Category: All Publications

Brief, group-based parent-child interaction therapy: Examination of treatment attrition, non-adherence, and non-response

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Blair, K., Topitzes, J., & Mersky, J. P. (2019). Brief, group-based parent-child interaction therapy: Examination of treatment attrition, non-adherence, and non-response. Children and Youth Services Review.

Abstract

Parent-Child Interaction Therapy (PCIT) has been shown to reduce challenging child behavior and improve parenting skills, yet treatment attrition, non-adherence and non-response remain matters of concern. This study analyzes rates and factors associated with attrition, non-adherence, and non-response using data from a randomized controlled trial of foster parent-child dyads who received brief, group-based PCIT. Multivariate logistic regressions demonstrated that, as compared to prior estimates of conventional outpatient PCIT, rates of treatment attrition, non-adherence and non-response from the group-based PCIT intervention were low. Compared to other racial/ethnic groups, rates of attrition were significantly higher among African American foster parents. No study variables were linked to treatment non-adherence. Foster parent ratings of child externalizing symptoms were positively associated with non-response. Implications for promoting retention and treatment effectiveness, successfully integrating PCIT into child welfare services and advancing future research are discussed.

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Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T‐SBIRT) within employment services: A feasibility trial

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Topitzes, J., Mersky, J. P., Mueller, D. J., Bacalso, E., & Williams, C. (2019). Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T‐SBIRT) within employment services: A feasibility trial. American Journal of Community Psychology.

Abstract

Research suggests that low‐income adults accessing employment services have experienced high levels of trauma exposure and associated consequences. Moreover, the health‐related effects of trauma undermine employment and employability. A trauma‐informed protocol—trauma screening, brief intervention, and referral to treatment or T‐SBIRT—was therefore implemented within employment service programs serving low‐income urban residents. To assess the feasibility of integrating T‐SBIRT within employment services, five domains were explored as follows: suitability, acceptability, client adherence, provider adherence or fidelity, and intended outcomes. With a sample of low‐income adults (N = 83), the study revealed that T‐SBIRT is suitable for employment service participants given high rates of trauma exposure (90.4% experienced two or more lifetime traumas), along with high rates of positive screening results for post‐traumatic stress disorder (48.8%), major depression (35.4%), and generalized anxiety (47.6%). Study participants appeared to find T‐SBIRT acceptable as evidenced by an 83% acceptance rate. All participants accepting T‐SBIRT services completed them, revealing strong client adherence. Provider adherence or model fidelity was high, that is, 98.5%. Finally, the majority of participants accepted a referral to a mental health care (i.e., 56.6%), and over three‐quarters accepted a referral to any outside service including primary or mental health care. Implications of findings are discussed.

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Applied and translational research on trauma-responsive programs and policy: Introduction to a special issue of the American Journal of Community Psychology

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Herrenkohl, T. I., Mersky, J. P., & Topitzes, J. (2019). Applied and translational research on trauma-responsive programs and policy: Introduction to a special issue of the American Journal of Community Psychology. American Journal of Community Psychology.

Abstract

The special issue highlights work across systems that include child welfare, education, juvenile justice and health, as well as agencies serving adults who are at‐risk for high levels of childhood and adult trauma exposure. While articles appearing in the special issue are not divided equally across these systems, they cover important and overlapping concepts within each. Some articles span more than a single system or domain of research, whereas others fit primarily within single area or domain. Articles provide new insights from research on practices, programs, and policies that help to transform systems so they are increasingly more responsive to the needs of vulnerable populations.

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Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample

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Mersky, J. P., & Plummer Lee, C. (2019). Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC Pregnancy and Childbirth, 19(387), 1-7.

Background
Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women’s birth outcomes.

Methods
We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant’s reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education.

Results
Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR = 1.12; 95% CI = 1.08–1.17), preterm birth (OR = 1.07; 95% CI = 1.01–1.12), and low birthweight (OR = 1.08; 95% CI = 1.03–1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern.

Conclusions
Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.

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Promoting evidence-based, trauma-informed social work practice

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Mersky, J. P., Topitzes, J., & Britz, L. (2019). Promoting evidence-based, trauma-informed social work practice. Journal of Social Work Education, 55(4), 645-657.

Abstract

Given the human costs of psychological trauma, social workers should be well versed in trauma-informed care (TIC). This framework helps guide the efforts of systems, organizations, and practitioners toward reducing trauma or mitigating its effects. The field has created TIC principles, although they have yet to be fully realized as practical applications. This article makes the case that theoretically and empirically grounded content on trauma should be foundational to social work education. We also argue that social work practice will be advanced by clearly defining trauma and by distinguishing TIC from trauma-focused and trauma-sensitive approaches. Finally, a TIC certificate program illustrates how graduate student training and social work practice are enhanced by integrating trauma content into classroom and field settings.

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Client and provider discomfort with an adverse childhood experiences survey

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Mersky, J. P., Plummer Lee, C., & Gilbert, R. M. (2019). Client and provider discomfort with an adverse childhood experiences survey. American Journal of Preventive Medicine, 57(2), e51-e58.

Introduction
Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients’ discomfort when they are asked similar questions by direct care providers, such as home visitors.

Methods
This study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort.

Results
More than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31).

Conclusions
Results indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.

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Do parents’ adverse childhood experiences influence treatment responses to Parent-Child Interaction Therapy? An exploratory study with a child welfare sample

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Blair, K., Topitzes, J., & Mersky, J. P. (2019).  Do parents’ adverse childhood experiences influence treatment responses to Parent-Child Interaction Therapy? An exploratory study with a child welfare sample. Child & Family Behavior Therapy, 41(2), 73-83.

