Browsing by Author "McMillen, J. Curtis"
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Item Development and Piloting of a Treatment Foster Care Program for Older Youth with Psychiatric Problems(Child and Adolescent Psychiatry and Mental Health, 06/26/15) McMillen, J. Curtis; Narendorf, Sarah C.; Robinson, Debra R.; Havlicek, Judy; Fedoravicius, Nicole; Bertram, Julie E.; McNelly, DavidBackground: Older youth in out-of-home care often live in restrictive settings and face psychiatric issues without sufficient family support. This paper reports on the development and piloting of a manualized treatment foster care program designed to step down older youth with high psychiatric needs from residential programs to treatment foster care homes. Methods: A team of researchers and agency partners set out to develop a treatment foster care model for older youth based on Multi-dimensional Treatment Foster Care (MTFC). After matching youth by mental health condition and determining for whom randomization would be allowed, 14 youth were randomized to treatment as usual or a treatment foster home intervention. Stakeholders were interviewed qualitatively at multiple time points. Quantitative measures assessed mental health symptoms, days in locked facilities, employment and educational outcomes. Results: Development efforts led to substantial variations from the MTFC model and a new model, Treatment Foster Care for Older Youth was piloted. Feasibility monitoring suggested that it was difficult, but possible to recruit and randomize youth from and out of residential homes and that foster parents could be recruited to serve them. Qualitative data pointed to some qualified clinical successes. Stakeholders viewed two team roles – that of psychiatric nurse and skills coaches – very highly. However, results also suggested that foster parents and some staff did not tolerate the intervention well and struggled to address the emotion dysregulation issues of the young people they served. Quantitative data demonstrated that the intervention was not keeping youth out of locked facilities. Conclusions: The intervention needed further refinement prior to a broader trial. Intervention development work continued until components were developed to help address emotion regulation problems among fostered youth. Psychiatric nurses and skills coaches who work with youth in community settings hold promise as important supports for older youth with psychiatric needs.Item Knowledge of and Attitudes toward Behavioral Health Services among Older Youth in the Foster Care System(Child and Adolescent Social Work Journal, 11/06/10) Munson, Michelle R.; Narendorf, Sarah C.; McMillen, J. CurtisThis study examined knowledge of and attitudes toward services among 268 17-year olds with psychiatric diagnoses preparing to exit foster care. A structured interview assessed knowledge of services with vignette scenarios and attitudes with a standardized scale. Descriptive statistics described the extent of knowledge and attitudes among this population and regression analyses examined predictors of these dimensions of literacy. Most youth suggested a help source, but responses often lacked specificity. Gender and depression were the strongest predictors of knowledge and attitudes, respectively. Knowing which aspects of literacy are low, and for whom, can inform education efforts to improve access to care in adulthood.Item Pioneering the Psychiatric Nurse Role in Foster Care(Archives of Psychiatric Nursing, 10/11/13) Bertram, Julie E.; Narendorf, Sarah C.; McMillen, J. CurtisOlder youth served in the foster care system have elevated rates of mental health disorders and are high users of mental health services, yet concerns have been raised about the quality of this care. This paper describes the details of a psychiatric nurse’s work within a multidisciplinary team to address gaps in care for older youth with psychiatric disorders. We describe the process, outcomes, and lessons learned in developing and piloting a psychiatric nurse intervention for older youth in the foster care system as part of a multidimensional treatment foster care program. Our experiences support further work to develop a role for nursing to improve the quality of mental health treatment in foster care.Item Pregnancy Risk among Older Youth Transitioning out of Foster Care(Children and Youth Services Review, 2013-10) Matta Oshima, Karen M.; Narendorf, Sarah C.; McMillen, J. CurtisYouth served in the foster care system have higher rates of pregnancy than general population youth; yet we have little information about risk and protective factors to target in order to prevent early pregnancy in this population. We assessed early pregnancy risk and protective factors known for general population adolescents for their relevance to youth in the foster care system. Using data from a longitudinal study of 325 older youth from the foster care system, we examined bivariate and multivariate relationships between these factors and pregnancy between age 17 and 19 using logistic regression. Models examined risk for early parenting separately by gender. The pregnancy rate increased by 300% between ages 17 and 19. At 19, 55% of females had been pregnant, while 23% of males had fathered a child. Although this study assessed multiple known factors, few were significant for this high risk group. Females who were not sexually active at age 17 were less likely to become pregnant, but those who reported using birth control were as likely to become pregnant as those who did not. Also, females with a history of arrest were more likely to have a pregnancy between 17 and 19. Males who left the foster care system before their 19th birthday were more likely to make someone pregnant. Youth from the foster care system are at exceptional risk of early pregnancy, no matter their maltreatment history, religiosity, school connectedness, or academic achievement, particularly in the years between 17 and 19. This high risk group needs pregnancy prevention interventions and access to effective birth control.Item Substance Use and Substance Use Disorders as Foster Youth Transition to Adulthood(Children and Youth Services Review, 01/01/10) Narendorf, Sarah C.; McMillen, J. CurtisLittle research has previously examined substance use and substance use disorders as youth age out of foster care. This study examined rates of getting drunk, marijuana use, and substance use disorders over time for a cohort of 325 older youth in foster care in Missouri. Rates of past month marijuana use increased from 9% at age 17 to 20% at age 19. Rates of getting drunk in past year increased from 18% at age 18 to 31% at age 19. Compared to the general population, older foster youth had lower rates of substance use but higher rates of substance use disorders (SUD), with 15% of youth meeting criteria for a SUD at age 19. Youth who had left the custody of the state had significantly higher rates of alcohol and marijuana use at ages 18 and 19. Transitions out of residential care and into independent living situations were associated with use of substances at age 18. Different risk factors were associated with substance use at ages 18 and age 19 while risk factors for SUDs were more stable over time. Findings highlight the need to screen and provide treatment for SUDs before youth leave state custody and to consider substance abuse treatment in decisions to extend care beyond age 18.