Communities have different neighborhood factors, such as economic, educational, and healthcare resources that can influence child development. This study evaluated the relationship between neighborhood factors and the clinical needs and treatment response of youth in a residential program. The Child Opportunity Index was used to gain a better understanding of the relationship between neighborhood factors and youth presenting problems, behavioral incidents, changes in total difficulties from intake to discharge, residential placement safety and stability, and discharge placement. The sample included 1773 youth from 34 states in the U.S. who resided in the Boys Town Family Home Program from 2013 to 2023. Including neighborhood factors in the clinical assessment provided new insights into youth treatment needs and response to services. Youth who came from neighborhoods with better community resources had more severe clinical needs, with mixed internalizing and externalizing problems, while greater proportion of youth from communities with poorer quality of resources presented with truancy and legal problems. Youth from different communities with varying neighborhood resources made progress in the program, but youth from neighborhoods with better resources made greater gains because they started with more significant clinical needs. Limitations and recommendations for further research are also discussed.

The School Support Program is a multi-tiered school behavioral intervention that incorporates components of the Teaching Family Model to decrease negative behaviors while increasing positive ones in the school setting. This program utilizes trained staff called School Support Specialists that work with teachers and administration to identify and refer students in need. Specialists are also trained to work with students, staff, and families to refer students and their families to programs within a larger array of services if additional family-based support is needed. Over the 2022-23 and 2023-24 school years, services were delivered to more than 12,500 unique students at over 100 elementary, middle, and high schools in the United States. This equated to approximately 22,000 hours directly serving students and approximately 2,700 parent contact hours. In aggregate, served students received approximately 1.76 hours of direct service. Further, approximately three percent of families of students served by the program received additional Boys Town services. Ratings of school climate were also associated with satisfaction with their Specialist. Data from a small pilot study indicated that improved attendance and grades were positively related to services received. Limitations and future research are discussed.

The study examines the replication of the In-Home Teaching-Family Model (TFM) across different service settings, including child welfare, juvenile justice, diversion, and other prevention programs. Using administrative data (i.e. fidelity, service delivery and family outcomes) for Boys Town In-Home Family Services (BT-IHFS) from 2021 to 2023, results indicate consistent implementation across service settings, with minor adaptations in dosage for juvenile justice cases. Significant improvements from intake to case closure were observed in family functioning and parenting skills across all contracts, with large effect sizes in several domains. When comparing family outcomes at case closure using an analysis of covariance approach, families in "other prevention programs" reported higher family-functioning outcomes compared to the three other contract types. The study highlights the ability to implement BT-IHFS in diverse contexts and obtain consistent positive outcomes for families, emphasizing the importance of routine data collection for continuous improvement. Limitations include missing data and challenges in measuring parenting across different child age groups. Overall, the research provides strong evidence for the In-Home TFM's adaptability and effectiveness, offering valuable insights for policymakers, practitioners, and researchers working to support families from child welfare, juvenile justice, diversion, and prevention program settings.

Social skills teaching is an effective intervention to support students with emotional and behavioral disorders. This paper describes the initial development and psychometric properties of the Boys Town Social Skills Assessment for Schools (BTSSA-S), a 15-item assessment intended to identify students' social skill strengths and needs. Fifteen educators at an educational center for a residential program for at-risk youth completed the instrument. A total of 150 students were rated at two points in time, approximately 30 days apart (129 students were matched). The BTSSA-S demonstrated good test-retest reliability (ICC = .83) as well as adequate internal consistency (alpha = .85) for a multi-dimensional scale (three factors: behavioral compliance, on-task, and sociability). Further, scale scores are significantly correlated (r = .76) with another social skills screener, indicating convergent validity. Finally, a ROC curve discriminated significantly between students with and without a disruptive school incident and was used to determine a preliminary cutoff score for identifying those at risk for such incidents. Limitations, implications, and future research are discussed.

