Accumulative adverse childhood experiences (ACEs) have been shown to increase the risk of physical and mental health issues in children. More recently, accumulative positive childhood experiences (PCEs) have been shown to lessen the negative impact of ACEs; however, the research to date has rarely included children in foster care. We investigated the cumulative association between ACEs and PCEs among youth in foster care (N = 19,888) ages 5-18 in a midwestern state between 2011-2023 on the likelihood of mood challenges (MCs), including affective dysregulation, anger control, anxiety, and depression. We further stratified by age, biological sex, and race. ACEs were associated with a greater likelihood of MCs, while PCEs were associated with decreased likelihood of these outcomes. The effect of PCEs was greater for affect dysregulation and anger control compared to anxiety and depression. In the affect dysregulation and anger control model, PCEs have associations, as measured by beta coefficients, nearly three times and ten times those of ACEs, respectively. Whereas PCEs also have a higher association in depression and anxiety models, the differences are less pronounced, highlighting the potentially distinct role of positive experiences with others on children's emotion regulation.

Background:Strength development in children across a range of psychiatric diagnoses may reduce needs for mental health, social, and functioning support over time. A strength-based adjunct to child and adolescent mental health may foster the developmental context most helpful for achieving desired outcomes with positive developmental cascading effects. Methods:We longitudinally examined changes across 5 years in the Child and Adolescent Needs and Strengths Assessment in 2- to 18-year-old children (N = 30,103) from a public mental health system. Results:First, children who began with a greater number of strengths consistently had fewer support needs, not only at entry but also at one, two, three, four, and five years later. Second, initial strengths appeared to have cumulative positive cascades with reduced support needs over time; each additional strength a child possessed at the beginning of service was associated with a progressively faster decrease in their support needs each subsequent year. Furthermore, developing more strengths during the service period also predicted lower support needs one, two, three, four, and five years later. Finally, the impact of developing strengths over time varied depending on the child's age. Developing more strengths was linked to an increasingly rapid reduction in support needs each year for 2- to 5-year-olds. In contrast, developing more strengths was linked to a progressively slower reduction in support needs each year for 11- to 15-year-olds. Conclusion:We provide empirical support suggesting both the clinical utility of strength-based behavioral health care and the value of strength development in relation to reduction in support needs as a transdiagnostic clinical dimension. In turn, positive developmental cascading effects during a sensitive period early in development suggest the importance of early intervention. Strength-based mental health classification and treatment systems can be balanced with a traditional mental health symptom focus to more broadly leverage individuals' abilities for adaptation.

Prior work suggests that children who are supported by their extended family kinship network experience fewer internalizing problems, with most of this support coming from the maternal side of the family. However, less is known about the unique contributions to well-being associated with maternal versus paternal extended family support among children in foster care, a gap in the literature this study sought to address. Participants included 336 children (six to 13 years) from the Illinois Department of Children and Family Services. Interviews with case workers and file reviews were used to measure support from the kinship network, and the Child and Adolescent Needs and Strengths (CANS) measure was used to assess children's longitudinal internalizing problems. Results from a Hierarchical Linear Model applied to the data indicated that both paternal and maternal kin support predicted lower internalizing problems trajectories as main effects, along with the interaction between both forms of support. Probing the interaction, optimal protection from internalizing problems was observed for children with higher levels of support from both the paternal and the maternal extended family. These results support efforts to engage both maternal and paternal kinship networks for children entering foster care.

Youth in foster care are at increased risk of developing internalizing symptoms, which are influenced by self-esteem. In the current study, we explored the relationship between explicit self-esteem (ESE), implicit self-esteem (ISE), and their interaction on internalizing symptoms among this population through negative binomial and hierarchical regressions. The sample included 131 youth aged 8–13 who provided information regarding ESE and ISE, as well as caseworker and caregiver reports of youth internalizing symptoms. The model assessing caregiver-reported internalizing symptoms was not significant. Lower ISE, experiencing physical abuse, and being a girl were positively associated with caseworker-reported internalizing symptoms. ISE was negatively associated with caseworker-reported internalizing symptoms for boys. Thus, boys in foster care with higher ISE are protected against internalizing symptoms. A significant interaction between ISE and sex indicated that ISE was negatively associated with caseworker-reported internalizing symptoms for boys but not girls. Thus, ISE may be uniquely protective for boys in foster care. Internalizing symptoms, Implicit Self-Esteem (ISE) and Explicit Self-Esteem (ESE) were assessed among children in foster care. ISE was associated with fewer internalizing symptoms, but ESE was not. Children’s sex moderated the association between ISE and internalizing symptoms. Increases in ISE was associated with lower internalizing symptoms for boys, but not girls. Models of childhood psychopathology should consider that non-conscious aspects of self may play differential roles according to sex.

