Drug Abuse, Juvenile Justice Involvement
Conditions
Keywords
Adolescent, Foster Care, Female
Brief summary
This study will determine the efficacy of a parent-involved intervention in preventing problem behavior in middle school girls who are currently in foster care.
Detailed description
The transition from elementary school to middle school presents a complex set of challenges for adolescents. These include increased expectations for time management and self-monitoring, renegotiation of rules and boundaries with parents, increased peer influence, and pubertal changes. For children in foster care, this transition is further complicated by issues such as a possible history of maltreatment, unpredictable changes in their living situations, and difficulty explaining their foster care background to peers and teachers. Such issues may be more serious for girls in foster care. Social problems for these girls in middle school can lead to a number of negative effects, including delinquency, substance abuse, poor school performance, mental health problems, and participation in risky sexual behavior. Despite such risks, adolescent girls are less likely to receive specialty mental health or school-based services than their male counterparts. This study is aimed at determining the effectiveness of a preventive intervention for preadolescent girls living in foster/kinship care. The intervention targets include preventing delinquency, initiation of substance use, participation in risky sexual behavior, school truancy and failure, and mental health problems. Participants were randomly assigned to receive either the preventive intervention or usual foster care services in the summer before entering middle school (typically sixth grade). The preventive intervention consisted of weekly training and support sessions for both participants and their foster or kin parents. The sessions began at study start and continued throughout participants' first year in middle school. Participants' relationship development, delinquency, school behavior and performance, sexual behavior, and substance use were assessed through questionnaires. Parenting practices were assessed through interviews. Assessments were conducted at study entry and at Months 6, 12, and 24, and 36. A new, follow-up assessment on the girls' decision making was conducted at age 14-16.
Interventions
BEHAVIORALMiddle School Success Intervention (MSS)
This is a 10-month, psychosocial intervention for foster parents and girls, with administration of the intervention beginning the summer before entry into middle school. The intervention consists of: (1) six summer Pride groups for the girls, (2) six summer parenting intervention sessions for the foster parents; (3) weekly foster parent training and support sessions for foster parents during the first year of middle school; and (4) weekly individual skills training for the girls during the first year of middle school.
Sponsors
National Institute of Mental Health (NIMH)
National Institute on Drug Abuse (NIDA)
Oregon Social Learning Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
10 Years to 12 Years
Healthy volunteers
Yes
Inclusion criteria
* Living in a foster home or receiving kinship care * Are about to enter middle school * Oregon resident * Guardian willing to provide informed consent * Female
Exclusion criteria
* male * not in foster care * not living in Oregon
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Delinquency | Measured at Month 36 | 36 items from the general delinquency scale from the Self-Report Delinquency Scale (SRD; Elliott, Huizinga, & Ageton, 1985). Units on a scale. Girls were asked to rate how many times they had committed various delinquent acts (e.g., damaging or destroying properties, and stealing) in the past year, using an open-ended format. The mean of frequencies across these items was used to represent the level of delinquency for girls. The general delinquency scale scores ranged from 0 to 24 (full scale) and from 0 to 13 (log transformed). Higher scores indicate higher levels of delinquency. |
| Tobacco Use | Measured at Month 36 | The girls were asked how many times in the past year they had smoked cigarettes or chewed tobacco. The response scale ranged from 1 (never) through 9 (daily). Units on a scale. |
