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How can foster care help vulnerable children?

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2012
Abstract: 

Background: Children who enter foster care often face significant obstacles beyond not being able to reside with their parents. These include higher rates of mental disorders, such as conduct disorder, as well as a reduced likelihood of completing high school.      

Methods: We used systematic review methods to identify studies evaluating treatment foster care, where children are cared for by foster parents who have specialized training and extra support, to determine if this type of care improved children’s outcomes relative to typical foster care.  Applying our inclusion criteria, we accepted five randomized controlled trials. 

Results: Most forms of Treatment Foster Care produced statistically significant benefits. Multidimensional Treatment Foster Care proved to be effective for adolescents with behaviour problems. A less intensive version of this intervention for younger children resulted in greater placement stability. Fostering Individualized Assistance Program also resulted in fewer behaviour problems among youth.

Conclusions: Treatment Foster Care is a promising intervention for children and youth experiencing emotional and behavioural problems and in need of protective care.  

Intervening after intimate partner violence

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2012
Abstract: 

Background: Many children witness their parents or caregivers experiencing physical and emotional violence by an intimate partner. Exposure to IPV harms children, including leading to emotional and behavioural problems.

Methods: We used systematic review methods to identify interventions aimed at helping children exposed to IPV. Applying our inclusion criteria, we accepted five randomized controlled trials evaluating four programs.

Results: Three programs — Advocacy, Child-Parent Psychotherapy and Project Support — all produced at least one beneficial outcome for children. Advocacy reduced children’s contact with the perpetrator of the abuse and also increased children’s self-confidence. Child-Parent Psychotherapy significantly reduced children’s behaviour problems. Project Support reduced diagnoses of oppositional defiant and conduct disorders, behaviour problems and  emotional problems. As well, it reduced mother’s perpetration of physical abuse. In contrast, Nurse Case Management did not improve children’s outcomes.

Conclusions: This review finds that much can be done to help women help their children after they have experienced IPV. The three successful programs achieved positive outcomes for children by helping their mothers access needed resources, by providing mother with parenting education and by providing children with direct support. 

Promoting healthy dating relationships

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2013
Abstract: 

Background: Abuse in adolescent dating relationships is a far too common experience with approximately 10% of youth reporting being a victim of dating violence. Rates of emotional abuse are even higher with 29% of youth describing being insulted, swore at, or threatened with violence. These figures suggest the need for interventions aimed at preventing adolescent dating violence.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to prevent adolescent dating violence. Applying our inclusion criteria, we accepted four RCTs.

Results: The three programs — Fourth R, Safe Dates and Youth Relationships — led to significantly less violence perpetration. Safe Dates also resulted in less physical violence victimization while Youth Relationship led to less emotional abuse victimization.  Only Ending Violence failed to reduce dating violence.

Conclusions: Prevention programs can significantly reduce adolescent dating violence. Among them, the classroom-based programs, Fourth R, Safe Dates and Youth Relationships, stand out.

Addressing acute mental health crises

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2013
Abstract: 

Background: Mental health crises can involve a number of circumstances, including suicidality and aggression to others. Such crises often result in young people and their families turning to hospital emergency rooms for support. 

Methods: We used systematic review methods to identify studies evaluating alternatives to inpatient mental health care for children in crises.  Applying our inclusion criteria, we accepted two randomized controlled trials.  

Results: Both Home-Based Crisis Intervention and Multisystemic Therapy (MST) aimed to avert hospitalization for young people in crisis by providing intensive community-based treatments. Both programs were associated with important gains. Home-Based Crisis Intervention reduced children’s emotional problems and overall problems at post-test. MST reduced days in hospital and behavioural problems at post-test. As well, a one year follow-up, MST youth also had significantly fewer suicide attempts.

Conclusions: Community based treatments, such as MST and Home-Based Crisis Intervention, can effectively treat young people experiencing mental health crises. These treatments can also result in better short-term outcomes than hospitalization.

Troubling trends in prescribing for children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2013
Abstract: 

Background: Off-label prescribing occurs when a practitioners prescribes a medication for either a condition or a population for which a regulatory body has not granted approval. Off-label prescribing can come with unintended negative consequences, such as safety concerns.

Methods: We used systematic review methods to identify psychotropics being prescribed for young people in Canada. We then compared how these prescription practices align with the best available research evidence regarding the use of psychotropics in children and youth.

Results: The data revealed striking increases in the number of antipsychotic prescriptions written and dispensed for young people with risperidone, quetiapine and olanzapine being prescribed most frequently. We also found that these medications were often prescribed for conditions, such as depression and anxiety disorders, for which there was neither regulatory approval nor high quality research evidence to support their use.

Conclusions: Off-label psychiatric prescribing comes with many risks. To help remedy this situation, more high-quality pediatric medication trials and more robust monitoring of drug safety are required. 

Addressing parental substance misuse

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2014
Abstract: 

Background: Approximately one in 10 children under the age of 12 lives with a parent with a substance use disorder. When parents misuse substances, children often suffer harmful consequences. For this reason, interventions for parents with substance use disorders also need to focus on helping children.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions aimed at treating parents with substance use disorders.  Applying our inclusion criteria to the studies identified from our searches, we accepted four RCTs evaluating three different programs.