For youth involved in foster care, maltreatment poses enormous challenges to healthy development. The involvement of kin and fictive kin in children's lives has been shown to be a protective factor following maltreatment and may therefore aid in youth's strength development. The present study investigated the association between kin and fictive kin involvement and longitudinal strengths development among youth in foster care (N = 300). We then examined whether any deleterious relationship between maltreatment and strengths development is buffered by kin and fictive kin involvement. Using the child and adolescent needs and strengths measure, youth strengths were categorized into four domains: community involvement (i.e., spiritual/religious, talents/interests, community life), psychosocial (i.e., optimism, coping/savoring, interpersonal), relationships (i.e., family, relationship permanence), and educational setting. Using multilevel modeling to estimate and predict strengths trajectories, results showed that kin and fictive kin involvement was associated gains in relationship and community involvement strengths. After adjusting for possible false discoveries, maltreatment was not associated with strengths trajectories, nor was the interaction between maltreatment and kin and fictive kin involvement. These results indicate that kin and fictive kin involvement may not just play a role in preventing negative outcomes but may also play a vital role in supporting youth thriving. These results further support efforts to find, engage, and support kin and fictive kin, so that their importance in children's development is realized. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Accumulative adverse childhood experiences (ACEs) have been shown to increase the risk of physical and mental health issues in children. More recently, accumulative positive childhood experiences (PCEs) have been shown to lessen the negative impact of ACEs; however, the research to date has rarely included children in foster care. We investigated the cumulative association between ACEs and PCEs among youth in foster care (N=19,888) ages 5-18 in a midwestern state between 2011-2023 on the likelihood of mood challenges (MC), including anger control, anxiety, depression, and affective dysregulation. We further stratified by age, sex, and race. ACEs were associated with a greater likelihood of MCs, while PCEs were associated with decreased likelihood of these outcomes. The offset effect of PCEs was greater for affect dysregulation and anger control compared to anxiety and depression, highlighting the potentially distinct role of positive experiences with adults on children's emotion regulation. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics committee/IRB of the State of Idaho Department of Health and Welfare gave ethical approval for this work. The IRB of the University of Kentucky gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The source data are not available to the public due to patient information protection requirement.

Objective This paper aims to examine the social support network structures of youth in out-of-home care and to delineate the type of social support activities provided by kin and fictive kin within the networks. Background Children in the child welfare system experience significant benefits from contact with non-custodial kin and fictive kin. However, little is known about the support activities they provide (e.g., childcare, transportation, etc.) and their relationship to the children (e.g., grandparents, godparents, etc.). Method Support provision and relationship to the child was measured through chart reviews and interviews with key stakeholders, allowing for a description of the amount of support provided by various types of kin and fictive kin. Latent Profile Analysis (LPA) was applied to the data to determine the presence of distinct profiles. Results A four-profile solution emerged: (1) Multigenerational Predominant Cousin, (2) Bigenerational Lower Involvement, (3) Bigenerational Predominant Fictive Kin, and (4) Multigenerational Predominant Aunt/Uncle), suggesting heterogeneity in the social support networks of children in foster care. Conclusion Children in foster care experience varying levels of social support, which were spearheaded by specific categories of caregivers who provide distinct types of support. Thus, there is great heterogeneity in the social support networks of children and youth in care. Implications The identified clusters suggest that “one-size fits all” policy practices may not be effective in engaging and maintaining social support for children in out-of-home care. This research indicates that child welfare practitioners need to appreciate the complexity of social support patterns available to children.

Little is known about the people who comprise the natural support networks of children in foster care and any barriers to their ability to provide social support. Based on interviews with the network members of 150 children entering foster care, four barriers (criminal history, child welfare history, domestic violence, and substance abuse) were submitted to a latent profile analysis. Two barrier profiles were identified: a lower-barrier profile (87%) and a higher-barrier profile (13%). These results suggest that barriers are common but not widespread across the networks of most children, with implications for what caseworkers can expect when working with families.

