This study reports the prevalence of PTSD, major depression, alcohol abuse/dependence and substance abuse/dependence diagnoses assessed with a structured clinical interview protocol in a population-based, multi-state, age cohort of older adolescents about to exit child welfare systems. PTSD was the most common diagnosis and was observed at rates above those seen in the general population. Rates of specific diagnoses varied according to gender, race, type of child welfare placement, and state of residence. In general, African American youth and those in kinship family foster care were less likely to have mental health and substance use problems. Analysis of the timing of onset relative to entry into care revealed that Caucasian youth were more likely to have diagnoses prior to entry into state custody, and race differentials were less pronounced for diagnosis after placement in foster care. Observed state-to-state differences suggest that age of entry into care and the likelihood of pre-existing mental health and substance use conditions could be attributable to child welfare policies regarding screening and placement.Older adolescents emancipating from the child welfare system often face the transition to independent adulthood abruptly and without guarantees of continuing support (Collins, 2001;Geenen & Powers, 2007;McCoy, McMillen, & Spitznagel, 2008;Stein, 2006). The transition from adolescence to adulthood typically provides new freedoms and opportunities, but it also poses many challenges that can test coping skills, exacerbate pre-existing difficulties, and derail developmental trajectories (Maughan & Champion, 1990;Schulenberg, Sameroff, & Cicchetti, 2004). In general, adolescents who enter this developmental period with psychiatric disorders or heavy substance use are more likely than others to experience negative outcomes in adulthood (Davis & Vander Stoep, 1997;Schulenberg & Maggs, 2002;Vander Stoep et al., 2000). Mental health and substance use problems are among the many factors that can jeopardize the prospects of youth exiting the foster care system (Anctil, McCubbin, O'Brien, Pecora, & Anderson-Harumi, 2007). Because they commonly are exposed to multiple adverse familial and environmental conditions associated with the development of psychopathology, youth leaving state custody are likely to have elevated risk for various forms Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptChild Youth Serv Rev. Author manuscript; available in PMC 2011 April 1. Published in final edited form as:Child Youth Serv Rev. (Pecora, White...

This study investigated whether more complex maltreatment experiences predicted higher levels of depressive symptomatology for young adults and examined the role of social support during late adolescence in that association. Specifically, the study tested whether social support had a direct effect on depression and whether it mediated and/or moderated the relationship between self-reported maltreatment and depression in a sample of 513 youth exiting the child welfare system. Indices of maltreatment types (neglect and physical, sexual, psychological abuse) experienced during two periods (pre-care and during-care) were used in conjunction with a measure of perceived social support (reflecting support availability and social network sufficiency) in negative binomial regression models predicting depressive symptoms. Both pre- and during-care maltreatment were associated with depressive symptoms as a young adult. Social support had a direct effect on depressive symptoms as well as moderation and partial mediation effects on the relationship between maltreatment and depression. Social support’s buffering effect was stronger for those experiencing fewer types of maltreatment. This buffering effect appears to diminish as maltreatment histories become more complex.

Purpose Youth in foster care represent a highly traumatized population. However, trauma research on this population has focused primarily on maltreatment rather than the full spectrum of trauma experiences identified within the DSM-IV. The current study aims to fill this gap by reporting the prevalence of exposure to specific types of traumatic events for a large sample of youth with foster care experience. The study also reports the likelihood of lifetime PTSD diagnoses associated with each specific type of trauma. Method Data are from a longitudinal panel study of 732 adolescents aged 17 and 18 who were in foster care. Lifetime trauma exposure and PTSD diagnosis were assessed using the Composite International Diagnostic Interview. Statistical comparisons were made using logistic regressions. Results The majority of respondents had experienced at least one trauma in their lifetime. While overall trauma prevalence did not differ by gender, males were more likely to experience Interpersonal Violence and Environmental Trauma, while females were more likely to experience Sexual Trauma. Caucasian participants reported higher rates of trauma exposure than African-American participants. The types of trauma associated with the highest probability of a lifetime PTSD diagnosis were rape, being tortured or a victim of terrorists, and molestation. Conclusions Youth in foster care are a highly traumatized population and meet diagnostic criteria for PTSD at higher rates than general youth populations. The ongoing impact of trauma may be particularly problematic for these young people given their abrupt transition to independence.

Topic Subject participation is a critical concern for clinicians and researchers involved in prevention programs, especially for intensive interventions that require randomized assignment and lengthy youth and parent involvement. Purpose This paper describes details of an integrated approach used to recruit and retain at-risk high school youth, their parents and high schools to two different comprehensive “indicated” prevention programs. Sources used Parent and youth recruitment and retention data for the two studies is provided in support of the approach described. A coordinated, multi-level approach, organized around cross-cutting issues, is described in detail as a response to the challenges of including vulnerable populations in intervention research. Conclusion Methods are relevant to nurse clinicians who deliver prevention programs, and important to clinical research that relies upon adequate participation in research programs.