Child Maltreatment Prevention and Health Promotion: Examining the Effectiveness of a Nurse Home-Visiting Program

Problem: Child abuse and neglect is a devastating, yet preventable, social problem. Early childhood home visiting services are currently considered the most promising approach to maltreatment prevention. Expansion of evidence-based home visiting services authorized by the Affordable Care Act has created a need to better understand the utilization and effectiveness of preventive services delivered in the community. Nurses for Newborns is a nurse home visiting program serving high-risk caregivers and medically-fragile newborns using a flexible, client-driven service model. Methods: This study used longitudinal services data linked with administrative child welfare data. A sample of low-income families: n = 3,620) who received services from 2009 to 2011 were followed through the end of 2012. Analyses first focused on describing the service population and identifying predictors of engagement and retention. Next, child maltreatment, child development, and maternal mental health outcomes were compared across policy-relevant subgroups. Last, a quasi-experimental design using propensity score analytic methods was conducted to identify a causal treatment effect for maltreatment prevention. Results: The program serves a very high-risk population with individuals experiencing multiple social stressors in addition to medical issues relating to the pregnancy or newborn. There is variation in the level of service use, but generally higher risk families are more likely to engage and participate in services longer. Subgroups of families were found to have higher rates of child developmental concerns, caregiver stress, postpartum depression, and later maltreatment. Families who enroll prenatally appear to be a very different group in terms of risk factors and maltreatment outcomes. Only 1% of families who enroll prenatally have a later maltreatment report compared to 19% of those who begin postpartum. Among postpartum families, propensity score matching was successful in balancing an engaged treatment group with a dropout comparison group. There was not a significant difference between these groups in risk for later maltreatment report. Among families with a maltreatment report prior to home visiting services, the risk of maltreatment was significantly lower for those in the treatment group. Conclusion: Consistent with prior home visiting research, this study found troubling levels of attrition and was not able to detect a statistically significant difference in overall risk of later maltreatment report. Families who receive services prenatally have an exceptionally low rate of later report despite high levels of risk. The program was successful in preventing maltreatment recurrence among those families with a prior report. While some programs serve only first-time mothers, this study found that multiparous clients had some of the highest levels of risk and the poorest outcomes. Lack of overall program findings may be at least partially attributable to low service dosage. This study indicates that NFN is making a measureable impact in maltreatment prevention among certain subgroups of families

A Longitudinal Study of Child Maltreatment and Mental Health Predictors of Admission to Psychiatric Residential Treatment Facilities

The child welfare system is an access point for children’s mental health services. Psychiatric residential treatment facilities (PRTFs) are the most restrictive, and most expensive setting for children to receive long-term care. Given the high rates of behavioral health concerns among maltreated children in out-of-home care, research is needed to examine the factors that predict entry in PRTFs among children investigated for maltreatment. This exploratory study used cross-sector administrative records linked across multiple systems, including child welfare records and Medicaid claims, from a single state over a five-year period (n = 105,982). Cox proportional hazards modeling was used to predict entry into a PRTF. After controlling for many factors, PRTF entry was predicted by diagnosis code indicating a trauma-related condition, antipsychotic medication prescriptions, and entry into lower levels of out-of-home care, supporting the view that youth are admitted to PRTFs largely due to clinical need. However, PRTF admission is also associated with characteristics of their experiences with the social service system, primarily foster care placement stability and permanency. Implications for practice and research are discussed

Parental Involvement and Adolescents’ Academic Achievement: Latent Profiles of Mother and Father Warmth as a Moderating Influence