Disease-based models of health often fail to consider socio-economic models that perpetuate optimal health. The promotion of human thriving, rather than merely surviving, can be achieved by promoting optimal health indicators that facilitate overall wellbeing. Such interventions are those that promote a high quality of life, otherwise conceptualized as a “life worth living,” and can consist of life activities that exist outside of traditional health care intervention. Despite the continuous rise of health outcomes in Canada, it is likely that the cost associated with thriving may reduce the likelihood that optimal health will be achieved by many. Previous studies have generated the cost of thriving calculated for a single individual living in the Greater Toronto Area and have found that the cost of thriving is below the median annual income for this region. In the current study, this framework has been applied to three additional communities in Northwestern Ontario. Results indicated that when costs of thriving in Thunder Bay, Sioux Lookout, and a small remote community were compared, costs of thriving were highest in more rural and remote areas. Given the limited availability of regional data, it was not possible to generate specific total costs for all communities in this review. Overall, health promotion and wellbeing approaches can be diversified by using evidence-based, strength-based health interventions. Such approaches can be offered in conjunction with traditional public health initiatives, to better foster individual-level health (through disease reduction) and wellbeing (such as promoting hope, belonging, meaning, and purpose) within community.

The self-esteem construct has failed to demonstrate a consistent association with externalizing behaviors in children, leading to a basic question in the field: What is healthy self-esteem? From this has emerged evidence that self-esteem is represented at both explicit (Explicit Self Esteem; ESE) and implicit levels (Implicit Self Esteem; ISE). Studies with adults have found that discrepancies between ESE and ISE (e.g., high ESE, low ISE) are associated with narcissism and anger management difficulties. However, ISE is rarely studied in children and adolescents. This study explores whether ESE, ISE, and maltreatment (physical abuse yes/no) are associated with externalizing behaviors in a sample of children in foster care. A total of 161 children between the ages of 8 and 13 participated; 64.1% were African American and 53.9% were female. Children reported on ESE (Self-Perception Profile for Children; SPPC) and ISE (Name Letter Task; NLT). Foster parents completed the Child Behavior Checklist (CBCL) and caseworkers completed the Child and Adolescent Needs and Strengths (CANS) to assess children’s externalizing behaviors. The two consistent results across both analyses were that ESE alone and the three-way interaction between ESE, ISE, and physical abuse were associated with fewer externalizing behaviors. Probing the interaction revealed that children who had not experienced physical abuse and had discrepant self-esteem (low ESE, high ISE) experienced the highest levels of externalizing behaviors. These results indicate that both conscious and non-conscious aspects of self-esteem, notably their discrepancies, should be considered in mental health interventions, assessment, and research.

Bronfenbrenner's framework highlights the importance of considering ecological systems to understand child well-being. Children entering foster care often experience disruption across systems. Yet, prior research has focused on specific disruptions linked to outcomes. This longitudinal study examined the impact of multiple ecological disruptions (i.e., changes in or separation from siblings, friends, school, church, community) on children's internalizing symptoms and externalizing behaviors over time. This study included 211 children between the ages of 6 and 13 years (M = 10.23, SD = 2.37; 55.0% female; 57.3% African American). Children entered foster care for up to four reasons: Neglect (73.9%), physical abuse (29.4%), dependency (10%), and/or sexual abuse (9.5%). Most of the children experienced a change in school (64.0%), 46.9% were separated from siblings, 25.1% lost friends, 12.8% experienced community disruptions, and 10.0% were separated from church. Hierarchical Linear Modeling was employed to examine the association between ecological disruptions and longitudinal internalizing symptoms and externalizing behaviors, while controlling for baseline internalizing and externalizing, demographic variables (i.e., child age, gender, and race), and maltreatment severity. Maltreatment severity, along with school and community disruptions related to the presence of internalizing symptoms. Loss of friends was associated with the absence of externalizing behaviors, while community disruption was associated with the presence of externalizing behaviors. This study suggests that maintaining children's connections to their school and community is important for well-being. Under certain circumstances, separation from friends may relate to improved behavioral functioning. Future research should explore additional and interacting facets of children's ecological systems and related outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Generalist health interventions that aim to reduce chronic health disparities between Indigenous and non-Indigenous populations can be culturally adapted to better meet the needs of Indigenous people in Canada; however, little is known regarding best practices in implementing these adaptations. The present study first provides a review of the research process used to adapt a previous evidence-based housing initiative for Indigenous youth in Northwestern Ontario. Second, it includes an overview of the adaptations that were made and the associated rationale for such adaptations. Third, it examines the experiences of participants and staff involved in the cultural adaptation of the Housing Outreach Program Collaborative (HOP-C), a health intervention re-designed to improve physical and mental health outcomes, wellbeing, and social support for formerly homeless Indigenous youth as they secure housing. Qualitative feedback from interviews with 15 participants and eight program staff, in addition to one focus group with an additional six frontline workers, described perceived outcomes of the program's cultural adaptations. Modifications to the overall program structure, specific roles within the program (including counseling services, peer mentorship, cultural services, and case management), and adaptations to general implementation within the health organization providing the intervention were described by participants and staff as effective and helpful adaptations. The focus of Indigenous values at an organizational level led to consistent adaptations in counseling and case management to best meet the unique needs of the youth involved. Based upon participant interviews, recommendations to future adaptations are provided.