Abstract

This exploratory study of 23 parent–child dyads receiving child welfare services examined the association between the number of adverse childhood experiences (ACEs) parents reported and their children’s externalizing behaviors. We also assessed whether the effects of Parent-Child Interaction Therapy (PCIT) on externalizing behaviors varied by parents’ ACE histories. Results indicated that parents’ ACE scores were associated with child externalizing symptoms at baseline, but not at a second postbaseline assessment. Although all parents reported reductions in child externalizing behavior from baseline to postbaseline, only reductions reported by parents with four or more ACEs were statistically significant. Implications for implementing PCIT with trauma-exposed families are discussed.

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Those who disappear and those who say goodbye: Patterns of attrition in long-term home visiting

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Janczewski, C. E., Mersky, J. P., & Brondino, M. J. (2019). Those who disappear and those who say goodbye: Patterns of attrition in long-term home visiting. Prevention Science, 1-11.

Abstract

Most evidence-based home visiting models are designed to support families from pregnancy through a child’s second birthday, though programs often struggle to retain families for this long. Previous research on client and program factors that predict attrition has produced mixed results, which may be partly because attrition is typically conceptualized as a homogeneous phenomenon. The current study sampled 991 women who received home visiting services from one of 26 agencies in a statewide network of evidence-based programs. Participants who remained in services were compared to three types of early leavers: those who communicated their intent to leave (active attrition), those whose cases closed due to non-participation (passive attrition), and those who moved from the service area. Within a year of enrollment, 42% of women exited services. Cox regression results suggested no differences in the timing of service exit among the three attrition types. Multinomial analyses revealed that, when compared to participants who remained in services, active leavers were more likely to be married or cohabitating, while passive leavers were more likely to be younger, African American, unemployed, and to have a home visitor with low job satisfaction. Participants who moved were less likely to be Latina and employed. An early pattern of inconsistent attendance was the strongest predictor of active and passive withdrawal. Rates of attrition varied by home visiting model, though inconsistent attendance was a robust predictor of passive attrition across models. This study underscores the need to scrutinize service duration as a metric of success in home visiting.

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Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms

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Mersky, J. P., & Janczewski, C. E. (2018). Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms. Maternal and Child Health Journal.

Objectives
In this study, we examined the prevalence of postpartum depression (PPD) and its association with select demographic factors and antenatal conditions. We also investigated whether greater exposure to adverse childhood experiences (ACEs) is associated with PPD, and if antenatal conditions mediate the ACE-PPD relationship.

Methods 
Data were collected from 735 low-income women receiving home visiting services. Descriptive and bivariate analyses provided estimates of PPD and its correlates, and nested path analyses were used to test for mediation.

Results 
We found that rates of PPD were high compared to prevalence estimates in the general population. Sample rates of antenatal depression were even higher than the rates of PPD. Omnibus tests revealed that PPD did not vary significantly by maternal age or race/ethnicity, although Hispanic women consistently reported the lowest rates. American Indian women and non-Hispanic white women reported the highest rates. PPD was significantly associated with increased exposure to ACEs. Nested path models revealed that the effects of ACEs were partially mediated by three antenatal conditions: intimate partner violence (IPV), perceived stress, and antenatal depression.

Conclusions for Practice 
Supporting prior research, rates of PPD appear to be high among low-income women. ACEs may increase the risk of antenatal IPV and psychological distress, both of which may contribute to PPD. The findings have implications for screening and assessment as well as the timing and tailoring of interventions through home visiting and other community-based services.

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Poor mental health among low-income women in the U.S.: The roles of adverse childhood and adult experiences

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Mersky, J. P., Janczewski, C. E., & Nitkowski, J. C. (2018). Poor mental health among low-income women in the U.S.: The roles of adverse childhood and adult experiences. Social Science and Medicine.

Rationale
It is well established that exposure to a greater number of adverse childhood experiences (ACEs)increases the risk of poor physical and mental health outcomes. Given the predictive validity of ACE scores and other cumulative risk metrics, a similar measurement approach may advance the study of risk in adulthood.Objective:We examined the prevalence and interrelations of 10 adverse adult experiences, including household events such as intimate partner violence and extra familial events such as crime victimization. We also tested the relation between cumulative adult adversity and later mental health problems, and we examined whether adult adversity mediates the link between childhood adversity and mental health.

Methods
Data were collected from 501 women in the Families and Children Thriving Study, a longitudinal investigation of low-income families that received home visiting services in Wisconsin. We conducted correlation analyses to assess interrelations among study measures along with multivariate analyses to test the effects of childhood and adult adversity on three outcomes: depression, anxiety, and post traumatic stress disorder (PTSD).We then fit a structural equation model to test whether the effects of childhood adversity on mental health are mediated by adult adversity.

Results
Over 80% of participants endorsed at least one adverse adult experience. Adult adversities correlated with each other and with the mental health outcomes. Controlling for ACEs and model covariates, adult adversity scores were positively associated with depression, anxiety, and PTSD scores. Path analyses revealed that the ACE-mental health connection was mediated by adult adversity.

Conclusion
Our findings indicate that mental health problems may be better understood by accounting for processes through which early adversity leads to later adversity. Pending replication, this line of research has the potential to improve the identification of populations that are at risk of poor health outcomes.

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Mediational pathways of meditation and exercise on mental health and perceived stress: A randomized controlled trial. Journal of Health Psychology

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Goldstein E, Topitzes J, Brown RL, et al. (2018) Mediational pathways of meditation and exercise on mental health and perceived stress: A randomized controlled trial. Journal of Health Psychology.

Abstract: This study investigated the effects of mindfulness and exercise training on indicators of mental health and stress by examining shared mediators of program effects. Community-recruited adults, (N = 413), were randomized into one of three conditions: (a) mindfulness-based stress reduction (MBSR), (b) moderate intensity exercise, or (c) wait-list control. Composite indicator structural equation models estimated direct, indirect and total effects. The results showed that mindfulness-based self-efficacy fulfilled a prominent role in mediating both meditation and exercise program effects. Our findings demonstrated that mindfulness and exercise training share similar mechanisms that can improve global mental health, including adaptive responses to stress.