Parental involvement in their adolescents’ education plays an important role in promoting their children's academic outcomes. Yet, more research is needed to examine the relationship between parenting practices and parental warmth as well as to consider the potential joint contribution of warmth from both fathers and mothers. Thus, the primary purpose of the current study is to examine the extent to which patterns of parental warmth across fathers and mothers moderate the association between parental involvement and adolescents’ grade point average (GPA) and school engagement behaviors. Latent profile analysis was conducted to identify disparate profiles of fathers’ and mothers’ warmth within a nationally representative sample of 2,306 youths (51% male; mean age = 15.31 years, SD = 1.50; 77% non‐Hispanic White) residing in opposite‐sex, two‐parent families from Wave I and II of the National Longitudinal Study of Adolescent to Adult Health. Latent‐class enumeration processes support a five‐profile solution characterized by differences in levels of parental warmth and congruency across parents: (a) Congruent High Warmth, (b) Congruent Moderate Warmth, (c) Congruent Low Warmth, (d) Incongruent High Mother/Low Father Warmth, and (e) Incongruent Low Father/Lower Mother Warmth. Subsequent multiple linear regression analyses reveal a moderating effect for Congruent Low Warmth on the relationship between parental involvement and adolescents’ GPA. Ultimately, the results show that variation in parental warmth exists across fathers and mothers with differing impact on adolescents’ outcomes. Excluding one parent without considering the joint effects of both parents will not produce an accurate and precise understanding of parenting in research or practice

A Systematic Review of the Effectiveness of Children’s Behavioral Health Interventions in Psychiatric Residential Treatment Facilities

Objective The purpose of this systematic review was to synthesize quantitative or mixed-method studies that evaluate the efficacy of interventions with youth in the context of psychiatric residential treatment facilities (PRTFs) in the United States. Methods Systematic review procedures were conducted to identify relevant studies, both published and from the gray literature in the United States. Search terms were informed via consultation with a university social science reference librarian, and four electronic databases were searched. Using a priori inclusion and exclusion criteria, team-based search procedures yielded a final sample of 47 relevant studies. Results Studies varied with respect to publication status; sample size; research design; youth gender identity; youth racial/ethnic identity; youth behavioral, psychological, and developmental or intellectual concerns at intake; outcomes measures; and interventions evaluated. Evaluated interventions could be clustered into one of five categories: (a) modifications to system of treatment, (b) therapeutic modalities, (c) educational/alternative programs, (d) practice behaviors, and (e) post-discharge engagement. The majority of studies noted youth outcome improvements; however, some studies also yielded mixed, inconclusive, or null results. Conclusions We would characterize the breadth and depth of research in this area to be insufficient in providing PRTF stakeholders a clear and firm understanding of “what works” for youth. Thus, one major implication of our review is the need for more research and efforts to incentivize the evaluation of ongoing practices in youth PRTFs. Still, this systematic review can serve as a convenient reference that can inform tentatively PRTF stakeholders’ decisions about the selection of interventions or practice behaviors

Evaluation of a Tobacco Educational Intervention for Pregnant Alaska Native Women

Tobacco cessation interventions developed and evaluated for Alaska Native women do not exist. As part of routine clinical care provided at a prenatal visit, a brief tobacco educational intervention for Alaska Native pregnant women (N=100; mean ± SD age = 25.9±6.2 years; mean 6.3± 2.6 months gestation) was piloted at the Y-K Delta Regional Hospital in Bethel, Alaska. This retrospective study reports on the evaluation of this clinical program. The intervention was consistent with the clinical practice guidelines (i.e., 5 A’s – ask, advise, assess, assist, arrange), with an average duration of 20.2 ± 6.8 minutes. The self-reported tobacco abstinence rate following the intervention was 11% at the last prenatal visit and 12% at delivery. Delivering a tobacco cessation intervention at a prenatal visit is feasible, but there is a need to identify more effective interventions for Alaska Native pregnant women

Quantifying sources of bias in longitudinal data linkage studies of child abuse and neglect: measuring impact of outcome specification, linkage error, and partial cohort follow-up