Housing stability is a complex concept to measure. One set of factors under consideration are those based on a personal or subjective sense of stability. We explore the variables associated with subjective stability and explore how subjective stability relates to housing stability across time. We use data from longitudinal, mixed methods research with 85 young people exiting homelessness. We find that subjective stability is a meaningful construct that can be validated through qualitative and quantitative data. The construct is primarily linked to indicators of environmental and social wellbeing. Subjective stability is also one of the only variables with a significant relationship to T2 housing stability. Qualitative analysis is used to explore these relationships in more detail. We conclude that subjective stability can provide holistic insight into the complex life circumstances influencing housing stability. However, this strength introduces complexity in that subjective stability appears to be developed in comparison with past experiences, as well as feelings of forward momentum on goals beyond housing.

Abstract The child welfare system has focused on kinship placements, which have been found to protect against disruption. The current study used survival analysis to investigate whether the type of placement (kin versus non-kin) related to the number of placement disruptions over time. Participants included 447 youth aged 5-15 years (M = 9.94, SD = 2.40; 50.8% female) from a larger project examining the outcomes of a family finding intervention. Using survival analysis, we examined the role of a kinship placement on placement disruptions across up to four placements while controlling for demographics, externalizing behaviors upon entry into care, treatment group (family finding versus control), and kin involvement outside of the placement. Results revealed that kin placements contributed to fewer disruptions across the first three placements. Findings align with policies prioritizing kin placements and suggest that the benefits of kinship care hold even for later disruptions. Thus, caseworkers should continue to consider kinship care, even if prior kin placements have disrupted.

The child welfare system has focused on kinship placements, which have been found to protect against disruption. However, the existing literature has primarily studied time to disruption for a single disruption despite the fact that many children have multiple placements while in care. The current study used survival analysis to investigate whether the type of placement (kin versus non-kin) related to time to placement disruption across up to four placements. Participants included 447 youth aged 5-15 years (M = 9.94, SD = 2.40; 50.8% female) from a larger project examining the outcomes of a family finding intervention. Using survival analysis, we examined the role of a kinship placement on placement disruptions across up to four placements while controlling for demographics, externalizing behaviors upon entry into care, treatment group (family finding versus control), and kin involvement outside of the placement. Results revealed that kin placements contributed to fewer disruptions across the first three placements. Findings align with policies prioritizing kin placements and suggest that the benefits of kinship care hold even for later disruptions. Thus, caseworkers should continue to consider kinship care, even if prior kin placements have disrupted.

This longitudinal study explored the unique profiles of maltreatment among youth in the child welfare system and examined their relation to mental health outcomes over time. We additionally examined the moderating role of age. Participants included 316 youth in the foster care system (age range: 6-13 years). Data were collected through the Department of Children and Family Services upon youths' entry into foster care, then quarterly for the duration of care. A latent profile analysis identified five profiles of maltreatment, categorized as primary neglect (PN), neglect and physical abuse (PA), complex trauma, complex trauma with severe sexual abuse (SA), and neglect with SA. A hierarchical general linear model applied to the data revealed that all four classes predicted higher internalizing symptom trajectories compared with the PN reference class, event rate ratios (eRRs) = 1.19-1.37, but none of these associations were significantly moderated by age. Membership in the two classes categorized by complex trauma predicted higher externalizing behavior trajectories as compared to the PN reference class, eRRs = 1.11-1.13. The relation between membership in the neglect with SA class and externalizing behaviors was moderated by age, eRR = 0.83. Finally, membership in all four classes predicted higher posttraumatic stress symptoms as compared with the reference group, eRRs = 1.84-2.45, and with all associations moderated by age, eRRs = 0.51-0.53. These findings provide insight into the maltreatment experiences of youth in the child welfare system and have important implications for treatment needs.

