OBJECTIVE: To determine factors influencing outpatient mental health service use by children in foster care. METHOD: Detailed survey and administrative data were collected on 480 children who entered long-term foster care in San Diego County from May 1990 through October 1991. These data were linked with claims data from Medicaid and San Diego County Mental Health Services information systems. A Poisson regression model was used to determine whether the following factors influenced outpatient mental health service use: age, race/ethnicity, gender, maltreatment history, placement pattern, and behavioral problems as measured by the Achenbach Child Behavior Checklist (CBCL). RESULTS: Except for maltreatment history, all independent variables included in the multivariate regression model were statistically significant. The total number of outpatient mental health visits increased with age, male gender, and non-relative foster placements. Relative to Caucasians, visits were lower for Latinos, and Asian/Others, but comparable for African-Americans. Concerning maltreatment history, differences were only found in one category; children experiencing caretaker absence received fewer visits compared to children who did not experience caretaker absence. Children with CBCL Total Problem Scale T-scores of 60 or greater had significantly more visits than those with a score less than 60. CONCLUSIONS: Both clinical and non-clinical factors influence outpatient mental health service use by foster children. Limitations imposed by gender, race/ethnicity, and placement setting need to be addressed by child welfare policies. These finding suggest that guidelines are needed to systematically link children in foster care with behavioral problems to appropriate services. 相似文献
Background: computer software is widely used to support literacy learning. There are few randomised trials to support its effectiveness. Therefore, there is an urgent need to rigorously evaluate computer software that supports literacy learning.
Methods: we undertook a pragmatic randomised controlled trial among pupils aged 11–12 within a single state comprehensive school in the North of England. The pupils were randomised to receive 10 hours of literacy learning delivered via laptop computers or to act as controls. Both groups received normal literacy learning. A pre‐test and two post‐tests were given in spelling and literacy. The main pre‐defined outcome was improvements in spelling scores.
Results: 155 pupils were randomly allocated, 77 to the ICT group and 78 to control. Four pupils left the school before post‐testing and 25 pupils did not have both pre‐ and post‐test data. Therefore, 63 and 67 pupils were included in the main analysis for the ICT and control groups respectively. After adjusting for pre‐test scores there was a slight increase in spelling scores, associated with the ICT intervention, but this was not statistically significant (0.954, 95% confidence interval (CI) – 1.83 to 3.74, p = 0.50). For reading scores there was a statistically significant decrease associated with the ICT intervention (?2.33, 95% CI ?0.96 to ?3.71, p = 0.001).
Conclusions: we found no evidence of a statistically significant benefit on spelling outcomes using a computer program for literacy learning. For reading there seemed to be a reduction in reading scores associated with the use of the program. All new literacy software needs to be tested in a rigorous trial before it is used routinely in schools. 相似文献
OBJECTIVE: To determine factors influencing the use of outpatient mental health services provided by mental health professionals (OMHS) for children in foster care using a national probability sample in the United States. METHOD: As part of the National Survey of Child and Adolescent Well-being, detailed survey data were collected on 462 children, ages 2-15, who had been in out-of-home care for approximately 12 months at the time of sampling. A multivariate logistic regression model was used to determine how clinical need, as measured by a Total Problem, Externalizing, or Internalizing Scale T-score of 64 or greater on the Achenbach Child Behavior Checklist (CBCL), and non-clinical factors affected OSMHS use. RESULTS: Over half of the children in the sample received at least one OMHS. Need, older age, and history of sexual abuse history all positively predicted OMHS. A history of physical neglect negatively predicted OSMHS. African-Americans used fewer services than children of Caucasian ancestry at all values on the CBCL. This finding was particularly salient at lower levels of CBCL scores; at higher levels, the discrepancy in the use of services diminished but the proportion of children receiving services remained lower for African-American children. CONCLUSIONS: This national study confirms previous findings regarding the use of mental health services based on regional data. Limitations in the use of services imposed by non-clinical factors, specifically, age, race/ethnicity and type of abuse, need to be examined in order to address implicit and explicit policies and practices that may result in inequitable distribution of services. 相似文献
