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Background Research indicates that youth exposed to commercial sexual exploitation tend to have extensive histories of trauma, including physical abuse, sexual abuse, and neglect, which increases their vulnerability to exploitation. Trauma literature finds youth who present to treatment with greater behavioral health needs tend to have higher trauma scores than youth with fewer behavioral health needs (Copeland et al., 2007; Finkelhor et al., 2007). Objective There is, however, limited research on the role of youth strengths as a buffer against the outcomes associated with trauma. With this in mind, the purpose of this study was to examine the relationship between Adverse Childhood Experiences (ACE scores) and youth outcomes such as risk behaviors, behavioral needs, and impairment in functioning across major life domains. Secondly, we explored how this relationship might be better explained by examining youth strengths as mediators—specifically, peer relationships and the stability of significant relationships in the youth’s life. Participants and setting Data on clients served in a treatment program specialized for commercially sexually exploited youth were used for this research. Results Results indicated that youth with higher ACE scores had a greater number of risk behaviors, behavioral needs, and impairment in functioning across major life domains. Findings of the mediation analysis provide some support that peer relationships and relationship stability, at least in part, mediates the relationship between ACEs and youth outcomes. Post hoc analyses indicated youth strengths mediated 9–18% of the total effect of ACE scores on youth outcomes. Conclusions Developing peer relationships and sustaining significant relationships can mitigate some of the adverse effects of trauma experienced by exploited youth.

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors' experiences working with this population.

This study examined characteristics and profiles of youth receiving services in 1 of Florida's Medicaid-funded residential mental health treatment programs--State Inpatient Psychiatric Program (SIPP)--between July 1, 2004, and June 30, 2008 (N=1,432). Latent class analysis (LCA) was used to classify youth, and 3 classes were identified: Children With Multiple Needs, Children With No Caregivers, and Abused Children With Substantial Maltreatment History. The results of LCA showed that Children With Multiple Needs experienced the greatest risk for adverse outcomes. Compared with youth in the other 2 classes, these children were more likely to get readmitted to SIPP, more likely to become involved with the juvenile justice system, and more likely to experience involuntary mental health assessments. Implications of the findings are discussed.

High rates of child maltreatment demand attention, as exposure to child maltreatment substantially increases the risk of developing PTSD. Some evidence exists that the presence of coping skills may reduce the likelihood that victims of childhood maltreatment will develop PTSD (Agaibi & Wilson, Trauma Violence Abuse 6:195–216, 2005). This study examined whether avoidant and/or approach coping skills moderated the relationship between childhood trauma exposure and trauma symptoms among adolescent females with a history of complex trauma. Results suggest that the use of avoidant coping moderates the relationship between trauma exposure and trauma symptoms. More specifically, girls with higher levels of trauma exposure demonstrated lower levels of trauma symptoms if they reported using higher levels of avoidant coping. Clinical implications for these results are discussed.

Background There are three options in Florida for young people with mental health needs who require out-of-home treatment: community-based group homes, foster families and inpatient group facilities. Prior research has suggested that young people in group settings have poorer criminal justice outcomes, perhaps attributable to negative peer effects in group environments. Aims To compare arrest rates during and after out-of-home treatment for youth across the three settings. To test the hypothesis that arrest rates during treatment are independently related to arrest rates after treatment, after allowing for pre-treatment characteristics and placement type. Methods Florida Medicaid claims data were used to identify children and adolescents in out-of-home mental health care from 2003–2007. These were then matched with Florida Department of Juvenile Justice and Law Enforcement records. Propensity score matching was used to allow for observed differences between youth in different treatment settings. Multinomial logistic regression models were used to test relationships between arrest rates. Results Unadjusted arrest rates for youth in therapeutic group home care were higher than in psychiatric inpatient units or foster care during and after treatment. Arrests during the treatment episode accounted for a substantial proportion of the difference in arrests after out-of-home treatment. After accounting for differences in arrest rates during treatment, the group versus non-group nature of the treatment setting per se was not a strong determinant of arrest after the treatment episode. Conclusions and implications for practise Attention to the causes of higher arrest rates in group homes, which may include peer contagion and staff policies, could improve outcomes. For youths without a major psychiatric disorder, therapeutic foster care may be better than community-based group care. Copyright © 2013 John Wiley & Sons, Ltd.

