Youth Care Research Articles

Young adults as paid care workers: gendered and classed transitions, trajectories, and experiences

ABSTRACT This article brings a youth lens to the study of care by empirically examining the accounts of young adults who pursue paid adult social care employment. The youth lens includes drawing on youth studies – particularly youth transitions – literature, which is combined with paid care work scholarship in a novel way. Young adults’ experiences as paid care workers are peripheral in youth studies and care work scholarship, despite this work’s increasing prevalence. The article examines the experiences of young adults pursuing, starting out and doing this work, through qualitative empirical research in Teesside, north-east England. A key finding of young people’s unpaid caring for adults influencing their pursuit of paid adult social care work is identified. The article contributes to understanding of youth transitions, particularly in relation to care work, and offers insights regarding the reproduction and sustainability of the paid adult social care workforce. It augments the growing sociological literature of Teesside [Shildrick, T., R. MacDonald, C. Webster, and K. Garthwaite. 2012. Poverty and Insecurity: Life in Low-Pay, No-Pay Britain. Bristol: Policy Press], and converses with work that foregrounds care work’s gendered and classed dimensions [Skeggs, B. 1997. Formations of Class and Gender: Becoming Respectable. London: Sage; Stacey, C. L. 2011. The Caring Self: The Work Experiences of Home Care Aides. Ithaca: Cornell University Press].

Patient physical violence toward healthcare workers at a US children's hospital.

An improved understanding of patient-related violent events toward healthcare workers (HCWs) is a critical step in mitigating patient violence in the pediatric medical hospital setting. Therefore, we sought to describe the timing/setting, potential antecedents to, and management of pediatric patient-related violence toward HCW. Using our electronic health record (EHR), we performed a retrospective study of patient-related physical violent events from 2017 to 2022 among youth hospitalized at our free-standing children's hospital. We identified 144 violent events associated with 75 patients. Most (66.7%) events occurred after a youth was medically cleared for discharge, and most (55%) events were preceded by an aversive experience the youth was trying to avoid. Most (77.1%) youth received medications for de-escalation, and nearly one-half (47.9%) experienced mechanical restraints. Our results highlight the challenges hospitals face while caring for youth at risk for behavioral escalations and support the need for both comprehensive in-patient behavioral health teams.

United States v Skrmetti—Testing the Transition to Politicized Regulation of Medicine

This Viewpoint discusses Tennessee’s ban on gender-affirming care for transgender youth and how the US Supreme Court’s decision on the constitutionality of this law could have potential implications for state regulation of medical practice.

Sustainability of an evidence-based intervention supporting transition to independent care for youth living with HIV in Kenya.

Integrating and sustaining evidence-based interventions (EBIs) in routine care is crucial to improving HIV treatment outcomes among youth living with HIV (YLH). However, EBIs are often not sustained post clinical trial. An Adolescent Transition Package (ATP) delivered by health care workers (HCWs) and tested in Kenya in 2021 significantly improved YLH readiness to transition to independent care. Post-trial, participating clinics could continue using the ATP. We conducted 30 in-depth interviews with health care workers to evaluate determinants of continued ATP implementation one-year post-trial. Interviews used semi-structured guides, informed by the Consolidated Framework for Implementation Research version 2.0 (CFIR v2.0). Transcripts were analyzed thematically to identify key influences of ATP sustainment and fidelity post-trial. Effective training during and after the trial, and continued internal and external support for implementation, were crucial for sustained acceptability and feasibility. In contrast, staff shortages and high turnover, lack of integration into the existing electronic medical system, and maintaining staff motivation were barriers to ATP sustainment. Implementation fidelity was limited by workforce constraints and HCW beliefs about the importance of individualizing content and delivery to be responsive to individual client needs. ATP adaptability afforded optimization of delivery to overcome workforce constraints and meet client needs, increasing HCW perceptions of feasibility and motivating continued use. Alignment between observed impact and care provision goals further motivated ongoing ATP utilization. Strategies to ensure continued training and integration of tools into existing systems have the potential to further enhance ATP sustainability.

