The purpose of this study was to evaluate the effectiveness of a 2-component intervention for biological and foster parent (pairs) to improve parenting practices, co-parenting, and child externalizing problems. Participants were biological and foster parents (N=128) of primarily neglected children (ages 3 to 10 years) placed in regular foster homes. Biological and foster parents were randomly assigned in pairs to the intervention (n=80) or a usual care (n=48) condition. Intervention families received a 12-week parenting course (Incredible Years) and a newly developed co-parenting component. Key findings included significant gains in positive parenting and collaborative co-parenting for both biological and foster parents at the end of the intervention. At follow-up, intervention parents sustained greater improvement in positive parenting, showed gains in clear expectations, and reported a trend for fewer child externalizing problems. Findings supported the feasibility of offering joint parenting training to meet the needs of participating families and demonstrated that the co-parenting construct applied to families in the foster care system was amenable to intervention.

This study examined how maternal distress mediates the link between exposure to community violence (CV) and the development of early child behavior problems. Research was conducted among 160 children, 3,0 to 5,11 in age, who resided in high-crime neighborhoods. Using structural equation modeling, latent variables were constructed to identify model components: maternal socioeconomic status (SES) and public assistance status, exposure to CV (maternal perceptions of local violence, social disorder, and fear of crime; and frequency of child cowitnessing violent events), family aggression (partner aggression toward mother and partner aggression toward child), maternal distress (global distress and posttraumatic stress disorder symptoms), and early child behavior problems (internalizing and externalizing). Bivariate correlations indicated that CV, maternal distress, and early child behavior problems were significantly intercorrelated. A series of structural equation models was specified to estimate the direct and indirect effect of CV on early child behavior problems. A direct model indicated a significant path from CV to early child behavior problems, after controlling for maternal SES and family aggression. The direct CV-early child behavior problems path diminished, however, when maternal distress was included in the model, after controlling for maternal SES and family aggression. Results are consistent with a mediation model of the impact of maternal distress symptoms on the link between CV and early child behavior problems.

Studies of posttraumatic stress disorder (PTSD) in adolescence published from 2000 to 2011 indicate that adolescents are at greater risk of experiencing trauma than either adults or children, and that the prevalence of PTSD among adolescents is 3-57%. Age, gender, type of trauma, and repeated trauma are discussed as factors related to the increased rates of adolescent PTSD. PTSD in adolescence is also associated with suicide, substance abuse, poor social support, academic problems, and poor physical health. PTSD may disrupt biological maturational processes and contribute to the long-term emotion and behavior regulation problems that are often evident in adolescents with the disorder. Recommendations are presented for practice and research regarding the promotion of targeted prevention and intervention services to maximize adolescents' strengths and minimize vulnerabilities. Public policy implications are discussed.Keywords adolescent, trauma, posttraumatic stress, abuse, development, risk factors, suicidality, substance use Key Points of the Research Review Trauma in AdolescenceFour of five adolescents meet DSM criteria for exposure to a serious traumatic event. Of these, 3-57% meet diagnostic criteria for Posttraumatic Stress Disorder (PTSD). Child maltreatment is a common type of trauma for those under 18. There were over 2 million reported cases in the United States in 2008, which likely represents a fraction of the actual incidents of abuse and neglect. PTSD in AdolescenceThe average rate of adolescent PTSD was nearly 14% among studies conducted in the last decade. Rates of PTSD in adolescence are related to type of trauma. Trauma that is associated with more shame and deviance is associated with higher rates of PTSD (e.g., for sexual abuse 57% have PTSD vs. 10% for natural disasters). Risk Factors for PSTDRates of traumatic exposure peak in adolescence compared to adulthood, which is associated with correspondingly higher rates of PTSD (adult PTSD 7% vs. adolescent PTSD 13%). Adolescent females are twice as likely to develop PTSD following a significant trauma than males. Repeated trauma, regardless of type, heightens the probability of PTSD symptoms and diagnosis. Adolescents with less social support are more likely to experience trauma and develop PTSD.Serious physical health problems increase risk of PTSD in adolescence. Correlates of PTSDAdolescents with PTSD are significantly more likely to have failed a grade or to have been suspended than those without PTSD. Over 80% of individuals with PTSD have a comorbid substance-use disorder, typically beginning in adolescence. Approximately 6% of adolescents with PTSD have made a suicide attempt versus less than 2% for adolescents with no history of trauma or PTSD. Brain imaging studies relate PTSD and trauma to differences in emotion regulation, dopamine, and norepinephrine activation.

This preliminary study examined intervention effects of a universal prevention program offered by classroom teachers to public elementary school students. The Unique Minds School Program (M.B. Stern, 1999) is a teacher-led program designed to promote cognitive-social-emotional (CSE) skills, including student self-efficacy, problem solving, social-emotional competence, and a positive classroom climate, with the dual goal of preventing youth behavioral problems and promoting academic learning. During 2 consecutive school years, 119 students and their teachers were assessed in the fall and spring of Grade 4 and again in the spring of Grade 5. As compared to students in the comparison school, students in the intervention showed gains in student selfefficacy, problem solving, social-emotional competencies, and math grades. Incremental gains within CSE domains were found after 1 and 2 years of intervention.