Family involvement is viewed as an important component of the treatment process for children in residential treatment centers, but little is known about the impact of contact with family members on changes in youth functioning. The goal of this study was to use administrative data to examine the association between family involvement and youth outcomes for a Medicaid-funded residential treatment program in Florida. Differences between in-person and telephone intervention contacts based on the proximity of the family residence to the program were also explored. The sample was divided into two groups based on the number of family contacts per month during the treatment episode; i.e., number of family contacts equal to or less than the median and number of family contacts greater than the median. Generalized estimating equations were used to examine characteristics related to the percent change in scores on a measure of emotional and behavioral functioning. Results suggest that maternal and paternal contacts, as well as the total number of family contacts, were associated with greater improvements in youth functioning. Youth that resided in a different county than the residential program had greater improvement in behaviors when the family was involved regardless of whether contact was in-person or over the phone. Family involvement, including phone contacts, is associated with improved youth outcomes during the treatment episode.

The goal of this study was to examine factors associated with time to first and subsequent readmissions of youth (N = 1,432) to one of Florida's residential mental health treatment programs, known as State Inpatient Psychiatric Program (SIPP). Results of multivariate Cox regression analysis indicated that greater maltreatment severity, shorter length of time spent in SIPP during the initial episode, and longer time to provision of targeted case management services were associated with earlier readmission. When time to subsequent readmission was examined, results of multivariate Cox regression analysis indicated that shorter length of stay during the second hospitalization and having more than one mental health diagnosis increased the odds of experiencing subsequent readmission. One consistent finding across initial and subsequent readmissions was that the timing of service provision but not the amount of services was crucial for preventing readmissions to inpatient residential programs.

This study examined family involvement among youth in residential mental health treatment facilities in Florida. Data were obtained from the provider reports from January 2005 through December 2007. Treatment episodes were divided into 30-day periods with family involvement measured by the number of contacts by all family members, the mother, and the father. In addition, we examined contacts by all family members for in-person treatment, treatment-related phone contacts, treatment planning, campus visits, and therapeutic home passes. Families averaged 3.4 contacts per 30 days for the 1333 treatment episodes. Sixty-seven percent of the contacts included mothers, while 22% of the contacts involved fathers. A majority of contacts were for family therapy, either by phone (29% of contacts) or in person (43%). Nearly twenty percent of residential stays had no family contact. After the first 30 days of treatment, contacts did not vary significantly over the course of the treatment episode, although there was some evidence that youth with longer treatment episodes had fewer contacts throughout the residential stay. Total contacts were lower for girls than boys, for blacks than whites, and for older youth, and were higher when the youth lived in the same county as the residential treatment provider. Outreach programs could target specific demographic groups with low involvement, and the alternative methods for involvement that use internet conferencing tools should be explored for parents that live far from the treatment provider.

Over time, residential mental health treatment programs for youth with serious emotional and behavioral disorders have shifted to a more family-focused paradigm that stresses the importance of family involvement during children's psychiatric care. Findings are presented from an in-depth qualitative examination of the factors that facilitate and hinder family involvement as well as expectations for family involvement from the perspective of providers at five residential youth treatment facilities in Florida. Results indicate that family involvement is facilitated by offering transportation assistance and flexible scheduling, fostering communication, and empowering families through education and support. Suggestions for future research are also offered.

Florida Medicaid claims data were used to assess antipsychotic medication use among children after therapeutic out-of-home mental health treatment. Fifty percent of youth received antipsychotics after the treatment episode, but differences exist across age, gender, and racial groups. Utilization was higher among males and youth ages 6-12, while blacks were less likely to be prescribed antipsychotics than whites. Youth receiving antipsychotics were less likely to return to out-of-home treatment within 6 months. However, among youth receiving antipsychotic medications, a higher medication possession ratio was not associated with the likelihood of returning to treatment. Such patterns require further investigation to determine whether they indicate inadequate treatment for some youth.

