervention interaction. Results suggest that foster care placement may be protective for emerging emotion regulation skills among young children referred to CPS, and an attachment-based parenting intervention buffers risks of remaining in the home for young children's emotion dysregulation.
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http://dx.doi.org/10.1007/s10802-020-00653-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891856PMC
August 2020

Adverse caregiving in infancy blunts neural processing of the mother.

Nat Commun 2020 02 28;11(1):1119. Epub 2020 Feb 28.

Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, 10016, USA.

The roots of psychopathology frequently take shape during infancy in the context of parent-infant interactions and adversity. Yet, neurobiological mechanisms linking these processes during infancy remain elusive. Here, using responses to attachment figures among infants who experienced adversity as a benchmark, we assessed rat pup cortical local field potentials (LFPs) and behaviors exposed to adversity in response to maternal rough and nurturing handling by examining its impact on pup separation-reunion with the mother. We show that during adversity, pup cortical LFP dynamic range decreased during nurturing maternal behaviors, but was minimally impacted by rough handling. During reunion, adversity-experiencing pups showed aberrant interactions with mother and blunted cortical LFP. Blocking pup stress hormone during either adversity or reunion restored typical behavior, LFP power, and cross-frequency coupling. This translational approach suggests adversity-rearing produces a stress-induced aberrant neurobehavioral processing of the mother, which can be used as an early biomarker of later-life pathology.
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http://dx.doi.org/10.1038/s41467-020-14801-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048726PMC
February 2020

Emergent life events in the delivery of a caregiver-mediated evidence-based intervention for children with autism spectrum disorder in publicly funded mental health services.

Autism 2020 07 31;24(5):1286-1299. Epub 2020 Jan 31.

Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.

Lay Abstract: Mental health clinicians often report significant challenges when delivering evidence-based interventions (EBI) in community settings, particularly when unexpected client stressors (or emergent life events; ELEs) interfere with the therapy process. The current study sought to extend the study of ELEs to children with Autism Spectrum Disorder (ASD) by examining the occurrence and impact of ELEs in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with ASD. This intervention was n ndividualized ental ealth ntervention for children with ASD (referred to as AIM HI). Participants included 38 clinicians and child clients who were enrolled in a community effectiveness trial of AIM HI. Video recordings of 100 therapy sessions were coded for caregiver-reported ELEs and also how well clinicians adhered to the AIM HI protocol. Results indicated that mild to severe ELEs were reported in 36% of therapy sessions, and were reported for 58% of children at some point during the intervention. Children who had a greater number of diagnoses (in addition to the autism diagnosis) tended to have more ELEs. In addition, clinicians with less years of experience tended to have sessions with more ELEs. There was no significant link between ELEs and how well clinicians adhered to the AIM HI protocol. Findings offer implications for the implementation of EBI, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of EBIs.
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http://dx.doi.org/10.1177/1362361319881084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115197PMC
July 2020

Caregiver Attendance as a Quality Indicator in the Implementation of Multiple Evidence-Based Practices for Children.

J Clin Child Adolesc Psychol 2020 Nov-Dec;49(6):868-882. Epub 2019 Dec 4.

Department of Psychiatry, University of California, San Diego and Child and Adolescent Services Research Center.

Objective: This study investigated a quality indicator for children's mental health, caregiver attendance in youth psychotherapy sessions, within a system-driven implementation of multiple evidence-based practices (EBPs) in children's community mental health services.

Method: Administrative claims from nine fiscal years were analyzed to characterize and predict caregiver attendance. Data included characteristics of therapists ( = 8,626), youth clients ( = 134,368), sessions (e.g., individual, family), and the EBP delivered. Clients were primarily Latinx (63%), male (54%) and mean age was 11; they presented with a range of mental health problems. Three-level mixed models were conducted to examine the association between therapist, youth, service, EBP characteristics and caregiver attendance.

