Suicide attempts and severe psychiatric morbidity among former child welfare clients--a national cohort study

BACKGROUND: Few large sample studies have examined psychiatric morbidity among former child welfare/protection clients. In this study, risks for suicide attempts and severe psychiatric morbidity in younger years were assessed for former child welfare clients in ten national birth cohorts, comparing them with general population peers and inter-country adoptees. METHODS: We used national register data for almost one million people: 22,305 former child welfare clients who had experienced interventions before their teens, 955,326 general population cohort peers and 12,240 inter-country adoptees. Multivariate Cox regression models were used to estimate risks of hospitalisation for suicide attempts and psychiatric disorders from age 13 to age 18-27. RESULTS: Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts. They were five to eight times more likely to have been hospitalised for serious psychiatric disorders in their teens, four to six times in young adulthood. High excess risks were also found for psychoses and depression. Individuals who had been in long-term foster care tended to have the most dismal outcome. Adjusting for birth parents' hospitalisations with a psychiatric diagnosis or for substance abuse, and for birth-home-related socio-economic factors, reduced excess risks to around twofold. CONCLUSIONS: Irrespective of issues of causality, findings suggest that former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity. Results have substantial practice implications for mental health and social agencies serving this group in adolescence and/or young adulthood.     

Developmental needs and individualized family service plans among infants and toddlers in the child welfare system

This study examines levels of developmental need in young children investigated by child protective services, estimates early intervention service use, and examines need and service use variations during the 5-6 years after investigation on the basis of maltreatment substantiation status. Data were from the National Survey of Child and Adolescent Well-Being, the first nationally representative study of children investigated for maltreatment. The sample comprised 1,845 children aged 0 to 36 months at baseline. Logistic regression with covariate adjustment was used to examine the relationship between having an Individualized Family Service Plan (IFSP; a proxy and marker of early intervention services through Part C of the Individuals With Disabilities Education Act) and substantiation status. A high prevalence of developmental problems was found among children with substantiated cases and children with unsubstantiated cases. Few children with developmental needs had an IFSP. Substantiation status and level of child welfare system involvement were significantly associated with having an IFSP.     

Accuracy of caregiver identification of developmental delays among young children involved with child welfare

Underidentification of developmental delays among young children involved with child welfare/child protective services (CW) is problematic. Caregivers of young children involved with CW may help increase identification of young children with developmental delays, but the accuracy of caregiver identification in this population and whether this varies by caregiver type is not known. This study uses data from the National Survey of Child and Adolescent Well-Being to determine if (1) caregivers of young children involved with CW accurately identify children with developmental delays and (2) foster caregivers are better able to identify developmental delays compared with other caregivers. Close to half the children had a delay in language, cognitive, and/or adaptive behavior (45%). Overall sensitivity for caregiver identification was 35% (95% confidence interval [CI]: 29%, 41%); specificity was 84% (95% CI: 80%, 87%). After controlling for certain child and caregiver characteristics, in-home caregivers had 0.15 times the odds of identifying a child with a developmental delay compared with foster caregivers (95% CI 0.1, 0.4). Results suggest that caregiver identification of developmental delays is specific but not sensitive, and that foster caregivers were more likely to identify a child with a developmental delay compared with in-home caregivers. Policy implications include improving educational programs regarding child development and developmental services for foster, kinship, as well as in-home caregivers in the hopes of increasing sensitivity of caregiver identification of developmental delays for the population of young children involved with CW.     

Psychosocial problems in families of a child with cancer

Eighty-one children with malignancies and their families were investigated for the psychosocial changes that take place during the course of the disease. Seventeen patients were in the initial phase of treatment, 24 were in first remission, 14 were long-term survivors already off therapy, 11 were in relapse, and 15 children died 1-5 years before this study. Detailed personal interviews with the parents showed profound changes in the families' life and severe problems in adapting to the new situation. Marital problems, neglecting the healthy siblings, and a loss of interest in work occurred in the majority of parents, especially in mothers. Younger siblings suffered more from the strains imposed on the family than did elder ones. Psychosocial care is felt to be helpful for all families in adjusting to the altered circumstances and emotional upheavals.     