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Racial and Ethnic Differences in the Prevalence of Adverse Childhood Experiences: Findings from a Low-Income Sample of U.S. Women

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Mersky, J. P., Janczewski, C. E. (2018). Racial and Ethnic Differences in the Prevalence of Adverse Childhood Experiences: Findings from a Low-Income Sample of U.S. Women. Child Abuse and Neglect.

Objective
Despite great interest in adverse childhood experiences (ACEs), there has been limited research on racial and ethnic differences in their prevalence. Prior research in the United States suggests that the prevalence of ACEs varies along socioeconomic lines, but it is uncertain whether there are racial/ethnic differences in ACE rates among low-income populations.

Method
This study examined the distribution of ACEs in a sample of 1523 low-income women in Wisconsin that received home visiting services. Participants ranging in age from 16 to 50 years were coded into five racial/ethnic groups, including Hispanics and four non-Hispanic groups: blacks, whites, American Indians, and other race. Following measurement conventions, ten dichotomous indicators of child maltreatment and household dysfunction were used to create a composite ACE score. Five other potential childhood adversities were also assessed: food insecurity, homelessness, prolonged parental absence, peer victimization, and violent crime victimization.

Results
Results from bivariate and multivariate analyses revealed that, while rates of adversity were high overall, there were significant racial/ethnic differences. Total ACE scores of American Indians were comparable to the ACE scores of non-Hispanic whites, which were significantly higher than the ACE scores of non-Hispanic blacks and Hispanics. Whites were more likely than blacks to report any abuse or neglect, and they were more likely than blacks and Hispanics to report any household dysfunction.

Conclusion
The results underscore the need to account for socioeconomic differences when making racial/ethnic comparisons. Potential explanations for the observed differences are examined.

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Translating Evidence-Based Treatments into Child Welfare Services Through Community-University Partnerships: A Case Example of Parent-Child Interaction Therapy

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Mersky, J. P., Topitzes, J., & Blair, K. (2017). Translating evidence-based treatments into child welfare services through community-university partnerships: A case example of parent-child interaction therapy. Children and Youth Services Review.

Objective
Children served by the child welfare system count among society’s most vulnerable members given their history of abuse, neglect, and other potentially traumatic experiences. Once they enter the system, however, these children seldom receive empirically validated interventions to mitigate the effects of trauma. This article highlights the promise of parent-child interaction therapy (PCIT), an evidence-based treatment (EBT) for trauma-exposed children in the child welfare system. Barriers to implementing PCIT and other EBTs in child welfare are discussed along with ways that community-university partnerships can help to navigate these barriers. Preliminary supporting evidence from a community-university partnership in Wisconsin is presented, followed by a set of recommendations for future work aimed at translating science into practice.

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Complementing SBIRT for Alcohol Misuse with SBIRT for Trauma: A Feasibility Study

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Topitzes, J., Berger, L., Otto-Salaj, L., Mersky, J.P., Weeks, F., Ford, J. (2017). Complementing SBIRT for alcohol misuse with SBIRT for trauma: A feasibility study. Journal of Social Work Practice in the Addictions.

Objective
Reducing alcohol misuse is a priority for U.S. health officials considering that misuse of alcohol is a leading preventable cause of morbidity and mortality. Consequently, health centers are routinely integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol misuse within usual care. Although SBIRT is well validated among general patient samples, results have not generalized to drinkers with probable alcohol use disorder, and little is known about the efficacy of SBIRT with low-income, minority patients. Members of these groups are of particular concern because they are at risk for experiencing high rates of trauma exposure concurrent with high rates of alcohol-related problems. Therefore, innovative approaches to delivering SBIRT might be needed in order to enhance the efficacy of SBIRT with these high risk groups and to meet the Grand Challenge of reducing alcohol misuse.

Method
This study combined SBIRT with a model designed to address psychological trauma: T-SBIRT. With a sample of 112 adults, most of whom were African American or Latino/a and of low-income status, authors analyzed multiple indicators of feasibility: a) suitability of treatment, b) acceptability of treatment, c) patient compliance (also known as patient adherence), d) treatment integrity, and e) intended outcomes.

Results
Results indicated that T-SBIRT is suitable for and acceptable to patients accessing community-based health services, and that T-SBIRT can generate high rates of patient compliance. Moreover, behavioral health providers can implement T-SBIRT with high rates of model fidelity, and the model can promote high referral acceptance rates to specialty treatment, particularly among patients with probable alcohol use disorder.

Conclusion
It is feasible to implement T-SBIRT within community-based primary health clinics according to both patient and provider indicators of feasibility. T-SBIRT may prove a promising supplement to SBIRT particularly for service recipients at-risk of alcohol use disorder and/or for low income, ethnic racial minority patients.

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Rethinking the Measurement of Adversity: Moving Toward Second-Generation Research on Adverse Childhood Experiences

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Mersky, J. P., Janczewski, C. E., & Topitzes, J. (2017). Rethinking the measurement of adversity: Moving toward second-generation research on adverse childhood experiences. Child Maltreatment.

Objective
Research on adverse childhood experiences (ACEs) has unified the study of interrelated risks and generated insights into the origins of disorder and disease. Ten indicators of child maltreatment and household dysfunction are widely accepted as ACEs, but further progress requires a more systematic approach to conceptualizing and measuring ACEs.

Method
Using data from a diverse, low-income sample of women who received home visiting services in Wisconsin (N = 1,241), this study assessed the prevalence of and interrelations among 10 conventional ACEs and 7 potential ACEs: family financial problems, food insecurity, homelessness, parental absence, parent/sibling death, bullying, and violent crime. Associations between ACEs and two outcomes, perceived stress and smoking, were examined. The factor structure and test–retest reliability of ACEs was also explored.

