Mental health outcomes among child welfare investigated children: In-home versus out-of-home care
Mental health outcomes among child welfare investigated children: In-home versus out-of-home care
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DOI：
10.1016/j.childyouth.2015.08.004
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发表时间：
2015-10-01
影响因子：
3.3
通讯作者：
Szilagyi, Peter G.
中科院分区：
文献类型：
--
作者：
Conn, Anne-Marie;Szilagyi, Moira A.;Szilagyi, Peter G.
背景：儿童福利越来越关注家庭外安置（OOH）的替代方案。家庭内服务，如父母培训，已经增加，更多受虐待的儿童留在家里。然而，对于将脆弱儿童留在家中与安置在稳定的户外护理中对心理健康的影响知之甚少。目的：评价和比较儿童福利调查的留守家庭儿童与稳定户外护理儿童的心理健康差异。设计/方法：我们检查了一组儿童（年龄在1.5-18岁），这些儿童来自全国代表性的儿童样本，通过儿童福利调查II （NSCAW II）进行调查。我们比较了在家中接受父母培训的儿童与在稳定的户外护理中接受培训的儿童在18个月内心理健康功能的变化。结果：在我们样本中的749名儿童中，留在家中接受父母培训的儿童和那些接受稳定户外护理的儿童的基线特征相似。在接受稳定户外护理的学龄儿童中，心理健康问题从26%下降到13% （p = 0.003）。这与留在家中的学龄儿童显著不同，他们的心理健康问题增加了（稳定的户外护理减少了50%，而在家的增加了23%；p = .007）。在学龄前儿童中，心理健康问题在两种环境中都有所增加，特别是稳定的户外护理（p = 0.008）。结论：对于有虐待史的学龄儿童，在稳定的户外广告投放后，心理健康状况有所改善，但与父母呆在家里时，心理健康状况恶化。儿科医生应该警惕虐待后留在家中的儿童的心理健康问题，并在必要时提倡高质量稳定的户外护理。儿童福利可能需要更密切地监测留守儿童的结果，并向家庭提供更密集的预防和治疗服务。(C) 2015 Elsevier Ltd.版权所有。
Background: Child welfare has increasingly focused on alternatives to out-of-home (OOH) placement In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.Objective: To evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methods: We examined a cohort of children (aged 1.5-18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.Results: Among the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).Conclusions: For school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families. (C) 2015 Elsevier Ltd. All rights reserved.