Self- and proxy reports of quality of life among adolescents living in residential youth care compared to adolescents in the general population and mental health services

Background: Child welfare services are aimed at providing care and protection, fostering well-being and prosocial behaviour. Thus, Quality of Life (QoL) should be an important outcome measure in Residential Youth Care (RYC) institutions. However, the dearth of research in this area gives rise to serious concern. The present study is the first large scale, nationwide study assessing QoL among adolescents living in RYC. To provide a reference frame, adolescent self- and primary contact proxy reports were compared to the general population and to adolescent outpatients in Child and Adolescent Mental Health Service (CAMHS). Also, we investigated the association between self-report of QoL in adolescents living in RYC and proxy reports of their primary contacts at the institution. Methods: All residents between the ages of 12–23 years living in RYC in Norway were the inclusion criteria. Eighty-six RYC institutions (with 601 eligible youths) were included, 201 youths/ parents did not give their consent. Finally, 400 youths aged 12–20 years participated, yielding a response rate of 67 %. As a reference frame for comparison, a general population (N = 1444) and an outpatient sample of adolescents in CAMHS (N = 68) were available. We used the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). General Linear Model analyses (ANCOVA) were conducted with five KINDL life domains as dependent variables and group as independent variable. Results: Self- and proxy reports of QoL in adolescents living in RYC revealed a significantly (p < 0.001) poorer QoL compared to the general population on the life domains Physical- and Emotional well-being, Self-esteem, and relationship with Friends. Adolescents evaluated their physical well-being as worse compared to adolescents in CAHMS. Self- and proxy reports in RYC differed significantly on two of five life domains, but correlated low to moderate with each other. Conclusions: The results in this study raise major concerns about the poor QoL of the adolescents living in RYC, thereby challenging the child welfare system and decision makers to take action to improve the QoL of this group. The use of QoL as outcome measures is highly recommended

Children placed in alternate care in Norway: A review of mental health needs and current official measures to meet them.

Children and youth placed in alternate care have often suffered detrimental care conditions before placement and the rupture of attachment bonds both before and during alternate care. In this article, we review the knowledge base on the prevalence of mental disorders, and access to mental health services, of children and youth in alternate care in Norway. Due to the increasing knowledge of this group's needs, official measures are now taken to improve service provision and cooperation between types and levels of services for children and youth in alternate care. We review the recent Norwegian official reports aiming to improve access to mental health services for children placed in alternate care and discuss their recommendations in light of empirical findings from our own research.publishedVersion© 2018 The Authors. International Journal of Social Welfare published by Akademikerförbundet SSR (ASSR) and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Do school teachers and primary contacts in residential youth care institutions recognize mental health problems in adolescents?

Background Studies show that adolescents living in residential youth care (RYC) institutions experience more mental health problems than others. This paper studies how well teachers and primary contacts in RYC institutions recognize adolescents’ mental health problems as classified by The Child and Adolescent Psychiatric Assessment diagnostic interviews (CAPA). Methods All residents between 12 and 23 years of age living in RYC institutions in Norway and enrolled in school at the time of data collection were invited to participate in the study. Of the 601 available children, 400 participated in the study, namely 230 girls, mean age = 16.9 years, SD = 1.2 and 170 boys, mean age = 16.5 years, SD = 1.5. The Child Behavior Checklist (CBCL) and Teacher’s Report Form (TRF) were used. The sensitivity and specificity of these instruments were studied. Results We observed a significant gap between the mental health problems diagnosed by the CAPA interviews and the problems reported by primary contacts on the CBCL and by teachers on the TRF. The CBCL showed a higher sensitivity than the TRF, whereas the TRF showed a higher specificity than the CBCL. Both primary contacts and teachers classified externalizing problems fairly well such as ADHD in both genders and conduct disorder in girls. Both teachers and primary contacts, however, had more problems detecting internalizing problems. Teachers may have a tendency to view most students as healthy and to underestimate the severity of their problems, whereas primary contacts may tend to overestimate the number of problems and view adolescents as sicker than they really are. Conclusion The Child Welfare System should revise their intake procedures to detect possible problems early on and to introduce the necessary treatment. It is important to identify factors that increase healthy school adaption in order for these adolescents to accomplish school in a proper way since education is important for a successful adult life

Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence

Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12–20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6–11%), and the prevalence of DSED was 8% (95% CI 5–11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups

Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder

Background: Low self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown. Objective: Investigate global and domain-specific self-esteem in adolescents with RAD or DSED. Participants and setting: All adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12-20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12-20). Methods: Self-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents. Results: Compared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = -0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = -0.42, p = .005), SA (MD = -0.40, p = .015), AC (MD = -0.22, p = .038), PA (MD = -0.33, p = .048), and SW (MD = -0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = -0.42, p = .012) and SW (MD = -0.32, p = .037). More RAD symptoms were associated with lower SA (B = -0.051, p = .013), AC (B = -0.048, p = .028), RA (B = -0.053, p = .007), and CF (B = -0.052, p = .005). More DSED symptoms were associated with lower SC (B = -0.125, p = .038). Conclusion: Both global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly

Reactive attachment disorder and disinhibited social engagement disorder in adolescence: co-occurring psychopathology and psychosocial problems

Insufficient care is associated with most psychiatric disorders and psychosocial problems, and is part of the etiology of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). To minimize the risk of misdiagnosis, and aid treatment and care, clinicians need to know to which degree RAD and DSED co-occur with other psychopathology and psychosocial problems, a topic little researched in adolescence. In a national study of all adolescents (N = 381; 67% consent; 12–20 years old; 58% girls) in Norwegian residential youth care, the Child and Adolescent Psychiatric Assessment interview yielded information about psychiatric diagnoses and psychosocial problems categorized as present/absent, and the Child Behavior Check List questionnaire was applied for dimensional measures of psychopathology. Most adolescents with a RAD or DSED diagnosis had several cooccurring psychiatric disorders and psychosocial problems. Prevalence rates of both emotional and behavioral disorders were high in adolescent RAD and DSED, as were rates of suicidality, self-harm, victimization from bullying, contact with police, risky sexual behavior and alcohol or drug misuse. Although categorical measures of co-occurring disorders and psychosocial problems revealed few and weak associations with RAD and DSED, dimensional measures uncovered associations between both emotional and behavioral problems and RAD/DSED symptom loads, as well as DSED diagnosis. Given the high degree of comorbidity, adolescents with RAD or DSED—or symptoms thereof—should be assessed for co-occurring psychopathology and related psychosocial problems. Treatment plans should be adjusted accordingly

Refining the COPES to Measure Social Climate in Therapeutic Residential Youth Care

Background Previous studies have shown that social climate in therapeutic residential youth care (TRC) is important to the welfare of residents, staff, and assessing treatment outcomes. The most influential theory on social climate in residential settings is the theory of Moos. The measurement of the concepts and aspects of this theory using the Community Oriented Programs Environment Scale (COPES) has repeatedly been criticized regarding usability, validity, and reliability, especially for TRC. Objective To improve the usability and psychometric quality of the COPES by shortening and refining the original subscale structure for usage in TRC. Methods Four-hundred adolescents living in Norwegian TRC participated. We supplemented confirmatory factor analysis (CFA) with item response theory (IRT) to evaluate model fit, investigate factor loadings, and shorten scales to improve their psychometric qualities and usability in describing social climate in TRC. Results The original subscales were not acceptable as evaluated by the criteria for CFA and IRT. By removing psychometrically weak items, the instrument was shortened to 40 items within the original ten subscales. This short version showed acceptable psychometric qualities based on both CFA and IRT criteria and the instrument retained its content validity. Finally, the original three higher-order dimensions was not supported. Conclusions Compared to the original instrument, the refined 40-item version of the COPES represents a more usable instrument for measuring social climate in TRC. Future studies are needed to confirm the multifaceted refined short version in comparable samples of youth and staff to further investigate predictive value and construct validity