Observational drift: a methodological research proposal for community prospecting in socio-educational services

PurposeThis article aims to describe the process of application of the technique of Observational Drift for prospection in three territories of Catalonia and to present recommendations for its application in research and socio-educational action with young people.Design/methodology/approachObservational Drift is a qualitative research technique that has proven effective as a practice for community prospection. The process of design and application in the pilot implementation of this technique is presented together with a reflection on the outcome.FindingsThe pilot implementation of the technique has made it possible, within the framework of the research project, to identify methodological recommendations such as the edition of an observation manual; the training of the research team; the identification of supporting computer applications and registration questionnaires. Records of youth dynamics have been obtained in the 3 communities studied: the town of Celrà, the western district of the city of Girona and the “Ciutat Vella” district of Barcelona, 3 environments of different sizes located in Catalonia, Spain.Practical implicationsObservational drift is a qualitative technique that shows, with methodological rigour, the observation of relational dynamics together with the relevant facilities and places, presenting a situational reality. The information obtained must be contrasted with other qualitative methodologies to be transferable. It is a methodological technique that requires a large team and a significant amount of work.Social implicationsThis technique provides the opportunity to carry out prospections, and introduce researchers and professionals to specific realities with a critical perspective. We recommend its use in qualitative research and socio-educational care to improve the design of socio-educational youth care programs and policies.Originality/valueThe use of this technique (Observational Drift) has been provided initial qualitative data to understand youth dynamics in three communities in Catalonia, Spain. This is interesting because helping research to improve community services addressing youth.

Evaluating the Feasibility of Utilizing Telehealth With Youth in Foster Care

Children in foster care are a highly vulnerable population. Consistent care, medication adherence, and clinic engagement are difficult with this population. This study evaluated the use of a telehealth initiative for youth in foster care utilizing a retrospective chart review to compare medication adherence and clinic engagement between 2 groups: those who had a 2-week follow-up telehealth visit and those who did not have a telehealth visit. Although participation in telehealth visit was promising, no differences in medication adherence and clinic engagement were identified between the 2 groups. Of interest, despite multiple barriers to care, families were actively engaged in the telehealth visits and expressed satisfaction with usage. Group home placements were also identified as having better engagement with telehealth visits compared with foster home placements. Further research is needed to explore the use of telehealth with youth in foster care to improve medication adherence and clinic engagement as well as broader health outcomes for this vulnerable population.

Predicting Reliable Improvements in Primary Care Youth Mental Health.

Amid a youth mental health crisis, community-based early intervention services have shown promising outcomes. Understanding the specific factors that predict clinical outcomes is crucial for enhancing intervention efficacy, yet these factors remain insufficiently understood. This study examined the individual and service-related factors associated with reliable improvement for young people (n = 4565) aged 12-25 years attending a brief primary care youth talk therapy mental health service across 14 sites. Reliable improvement was measured using the clinical outcomes in routine evaluation (YP-CORE and CORE-10) measure at baseline and follow up. Poisson regression was used to identify individual and service-related factors associated with reliable improvement. Higher initial distress levels predicted increased levels of reliable improvement (adjusted risk ratios ranged from 235.7 to 415.1, p < 0.001), indicating that this intervention is particularly effective for individuals with higher initial distress levels. Conversely, extended wait times negatively affected therapeutic outcomes for young people aged 12-16, with waiting times exceeding 60 days associated with lower likelihoods of improvement (adjusted risk ratio = 89.2 for > 60 days, p < 0.01). Waiting times did not significantly impact individuals aged 17-25. Attending nine or more sessions was associated with a lower likelihood of reliable improvement. This study underscores the critical importance of minimising wait times for young people and the importance of tailored approaches to early intervention services. Addressing these factors can enhance the efficacy of early intervention services and better support the mental well-being of young people.

A Socioecological Approach to Support the Transition to Adult Care for Youth With Medical Complexity: Family Perspectives and Recommendations

ABSTRACTIntroductionThe transition from paediatric to adult health care (i.e., ‘health care transition’) poses many challenges for youth with medical complexity (YMC) and their families. YMC need specific approaches to supporting transition, tailored to individual youth and family contexts. In this study, we examine the contextual factors influencing families' transition experiences and describe their recommendations for improving the experience.MethodsWe conducted a qualitative explanatory case study in Ontario, Canada. We completed 21 interviews with 17 participants (11 mothers, 2 fathers, 2 YMC, 2 siblings) from 11 families of YMC. Six YMC (55%) were under 18 years of age (pre‐transfer) and five (45%) were aged 18 years and older (post‐transfer). Analytic approaches included reflexive thematic analysis and directed content analysis.FindingsParticipants described how the interplay of personal and environmental factors impacted their transition experiences. Recommendations for health care providers focused on providing instrumental and psychological support, advocacy and care continuity. Families expressed a need for better access to information and support from primary care providers. System‐level recommendations included streamlining transition processes, improving adult health care services and expanding community supports. A socioecological model is presented to guide health care providers and decision makers in assessing and tackling the challenges faced by YMC and their families during transition.ConclusionFindings highlight the complexity and scope of issues surrounding the transition to adult care for YMC in Ontario, with evidence of major gaps in services across multiple sectors and settings. Ongoing efforts are needed to move evidence into practice and advocate for more equitable and responsive care for YMC during the transition and beyond.Patient or Public ContributionThe research team included two parent co‐researchers with lived experience, who contributed to protocol refinement, funding acquisition, recruitment, findings interpretation and ongoing knowledge translation efforts.