Results
As expected, prevalence rates were high compared to studies of more representative samples. Except for parent/sibling death, all ACEs were intercorrelated and associated at the bivariate level with perceived stress and smoking. Exploratory factor analysis confirmed that conventional ACEs loaded on two factors, child maltreatment and household dysfunction, though a more complex four-factor solution emerged once new ACEs were introduced. All ACEs demonstrated acceptable test–retest reliability.

Conclusion
Implications and future directions toward a second generation of ACE research are discussed.

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Adverse Childhood Experiences, Health, and Employment: A Study of Men Seeking Job Services

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Topitzes, J., Pate, D., Berman, N., Medina-Kirchner, C. (2016). Adverse childhood experiences, health, and employment: A study of men seeking job services. Child Abuse and Neglect.

Objective
The present study explored factors associated with barriers to current employment among 199 low-income, primarily Black American men seeking job services.

Method
The study took place in an urban setting located within the upper Midwest region of the U.S., where the problem of Black male joblessness is both longstanding and widespread. Recent research suggests that Black male joblessness regionally and nationally is attributable to myriad macro- and micro-level forces. While structural-level factors such as migration of available jobs, incarceration patterns, and racism have been relatively well-studied, less is known about individual-level predictors of Black male joblessness, which are inextricably linked to macro-level or structural barriers. This study therefore examined relations between adverse childhood experiences (ACEs), health-related factors, and employment-related problems.

Results
Participants faced both specific and cumulative childhood adversities at much higher rates than men from more economically advantaged contexts. In addition, the physical, behavioral, and mental health of the study participants were, according to self-report survey results, notably worse than that of the general population or alternative samples.

Conclusion
Finally, results indicated that exposure to ACEs may have helped to undermine the men’s ability to attain current employment and that drug problems along with depression symptoms helped explain the link between ACEs and employment barriers. Theoretical and practical implications of results are explored.

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What’s So Different About Differential Response? A Multilevel and Longitudinal Analysis of Child Neglect Investigations

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Janczewski, C.E., Mersky, J.P. (2016). What’s so different about differential response? A multilevel and longitudinal analysis of child neglect investigations. Children and Youth Services Review.

Objective
Differential response (DR) is a system reform that allows child protective services (CPS) agencies to divert low-to-moderate risk families from an investigative track to an alternate track that does not require a maltreatment disposition or identification of an alleged perpetrator. Knowledge of how DR alters the flow of cases through CPS systems has been restricted by methodological limitations in prior research.

Method
This study uses cross-sectional and longitudinal data from the National Child Abuse and Neglect Data System (NCANDS) child file to examine the extent to which DR implementation affects the number and demographic composition of cases investigated for neglect.

Results
Results from multivariate, multilevel cross-sectional analysis of 2010 data indicated that investigations were 2.4 times more likely to be substantiated in DR counties than in non-DR counties. Children with a previous substantiated report were also more likely to have a current report substantiated and this difference was significantly greater in DR counties than in non-DR counties. Child race and ethnicity did not predict substantiation decisions. Results from a mixed-effect longitudinal analysis of 997,512 cases from 269 counties between 2001 and 2010 suggest that the rate of investigations fell sharply nationwide within three years of DR implementation. However, substantiation rates did not change as a result of DR implementation. Instead, analysis indicated differences between DR and non-DR counties emerged before the launch of DR.

Conclusion
The findings highlight the benefit of using “big data” and longitudinal analysis to assess large-scale policy changes.

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Enhancing Foster Parent Training with Parent-Child Interaction Therapy: Evidence from a Randomized Field Experiment

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Mersky, J.P., Topitzes J., Janczewski, C.E., McNeil, C. (2015). Enhancing foster parent training with parent-child interaction therapy: evidence from a randomized field experiment. Journal of the Society for Social Work and Research.

Objective
Research indicates that foster parents often do not receive sufficient training and support to help them meet the demands of caring for foster children with emotional and behavioral disturbances. Parent-Child Interaction Therapy (PCIT) is a clinically efficacious intervention for child externalizing problems, and it also has been shown to mitigate parenting stress and enhance parenting attitudes and behaviors. However, PCIT is seldom available to foster families, and it rarely has been tested under intervention conditions that are generalizable to community-based child welfare service contexts. To address this gap, PCIT was adapted and implemented in a field experiment using two novel approaches – group-based training and telephone consultation – both of which have the potential to be integrated into usual care.

Method
This study analyzes 129 foster-parent-child dyads who were randomly assigned to one of three conditions: (a) waitlist control, (b) brief PCIT, and (c) extended PCIT. Self-report and observational data were gathered at multiple time points up to 14 weeks post baseline.

Results
Findings from mixed-model, repeated measures analyses indicated that the brief and extended PCIT interventions were associated with a significant decrease in self-reported parenting stress. Results from mixed-effects generalized linear models showed that the interventions also led to significant improvements in observed indicators of positive and negative parenting. The brief course of PCIT was as efficacious as the extended PCIT intervention.

Conclusion
The findings suggest that usual training and support services can be improved upon by introducing foster parents to experiential, interactive PCIT training.

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The Influence of Differential Response on Decision-Making in Child Protective Service Agencies

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Janczewski, C.E. (2015). The influence of differential response on decision-making in child protective service agencies. Child Abuse and Neglect.

Objective
Differential response (DR) profoundly changes the decision pathways of public child welfare systems, yet little is known about how DR shapes the experiences of children whose reports receive an investigation rather than an alternate response. Using data from the National Child Abuse and Neglect Data System (NCANDS), this study examined the relationship between DR implementation and decision outcomes in neglect cases, as measured by investigation, substantiation, and removal rates in 297 U.S. counties.