Psychosocial needs of families with a child with cancer

PURPOSE: The aims of this study were to map the problems and needs of children with cancer and their families with regard to possible psychosocial interventions, and to do an acceptability study of different ways to provide support. METHODS: The authors performed a cross-sectional structured telephone interview with 56 parents of children with cancer and 13 adolescents from these families. On 0 to 10 analog scales, parents and adolescents rated the importance of different needs, how these needs had been met, the acceptability of different ways of providing supportive interventions, how often these ways had been used, and comfort using them. RESULTS: Parents' mean rating of importance of information needs was 9.42, peer social support 7.84, and self-management therapy 9.21. The ratings of how well these needs had been met were 8.05, 5.30, and 7.13, respectively. Both parents and adolescents ranked getting information written on paper highest, preferred to communicate in a face-to-face support group for peer social support, and preferred a therapist for self-management therapy. The comfort ratings for using different ways to provide the interventions were all high, as was access; 89% of families had computers in their homes, 76% had Internet access. CONCLUSIONS: The needs for information, peer social support, and self-management therapy are all high. There is still room to meet these needs better. Using paper-based, telephone, computer CD, or an interactive Web-based intervention package all seem to be acceptable and accessible ways to meet the needs and might reduce the risk of families developing psychosocial problems.     

Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems

AIM: To study the risk of children to mothers with alcohol and/or substance abuse related problems for early childhood out-of-home care in Finland. METHODS: A population-based cross-sectional retrospective analysis of 526 pregnant women attending special outpatient clinics during 1992-2001 and their 626 offspring, with out-of-home care data until 2003 provided by the National Child Welfare Register. RESULTS: Fifty percent (95% confidence interval 46-54%) were at some point and 38% (34-42%) by the age of two years, in out-of-home care. Out-of-home care was associated with maternal care for substance abuse after delivery, nonemployment, housing, daily smoking during pregnancy, increasing number of previous births, mother in custody in her childhood, maternal education, previous child in custody, drug in urine during pregnancy, unplanned pregnancy, partner with significant abuse, regular health-care contact for abuse, daily alcohol consumption before and/or during pregnancy, newborn not discharged with mother, neonatal abstinence symptoms (NAS), intensified perinatal surveillance or NICU, and delayed discharge from hospital. CONCLUSIONS: There is a substantial risk of children born to mothers with significant alcohol and/or substance abuse related problems for out-of-home care during early childhood. Factors identified during the pre- and perinatal period are associated with this risk.     

Maternal depressive symptoms, father's involvement, and the trajectories of child problem behaviors in a US national sample

OBJECTIVE: To examine the effect of maternal depressive symptoms on child problem behavior trajectories and how the father's positive involvement may modify this association. DESIGN: Secondary data analysis using data from the National Longitudinal Survey of Youth. SETTING: A nationally representative household sample of men and women from the National Longitudinal Survey of Youth. PARTICIPANTS: The study sample includes 6552 mother-child dyads interviewed biennially between January 1, 1992, and December 31, 2002; children were 0 to 10 years old at baseline. Intervention Past-week maternal depressive symptoms in 1992. MAIN OUTCOME MEASURES: Maternal self-reports of child internalizing and externalizing behaviors were assessed repeatedly using a modified Child Behavior Checklist. RESULTS: Linear growth curve models indicate that the adverse effects of maternal depressive symptoms on child problem behavior trajectories become negligible after controlling for the father's involvement and other covariates, including the child's age, sex, and race/ethnicity; the mother's educational level; maternal age at child birth; number of children; poverty status; urban residence; and father's residential status. Positive involvement by the father was inversely associated with child problem behavior trajectories. The effects of maternal depressive symptoms on child problem behaviors varied by the level of the father's positive involvement. CONCLUSION: When the father actively compensates for limitations in the depressed mother's functioning, the child's risk of problem behaviors may be reduced.     

Multicentric Castleman's disease in a child with subpectoral involvement

Castleman's disease is a benign lymphoproliferative disorder characterised by enlarged hyperplastic lymph nodes. It is rare in children and usually presents as localised disease. Subpectoral involvement has not been previously described in multicentric Castleman's disease in children. We present the CT, US and Doppler US findings of hyaline-vascular type multicentric Castleman's disease in a 5 year-old-boy with masses in the left subpectoral region and supraclavicular and axillary lymphadenopathy.     

Symptomatic kidney involvement in a child with tuberous sclerosis

Tuberous sclerosis complex is an autosomal dominant disorder of cellular proliferation and differentiation with variable penetrance and a high spontaneous mutation rate that affects multiple organs, including the kidney. Kidney involvement is commonly asymptomatic and bilateral, and rare in childhood, especially under 10 years. Herein, we report a case of unilateral renal angiomyolipoma in a nine-year-old girl with tuberous sclerosis who had symptoms of pain and macroscopic hematuria.     

Carcinoid tumor with bilateral renal involvement in a child

Carcinoid tumors are uncommon in children. Kidneys are rarely involved as they do not possess neuro-endocrine cells. Work up of painless hematuria after abdominal trauma in a 10-year-old boy revealed primary carcinoid tumors with metastasis to both kidneys. We were unable to find any previous reports of renal involvement by carcinoid tumor in children.