Navigating immigrant paths: A case study of unaccompanied youth in foster care

AbstractUnderstanding the experiences of unaccompanied youths in refugee foster care is important to tailor such systems to support the complex needs and desires of these youth. This instrumental case study sought to understand how a cohort of unaccompanied refugee youth experience refugee foster care as they navigate the “in‐betweenness” of adolescence. Eight youth (ages 17–21) from Guatemala and Honduras, nine foster parents, and two staff were interviewed. A constructivist grounded theory analytic approach was implemented, which resulted in a substantive theory, Growing up to be independent but alone: Navigating tension between paths. This tension results from youth being pulled to adult and child‐like paths by different forces. As youth come of age in the United States, they are expected to fulfill the US vision of adulthood by becoming independent and self‐sufficient. However, definitions of adulthood in their cultures of origin involve interdependence and the responsibility to provide for their families. They experience the pressure to become independent as being alone. Findings underscore the need for comprehensive support systems tailored to address the unique challenges faced by unaccompanied youth during their complex migration journey and transition into independence.

Revealing the freedom of movement of youngsters in residential youth care: towards the creation of a socio-spatial citizenship climate

ABSTRACT Recent research shows the relevance of a socio-spatial citizenship climate in residential youth care to shift the focus from youngsters as objects of care due to their challenging behaviour to youngsters as citizens in their own right who give meaning to the various circumstances in their everyday lives. A socio-spatial citizenship climate acknowledges the synergy between residential youth care and the wider living environment, as residential youth care is embedded in a wider living environment in which youngsters practise and experience their freedom of movement by navigating socially and physically through different socio-spatial relationships, circumstances and pedagogical milieus. Based on a qualitative study in a residential youth care facility in Flanders (the Dutch-speaking part of Belgium), we explore how residential youth care can create circumstances for youngsters to realise their freedom of movement as part of the development of a socio-spatial citizenship climate. This article discusses three key findings: (1) creating local coalitions and partnerships, (2) creating circumstances for spatial appropriation, and (3) creating space for complexity and convivial encounters. The findings show that creating circumstances for a socio-spatial citizenship climate requires a critical and reflexive social and pedagogical professional discretion and orientation on different levels of the organisation.

Online learning modules improve confidence in providing gender affirming care for youth

PurposeHealthcare providers often lack training and education in caring for gender diverse youth. We aimed to explore changes in provider confidence and behaviors following the implementation of an online learning course focused on gender affirming care for youth.MethodsAn asynchronous, online training consisting of 2 modules was made available in October 2021. Participants were asked to complete 3 surveys for each module they completed: a pre-survey, a post-survey, and a 3-month follow-up survey. Surveys included demographic data and an assessment of provider confidence and self-reported behaviors related to the provision of gender affirming care for adolescents that were in line with the objectives outlined in each module. Paired sample t-tests were used to compare participant confidence at all timepoints.ResultsParticipants (n = 487) completed at least one survey from one module. There was notable diversity in provider types, including mental health providers (n = 86, 17.7%), community health workers (n = 71, 14.6%), and medical students or health professionals (n = 61, 12.5%). Participants were significantly more confident in all aspects of care provision when comparing pre-surveys and post-surveys (p < 0.001 for all survey items focused on change in provider confidence ). At 3-month follow-up after module completion, improvements in confidence were sustained in providing information and resources to adolescents and their families, and having conversations with them about gender identity along with the importance of using affirming language. However, these modules did not result in self-reported behavior change regarding provision of gender affirming hormones or puberty blockers.ConclusionsOnline learning modules may be an effective means of educating a large number of healthcare providers about caring for gender diverse youth in a variety of settings and across disciplines.