There is a high prevalence of Indigenous youth experiencing either precarious housing or homelessness in northwestern Ontario. Given that Indigenous pathways to homelessness can differ from non-Indigenous youth, interventions that address homelessness must also adapt to meet diverse needs. The Housing Outreach Program Collaborative (HOP-C) is a tertiary prevention intervention designed to provide congruent housing and peer and mental health supports for youth experiencing homelessness in Toronto, Ontario. Less is known regarding its adaptability to adequately serve Indigenous youth in northwestern Ontario. This study assessed the preliminary effectiveness and feasibility of an adaptation of the HOP-C North program for transitional aged Indigenous youth exiting homelessness in Thunder Bay, Ontario. Participants completed premeasures (n = 15) and postmeasures (n = 8) as well as qualitative interviews regarding their experiences in the program. Qualitative interviews were also conducted with staff (n = 14) engaged in implementing the program. After completing the HOP-C North program, participants reported improvements in a number of outcomes, including increased educational enrollment, attainment of employment, reduced hospitalizations, and increased engagement in clinical mental health services. Specific program aspects that participants found helpful included increased program flexibility, accessibility, emphasis on relationships, relevance of programming, fostering participant autonomy, and an adaptive approach to program implementation. These findings suggest that the HOP-C North model, when adapted, is a helpful program for Indigenous youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Little is known regarding the specific types of service models and collaborations that are necessary to support diverse populations of youth in transition out of homelessness. Transitional supports addressing the complex needs of this population are needed to stabilize the array of housing arrangements that youth access. This study was a pilot randomized controlled trial of one such critical time intervention, called the Housing Outreach Program-Collaboration (HOP-C). HOP-C is a multicomponent, multidisciplinary intervention that provides 6 months of mental health and peer support, along with transitional case management to youth who have transitioned into some form of stable housing out of homelessness. In this trial, 65 youth were randomized to receive HOP-C plus treatment as usual or transitional case management plus treatment as usual. Outcome assessments were completed by 30 treatment and 28 control participants. The findings suggest that this intervention is feasible with mental health, employment or education, and housing metrics favoring HOP-C with odds ratios ranging from 2.28 to 3.18 and better subjective housing stability. Other indicators showed less change. HOP-C appears feasible and should be tested in a fully powered trial, providing the intervention for a duration longer than 6 months. Overall, these data suggest the potential benefit in fostering city-level, multidisciplinary teams sourced from several organizations to support youth transitioning out of homelessness. Pragmatic trial method considerations for this population are also addressed as are the ethical considerations pertinent to engaging highly marginalized youth in clinical trials. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

This study examined the relation between paternal criminal justice involvement (i.e., biological fathers incarcerated upon children's entry into foster care) and emotional and behavioral outcomes among children in foster care; gender and racial differences were considered. Further, this study investigated whether in-person visits with fathers with and without criminal justice involvement related to children's outcomes. The sample included 274 children (M = 10.18, SD = 2.36 years) who entered foster care in 2011-2014 and whose fathers were allowed to have contact with them. About 15.7% of children had fathers who were incarcerated in a jail or prison when they entered foster care. Hierarchical Generalized Linear Modeling showed that paternal incarceration related to higher rates of externalizing behaviors but not internalizing symptoms. A significant interaction revealed the detrimental effects of incarceration were less pronounced among African American children. Finally, a significant interaction indicated that the association between paternal incarceration and externalizing behaviors was attenuated among children who had at least one visit with their fathers. These results support efforts to promote the psychological adjustment of children of color while also working to eliminate racial disparities in contact with the criminal justice system and promote health equity, along with encourage visits between fathers involved in the criminal justice system and children in foster care.

To identify different kin and fictive kin network support profiles available to children in foster care and examine whether these profiles predict behavioral outcomes. For kids in foster care, individual-level strengths have been shown to buffer the impact of maltreatment on negative outcomes. However, little is known about the possible benefit of kin and fictive kin networks on outcomes (e.g., internalizing symptoms and externalizing behaviors). This longitudinal study measured the involvement of 221 foster care children's (6–14 years of age) kin and fictive kin networks (e.g., visits, childcare, homework help, transportation). Strengths (e.g., coping, talents), maltreatment, internalizing symptoms, and externalizing behaviors were measured using the Child and Adolescent Needs and Strengths dataset. Using latent profile analysis, two kinship involvement profiles emerged: A low-involvement profile (75.5%) and a high-involvement profile (23.5%). The high-involvement profile was negatively associated with internalizing symptoms trajectories but not externalizing behavior trajectories. However, this effect was moderated by child-level strengths: Children with more strengths and in the high-involvement profile had the best internalizing symptoms outcomes. Finally, membership in the high-involvement profile buffered the negative impact of maltreatment on internalizing symptoms trajectories. The presence of both child strengths and kin and fictive kin involvement is associated with better outcomes. These results support efforts to promote policies and practices designed to engage kin and fictive kin networks, which is not currently a priority in child welfare.