| Marijuana Use | Measured at Month 36 | The girls were asked how many times in the past year they had used marijuana. The response scale ranged from 1 (never) through 9 (daily). Units on a scale. Log transformed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Placement Changes | Measured at Months 6 and 12 | Child welfare system records were collected at each assessment to determine the girls' placement changes (including the number and type of changes). Placement changes since the start of the study through 12 months were summed for each girl. The number of placement changes ranged from 0 to 7 during this period. Units on a scale. Higher scores indicate more placement changes. |
| Mental Health Problems | Measured at Months 12 and 24 | Internalizing and externalizing symptoms at 12 and 24 months were measured with caregiver report on the Achenbach System of Empirically Based Assessment (ASEBA). This widely used checklist for psychopathological behaviors includes scales for behaviors such as Anxious/Depressed; Withdrawn; Somatic Complaints; Thought Problems; Attention Problems; Aggressive Behavior; Rule-Breaking Behavior; and Intrusive. The ASEBA has been shown to have both construct and content validity in the literature. For the present study, raw scores for the internalizing and externalizing symptoms subscales were used. Scores at 12 and 24 months were combined and averaged (mean). Units on a scale. Range = 0-66. Higher scores indicate higher levels of internalizing or externalizing problems. |
| Decision Making | Measured at age 15-17 | Cups task (Weller et al., 2007). On each trial, participants see 2 arrays with equal number of X cups (2, 3, or 5) each. On gain trials, participants informed that under each cup in one array is 1 quarter, and the other array includes 1 cup with Y quarters (either 2, 3, or 5), but the other cups have 0 quarters. Choosing from the riskless side leads to a sure gain of 1 quarter while choosing the risky side can lead to gain of Y quarters or no quarters. On loss trials, participants shown that choosing cup from 1 array will lead to 1 quarter taken away while choosing cup from other array will lead to no quarters or Y quarters taken. Cups task consists of 54 trials of 3 trials each of all combinations of 2 levels of domain (gain, loss). Expected Value Sensitivity (EV) calculated by subtracting proportion of risky choices made when EV actually favored the sure choice from proportion of risky choices made on trials where EV favored risky option. Score can range from -1.0 to -1.0. |
| Participation in Risky Sexual Behaviors | Measured at Month 36 | Eight items from the girls' in-person interviews were used to assess health risking sexual behavior at the 36-month followup. The girls reported on items such as touching a boy's body above or below the waist, having sexual intercourse, having sex with someone who they just met, or having sex with someone using drugs in the past 12 months. Positive answers to these items were totaled to represent the cumulative number of health-risking sexual behaviors. The frequency of the cumulative number of risky sexual acts ranged from 0 to 7. Units on a scale. Higher scores indicate more health-risking sexual behaviors. |
| Social Competence | Measured at Months 6, 12 | Prosocial behavior was measured with a subscale from the Parent Daily Report (PDR; Chamberlain & Reid, 1987). The PDR was administered individually by telephone to foster parents on 3 consecutive or closely spaced days (1-3 days apart) at each assessment. A trained interviewer asked the foster parent whether a list of prosocial behaviors took place during the previous 24 hr (yes/no format). The prosocial scale was computed based on nine items, such as cleans up after herself and do a favor for someone. The PDR was designed to avoid the potential bias of aggregate recall of frequency estimates. Studies have reported concurrent and predictive validity of the PDR checklist. The scores were averaged (mean) across calls from 3 days. Scores on prosocial behavior at 6 and 12 months were averaged and the mean across both time points was used in analysis. Units on a scale. Range = 0-9. Higher scores indicate more prosocial behavior. |
Countries
United States
Participant flow
Recruitment details
Child welfare staff members referred girls to the study between 2003-2006, by searching their database to gather information on all girls who were 10-12 years old, in their final year of elementary school, currently in foster care, and living in the targeted counties in Oregon.