This paper examined juvenile justice encounters among youth with mental health needs who received care in residential treatment settings. The focus is on peer effects, and whether delinquent peers negatively affected youth. Matched data from Florida Medicaid and Juvenile Justice were used to examine the association between peer delinquency in a residential treatment setting and juvenile justice encounters during and after the treatment episode. Fifteen percent of youth had justice encounters during residential out-of-home treatment, while the rate was lower in the six months after (23.0%) treatment than the six months before (33%). Support for peer contagion was found as youth treated in Medicaid-funded residential mental health treatment programs were more likely to have JJ encounters when the other youth in the facility had histories of delinquency.

This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were used to examine youth receiving out-of-home treatment. Propensity score matching was used to examine the effect of out-of-home treatment on outcomes. Males, older youth, and youth with prior involuntary examinations, felony charges, misdemeanor charges, or inpatient psychiatric treatment were more likely to be placed in treatment group care. Treatment foster care placement was more likely for youth with prior treatment foster care episodes. Propensity matching results indicated that youth in treatment foster care had greater reductions in felony charges, and were less likely to return to out-of-home treatment in the following 6 months. While often placed in group care settings, youth with prior criminal justice encounters, especially for felony charges, may be better served in treatment foster care programs.

In recent years, zero-tolerance policies have been implemented in an attempt to reduce violent and/or drug-related activities in schools. These policies are sometimes expanded to include less serious crimes, which raises a number of questions regarding juvenile justice (JJ) system response and processing. This article discusses the need, implementation, and some preliminary program outcomes related to a civil citation (CC) process undertaken to provide an alternative to school-based justice referrals. Aggregate trends were reviewed based on internal program data as well as publicly available information. Follow-up data on CC youth were obtained and a matched sample of youth not engaged in the CC process was created using a state-level administrative data set to provide a preliminary assessment of outcomes. Key informant interviews examined program development and implementation. Results of this preliminary evaluation are considered in the larger context of youth diversion and school-based practices for dealing with youth misconduct.

There is growing literature examining the use of psychotropic medications and specifically antipsychotic medications among youth in the United States. This study uses administrative claims data to assess antipsychotic medication use among children prior to being served in therapeutic out-of-home care settings and whether there are utilization differences by age, race, or gender. Florida Medicaid claims data were analyzed for children and adolescents receiving out-of-home care between July 2003 and June 2006. The majority of children and adolescents in out-of-home treatment settings received antipsychotic medications prior to the therapeutic care episode, but differences existed in treatment patterns across age, gender, and racial groups. Utilization was higher among youth ages 6–12 compared to those 13–18, and was higher among males than females. Blacks are less likely to be prescribed antipsychotics, but those prescribed antipsychotics receive them for the same number of days, and for the same number of ...

The inverse relationship between economic status and mental illness is well established. Less is known, however, about the nature of this relationship. A comparison of poor suburban and rural youth receiving services for their emotional and behavioral problems revealed more similarities than differences. Family income increased during the first year of service for a small percentage of families. A small but significant relationship was found between increased income and caregiver strain as well as child outcomes. For families who are poor and have a child with a disability, highly individualized services and support that reduce caregiver strain are necessary to improve child outcomes.

The high rates of both mental health disorders and exposure to trauma among the juvenile justice population highlights the importance of understanding whether and under what conditions mental health services can prevent further justice system involvement among youth with previous juvenile justice encounters. The relationship between mental health treatment and juvenile justice recidivism is examined for youth distinguishing between those who have experienced trauma and those who have not. This article examines whether mental health treatment reduces the likelihood of juvenile justice recidivism among youth with several risk factors associated with adverse outcomes.

Background: Youth treated in a RTC receive an array of services to address their mental health and behavioral issues, including psychotherapy and medication. Prior studies have shown that youth continue to receive a considerable number of services after discharge from a RTC. Objective: This study describes the characteristics of children and youth served in Florida’s Medicaid-funded residential treatment facilities, known as the Statewide Inpatient Psychiatric Program (RTC), examines whether family involvement in treatment is associated with discharge to a family-like setting and continuity of treatment after discharge. Method: Data for this study were obtained from the RTC Provider Monthly Report Database (SPMRD) from January 2005 through December 2011. These data contain information on family involvement during treatment. Post-discharge data are from Medicaid enrollment/claims files and Prepaid Mental Health Plan (PMHP) encounters. Results: Results of this study suggest that family contacts for interventions and treatment planning are associated with a greater likelihood of discharge to a family-like setting. Among youth discharged to a family-like setting, family involvement during treatment was associated with receiving follow-up outpatient care. Conclusion: Results support the continued emphasis on including family members in the treatment of youth with mental health needs to ensure better outcomes and continuity of treatment.