Method
Multivariate regression models included county-level measures of child poverty and proportions of African American children. Path analyses were also conducted to identify mediating effects of prior decision points and moderating effects of DR on poverty and race’s influence on decision outcomes.

Results
Results indicate that compared to non-DR counties, those implementing DR have significantly lower investigation and substantiation rates within county populations but higher substantiation rates among investigated cases. Regression models showed significant reductions in removal rates associated with DR implementation, but these effects became insignificant in path models that accounted for mediation effects of previous decision points. Findings also suggest that DR implementation may reduce the positive association between child poverty rates and investigation rates, but additional studies with larger samples are needed to confirm this moderation effect. Two methods of calculating decision outcomes, population- and decision based enumeration, were used, and policy and research implications of each are discussed.

Conclusion
This study demonstrates that despite their inherit complexity, large administrative datasets such as NCANDS can be used to assess the impact of wide-scale system change across jurisdictions.

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Implementation of Parent-Child Interaction Therapy Within Foster Care: An Attempt to Translate an Evidence-Based Program Within a Local Child Welfare Agency

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Topitzes, J., Mersky, J.P., McNeil, C. (2015). Implementation of parent-child interaction therapy within foster care: An attempt to translate an evidence-based program within a local child welfare agency. Journal of Public Child Welfare.

This article describes an implementation project in which parent-child interaction therapy was adapted for and tested within foster parent training services. The authors recount multiple steps involved in translating an evidence-based intervention to child welfare services: (a) specifying the child welfare context for implementation and testing purposes, choosing an intervention model that responded to child welfare service needs, and tailoring the model for the child welfare setting; (b) securing external funding and initiating sustainability plans; and (c) forging a university-community partnership. The article concludes with a discussion of promising preliminary study results, future implementation plans, and lessons learned.

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Adapting Parent-Child Interaction Therapy to Foster Care: Outcomes From a Randomized Trial

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Mersky, J.P., Topitzes, J., Grant-Savela, S., Brondino, M., McNeil, C. (2014). Adapting parent-child interaction therapy to foster care: Outcomes from a randomized trial. Research on Social Work Practice.

Objective
This study presents outcomes from a randomized trial of a novel Parent-Child Interaction Therapy (PCIT) model for foster families. Differential effects of two intervention doses on child externalizing and internalizing symptoms are examined.

Method
A sample of 102 foster children was assigned to one of three conditions—brief PCIT, extended PCIT, or wait-list control. The brief and extended groups received 2 days of PCIT training and 8 weeks of telephone consultation. The extended PCIT group received an additional booster training plus 6 more weeks of consultation. Wait-list controls received services as usual. Tests of change over time were estimated using mixed-model repeated measures analysis of covariance.

Results
Compared to controls, children in both PCIT groups exhibited a greater reduction in externalizing and internalizing scores over time. Pairwise contrasts of the two PCIT conditions yielded mixed results.

Conclusion
Results indicate that PCIT can be tailored efficaciously for foster families using alternative treatment modalities.

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Impacts of Adverse Childhood Experiences on Health, Mental Health, and Substance Use in Early Adulthood: A Cohort Study of an Urban, Minority Sample in the U.S.

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Mersky, J.P., Topitzes, J., Reynolds, A. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse and Neglect.

Objective
Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health-related outcomes in later life. Less is known about the consequences of ACEs in early adulthood or among diverse samples. Therefore, we investigated the impacts of differential exposure to ACEs on an urban, minority sample of young adults.

Method
Health, mental health, and substance use outcomes were examined alone and in aggregate. Potential moderating effects of sex were also explored. Data were derived from the Chicago Longitudinal Study, a panel investigation of individuals who were born in 1979 or 1980. Main-effect analyses were conducted with multivariate logistic and OLS regression. Sex differences were explored with stratified analysis, followed by tests of interaction effects with the full sample.

Results
Results confirmed that there was a robust association between ACEs and poor outcomes in early adulthood. Greater levels of adversity were associated with poorer self-rated health and life satisfaction, as well as more frequent depressive symptoms, anxiety, tobacco use, alcohol use, and marijuana use. Cumulative adversity also was associated with cumulative effects across domains. For instance, compared to individuals without an ACE, individuals exposed to multiple ACEs were more likely to have three or more poor outcomes (OR range = 2.75–10.15) and four or more poor outcomes (OR range = 3.93–15.18). No significant differences between males and females were detected.

Conclusion
Given that the consequences of ACEs in early adulthood may lead to later morbidity and mortality, increased investment in programs and policies that prevent ACEs and ameliorate their impacts is warranted.

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Adult Resilience Among Maltreated Children: A Prospective Investigation of Main Effect and Mediating Models

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Topitzes, J., Mersky, J.P., Dezen, K., Reynolds, A. (2013). Adult resilience among maltreated children: A prospective investigation of main effect and mediating models. Children and Youth Services Review.

Objective

Studies examining resilience to child maltreatment reveal that maltreatment victims can achieve adaptive functioning in several areas of development; however, few of these individuals persistently demonstrate resilience across multiple domains. The majority of these investigations define adjustment with a limited number of outcomes measured proximal in time to the maltreatment experience. In contrast, this study measured adjustment across a diverse set of domains during early adulthood (ages 16–24), a number of years after the occurrence of childhood maltreatment (ages 0–11).

Method

Main effect and mediation analyses were conducted. Data were derived from the Chicago Longitudinal Study, an examination of 1539 minority individuals born in low-income Chicago-area neighborhoods in 1979 or 1980. Study participants were followed prospectively from birth through age 24. Maltreatment data originated from official court and child protective service records. Parent report, self report, and administrative sources informed covariate, mediator and outcome measures.

