Health-Risk Behaviors in Young Adolescents in the Child Welfare System

doi:10.1016/j.jadohealth.2009.12.032

Journal of Adolescent Health

Volume 47, Issue 1, July 2010, Pages 26-34

https://doi.org/10.1016/j.jadohealth.2009.12.032 Get rights and content

Abstract

Purpose

To examine rates and patterns of health-risk behavior (e.g., sexuality, depression/suicidality, substance use, delinquency) among a national probability sample of youth active to the child welfare/child protective services system. Recent federal legislation, P.L. 110-351, encourages child welfare systems, Medicaid, and pediatric experts to collaborate to ensure youth entering foster care receive comprehensive health examinations.

Methods

Analysis of baseline caregiver, caseworker, and child interviews, and assessment data for a subsample (n = 993) of youth, aged 11–15 years, from the National Survey of Child and Adolescent Well-Being, a national probability sample of children and adolescents undergoing investigation for abuse or neglect.

Results

Almost half of the sample (46.3%) endorsed at least one health-risk behavior. On Poisson multivariate regression modeling, factors related to higher rates of health-risk behaviors included older age, female gender, abuse history, deviant peers, limited caregiver monitoring, and poor school engagement.

Conclusion

Given the heightened vulnerability of this population, early screening for health-risk behaviors must be prioritized. Further research should explore specific subpopulations at risk for health-risk behaviors and possible interventions to change these youths' trajectories.

Section snippets

Study design

The NSCAW study examined the characteristics, needs, and outcomes of children and families who underwent investigation for alleged abuse and neglect. For the current analysis, we chose a cross-sectional approach, investigating risk behaviors and risk and protective factors at Wave 1, approximately five months after maltreatment investigation.

Sample

NSCAW used a stratified two-stage cluster sampling strategy to select 100 primary sampling units (PSUs) from a national sampling frame, with the

Sample characteristics

The majority of youth were between the ages of 12 and 14 years (71.5%), with a mean age of 12.67 (standard error = 0.07) (see Table 2). More than half of the sample was females (57.4%). In terms of ethnicity of the respondents, half were Caucasian (50.9%), 27.1% were African American, and 16.6% were Hispanic. The most common maltreatment types were neglect (49.8%) and physical abuse (41.5%). The majority (87.8%) were living in-home; only 12.2% were in foster care at Wave 1. Approximately half

Discussion

This research contributes to the existing published data by establishing baseline rates of health-risk behaviors and associated risk and protective factors in the first national probability sample of early adolescent youth involved with child welfare. Findings should be interpreted within the context of the study's reliance on youth self-report. Specifically, validity and reliability of data obtained from youth involved in child welfare about their engagement in health-risk behaviors cannot be

Summary

Although a recent report from the American Academy of Pediatrics Committee on Child Abuse and Neglect and Section on Adoption and Foster Care concurs that youth with histories of maltreatment are at high risk for health-risk behaviors, current policy statements by professional and advocacy organizations regarding comprehensive evaluations for youth in foster care do not specifically highlight the assessment of risk behaviors as part of this evaluation [40]. This study affirms the critical role

Acknowledgments

This study was supported by the Charles H. Hood Foundation (Dr. Leslie, Ms. Kauten); the Administration on Children, Youth, and Families, U.S. Department of Health and Human Services (ACYF/DHHS; Grant No. 90PH0006, Dr. Leslie, Dr. James, Ms. Zhang, Ms. Monn) and NIMH Grant No. R01MH072961 (Dr. Aarons).

References (40)

V.J. Felitti et al.
Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study
Am J Prev Med
(1998)
H.N. Taussig
Risk behaviors in maltreated youth placed in foster care: A longitudinal study of protective and vulnerability factors
Child Abuse Negl
(2002)
A. Grogan-Kaylor et al.
Behaviors of youth involved in the child welfare system
Child Abuse Negl
(2008)
H.D. Orton et al.
Prevalence and characteristics of depression and substance use in a US child welfare sample
Child Youth Serv Rev
(2009)
C.S. Widom et al.
Criminal consequences of childhood sexual victimization
Child Abuse Negl
(1994)
A.A. Rai et al.
Relative influences of perceived parental monitoring and perceived peer involvement on adolescent risk behaviors: An analysis of six cross-sectional data sets
J Adolesc Health
(2003)
S. James et al.
Sexual risk behaviors among youth in the child welfare system
Child Youth Serv Rev
(2009)
Fostering Connections to Successand Increasing Adoptions Act of 2008, H.R. 6893/P.L. 110–351, United States 110th Cong...
Developmental issues for young children in foster care
Pediatrics
(2000)
US Department of Health and Human Services, Administration for Children, Youth and Families, Children's Bureau. The...