Participants by arm
| Arm | Count |
|---|---|
| 1 - Intervention Participants receive the preventative intervention. The intervention consisted of two primary components: (a) six sessions of group-based caregiver management training for the foster parents and (b) six sessions of group-based skill-building sessions for the girls. The groups met twice a week for 3 weeks, with approximately seven participants in each group. The caregiver sessions were led by one facilitator and one cofacilitator. The girl sessions were led by one facilitator and three assistants to allow a high staff-to-girl ratio (1:2) for individualized attention, one-on-one modeling/practicing of new skills, and frequent reinforcement of positive behaviors. In addition to the summer group sessions, follow-up intervention services (i.e., ongoing training and support) were provided to the caregivers and girls in the intervention group once a week for 2 hr (foster parent meeting; one-on-one session for girls) during the first year of middle school. | 48 |
| 2 - Foster Care Services as Usual The girls and caregivers in the control condition received the usual services provided by the child welfare system, including services such as referrals to individual or family therapy, parenting classes for biological parents, and case monitoring. Of the girls in the control condition, 62% received individual counseling, 20% received family counseling, 22% received group counseling, 30% received mentoring, 37% received psychiatric support, and 40% received other counseling or therapy services (e.g., school counseling, academic support) during the first year of middle school. Note that many girls received more than one service, and therefore the percentages listed above exceed 100%. Child Welfare caseworkers managed each case and were responsible for making all decisions on referrals to community resources, including individual and family therapy and parenting classes. | 52 |
| Total | 100 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 3 | 7 |
Baseline characteristics
| Characteristic | 2 - Foster Care Services as Usual | 1 - Intervention | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 52 Participants | 48 Participants | 100 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 11.59 years STANDARD_DEVIATION 0.45 | 11.48 years STANDARD_DEVIATION 0.51 | 11.54 years STANDARD_DEVIATION 0.48 |
| Region of Enrollment United States | 52 participants | 48 participants | 100 participants |
| Sex: Female, Male Female | 52 Participants | 48 Participants | 100 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 48 | 0 / 52 |
| serious Total, serious adverse events | 0 / 48 | 0 / 52 |
Outcome results
Primary
Delinquency
36 items from the general delinquency scale from the Self-Report Delinquency Scale (SRD; Elliott, Huizinga, & Ageton, 1985). Units on a scale. Girls were asked to rate how many times they had committed various delinquent acts (e.g., damaging or destroying properties, and stealing) in the past year, using an open-ended format. The mean of frequencies across these items was used to represent the level of delinquency for girls. The general delinquency scale scores ranged from 0 to 24 (full scale) and from 0 to 13 (log transformed). Higher scores indicate higher levels of delinquency.
Time frame: Measured at Month 36
Population: FIML analysis includes estimation of all cases even when missing data are present
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1 - Intervention | Delinquency | .30 log(units on a scale) | Standard Deviation 0.92 |
| 2 - Foster Care Services as Usual | Delinquency | .95 log(units on a scale) | Standard Deviation 2.69 |
Primary
Marijuana Use
The girls were asked how many times in the past year they had used marijuana. The response scale ranged from 1 (never) through 9 (daily). Units on a scale. Log transformed.
Time frame: Measured at Month 36
Population: Full information maximum likelihood (FIML) analysis includes estimation of all cases even when missing data are present
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1 - Intervention | Marijuana Use | 1.29 log(units on a scale) | Standard Deviation 0.82 |
| 2 - Foster Care Services as Usual | Marijuana Use | 2.33 log(units on a scale) | Standard Deviation 2.43 |
Primary
Tobacco Use
The girls were asked how many times in the past year they had smoked cigarettes or chewed tobacco. The response scale ranged from 1 (never) through 9 (daily). Units on a scale.
Time frame: Measured at Month 36
Population: Full information maximum likelihood (FIML) analysis includes estimation of all cases even when missing data are present
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1 - Intervention | Tobacco Use | 1.49 log(units on a scale) | Standard Deviation 1.63 |
| 2 - Foster Care Services as Usual | Tobacco Use | 2.36 log(units on a scale) | Standard Deviation 2.49 |
Secondary
Decision Making
Cups task (Weller et al., 2007). On each trial, participants see 2 arrays with equal number of X cups (2, 3, or 5) each. On gain trials, participants informed that under each cup in one array is 1 quarter, and the other array includes 1 cup with Y quarters (either 2, 3, or 5), but the other cups have 0 quarters. Choosing from the riskless side leads to a sure gain of 1 quarter while choosing the risky side can lead to gain of Y quarters or no quarters. On loss trials, participants shown that choosing cup from 1 array will lead to 1 quarter taken away while choosing cup from other array will lead to no quarters or Y quarters taken. Cups task consists of 54 trials of 3 trials each of all combinations of 2 levels of domain (gain, loss). Expected Value Sensitivity (EV) calculated by subtracting proportion of risky choices made when EV actually favored the sure choice from proportion of risky choices made on trials where EV favored risky option. Score can range from -1.0 to -1.0.
