Positive Youth Development for Children and Youth with Special

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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
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 individual’s environment and
developmental context
– E.g., families, schools, peers, neighborhoods
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
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
Positive Youth Development
4 concerns
– Single vs multiple contexts
– Inclusion of multiple positive and negative
  developmental outcome measures
– Samples
– Generalizability to CYSHCN
                Goals
Used 2003 National Survey of Children’s
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
             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
              Methods
2003 NSCH: random-digit-dial sample,
households with children < 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
                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 > high school
–   53% were two-parent homes
–   Income:
       16% below 100% FPL
       56% between 100-400% FPL
       28% above 400% FPL
       Outcome Variables
Positive Indicators
– Social Competence
– Health Promoting Behavior
– Self-esteem
Negative Indicators
– Externalizing Behavior
– Internalizing Behavior
– Academic Problems
                              ASHCN
                              No ASHCN
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                                         Outcome Variables




                          le
                             m
                                s
        Predictor Domains
Family Promotive          Family Risk
– Family Engagement       – Family Aggression
– Family Closeness        – Parent Aggravation
– Healthy Role Modeling   – Negative Health
– Household rules           Modeling
– Communication skills
– Child safety at home
– Coping well with
  parenthood
– Emotional support
  available
          En
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                     R
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         Predictor Domains
School/Neighborhood      School/Neighborhood
Promotive                Risk
– School and             – Negative
  neighborhood safety      Neighborhood
– Connectedness            Influence
                         – School violence



Health Care
– Usual source of care
School/Neighborhood Variables
                     ASHCN            No ASHCN

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              Methods
6 regressions run separately for sample of
families with ASHCN and families with no
ASHCN
All variables entered simultaneously
                   So
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       l   th                      m




                                                              0%
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                       d   em
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                                                                              Variance Explained in Model
       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
       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
       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
       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
       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
   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
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)
          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 Children’s Health (SLAITS)
– Communities that Care (Univ. of WA Seattle Social Development Project)
Thank you!