US Department of Health and Human Services. Healthy people 2010. Available at:...

J.A. Grunbaum et al.

Youth risk behavior surveillance—United States, 2001

J Sch Health

(2002)

A. Bryan et al.

A case control study of adolescent risky sexual behavior and its relationship to personality dimensions, conduct disorder, and substance use

J Youth Adolesc

(2002)

M.D. Resnick et al.

Protecting adolescents from harm. Findings from the National Longitudinal Study on adolescent health

JAMA

(1997)

J.A. Grunbaum et al.

Youth risk behavior surveillance—United States, 2003

MMWR Surveill Summ

(2004)

C.W. Sells et al.

Morbidity and mortality among US adolescents: An overview of data and trends

Am J Public Health

(1996)

C. Barone et al.

Involvement in multiple problem behaviors of young urban adolescents

J Prim Prev

(1995)

J.A. Landsverk et al.

Mental health services for children reported to child protective services

S.C. Carpenter et al.

The association of foster care or kinship care with adolescent sexual behavior and first pregnancy

Pediatrics

(2001)

M.E. Courtney et al.

Early outcomes for young adults transitioning from out-of-home care in the USA

Child Fam Soc Work

(2006)

Cited by (109)

Health status and missed care among youth in care in British Columbia, Canada: A population study
2024, Children and Youth Services Review
Youth in care (YIC) are a marginalized population with high health care needs and barriers to access, resulting in lifelong health disparities. This study examines the health of Canadian YIC and their engagement with the Canadian health care system on a population level.
Data were retrieved from the 2018 British Columbia Adolescent Health Survey, a cross-sectional population survey of Grade 7–12 students (ages 12–19 years) in British Columbia, Canada (n = 38,015). Primary outcomes were self-rated general health and mental health, missed medical care, and missed mental health care among YIC. Secondary outcomes included health care access and gender differences. Multivariate analyses adjusted for age, gender, and food insecurity.
YIC represented 1.9 % of the weighted sample population. Compared to non-YIC, YIC accessed health care more frequently from mental health professionals and youth-focused clinics and less frequently from family physicians. YIC reported worse general health (AOR 1.81 [99 % CI 1.40–2.34]) and mental health (AOR 1.81 [99 % CI 1.42–2.32]) than non-YIC. Adjusted for health status, YIC experienced more missed medical care (AOR 1.96 [99 % CI 1.46–2.62]) but comparable missed mental health care to non-YIC. Significant barriers for YIC included negative health care experiences and transportation. Among YIC, female and non-binary genders also had increased risk for worse health and missed care compared to males.
YIC in Canada have inequitably unmet health care needs. Many complex factors contribute to this disparity and its correlation with out-of-home care. Further action is needed to reduce health care barriers for YIC.
Preliminary evaluation of A Home Within psychotherapy with clients with a history of foster care
2022, Children and Youth Services Review
Children and youth in foster care often experience numerous traumas both in and out of the child welfare system, and as a result many need access to mental health support. Researchers report low utilization rates of mental health services among individuals who have lived in foster care, often attributed to barriers to both access and receipt of consistent mental healthcare. A Home Within is a national nonprofit organization that aims to reduce these barriers to mental healthcare for those with past or current involvement in foster care by facilitating their access to consistent pro bono psychotherapy for “as long as it takes.” Eighty-five A Home Within therapists completed interviews with trained research assistants at two time points. Interviews included 44 closed- and open-ended questions regarding therapist demographics, client demographics, clients’ presenting concerns and mental health status, and treatment description. Repeated measures analysis of variance (ANOVA) models showed significant decreases in all five outcomes from baseline to termination of treatment. The associated effect sizes for length of time in treatment were medium to large for depression, anxiety, conduct disorder, and perpetrating aggression/violence. There was a small to medium associated effect size for peer relationship problems and the effect of time was not significant for cohabitation relationship problems. Findings provide preliminary support for continued development and evaluation of mental health services facilitated through A Home Within among clients currently or previously in foster care.