Sibling unity during family transitions is considered a protective factor for child behavior problems, but there is little empirical support for the widespread child protection policy of placing siblings together in foster care. In a prospective study of 156 maltreated children, siblings were classified in 1 of 3 placement groups: continuously together (n = 110), continuously apart (n = 22), and disrupted placement (siblings placed together were separated; n = 24). Changes in child adjustment as a function of sibling relationship and placement group were examined. Sibling positivity predicted lower child problems at follow-up (about 14 months later), while sibling negativity predicted higher child problems. Placement group did not affect child behavior problems at follow-up; however, compared to siblings in continuous placement (either together or apart), siblings in disrupted placement with high initial behavior problems were rated as having fewer problems at follow-up, while siblings in disrupted placement with low initial behavior problems were rated as having more problems at follow-up. These findings highlight the importance of considering relationships between siblings and the risk that one poses to another before early placement decisions are made.

ObjectivesPublished human papillomavirus (HPV) vaccine trials indicate efficacy is strongest for those naive to the vaccine-types. However, few high-risk young women have been followed and cervical HPV has been the predominant outcome measure.MethodsWe collected cervical and anal swabs, as well as oral rinse specimens from 645 sexually active inner-city young females attending a large adolescent health-clinic in New York City that offers free care and HPV vaccination. Specimens were tested for HPV-DNA using a MY09/MY11-PCR system. Type-specific prevalence of HPV at each anatomic site was compared for individuals by vaccination dose using generalized estimating equation logistic regression models.ResultsThe majority of subjects reported being of non-Caucasian (92%) and/or Hispanic ethnicity (61%). Median age was 18 years (range:14–20). All had practiced vaginal sex, a third (33%) practiced anal sex, and most (77%) had also engaged in oral sex. At enrollment, 21% had not received the vaccine and 51% had received three doses. Prevalent HPV infection at enrollment was detected in 54% of cervical, 42% of anal and 20% of oral specimens, with vaccine types present in 7%, 6% and 1% of specimens, respectively. Comparing prevalence for vaccine types, the detection of HPV in the cervix of vaccinated compared to unvaccinated adolescents was significantly reduced: HPV6/11 (odds ratio [OR] = 0.19, 95%CI:0.06–0.75), HPV16 (OR = 0.31, 95%CI:0.11–0.88) and HPV18 (OR = 0.14, 95%CI:0.03–0.75). For anal HPV, the risk of detecting vaccine types HPV6/11 (OR = 0.27, 95%CI:0.10–0.72) and HPV18(OR = 0.12, 95%CI:0.01–1.16) were significantly reduced for vaccinated adolescents however, the risk for HPV16 was not significantly decreased (OR = 0.63, 95%CI:0.18–2.20).ConclusionHPV Prevalence is extremely high in inner-city female adolescents. Administration of the HPV vaccine reduced the risk for cervical HPV; however continued follow-up is required to assess the protection for HPV at all sites in young women with high exposure.

Sibling aggression among maltreated children placed in foster homes is linked to other externalizing problems and placement disruption. The reduction of sibling conflict and aggression may be achieved via a multicomponent ecologically focused intervention for families in the foster care system. The focus of the study is to evaluate the feasibility and short-term effectiveness of a transtheoretical intervention model targeting sibling pairs and their foster parent that integrates family systems, social learning theory, and a conflict mediation perspective. In this pilot study, sibling pairs (N=22) and their foster parent were randomized into a three-component intervention (n=13) or a comparison (n=9) group. Promoting Sibling Bonds (PSB) is an 8-week prevention intervention targeting maltreated sibling pairs ages 5–11 years placed together in a foster home. The Siblings, Parent, and Joint components were delivered in a program package at the foster agency by a trained two-clinician team. Average attendance across program components was 73%. Outcomes in four areas were gathered at pre-and post-intervention: observed sibling interaction quality (positive and negative) including conflict during play, and foster parent reports of mediation strategies and sibling aggression in the foster home. At post-intervention, adjusting for baseline scores and child age, intervention pairs showed higher positive (p<.001) and negative (p<.05) interaction quality, and lower sibling conflict during play (p <.01) than comparison pairs. Foster parents in the intervention group reported a higher number of conflict mediation strategies than those in the comparison group (p <.001). Foster parents in the intervention group reported lower sibling physical aggression from the older toward the younger child than those in the comparison group (p <.05). Data suggest that the PSB intervention is a promising approach to reduce conflict and promote parental mediation which together may reduce sibling aggression in the foster home.

Although literature supports the association between harmonious coparenting practices and lowered child problems, little is known about coparenting influences among family constellations in the foster care system. Via a compilation of a new coparenting practices measure, we examined similarities and differences on foster parent-derived perceptions of support/flexibility, shared communication, conflict/triangulation, and total coparenting between foster and biological parents and their independent contribution to child internalizing and externalizing problems. Self-reports were gathered from foster parents (N=80) in 2 groups: kin and nonkin. As compared with nonkin, kin foster parents reported higher perceived support/flexibility, shared communication, and total coparenting. A tendency for higher conflict/triangulation among kin foster parents was also found. After considering foster parent group, psychological distress, and harsh discipline, hierarchical regression analyses revealed that perceived total coparenting and conflict/triangulation contributed to child internalizing and externalizing problems. Results support the linkage between perceptions of coparenting and child problems among caregivers (foster and biological alike) in kin and nonkin arrangements and highlight training in coparenting in general, and conflict management in particular, as an important intervention focus to reduce the high level of child problems in this vulnerable population.