Results

Results from multivariate probit regression revealed that childhood maltreatment significantly and negatively predicted adult resilience. Exploratory and confirmatory mediation analyses showed that the following adolescent indicators helped explain the long-term association between childhood maltreatment and young adult adjustment: school moves and out-of-home placement, reading ability, acting out behavior, social skills, juvenile delinquency, commitment to school, and expectation to attend college.

Conclusion

Implications of results are explored.

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Adult Well-Being of Foster Care Alumni: Comparisons to Other Child Welfare Recipients and a Non-Child Welfare Sample in a High-Risk, Urban Setting

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Mersky, J.P., Janczewski, C.E. (2013). Adult well-being of foster care alumni: Comparisons to other child welfare recipients and a non-child welfare sample in a high-risk, urban setting. Children and Youth Services Review.

Objective
Research has shown that children placed in foster care fall below population norms on many indicators of well-being. Yet few studies have been designed to distill the effects of foster care from conditions that precede foster care. Based on the available evidence, it is also uncertain whether the purported effects of foster care are lasting. This study used data gathered prospectively from an economically disadvantaged, urban cohort to examine whether foster care is associated with decreased educational and economic attainments as well as increased criminality in adulthood.

Method
Individuals who were placed in foster care after an indicated allegation of maltreatment were compared to three naturally occurring groups: (a) maltreatment victims who did not reside in foster care, (b) individuals without an indicated maltreatment allegation who were raised in a household with a Child Protective Services (CPS) record, and (c) individuals without an individual or household record of CPS involvement.

Results
Using multiple estimation procedures, we found that all participants with a CPS record fared worse in adulthood than their peers without a CPS record. Despite their poor outcomes, foster children functioned as well as other CPS recipients who did not reside in foster care.

Conclusion
Our findings indicate that caution is warranted when attributing dysfunction observed in foster children to the effects of foster care. Implications for prevention and intervention within the context of child welfare are discussed.

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From Child Maltreatment to Violent Offending: An Examination of Mixed-Gender and Gender-Specific Models

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Topitzes, J., Mersky, J.P., Reynolds, A. (2012). From child maltreatment to violent offending: An examination of mixed-gender and gender-specific models. Journal of Interpersonal Violence.

Objective

Research suggests that child maltreatment predicts juvenile violence, but it is uncertain whether the effects of victimization persist into adulthood or differ across gender. Furthermore, we know little about the mechanisms underlying the victim–perpetrator cycle for males and females. Consequently, this study analyzed associations between child maltreatment and a number of adult measures of violent offending within mixed-gender and gender-specific models. Along with main effects, the study directly tested the moderating effects of gender on the maltreatment–violence link and analyzed theory-informed gender-specific mediators.

Method

Data were derived from the Chicago Longitudinal Study, a panel investigation of 1,539 low-income minority participants born in 1979 or 1980. Child welfare, juvenile court, and criminal court records informed the study’s explanatory and outcome measures. Prospectively collected covariate and mediator measures originated with parent, teacher, and self-reports along with several administrative sources.

Results

Results indicated that child maltreatment, ages 0 to 11, significantly predicted all study indicators of violence in the full sample and most study outcomes in the male and female subsamples. In no instance did gender moderate the maltreatment–violence association. Late childhood/early adolescence environmental instability, childhood externalizing behaviors, and adolescent peer social skills fully mediated the maltreatment–violence nexus among males. Adolescent externalizing behavior partially mediated the relationship of interest among females. Evidence also indicated that internalizing processes protected females who had been maltreated in childhood against perpetrating violence later in life.

Conclusion

Implications of results are discussed.

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Unsafe at Any Age: Linking Childhood and Adolescent Maltreatment to Delinquency and Crime

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Mersky, J.P., Topitzes, J., Reynolds, A. (2011). Unsafe at any age: linking childhood and adolescent maltreatment to delinquency and crime. Journal of Research in Crime and Delinquency.

Objective
This study compares the effects of childhood maltreatment and adolescent maltreatment on delinquency and crime, including violent and nonviolent offending.

Method
Data were derived from the Chicago Longitudinal Study, a prospective investigation of 1,539 underprivileged, minority subjects.

Results
Results confirmed that rates of overall delinquency, along with violent, drug, and property offending specifically, were elevated among childhood and adolescent maltreatment victims compared to their nonmaltreated peers. Childhood maltreatment was associated with delinquency independent of adolescent maltreatment, and strong connections between adolescent maltreatment and delinquency were present independent of prior victimization. Childhood maltreatment was also significantly related to a panel of adult crime measures, while the effects of adolescent maltreatment on adult crime were less robust.

Conclusion
The study findings suggest that maltreatment at any age increases the risk of future offending, implying that investments in prevention and intervention strategies throughout childhood and adolescence may reduce delinquency and crime.

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Maltreatment Prevention Through Early Childhood Intervention: A Confirmatory Evaluation of the Chicago Child-Parent Center Preschool Program

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Mersky, J.P., Topitzes, J., Reynolds, A. (2011). Maltreatment prevention through early childhood intervention: A confirmatory evaluation of the Chicago child-parent center preschool program. Children and Youth Services Review.

Objective
Increased recognition of the consequences associated with child maltreatment has led to greater emphasis on its prevention. Promising maltreatment prevention strategies have been identified, but research continues to suffer from methodological limitations and a narrow focus on select prevention models. This investigation uses data from the Chicago Longitudinal Study to examine mediating mechanisms that link the Chicago Child-Parent Center preschool program to a reduction in overall child maltreatment and, more specifically, child neglect.

Method
We use structural equation modeling to test child, family, and school measures hypothesized to mediate the effects of CPC participation on maltreatment and neglect.

Results
Results indicate that a substantial proportion of the program’s impacts can be accounted for by family support processes, including increased parent involvement in school and maternal educational attainment as well as decreased family problems. The CPC program’s association with reduced school mobility and increased attendance in higher-quality schools also significantly mediated its effects on maltreatment and neglect. Further, a decrease in troublemaking behavior contributed modestly to mediating the program’s association with maltreatment but not neglect.