A better understanding of how childhood adversity (CA) patterns influence the effectiveness of Trauma Informed Care (TIC) for youth in residential programs is needed. Utilizing a longitudinal design, the study examined how CA patterns influenced aggression and self-injurious behavior during treatment and emotional and conduct outcomes for 1,343 racially diverse adolescents in a TIC residential program. Latent class analysis identified five CA patterns. Subsequent mixed, two-factor ANCOVAs indicated youth from all CA patterns experienced parallel decreases in emotional problems from intake to discharge while changes in conduct problems during this same period differed by CA pattern. Likewise, Hierarchical Linear Modeling revealed that youths' self-injurious behavior and aggressive behaviors over the first 12 months of the program also differed by CA pattern. Some demographic differences based on sex and race were found, which are discussed in turn. Findings indicate that while the program is functioning as TIC, more tailored support is needed for youth with specific CA patterns and demographics. Trauma-informed practices are important for improving emotional well-being in residential care.Tailored interventions for youth with specific trauma histories may help reduce self-injurious behavior and behavior problems.TIC programs may better serve youth with a variety of trauma histories by incorporating interventions that target social development.

Suicide is the third leading cause of death for individuals between 15 and 19 years of age. The high suicide mortality rate and limited prior success in identifying neuroimaging biomarkers indicate that it is crucial to improve the accuracy of clinical neural signatures underlying suicide risk. The current study implements machine-learning (ML) algorithms to examine structural brain alterations in adolescents that can discriminate individuals with suicide risk from typically developing (TD) adolescents at the individual level. Structural MRI data were collected from 79 adolescents who demonstrated clinical levels of suicide risk and 79 demographically matched TD adolescents. Region-specific cortical/subcortical volume (CV/SCV) was evaluated following whole-brain parcellation into 1000 cortical and 12 subcortical regions. CV/SCV parameters were used as inputs for feature selection and three ML algorithms (i.e., support vector machine [SVM], K-nearest neighbors, and ensemble) to classify adolescents at suicide risk from TD adolescents. The highest classification accuracy of 74.79% (with sensitivity = 75.90%, specificity = 74.07%, and area under the receiver operating characteristic curve = 87.18%) was obtained for CV/SCV data using the SVM classifier. Identified bilateral regions that contributed to the classification mainly included reduced CV within the frontal and temporal cortices but increased volume within the cuneus/precuneus for adolescents at suicide risk relative to TD adolescents. The current data demonstrate an unbiased region-specific ML framework to effectively assess the structural biomarkers of suicide risk. Future studies with larger sample sizes and the inclusion of clinical controls and independent validation data sets are needed to confirm our findings.

Youth in residential programs have high rates of Posttraumatic Stress Disorder (PTSD) and suicidality. Although trauma symptoms and suicidality can both be related to peer relationship problems, there is little research on how social skills training on peer relations could help these youth. This study examined if progress made on peer relations training and sex moderated the association between trauma symptoms at intake and suicide ideation incidents while in the program. The sample included archival data on youth placed in a large residential program in the Midwest (N = 1118) ages 12–19 years old (M = 15.97 years, SD = 1.15), of which 62.2% were boys. Results indicated both peer relations training (b = −0.07, SE = 0.02, p = 0.001) and sex (b = −0.04, SE = 0.02, p = 0.032) moderated the relationship between trauma symptoms at intake and suicide ideation incidents in care. The benefits of peer relations training for youth presenting with trauma symptoms and suicide ideations are discussed along with recommendations for further research.

Suicide is one of the leading causes of death in youth in the US. Previous studies have mainly attempted to examine structural neural correlates of suicide risk using pre-specified brain regions. The current study implements a machine-learning (ML) algorithm to examine whole-brain structural brain alterations in adolescents at suicide risk relative to typically developing (TD) adolescents.

While neuro-cognitive work examining aggression has examined patients with conditions at increased risk for aggression or individuals self-reporting past aggression, little work has attempted to identify neuro-cognitive markers associated with observed/recorded aggression. The goal of the current study was to determine the extent to which aggression by youth in the first three months of residential care was associated with atypical responsiveness to threat stimuli. This functional MRI study involved 98 (68 male; mean age = 15.96 [sd = 1.52]) adolescents in residential care performing a looming threat task involving images of threatening and neutral human faces or animals that appeared to be either loom or recede. Level of aggression was negatively associated with responding to looming stimuli (irrespective of whether these were threatening or neutral) within regions including bilateral inferior frontal gyrus, right inferior parietal lobule, right superior/middle temporal gyrus and a region of right uncus proximal to the amygdala. These data indicate that aggression level is associated with a decrease in responsiveness to a basic threat cue-looming stimuli. Reduced threat responsiveness likely results in the individual being less able to represent the negative consequences that may result from engaging in aggression, thereby increasing the risk for aggressive episodes.