Results: Caregivers attended, on average, 46.0% of sessions per client for the full sample and 59.6% of sessions for clients who were clinically indicated, based on age and presenting problem, to receive caregiver-focused treatment. Following initial EBP implementation, the proportion of caregiver attendance in sessions increased over time. Caregivers attended a higher proportion of youth psychotherapy sessions when clients were younger, had an externalizing disorder, were non-Hispanic White, and were male. Further, higher proportions of caregiver attendance occurred when services were delivered in a clinic setting (compared with school and other settings), by bilingual therapists, and the EBP prescribed caregiver attendance in all sessions.

Conclusions: Overall, the patterns of caregiver attendance appear consistent with evidence-informed practice parameters of client presenting problem and age. Yet, several improvement targets emerged such as client racial/ethnic background and service setting. Potential reasons for these disparities are discussed.
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http://dx.doi.org/10.1080/15374416.2019.1683851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269837PMC
February 2021

When Do Therapists Stop Using Evidence-Based Practices? Findings from a Mixed Method Study on System-Driven Implementation of Multiple EBPs for Children.

Adm Policy Ment Health 2020 03;47(2):323-337

Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.

Therapist discontinuation of delivering an evidence-based practice (EBP) is a critical outcome in the community implementation of EBPs. This mixed methods study examined factors associated with therapist discontinuation within a large reimbursement-driven implementation of multiple EBPs in public children's mental health services. The study integrated quantitative survey data from 748 therapists across 65 agencies, and qualitative interviews from a subset of 79 therapists across 14 agencies. Therapists adopted, on average, 2.41 EBPs (SD = 1.05, range = 1-5), and nearly half (n = 355, 47.5%) reported discontinuing at least one EBP. Multi-level models were used to predict the binary outcome of discontinuation, and qualitative analyses were used to expand upon quantitative findings. Quantitative models revealed that therapist factors, including fewer direct service hours per week, a greater number of EBPs adopted, higher emotional exhaustion, and more negative attitudes toward EBPs in general were associated with discontinuation. In addition, EBP-specific factors including more negative perceptions of the particular EBP and lower self-efficacy for delivering the specific EBP predicted discontinuation. Themes from interview responses highlighted the importance of fit of the EBP with the agency's client base, as well as therapist perceptions of adequate EBP training supports, and the alignment of an EBP with therapists' professional goals. Together, the findings suggest the need for strategic sustainment planning interventions that target EBP fit (i.e., fit between adopted EBPs and agency target population, fit between EBP and therapist preferences and career goals) and support therapist self-efficacy in delivering EBPs.
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http://dx.doi.org/10.1007/s10488-019-00987-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237196PMC
March 2020

Defining and Predicting High Cost Utilization in Children's Outpatient Mental Health Services.

Adm Policy Ment Health 2020 09;47(5):655-664

Child and Adolescent Services Research Center, San Diego, CA, USA.

Little is known about high-cost service users in the context of youth outpatient mental health, despite the fact that they account for a large proportion of overall mental healthcare expenditures. A nuanced understanding of these users is critical to develop and implement tailored services, as well as to inform relevant policies. This study aims to characterize high-cost service users by examining demographic factors, diagnoses, and service type use. Administrative service use data were extracted from a large County Department of Behavioral Health Services database. Latent profile analyses suggest a four-profile solution primarily distinguished by youth age and diagnostic complexity. Study findings have implications for defining high-cost service users and key targets for efforts aiming to improve outcomes for these youth.
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http://dx.doi.org/10.1007/s10488-019-00988-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202946PMC
September 2020

Promoting Compliance in Children Referred to Child Protective Services: A Randomized Clinical Trial.

Child Dev 2020 03 28;91(2):563-576. Epub 2019 Feb 28.

University of Delaware.

Early experiences of maltreatment have long-term negative effects on children's compliance. This randomized clinical trial examined whether a brief preventative intervention (Attachment and Biobehavioral Catch-up; ABC) was effective in enhancing compliance in children who had been referred to Child Protective Services. Participants included 101 parent-child dyads who received either ABC or a control intervention when children were infants (M = 9.4 months old, SD = 6.1). When children were approximately 36 months old (M = 38.5, SD = 3.0), ABC children demonstrated significantly better compliance than control children. Further, parent sensitivity, measured 1 month post intervention when children were, on average, 18.4 months old (SD = 6.9) partially mediated the effect of ABC on child compliance at 36 months old.
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http://dx.doi.org/10.1111/cdev.13207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736762PMC
March 2020

Enhancing the language development of toddlers in foster care by promoting foster parents' sensitivity: Results from a randomized controlled trial.