Conclusion
We discuss the implications of these results for the field of maltreatment prevention.

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Child Maltreatment and Offending Behavior Gender-Specific Effects and Pathways

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Topitzes, J., Mersky, J.P., Reynolds, A. (2011). Child maltreatment and offending behavior: Gender-specific effects and pathways. Criminal Justice and Behavior.

Objective

This study assessed the association between child maltreatment (ages 0–11) and offending behavior within gender-specific models.

Method

Prospectively collected data, including official measures of maltreatment and offending, were derived from the Chicago Longitudinal Study, a panel study of 1,539 low-income minority participants.

Results

Multivariate probit analyses revealed that maltreatment significantly predicted delinquency for males but not females yet forged a significant relation to adult crime for both genders. Exploratory, confirmatory, and comparative analyses suggested that mechanisms linking maltreat-ment to adult crime primarily differed across gender. For males, childhood-era externalizing behavior and school commitment along with adolescent-era socioemotional skills, delinquency, and educational attainment explained the maltreatment-crime nexus. For females, childhood-era parent factors along with adolescent indicators of externalizing behavior, cognitive performance, mobility, and educational attainment partially mediated the maltreatment–crime relation.

Conclusion

Implications of results were explored.

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Comparing Early Adult Outcomes of Maltreated and Non-Maltreated Children: A Prospective Longitudinal Investigation

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Mersky, J.P., Topitzes, J. (2010). Comparing early adult outcomes of maltreated and non-maltreated children: A prospective longitudinal investigation. Children and Youth Services Review.

Objective
Using prospective data from the Chicago Longitudinal Study, this investigation examined associations between child maltreatment and an array of outcomes in early adulthood.

Results
Findings from bivariate and multivariate analyses indicated that verified maltreatment victims fared significantly worse than participants without an indicated maltreatment report on indicators of educational and economic attainment, criminal offending, and behavioral and mental health. Results also revealed that, while many maltreated children appeared to function well on individual outcomes, a large majority did not achieve criteria for resilience when development was assessed across domains. For example, non-maltreated participants were more than twice as likely to attain five or more positive outcomes (38.2%) on an aggregate seven-item index as the maltreated group (15.7%).

Conclusion
These findings suggest that child maltreatment is associated with extensive and enduring impacts, reinforcing the need to develop and implement effective maltreatment prevention and intervention strategies.

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Child Maltreatment and Adult Cigarette Smoking: A Long-term Developmental Model

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Topitzes, J., Mersky, J.P., Reynolds, A. (2009). Child maltreatment and adult cigarette smoking: A long-term developmental model. Journal of Pediatric Psychology.

Objective

To examine: (a) child maltreatment’s association with young adult daily cigarette smoking, (b) variations in this association by gender, and (c) mediators of this association.

Method

For all study participants (N¼1,125, 94% African American), data from multiple sources (e.g., child welfare records) were collected prospectively at child, adolescent, and young adult time points. Authors enlisted multivariate probit regression for objectives a and b versus exploratory and confirmatory mediation strategies for objective c.

Results

Maltreatment was significantly associated with daily cigarette smoking. Although not moderated by gender, this relation was fully mediated by adolescent indicators of family support/stability, social adjustment, and cognitive/school performance along with young adult indicators of educational attainment, life satisfaction, substance abuse, and criminality.

Conclusion

Maltreatment places low-income, minority children at risk for daily cigarette smoking and other deleterious young adult health outcomes. Recommended treatment targets include family support/stability, emotion regulation, social skills, and cognitive/academic functioning.

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Educational Success and Adult Health: from the Chicago Longitudinal Study

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Topitzes, J., Godes, O, Mersky, J.P., Ceglarek, S., Reynolds, A. (2009). Educational success and adult health: from the Chicago Longitudinal Study. Prevention Science: The Official Journal for the Society of Prevention Research.

Objective

Growing evidence indicates that education is associated with health, yet we lack knowledge about the specific educational experiences influencing health trajectories. This study examines the role school factors play in the emergence of poor young adult health outcomes for a low-income, minority sample. The following research questions are addressed. First, what are the education-based predictors of daily tobacco smoking, frequent substance use, depression, and no health insurance coverage? Second, do later-occurring school factors explain the association between earlier school measures and the outcomes and, if so, what pathways account for this mediation effect?

Method

Data were derived from the Chicago Longitudinal Study, an investigation of a cohort of 1,539 individuals, born around 1980, who attended kindergarten programs in the Chicago Public Schools. Participants were followed prospectively from early childhood through age 24, and study measures were created from various data sources and multiple assessment waves.

Results

Findings from probit hierarchical regressions with controls for early sociodemographic covariates indicated that elementary school socioemotional classroom adjustment and high school completion were significantly and negatively associated with all four study outcomes. Participation in the Chicago Child Parent Center preschool program predicted lower rates of both daily tobacco smoking and no health insurance coverage (p<.05). Middle school reading achievement was inversely related to depression (p<.Ol), while middle school frustration toler-ance was inversely associated with daily tobacco smoking and frequent drug use (p<.05). Also, negatively linked to frequent drug use was a high school measure of students’ expectation to attend college (p<.01). In nearly all cases, later-occurring school factors fully mediated significant associations between earlier ones and the outcomes.

Conclusion

Patterns of mediation were explored along with implications of results.

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Risk Factors for Child and Adolescent Maltreatment

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Mersky, J.P., Berger, L., Reynolds, A., Gromoske, A. (2009). Risk factors for child and adolescent maltreatment. Child Maltreatment.

Objective
This study investigates associations between individual, family, and extrafamilial factors and the likelihood of subsequent childhood and adolescent maltreatment.