Time frame: Measured at age 15-17
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1 - Intervention | Decision Making | EV Sensitive in Loss Domain | .1383 units on a scale | Standard Deviation 0.22617 |
| 1 - Intervention | Decision Making | EV Sensitivity in Gain Domain | .2123 units on a scale | Standard Deviation 0.2282 |
| 2 - Foster Care Services as Usual | Decision Making | EV Sensitive in Loss Domain | .0378 units on a scale | Standard Deviation 0.18861 |
| 2 - Foster Care Services as Usual | Decision Making | EV Sensitivity in Gain Domain | .2743 units on a scale | Standard Deviation 0.2429 |
p-value: 0.008Regression, Logistic
Secondary
Mental Health Problems
Internalizing and externalizing symptoms at 12 and 24 months were measured with caregiver report on the Achenbach System of Empirically Based Assessment (ASEBA). This widely used checklist for psychopathological behaviors includes scales for behaviors such as Anxious/Depressed; Withdrawn; Somatic Complaints; Thought Problems; Attention Problems; Aggressive Behavior; Rule-Breaking Behavior; and Intrusive. The ASEBA has been shown to have both construct and content validity in the literature. For the present study, raw scores for the internalizing and externalizing symptoms subscales were used. Scores at 12 and 24 months were combined and averaged (mean). Units on a scale. Range = 0-66. Higher scores indicate higher levels of internalizing or externalizing problems.
Time frame: Measured at Months 12 and 24
Population: Full information maximum likelihood (FIML) analysis includes estimation of all cases even when missing data are present
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1 - Intervention | Mental Health Problems | 12.77 units on a scale | Standard Deviation 8.53 |
| 2 - Foster Care Services as Usual | Mental Health Problems | 12.50 units on a scale | Standard Deviation 8.29 |
Secondary
Participation in Risky Sexual Behaviors
Eight items from the girls' in-person interviews were used to assess health risking sexual behavior at the 36-month followup. The girls reported on items such as touching a boy's body above or below the waist, having sexual intercourse, having sex with someone who they just met, or having sex with someone using drugs in the past 12 months. Positive answers to these items were totaled to represent the cumulative number of health-risking sexual behaviors. The frequency of the cumulative number of risky sexual acts ranged from 0 to 7. Units on a scale. Higher scores indicate more health-risking sexual behaviors.
Time frame: Measured at Month 36
Population: FIML analysis includes estimation of all cases even when missing data are present
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1 - Intervention | Participation in Risky Sexual Behaviors | .89 units on a scale | Standard Deviation 1.17 |
| 2 - Foster Care Services as Usual | Participation in Risky Sexual Behaviors | 1.69 units on a scale | Standard Deviation 2.04 |
Secondary
Placement Changes
Child welfare system records were collected at each assessment to determine the girls' placement changes (including the number and type of changes). Placement changes since the start of the study through 12 months were summed for each girl. The number of placement changes ranged from 0 to 7 during this period. Units on a scale. Higher scores indicate more placement changes.
Time frame: Measured at Months 6 and 12
Population: Full information maximum likelihood (FIML) analysis includes estimation of all cases even when missing data are present
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1 - Intervention | Placement Changes | .33 placement changes | Standard Deviation 1.05 |
| 2 - Foster Care Services as Usual | Placement Changes | .76 placement changes | Standard Deviation 1.19 |
Secondary
Social Competence
Prosocial behavior was measured with a subscale from the Parent Daily Report (PDR; Chamberlain & Reid, 1987). The PDR was administered individually by telephone to foster parents on 3 consecutive or closely spaced days (1-3 days apart) at each assessment. A trained interviewer asked the foster parent whether a list of prosocial behaviors took place during the previous 24 hr (yes/no format). The prosocial scale was computed based on nine items, such as cleans up after herself and do a favor for someone. The PDR was designed to avoid the potential bias of aggregate recall of frequency estimates. Studies have reported concurrent and predictive validity of the PDR checklist. The scores were averaged (mean) across calls from 3 days. Scores on prosocial behavior at 6 and 12 months were averaged and the mean across both time points was used in analysis. Units on a scale. Range = 0-9. Higher scores indicate more prosocial behavior.
Time frame: Measured at Months 6, 12
Population: Full information maximum likelihood (FIML) analysis includes estimation of all cases even when missing data are present
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1 - Intervention | Social Competence | .80 units on a scale | Standard Deviation 0.12 |
| 2 - Foster Care Services as Usual | Social Competence | .74 units on a scale | Standard Deviation 0.14 |