This study conducted a randomized trial to examine the efficacy of the Boys Town In-Home Family Services (IHFS) program for families of high-risk youth. Participants were recruited from a state helpline for families struggling with poor family functioning and child emotional or behavioral issues. Consent was obtained for 300 of which 152 were randomly assigned to participate in IHFS for 3-4 months and 148 were assigned to the services as usual comparison group. For the families in the treatment group, 18% did not participant in the intervention, and 66% of families received 20 or more service hours. Parent report data were collected at intake, post, as well 6 and 12 months after post data collection. Data were collected on constructs such as caregiver strain, family functioning, parenting, family resources, and parent report of child behavior. Piecewise analyses of the intake to post data indicated significantly greater reductions in caregiver strain for the treatment condition. Given the conservative corrections for the use of multiple tests, no other measures demonstrated significant differences. For the piecewise model of the maintenance phase, there were no significant differences between groups aside from caregiver strain that showed a significant improvement for the comparison condition. Supplementary dose-response analyses indicated that for most families there was an ideal dosage of about 25-75 hr to bring about the largest improvements in caregiver strain, parenting skills, and child behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Youth safety is an essential component of trauma-informed services (U.S. Department of Health & Human Services, 2020). Youth perception of safety should be indicative of a healthy care environment and contribute to successful outcomes. It has been shown that trauma impacts an individual's perception of and response to perceived threat. This study examines the relationship between youth perception of safety, history of trauma, level of aggression, and outcomes in a residential care setting. Data came from the organization's administrative database and from the care provider certification measures collected during the period of January 2016 through December 2018. Trauma exposure and symptoms, the perceived safety and aggression were used in a mediational path model analysis in predicting goal attainment, program completion, and post-discharge placement. Higher levels of youth trauma were not directly associated with poorer outcomes, and higher percentages of goals met when program supervisor perception of safety was higher. Additionally, trauma symptoms were related to lower rates of program completion when youth perception of safety was higher. Results provide insight into how trauma, perception of safety, and aggression within a residential placement intersect to impact the youth's treatment progress.

This study tests a developmental cascades model in which childhood maltreatment is hypothesized to influence adult educational attainment by increasing attention problems and reducing successful school experiences during adolescence. Two path models tested direct and indirect associations of childhood maltreatment with adult educational attainment. Model 1 used three parent-reported subtypes of childhood maltreatment (physical/emotional abuse, sexual abuse, neglect). Model 2 added an agency-reported measure of childhood maltreatment. Both models detected indirect effects of childhood maltreatment subtypes on adult educational attainment through attention and school discipline problems, poor school engagement, and low extracurricular involvement. Model 2 also detected a direct effect of agency-reported childhood maltreatment on the adult outcome. Regardless of the type of maltreatment or data source used, school factors mediated the associations of childhood maltreatment on adult educational attainment. Promoting school engagement and reducing disciplinary referrals for maltreated youth could improve their educational attainment over the long term.

Objective: Youth who receive services in residential programs have high rates of traumatic exposure and associated symptoms of Posttraumatic Stress Disorder (PTSD). Little information is available on specific social skills training that could be beneficial for youth in residential programs with PTSD. This study examined changes in behavioral incidents and psychopathology in youth receiving group home services based on training they received across three categories of social skills (i.e., self-advocacy, emotional regulation, problem-solving). Method: The sample included archival data on youth (N = 677) ages 10-18 years (M = 15.7 years, SD = 1.53). Hierarchical Linear Modeling was used to examine the frequency of disruptive and self-injurious behaviors over 12 months as it relates to reported traumatic symptoms at admission and the presence of the three types of social skills objectives. Analysis of Covariance was conducted to test whether the social skill objectives differentially predicted changes in youth psychopathology from intake to discharge for youth with low and high trauma symptoms. Results: Youth with high trauma symptoms who received training on problem-solving skills had significantly greater decrease in emotional problems from intake to discharge compared to youth with high trauma symptoms who did not receive problem-solving training (d = -.54). Conclusion: Problem-solving training could be further developed and tested to maximize the support youth with trauma symptoms receive in trauma-informed residential programs.