Background: Youth with mental health needs that require out-of-home treatment receive services in three settings in Florida: community-based group homes and foster family settings, and inpatient group facilities. Research suggests that youth in group settings have poorer criminal justice outcomes. Such differences are attributed to the negative peer effects in group environments. Aims: To compare arrest rates during and after out-of-home treatment for youth across the three settings. In addition, to determine whether the higher arrest rate after youth received therapeutic group home services was due to the group setting or the higher rate of arrests during treatment. Methods: Florida Medicaid claims data were analyzed to identify youth who received out-of-home care from 2003-2007. Propensity score matching accounted for observed differences between youth in different treatment settings. Results: Arrest rates for youth in therapeutic group home care were higher during and after treatment. Arrests during the treatment episode accounted for a substantial portion of the difference in arrests after out-of-home treatment. The group versus non-group nature of the treatment setting was not a strong determinant of arrest after the treatment episode. Conclusions and implications for practice: Youth with histories of delinquency may be better served in therapeutic foster care settings than group home settings. Therapeutic foster care settings reduce the negative peer effects associated with group treatment. Outcomes for non-delinquent youth receiving group home services may also improve is the absence of negative peer effects.

There are three options in Florida for young people with mental health needs who require out-of-home treatment: community-based group homes, foster families and inpatient group facilities. Prior research has suggested that young people in group settings have poorer criminal justice outcomes, perhaps attributable to negative peer effects in group environments.To compare arrest rates during and after out-of-home treatment for youth across the three settings. To test the hypothesis that arrest rates during treatment are independently related to arrest rates after treatment, after allowing for pre-treatment characteristics and placement type.Florida Medicaid claims data were used to identify children and adolescents in out-of-home mental health care from 2003-2007. These were then matched with Florida Department of Juvenile Justice and Law Enforcement records. Propensity score matching was used to allow for observed differences between youth in different treatment settings. Multinomial logistic regression models were used to test relationships between arrest rates.Unadjusted arrest rates for youth in therapeutic group home care were higher than in psychiatric inpatient units or foster care during and after treatment. Arrests during the treatment episode accounted for a substantial proportion of the difference in arrests after out-of-home treatment. After accounting for differences in arrest rates during treatment, the group versus non-group nature of the treatment setting per se was not a strong determinant of arrest after the treatment episode.Attention to the causes of higher arrest rates in group homes, which may include peer contagion and staff policies, could improve outcomes. For youths without a major psychiatric disorder, therapeutic foster care may be better than community-based group care.

It is commonly agreed that flexible service dollars are a crucial aspect of tailoring services to meet the unique and changing needs of children with serious emotional disturbance and their families. This is particularly true in isolated rural areas. The need for a common terminology that distinguishes among the philosophy of individualized care, the programmatic components of such systems, and the types of flexible-funding mechanisms that facilitate such approaches are discussed. The uses of flexible service dollars in North Idaho and upstate New York, along with some case studies, are presented to highlight the similarities in the needs of families in both states; namely, economic supports, transportation, social-recreational, and respite services. Finally, the elements that contributed to successful use of service dollars are identified, and a call for additional research on outcomes associated with individualized care is made.

Youth with emotional disturbance who have substance abuse problems are of particular concern to child-serving agencies. Approximately 22% of the youth served in New York State's Intensive Case Management Program for Children and Youth (CYICM) have identified substance abuse problems. We compared youths enrolled in CYICM who abuse substances with those who do not abuse substances. Adolescents with substance abuse problems differed from non-abusing adolescents. The abusing cohort was most likely to be emancipated minors, not enrolled in school, less likely to be members of a minority group, and more likely to have private health care coverage. They also evidenced a different constellation of symptoms than the non-abusing cohort, with abusers tending to display suicidal symptoms and behaviors and sexual acting out. Abusers were also more likely to have been admitted to private psychiatric hospitals and to have had crisis contacts in emergency rooms. Similar to non-abusers, however, abusers spent significantly fewer days as inpatients in state hospitals, and had fewer admissions to these hospitals following their enrollment in CYICM.