Method
The authors analyzed 1,411 participants in the Chicago Longitudinal Study whose maltreatment records were verified from administrative data.

Results
Findings suggest that maternal age at the child’s birth was a robust predictor of maltreatment outcomes. Receipt of public assistance and single-parent family status were significantly associated with select outcomes. Among school-age indicators examined, parent participation in school was negatively associated with most maltreatment outcomes. Participation in the Chicago Child-Parent Center program was negatively associated with maltreatment, although effects varied by type and timing of maltreatment. In separate analyses, several factors were associated with neglect, but only maternal age at the child’s birth was associated with physical abuse.

Conclusion
Findings suggest that prevention programs may need to target select populations and specific mechanisms associated with different types of maltreatment to maximize effectiveness.

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Chronic Neglect: Prediction and Prevention

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Mersky, J.P., Topitzes, J., & Reynolds, A. J. (2009). Chronic neglect: Prediction and prevention. Protecting Children, 24, 67-77.

In 2006, more than 60% of verified child maltreatment victims in the United States experienced child neglect, exceeding the official rates of all other maltreatment types combined (U.S. Department of Health and Human Services [USDHHS], 2008). Despite its relatively high incidence, neglect remains one of the least studied forms of child maltreatment (Behl, Conyngham, & May, 2003; Lounds, Borkowski, & Whitman, 2006).

This disparity is disturbing because neglect often poses serious and persistent threats to child well-being. Among all types of maltreatment, neglect is associated with the largest number of child fatalities annually. In addition, neglected children are at risk for poor outcomes in multiple domains, including neurobiological development, physical and mental health, cognitive and educational performance, and social-emotional and behavioral functioning (Cicchetti & Valentino, 2006; Hildyard & Wolfe, 2002; Kendall- Tackett & Eckenrode, 1996; Kotch et al., 2008; Tyler, Allison, & Winsler, 2006).

Emerging evidence also suggests that the effects of child neglect are cumulative, meaning that the risk of unwanted consequences may rise in response to increased exposure to neglect (Bolger, Patterson, & Kupersmidt, 1998; Hildyard & Wolfe, 2002).

This is especially concerning because neglect is more likely than other types of maltreatment to manifest as a chronic pattern (DePanfilis & Zuravin, 1999; Fluke, Yuan, & Edwards, 1999). However, research into the processes that distinguish recurring and transitory forms of neglect is limited.

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Crafting the Greenbook: Framers Reflect on the Vision, Process, and Lessons Learned

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Janczewski, C.E., Dutch, N., Wang, K. (2008). Crafting the Greenbook: Framers Reflect on the Vision, Process, and Lessons Learned. Journal of Interpersonal Violence.

Guided by research and the experiences of judges nationwide, the National Council of Juvenile and Family Court Judges made a commitment in 1998 to improve community response to families experiencing domestic violence and child maltreatment.

A year later, the council’s work culminated in a set of recommendations commonly called the Greenbook, which summoned child welfare agencies, domestic violence service providers, and dependency courts to implement internal changes and collaborate to address co-occurring domestic violence and child maltreatment.

In 2000, the federal government funded six community-based demonstration programs to implement the Greenbook recommendations. As part of the evaluation of the Greenbook initiative, the evaluation team asked the national experts who helped frame the Greenbook to reflect on the processes used and the decisions that shaped the document. In addition, the experts were asked to describe their expectations for the systems and communities that implemented the recommendations, including anticipated challenges.

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Child Maltreatment and Violent Delinquency: Disentangling Main Effects and Subgroup Effects

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Mersky, J.P., Reynolds, A. (2007). Child maltreatment and violent delinquency: disentangling main effects and subgroup effects. Child Maltreatment.

Objective
This study employs data from the Chicago Longitudinal Study (CLS) to investigate the relation between child maltreatment and the incidence and frequency of violent delinquency. The authors also examine if effects vary between physically abused and neglected children and if select indicators (sex, cumulative risk, public aid receipt) moderate the connections between maltreatment and violent outcomes.

Method
The CLS follows a cohort of 1,539 low-income, minority children who attended public kindergarten programs in 1985-1986. The primary sample includes 1,404 participants for whom maltreatment and delinquency status were verified.

Results
Maltreatment is significantly associated with all violent outcomes investigated. Effects are comparable for physically abused and neglected children. Results indicate that public assistance, particularly persistent receipt, moderates the association between maltreatment and multiple outcomes.

Conclusion
Findings support the hypothesized connection between maltreatment and violent delinquency while highlighting certain subgroups that may be at elevated risk. Implications for research design and program development are discussed.

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Predictors of Early Childbearing: Evidence from the Chicago Longitudinal Study

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Mersky, J.P., Reynolds, A. (2007). Predictors of early childbearing: Evidence from the Chicago Longitudinal Study. Children and Youth Services Review.

Objective

Using prospective data from the Chicago Longitudinal Study (CLS), we investigated the effects of early childhood and school-age predictors on female childbearing, including participation in the Chicago Child-Parent Center (CPC) Program, and related family and school behaviors.

Method
The CLS follows the progress of a single cohort of 1539 low-income, minority children who attended the CPCs and other public early childhood programs in 1985–1986. Birth records were obtained for 706 females (92% of original sample) from survey data collected between ages 22–24 and supplemental public aid and school records.

Results
Results from regression and survival analyses indicated that the CPC program had a limited impact on childbearing patterns. There was no evidence that preschool participation was associated with lower rates of early childbearing. CPC school-age participation was linked to significantly lower rates of multiple births by age 20.

Conclusion
The most consistent predictor of a female’s childbearing status was her parent’s educational attainment. Parent involvement in elementary school, children’s enrollment in magnet schools, AFDC receipt, and teacher ratings of acting out behavior also were significant predictors of early childbearing. Implications for the tailoring of future interventions are discussed.

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