Trauma-informed care is recommended to improve the quality of group home services for youth. Youth exposure to trauma and associated symptoms are important factors involved in making the clinical impression that determines treatment services. This study considered three dimensions of trauma (exposure, symptoms, and clinical impression) to determine associations with behavioral incidents of youth in trauma-informed group homes and how trauma was related to changes in psychopathology from intake to discharge. Archival records of youth (N = 1,096), age 9-18 (M = 15.7 years) who received services from January 2013 to December 2017, and departed the program were used. Statistical procedures included hierarchical linear modeling and analysis of covariance. Results indicated trauma symptoms predicted emotional problems and self-injurious behavior. Youth in high- and low-trauma groups both showed decreases in behavioral incidents and psychopathology, but clinical impression of trauma moderated the change in emotional problems from intake to discharge. Youth deemed by clinicians to have lower trauma (based on history of maltreatment and expression of trauma symptoms) had greater decrease in emotional problems from admission to discharge. Limitations and implications for further research on implementation and effectiveness of trauma-informed models are discussed.

Psychometric properties of the 30-item Family Resource Scale (FRS) were examined in a sample of families seeking assistance for their child's behavioral difficulties (N = 300). The FRS is a measure that assesses the adequacy of family resources across several contexts including intra-family support and personal resources. Our analyses supported a modified 29-item four-factor solution (basic needs, extra money and time, time for family, and essential) compared with the seven-factor solution provided by the developers. Results showed that families' perception of their resources as adequate across all domains was associated with better family functioning and less caregiver strain. Combined, our findings suggest modifications to the existent structure of the FRS.

In this study the 15-item Evidence-Based Practices Attitude Scale (EBPAS), a measure designed to assess attitudes toward the adoption of EBPs, was collected from administrators of residential care facilities for youth in the United States. As the EBPAS was administered to a different sample for which it was originally developed (i.e., community mental health), we conducted a Confirmatory Factor Analysis (CFA) to investigate if its factor structure was maintained. Results confirm the factor structure of the EBPAS as a valid measure of attitude toward evidence-based practice among youth residential care providers. Limitations and areas of future research are discussed.

Parenting is multidimensional and dynamic, involving a complex set of behaviors as well as thousands of decisions and interactions that affect the lives of children. Numerous parenting measures have been developed over the years, but very few have been shown to have strong psychometric properties. Further, of those with strong psychometric properties, only a handful have been translated into Spanish, and these have not been well tested. Given the importance that parenting plays in the development of children and the fact that Latinos are the fastest growing minority group in the United States, there is a need for studies of general parenting measures that compare the psychometric properties of their English and Spanish versions. The current study tests measurement invariance of the English and Spanish versions of the Parenting Children and Adolescents (PARCA) scale, a brief 19-item questionnaire designed to measure parenting practices in children between the ages of 6 and 18 years. Results indicate that the PARCA was largely invariant across language groups (i.e., configural and metric invariance were supported); though a few items demonstrated differential functioning in the intercepts, effect sizes for these group differences were generally modest to negligible. Thus, findings suggest that the PARCA can be used to measure parenting dimensions and examine associations among those dimensions in studies of English- compared with Spanish-speaking parents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The high cost of residential services for troubled youth is an ongoing concern, and has formed the basis for arguments made for reducing or eliminating residential services for these youth with some recommending that lengths of residential stay be less than 6 months. This is countered by the view that the challenges faced by troubled youth are associated with high public funds expenditures in the future due to limited education, underemployment, and increased risk of criminality. Analysis used 24 month follow-up education, employment, and criminality data from 1476 former residential care youth who were now in their 20s. Individuals who were in the program for more than 6 months had better educational, employment, and criminality outcomes than youth that were in the program for less than 6 months. These improved outcomes were associated with significantly better estimated financial societal benefit over the long-term, specifically a 361% return on investment from a societal perspective.

OBJECTIVE:The objective of this article is to describe a care coordination model that includes promising practices which are supported by both practice-based and research-based evidence. This model was developed to address the gaps of other models, namely an emphasis on skill teaching with parents, the flexibility to adapt to the needs of youth with a wide variety of presenting problems, and model fidelity assessment tools to help scale up the program across multiple locations with fidelity.METHOD:We discuss preliminary administrative and outcome data from 898 youth served across eight locations.RESULTS:Data suggest positive outcomes at departure from service, as well as 6 months and 12 months post case closure.CONCLUSION:Preliminary data indicate that youth with educational and behavioral health challenges can benefit from coordination of services that are both youth guided and family driven. As this program has been scaled up and has an established vehicle of dissemination, it is in a unique position to be tested via more highly controlled and rigorous efficacy trials.