Positive Youth Development for Children and Youth with Special Health Care Needs (CYSHCN) and Their Families

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Positive Youth Development for Children and Youth
with Special Health Care Needs (CYSHCN) and Their
Families

• Lise M. Youngblade, PhD
• Department of Human Development and Family
  Studies
• Colorado State University

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Positive Youth Development

• Number of comprehensive models available to
  predict problem behavior and, more recently, the
  promotion of optimal development
• Models take into account the multiple layers of
  individuals environment and developmental
  context
• E.g., families, schools, peers, neighborhoods

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Positive Youth Development

• Optimal development owes not simply to reduction
  in negative behavior, but growth of strengths and
  competencies that prepare youth for the future

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Positive Youth Development

• Critical dimensions of important social contexts
  related to positive youth development
• Connection, regulation, autonomy
• Safety, supervision, monitoring
• Resources and opportunities for skill building
• Integration across settings
• When these are evident, youth thrive

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Positive Youth Development

• 4 concerns
• Single vs multiple contexts
• Inclusion of multiple positive and negative
  developmental outcome measures
• Samples
• Generalizability to CYSHCN

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Goals

• Used 2003 National Survey of Childrens Health to
  illustrate some of these points
• Focused on adolescence
• Interest in comparing risk and promotive factors
  for families with adolescent with identified
  special health care needs (ASHCN) and families
  with no identified ASHCN on range of positive and
  negative outcomes

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Hypotheses

• Differences in outcome based on ASHCN status
• Negative contextual factors associated with
  negative behavioral outcomes and inversely
  related to positive outcomes vice versa for
  positive contextual factors
• All levels (family, school and community, and
  health care) significantly associated with
  outcomes
• Explored salience of contextual variables based
  on ASHCN status

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Methods

• 2003 NSCH random-digit-dial sample, households
  with children lt 18 years of age
• Parent/guardian respondents
• 102,353 completed interviews (55 response rate)
• Estimates based on sampling weights generalize to
  noninstitutionalized population of children in
  each state and nationwide

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Study Sample

• 42,305 adolescents, aged 11-17 years
• Demographics
• Mean age 13.94 years (se.017 yrs)
• 51 female
• Generally healthy (mean 3.38, se.008, scale 0-4)
• 21 met screening criteria for special health
  care need
• 19 African American 81 White or other
• 15 Hispanic
• 62 Highest level household education was gt high
  school
• 53 were two-parent homes
• Income
• 16 below 100 FPL
• 56 between 100-400 FPL
• 28 above 400 FPL

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Outcome Variables

• Positive Indicators
• Social Competence
• Health Promoting Behavior
• Self-esteem
• Negative Indicators
• Externalizing Behavior
• Internalizing Behavior
• Academic Problems

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Outcome Variables
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Predictor Domains

• Family Promotive
• Family Engagement
• Family Closeness
• Healthy Role Modeling
• Household rules
• Communication skills
• Child safety at home
• Coping well with parenthood
• Emotional support available

• Family Risk
• Family Aggression
• Parent Aggravation
• Negative Health Modeling

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Family Variables

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Predictor Domains

• School/Neighborhood Promotive
• School and neighborhood safety
• Connectedness
• Health Care
• Usual source of care

• School/Neighborhood Risk
• Negative Neighborhood Influence
• School violence

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School/Neighborhood Variables
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Usual Source of Care
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Methods

• 6 regressions run separately for sample of
  families with ASHCN and families with no ASHCN
• All variables entered simultaneously

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Variance Explained in Model
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Regression Results

• Overall impressions
• Risk and promotive factors function in the way
  hypothesized
• Not much difference for most of the predictors
  between ASHCN and non-ASHCN
• Most of the coefficients are rather small
  (although statistically significant)
• Some interesting findings however

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Regression Results

• Parent-child closeness is strong predictor of
  self-esteem and less problematic academic
  outcomes
• For both ASHCN and non-ASHCN, but more so for
  ASHCN
• Parent-child communication promotes social
  competence and less externalizing behavior
• For both ASHCN and non-ASHCN, but more so for
  ASHCN

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Regression Results

• Parent aggravation had one of the most consistent
  effects, all of which were amplified for families
  with ASHCN
• Less social competence
• Lower self-esteem
• Greater externalizing behavior
• Greater internalizing behavior
• Greater academic problems

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Regression Results

• School violence and bullying was strongly related
  to less self-esteem, greater internalizing
  behavior, and more academic problems for ASHCN
  and non-ASHCN
• Also evinced a small but positive relation to
  social competence in ASHCN (but opposite in
  non-ASHCN), which may indicate resilience in some
  children

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Regression Results

• Usual source of care had similar results for both
  ASHCN and non-ASHCN
• Greater social competence
• Less externalizing and internalizing behavior,
  and fewer academic problems

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What does this suggest?

• Efforts to ameliorate problem behavior, as well
  as promote healthy and competent behavior, need
  to include multiple salient contexts
• Despite mean level differences in outcome
  variables, the processes and resources necessary
  to promote optimal development are very similar
  for CYSHCN and children without special needs

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What should we pay attention to?

• Multiple resources, supports, connections are
  important for positive youth development
• When such provisions are available, youth thrive,
  but it is also true that when youth thrive,
  systems serving youth benefit
• Focus on measuring and reducing negative behavior
  (externalizing, internalizing, school problems)
  BUT also increasing positive outcomes (self
  esteem, social competence, health promoting
  behavior)

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Taking it to the Streets

• Screen
• Identify CYSHCN (MCHB CSHCN Screener)
• Identify insurance (or lack of) and usual source
  of care
• Support
• Support families to support youth this is a
  public health message!
• Pay attention to parent aggravation and
  frustration
• Accentuate the positive closeness and
  communication
• Support youth to succeed
• Accentuate the positive self esteem and social
  competence
• Promote
• Usual source of care
• Medical home (www.medicalhomeinfo.org)
• Connections between families, schools, health
  system
• Safe schools bullying is a public health
  concern
• Resources
• Assets for Youth (Search Institute)
• National Survey of Childrens Health (SLAITS)
• Communities that Care (Univ. of WA Seattle Social
  Development Project)

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Thank you!