Results: All three programs — Focus on Families, Parent Skills Training and Relational Psychotherapy Mothers’ Group  — produced some benefits. Focus on Families resulted in reduced drug use among parents as well as fewer alcohol and marijuana use disorders among their sons 12 to 15 years after the program ended. Parent Skills training reduced children’s anxiety and depression symptoms but had no effect on parent substance use.  Finally, Relational Psychotherapy Mothers’ Group had no impact on children’s mental health but did reduce parent substance use in the first RCT. In the second RCT, the program reduced children’s depression symptoms but only in the short-term and had no impact on parent substance use.

Conclusions: Much can be done to help families when parents have substance use problems. Comprehensive programs such as Focus on Families can produce long-term benefits including reduced parental substance misuse, better care for children and the prevention of substance use disorders in children.

Treating childhood obsessive-compulsive disorder

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2014
Abstract: 

Background: Approximately 0.4% of children meet diagnostic criteria for OCD. These young people need effective treatment in order to reach their full potential.   

Methods: We used systematic review methods to identify studies evaluating OCD treatments. Applying our inclusion criteria, we accepted one systematic review which included 13 randomized controlled trials (RCTs).  We also identified three RCTs published since the systematic review that met inclusion criteria.

Results: Our review found strong evidence supporting a form of Cognitive-Behavioural Therapy (CBT) — Exposure and Response Prevention — for treating OCD. This therapy produced large treatment effects which persisted months after treatment ended. There was also evidence supporting the effectiveness of the medications clomipramine, fluoxetine, fluvoxamine, paroxetine and sertraline. While all medications were associated with side effects, clomipramine all resulted in serious adverse events.

Conclusions: Treatment for childhood OCD should begin with CBT.  Then, if needed, fluoxetine or sertraline should be considered. If medications are used, they should be carefully monitoring for both benefits and side effects.

Kinship foster care

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2014
Abstract: 

Background: Kinship care occurs when a relative other than a parent provides care for a child. It can be formal, such as when a child protection agency funds the placement, or informal, such as when parents arrange for an individual to care for their child without involvement of the child protection system. Regardless of the type of kinship care, there is a need to determine how it affects children’s outcomes.

Methods: We used systematic review methods to identify studies evaluating kinship care. Applying our inclusion criteria, we accepted one systematic review which included 102 quas-experimental studies. We also identified two quasi-experimental studies published since the systematic review that met inclusion criteria.

Results: Kinship care was associated with greater stability for children, including fewer out-of-home placements, a reduced number of placements, and greater odds of having a relative assume legal custody than typical foster care placements. Kinship care was also associated with mental health benefits for children, including better emotional well-being and improved adaptive behaviours as well as a reduction in behavioural problems and mental disorders.

Conclusions: Kinship care has many potential benefits for children when their parents are unable to care for them. Relatives willing to provide kinship care need to be provided with adequate resources to ensure they can provide the best care possible.

Enhancing mental health in schools

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2014
Abstract: 

Background: Because children spend more than a third of their waking hours in school, these institutions have tremendous potential to influence young people’s lives. In addition to academics, schools are increasingly focused on trying to enhance students’ emotional and behavioural health. We set out to determine if programs designed to improve school social environments have an impact on students’ well-being.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to improve school social environments and that measured student’s well-being as an outcome. Applying our inclusion criteria, we accepted three RCTs.

Results: The three programs — Beyondblue, Gatehouse Project and Teacher Mentoring — all produced modest results. Beyondblue led to a more positive school climate by teacher reports but not student reports. Gatehouse Project reduced cigarette smoking but only for students who had a positive connection to their schools. As well, Gatehouse Project students who did not smoke cigarettes were significantly less likely to use cannabis weekly or more. Finally, Teacher Mentoring increased grade point average.

Conclusions: Given the modest gains achieved by these programs, their widespread implementation does not appear to be justified, especially given the resources and staffing they require. Rather, schools focused on improving students’ mental health may be better served by investing in classroom-based interventions with proven efficacy in preventing mental disorders rather than  interventions that aim to change the school environment.

Parenting without physical punishment

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2015
Abstract: 

Background: Most parents use effective disciplinary strategies, such as modelling positive behaviours and setting age-appropriate expectations. Still, some parents resort to using physical punishment despite it being linked to problematic outcomes, such as injuries and emotional problems for children.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating parenting interventions with outcomes that included parents’ use of physical punishment and children’s wellbeing. Applying our inclusion criteria to the 48 studies identified from our searches, we accepted five RCTs evaluating three parenting programs.

Results: Our review found Chicago Parent Program and Incredible Years  reduced physical punishment and other problematic forms of discipline and also enhanced positive parenting. As well, both programs resulted in improved mental health outcomes for children, including reductions in behaviour problems.

Conclusions: This review finds that parents can be taught effective alternatives to physically punishing children. Investments in effective parenting programs can have produce long term benefits including advancing children’s wellbeing and safety.