Dev Sci 2019 03 3;22(2):e12753. Epub 2018 Oct 3.

Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware.

Young children in foster care are at increased risk for problematic language development, making early intervention a critical tool in enhancing these children's foundational language abilities. This study examined the efficacy of an early preventative intervention, Attachment and Biobehavioral Catch-up for Toddlers (ABC-T), in improving the receptive vocabulary abilities of toddlers placed in foster care. All the children had been removed from their biological parents' care and placed into foster care. When children were between 24 and 36 months old, foster parents were contacted by research staff and consented to participate. Parents were randomly assigned using a random number generator to receive either ABC-T (n = 45), which aimed to promote sensitive parenting for children who have experienced early adversity, or a control intervention (n = 43). Foster children's receptive vocabulary skills were assessed post-intervention using the Peabody Picture Vocabulary Test, Third Edition, when children were between 36 and 60 months old. Children whose foster parents received ABC-T demonstrated more advanced receptive vocabulary abilities than children whose foster parents received the control intervention. The positive effect of ABC-T on foster children's receptive vocabulary was mediated by increases in foster parents' sensitivity during parent-child interactions. Trial registration: ClinicalTrials.gov NCT01261806.
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http://dx.doi.org/10.1111/desc.12753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716063PMC
March 2019

Identifying Youth at Risk for Commercial Sexual Exploitation Within Child Advocacy Centers: A Statewide Pilot Study.

J Interpers Violence 2021 03 26;36(5-6):NP2368-NP2390. Epub 2018 Mar 26.

University of Arkansas for Medical Sciences, Little Rock, USA.

Commercial sexual exploitation of children (CSEC) is a social problem in the United States that has recently received growing attention from policy makers, advocates, and researchers. Despite increasing awareness of this issue, information on the prevalence, demographic profile, and psychosocial needs of victims of CSEC is scarce. To better understand the scope of CSEC and to examine the feasibility of screening for CSEC in Child Advocacy Centers (CACs), a pilot study was initiated through Arkansas Building Effective Services for Trauma (ARBEST) to identify youth who may be at risk for commercial sexual exploitation. Data for this pilot study were collected from all of the state's CACs ( = 14) over a 6-month period. Family advocates completed a screening questionnaire adapted from Greenbaum, Dodd, and McCracken with 918 youth aged 12 to 18 years old treated at CACs. Almost 20% of youth were identified as being at high risk for experiencing CSEC. Furthermore, youth classified as high-risk for commercial sexual exploitation reported significantly more avoidance symptoms on the UCLA (University of California at Los Angeles) PTSD (Posttraumatic Stress Disorder) Reaction Index than youth classified as low-risk. The results suggest that a significant portion of youth treated at CACs in Arkansas are at high risk for experiencing commercial sexual exploitation, which may be associated with a particular pattern of trauma symptoms. These findings also lend support for the feasibility and utilization of a screening questionnaire as part of routine care in CACs to potentially identify youth at risk for CSEC.
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http://dx.doi.org/10.1177/0886260518766560DOI Listing
March 2021

Longitudinal associations between low morning cortisol in infancy and anger dysregulation in early childhood in a CPS-referred sample.

Dev Sci 2018 May 21;21(3):e12573. Epub 2017 Jun 21.

Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA.

Children who experience early adversity are at increased risk for developing psychopathology, and dysfunction of the hypothalamic pituitary adrenal (HPA) axis is a possible mechanism conferring this risk. This study sought to characterize the association between morning cortisol during different developmental periods and deficits in children's emotion regulation, a core feature of many psychological disorders. Morning cortisol was collected at two time points (i.e., during infancy, M = 13.0 months old, and during early childhood, M = 36.8 months old) from 120 children with histories of child protective services (CPS) involvement. Children completed a lab visit during early childhood (M = 38.6 months old) that involved an observational measure of anger regulation. Results showed that low morning cortisol during infancy, but not early childhood, predicted increased anger dysregulation during early childhood. These results highlight the importance of developmental timing in assessing the effects of HPA axis functioning and suggest that low cortisol during infancy is a risk factor for later emotion regulation difficulties.
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http://dx.doi.org/10.1111/desc.12573DOI Listing
May 2018

Enhancing executive functioning among toddlers in foster care with an attachment-based intervention.