The reciprocal relationships between school engagement and self-esteem among Turkish early adolescents: A three-wave cross-lagged model
2020, Children and Youth Services Review
Cross-sectional studies indicate a positive relationship between school engagement and self-esteem. However, the reciprocal nature of relationships between school engagement and self-esteem among early adolescents has never been investigated. Therefore, the aim of the current manuscript was to explore the reciprocal relationships between school engagement and self-esteem among Turkish early adolescents. A total of 438 secondary school students aged from 10 to 14 years old (T1; M_age 12.2 years; 50.9% 223 female; 49.1% 215 male) completed measures of school engagement and self-esteem at three-time points across an academic year, with four-month assessment intervals. In the study, a three-wave cross-lagged model was conducted by AMOS. The findings of the study showed that higher school engagement predicted subsequent higher self-esteem, and higher self-esteem predicted subsequent higher school engagement among early adolescents. This study which is one of the first in the literature to examine the reciprocal relationships between school engagement and self-esteem among early adolescents, suggests that self-esteem and school engagement mutually reinforce each other over time. Finally, the practical and theoretical implications were discussed.
“We are kind of their parents”: Child welfare workers’ perspective on sexuality education for foster youth
2020, Children and Youth Services Review
Adolescents and young adults placed in our child welfare system are at an increased risk for pregnancy and sexually transmitted infections due to their likelihood to engage in high-risk behaviors, such as unprotected sex and sex with multiple partners. They receive unclear and inconsistent messages about sexual and reproductive health and lack access to reproductive health services and programs. Focus groups (N = 3) comprised of child welfare workers and foster parents were conducted to capture the issues relevant to addressing the sexual reproductive health needs of youth in out-of-home care. Participants indicated that they generally did not receive sufficient training, if any, yet were expected to address sexual reproductive health issues with youth. The responses were organized into three themes that should be considered when developing training interventions: (1) how to communicate with youth about sexual reproductive health; (2) defining adults’ roles and activities in assisting youth; and, (3) discussions about their values about sex and sexual activity. The results of this study point to a need for child welfare workers and foster parents to receive concrete practice skills regarding how to address the sexual reproductive health needs of youth.
Parental education and youth suicidal behaviours: a systematic review and meta-analysis
2022, Epidemiology and Psychiatric Sciences
The Young Adolescent Project: A longitudinal study of the effects of maltreatment on adolescent development
2020, Development and Psychopathology

View all citing articles on Scopus

: The National Survey of Child and Adolescent Well-Being (NSCAW) was developed under contract to RTI from the ACYF/DHHS. The information and opinions expressed herein reflect solely the position of the author(s). Nothing herein should be construed to indicate the support or endorsement of its content by ACYF/DHHS.

View full text

Original articleHealth-Risk Behaviors in Young Adolescents in the Child Welfare System

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Study design

Sample

Sample characteristics

Discussion

Summary

Acknowledgments

Am J Prev Med

Child Abuse Negl

Child Abuse Negl

Child Youth Serv Rev

Child Abuse Negl

J Adolesc Health

Child Youth Serv Rev

Developmental issues for young children in foster care

Pediatrics

Youth risk behavior surveillance—United States, 2001

J Sch Health

A case control study of adolescent risky sexual behavior and its relationship to personality dimensions, conduct disorder, and substance use

J Youth Adolesc

Protecting adolescents from harm. Findings from the National Longitudinal Study on adolescent health

JAMA

Youth risk behavior surveillance—United States, 2003

MMWR Surveill Summ

Morbidity and mortality among US adolescents: An overview of data and trends

Am J Public Health

Involvement in multiple problem behaviors of young urban adolescents

J Prim Prev

Mental health services for children reported to child protective services

The association of foster care or kinship care with adolescent sexual behavior and first pregnancy

Pediatrics

Early outcomes for young adults transitioning from out-of-home care in the USA

Child Fam Soc Work

Original article
Health-Risk Behaviors in Young Adolescents in the Child Welfare System