Abstract Background Health informatics projects combining statewide birth populations with child welfare records have emerged as a valuable approach to conducting longitudinal research of child maltreatment. The potential bias resulting from linkage misspecification, partial cohort follow-up, and outcome misclassification in these studies has been largely unexplored. This study integrated epidemiological survey and novel administrative data sources to establish the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project. Using these data we evaluated and quantified the impact of non-linkage misspecification and single source maltreatment ascertainment use on reported maltreatment risk and effect estimates. Methods The ALCANLink project integrates the 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) sample with multiple administrative databases through 2014, including one novel administrative source to track out-of-state emigration. For this project we limited our analysis to the 2009 PRAMS sample. We report on the impact of linkage quality, cohort follow-up, and multisource outcome ascertainment on the incidence proportion of reported maltreatment before age 6 and hazard ratios of selected characteristics that are often available in birth cohort linkage studies of maltreatment. Results Failure to account for out-of-state emigration biased the incidence proportion by 12% (from 28.3%w to 25.2%w), and the hazard ratio (HR) by as much as 33% for some risk factors. Overly restrictive linkage parameters biased the incidence proportion downwards by 43% and the HR by as much as 27% for some factors. Multi-source linkages, on the other hand, were of little benefit for improving reported maltreatment ascertainment. Conclusion Using the ALCANLink data which included a novel administrative data source, we were able to observe and quantify bias to both the incidence proportion and HR in a birth cohort linkage study of reported child maltreatment. Failure to account for out-of-state emigration and low-quality linkage methods may induce bias in longitudinal data linkage studies of child maltreatment which other researchers should be aware of. In this study multi-agency linkage did not lead to substantial increased detection of reported maltreatment. The ALCANLink methodology may be a practical approach for other states interested in developing longitudinal birth cohort linkage studies of maltreatment that requires limited resources to implement, provides comprehensive data elements, and can facilitate comparability between studies

Innovative Solutions for State Medicaid Programs to Leverage Their Data, Build Their Analytic Capacity, and Create Evidence-Based Policy

As states have embraced additional flexibility to change coverage of and payment for Medicaid services, they have also faced heightened expectations for delivering high-value care. Efforts to meet these new expectations have increased the need for rigorous, evidence-based policy, but states may face challenges finding the resources, capacity, and expertise to meet this need. By describing state-university partnerships in more than 20 states, this commentary describes innovative solutions for states that want to leverage their own data, build their analytic capacity, and create evidence-based policy. From an integrated web-based system to improve long-term care to evaluating the impact of permanent supportive housing placements on Medicaid utilization and spending, these state partnerships provide significant support to their state Medicaid programs. In 2017, these partnerships came together to create a distributed research network that supports multi-state analyses. The Medicaid Outcomes Distributed Research Network (MODRN) uses a common data model to examine Medicaid data across states, thereby increasing the analytic rigor of policy evaluations in Medicaid, and contributing to the development of a fully functioning Medicaid innovation laboratory

1938: Abilene Christian College Bible Lectures - Full Text

Delivered in the Auditorium of Abilene Christian College, February, 1938 Abilene, Texas. Published October, 1939 PRICE, $1.00 FIRM FOUNDATION PUBLISHING HOUSE Austin, Texas

Matched sizes of activating and inhibitory receptor/ligand pairs are required for optimal signal integration by human Natural Killer cells

It has been suggested that receptor-ligand complexes segregate or co-localise within immune synapses according to their size, and this is important for receptor signaling. Here, we set out to test the importance of receptor-ligand complex dimensions for immune surveillance of target cells by human Natural Killer (NK) cells. NK cell activation is regulated by integrating signals from activating receptors, such as NKG2D, and inhibitory receptors, such as KIR2DL1. Elongating the NKG2D ligand MICA reduced its ability to trigger NK cell activation. Conversely, elongation of KIR2DL1 ligand HLA-C reduced its ability to inhibit NK cells. Whereas normal-sized HLA-C was most effective at inhibiting activation by normal-length MICA, only elongated HLA-C could inhibit activation by elongated MICA. Moreover, HLA-C and MICA that were matched in size co-localised, whereas HLA-C and MICA that were different in size were segregated. These results demonstrate that receptor-ligand dimensions are important in NK cell recognition, and suggest that optimal integration of activating and inhibitory receptor signals requires the receptor-ligand complexes to have similar dimensions