Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
J Am Acad Child Adolesc Psychiatry. 2010 Jan;49(1):70-80. doi: 10.1097/00004583-201001000-00011.
There is ongoing debate regarding the impact of youth behavior problems on placement change in child welfare compared to the impact of placement change on behavior problems. Existing studies provide support for both perspectives. The purpose of this study was to prospectively examine the relations of behavior problems and placement change in a nationally representative sample of youths in the National Survey of Child and Adolescent Well-Being.
The sample consisted of 500 youths in the child welfare system with out-of-home placements over the course of the National Survey of Child and Adolescent Well-Being study. We used a prospective cross-lag design and path analysis to examine reciprocal effects of behavior problems and placement change, testing an overall model and models examining effects of age and gender.
In the overall model, out of a total of eight path coefficients, behavior problems significantly predicted placement changes for three paths and placement change predicted behavior problems for one path. Internalizing and externalizing behavior problems at baseline predicted placement change between baseline and 18 months. Behavior problems at an older age and externalizing behavior at 18 months appear to confer an increased risk of placement change. Of note, among female subjects, placement changes later in the study predicted subsequent internalizing and externalizing behavior problems.
In keeping with recommendations from a number of professional bodies, we suggest that initial and ongoing screening for internalizing and externalizing behavior problems be instituted as part of standard practice for youths entering or transitioning in the child welfare system.
关于青少年行为问题对儿童福利安置变化的影响与安置变化对行为问题的影响,目前仍存在争议。现有研究从这两个角度均提供了支持。本研究的目的是前瞻性地考察全国儿童福利和青少年健康调查中具有家庭外安置经历的代表性青年群体中行为问题与安置变化之间的关系。
该样本由全国儿童福利和青少年健康调查研究过程中有家庭外安置经历的 500 名儿童福利系统中的青少年组成。我们使用前瞻性交叉滞后设计和路径分析来检验行为问题和安置变化的相互影响,检验了一个总体模型和分别检验年龄与性别影响的模型。
在总体模型中,8 个路径系数中,行为问题显著预测了 3 个路径的安置变化,而安置变化则预测了 1 个路径的行为问题。基线时的内化和外化行为问题预测了基线到 18 个月期间的安置变化。年龄较大时的行为问题和 18 个月时的外化行为问题似乎增加了安置变化的风险。值得注意的是,在女性被试中,研究后期的安置变化预测了随后的内化和外化行为问题。
根据多个专业机构的建议,我们建议在儿童福利系统中进入或过渡的青少年中,将初始和持续的内化和外化行为问题筛查纳入标准实践。