Dev Psychopathol 2017 05;29(2):575-586

University of Delaware.

Young children in foster care often experience adversity, such as maltreatment and lack of stability in early caregiving relationships. As a result, these children are at risk for a range of problems, including deficits in executive functioning. The Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention was designed to help foster parents behave in ways that promote the development of young children's emerging self-regulatory capabilities. Participants included 173 parent-toddler dyads in three groups: foster families that were randomly assigned to receive either the ABC-T intervention (n = 63) or a control intervention (n = 58), as well as low-risk parent-toddler dyads from intact families (n = 52). At a follow-up conducted when children were approximately 48 months old, children's executive functioning abilities were assessed with the attention problems scale of the Child Behavior Checklist (Achenbach & Rescorla, 2000) and a graded version of the Dimensional Change Card Sort developed for preschoolers (Beck, Schaefer, Pang, & Carlson, 2011). Results showed that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. These results indicate that an attachment-based intervention implemented among toddlers in foster care is effective in enhancing children's executive functioning capabilities.
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http://dx.doi.org/10.1017/S0954579417000190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650491PMC
May 2017

Attachment states of mind among internationally adoptive and foster parents.

Dev Psychopathol 2017 05;29(2):365-378

University of Delaware.

The first aim of the current study was to examine the latent structure of attachment states of mind as assessed by the Adult Attachment Interview (AAI) among three groups of parents of children at risk for insecure attachments: parents who adopted internationally (N = 147), foster parents (N = 300), and parents living in poverty and involved with Child Protective Services (CPS; N = 284). Confirmatory factor analysis indicated the state of mind rating scales loaded on two factors reflecting adults' preoccupied and dismissing states of mind. Taxometric analyses indicated the variation in adults' preoccupied states of mind was more consistent with a dimensional than a categorical model, whereas results for dismissing states of mind were indeterminate. The second aim was to examine the degree to which the attachment states of mind of internationally adoptive and foster parents differ from those of poverty/CPS-referred parents and low-risk parents. After controlling for parental age, sex, ethnicity, and socioeconomic status, (a) internationally adoptive parents had lower scores on the dismissing dimension than the sample of community parents described by Haltigan, Leerkes, Supple, and Calkins (2014); (b) foster parents did not differ from community parents on either the dismissing or the preoccupied AAI dimension; and (c) both internationally adoptive and foster parents had lower scores on the preoccupied dimension than poverty/CPS-referred parents. Analyses using the traditional AAI categories provided convergent evidence that (a) internationally adoptive parents were more likely to be classified as having an autonomous state of mind than low-risk North American mothers based on Bakermans-Kranenburg and van IJzendoorn's (2009) meta-analytic estimates, (b) the rates of autonomous states of mind did not differ between foster and low-risk parents, and
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http://dx.doi.org/10.1017/S0954579417000049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610913PMC
May 2017

Intervention effects on negative affect of CPS-referred children: results of a randomized clinical trial.

Child Abuse Negl 2014 Sep 10;38(9):1459-67. Epub 2014 May 10.

University of Delaware, USA.

Exposure to early adversity places young children at risk for behavioral, physiological, and emotional dysregulation, predisposing them to a range of long-term problematic outcomes. Attachment and Biobehavioral Catch-up (ABC) is a 10-session intervention designed to enhance children's self-regulatory capabilities by helping parents to behave in nurturing, synchronous, and non-frightening ways. The effectiveness of the intervention was assessed in a randomized clinical trial, with parents who had been referred to Child Protective Services (CPS) for allegations of maltreatment. Parent-child dyads received either the ABC intervention or a control intervention. Following the intervention, children from the ABC intervention (n=56) expressed lower levels of negative affect during a challenging task compared to children from the control intervention (n=61).
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http://dx.doi.org/10.1016/j.chiabu.2014.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160393PMC
September 2014
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