Reducing Barriers to Evidence-Based Services: A High School-University Partnership to Adapt the Unified Protocol for Urban, Underserved Youth with Elevated Internalizing Symptoms

ABSTRACT Background Rates of depression and anxiety in adolescents are rising and access to effective treatment remains limited. Public schools are instrumental in reducing barriers to treatment. Objective The present study describes a community-engaged approach to the adaptation and open trial of The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al. 2018) delivered as a group-based intervention in a Chicago Public High School among predominantly low-income Black and Latine adolescents experiencing elevated depression symptoms (i.e. “Healthy Minds, Happy Lives program;” HMHL). Methods This study utilized qualitative and quantitative analyses to evaluate: (1) the systematic adaptation process that aimed to balance fidelity (to the original UP-A intervention) and flexibility (e.g. the school-based group delivery, and community partner input), (2) the initial feasibility and acceptability of the HMHL intervention by analyzing salient themes from focus groups, and (3) pre- to post-intervention changes in symptoms, in order to inform intervention refinement and methodological considerations for a pilot clinical trial. Our adaptation process utilized the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions and relied on the engagement of key school-staff partners (N = 8) and student-trial participants with elevated depression symptoms (N = 16). Focus group content was coded and thematically analyzed. Outcome trends were evaluated using reliable change indices. Results Preliminary feasibility was promising, with participants attending an average of 7 out of 8 hMHL sessions and retention was excellent with 100% of participants completing the program. Additionally, most trial participants demonstrated a clinically meaningful reduction in depression symptoms and increased emotional state awareness following the intervention. Conclusions HMHL may be a feasible and acceptable intervention for increasing access to care for youth who may otherwise not have access to evidence-based services. Recommendations are provided for enhancing both the content and delivery of the intervention.

Journeying Towards Decolonial Child and Youth Care

Indigenous Child and Youth Care: Weaving Two Heart Stories Together by Cherylanne James is discussed in this review as a critical contribution to child and youth care education in Canada. James’s Indigenous feminist orientation invites child and youth care students to unlearn colonial narratives, to instead center Indigenous approaches to care. The reviewer highlights the effectiveness of James’s approach in engaging in “difficult knowledge” with learners to foster relational accountability, and shares how this approach models “journeying,” moving from deficit-centered orientations toward Indigenous-led, desire-based approaches for decolonial care. The text guides child and youth care students to reflect critically on their role in supporting Indigenous futurities.

Self-Regulation and High School Graduation for Youth With and Without Disabilities in Foster Care

High school graduation rates for youth in foster care are disproportionally low. The purpose of this study was to examine the relationship between self-regulation and high school graduation trajectory for foster youth with and without disabilities. Approximately 54% of the 37 youth in this study were on-track for on time high school graduation, although youth with disabilities were significantly less likely to be on track for graduation. Importantly, higher self-regulation skill increased the likelihood that all foster youth (with and without disabilities) were on track for graduation. Implications for school-based youth supports are discussed.

Exploring the associations between the presence, characteristics, and biopsychosocial covariates of pain and lifetime depression in adolescents: A cross-sectional ABCD study analysis

IntroductionDepression and pain co-occur, even during adolescence. However, there is limited knowledge on the association between pain and lifetime depression, and which biopsychosocial measures are associated with this co-occurrence. MethodsCross-sectional analysis of the Adolescent Brain and Cognitive Development (ABCD) two-year follow-up. We explored associations between the presence and characteristics of past month pain (intensity, duration, activity limitations, and number of pain sites) and lifetime depression using logistic regression. We explored associations of brain structure, physical, behavioural, emotional, social, and cognitive measures with lifetime depression and past month pain compared to having had one or neither condition using multinomial logistic regression. ResultsA total of 5211 adolescents (mean age = 12.0 years) who had: (1) no lifetime mental ill-health and no pain (n = 3327); (2) pain only (n = 1407); (3) lifetime depressive disorder but no pain (n = 272); and (4) lifetime depressive disorder and pain (n = 205) were included. Pain presence was associated with lifetime depression (OR[95%CI]: 1.76 [1.45, 2.13], p < 0.001). Pain-related activity limitations (1.13 [1.06, 1.21], p < 0.001) and the number of pain sites (1.06 [1.02, 1.09], p < 0.001) were associated with lifetime depression. Various behavioural, emotional, social, and cognitive, but not brain structure or physical measures, were associated with lifetime depression and past month pain. LimitationsLongitudinal analyses should validate prognostic markers for predicting co-occurring depression and pain. ConclusionsResults support an association between the presence and characteristics of pain and lifetime depression during adolescence and could indicate the need for more integrated recognition and clinical care of youth experiencing both depression and pain.

Continuous metabolic syndrome score in cardiovascular risk assessment in adolescents.

This study aimed to determine the metabolic syndrome (MS) prevalence in a sample of adolescents, to calculate their continuous metabolic syndrome scores, and to determine the associations of continuous metabolic syndrome score with overweight/obesity and selected cardiometabolic and lifestyle factors. We enrolled a sample of 2,590 adolescents (1,180 males, mean age 17.1 ± 1.04 years) from 14 grammar schools and 48 secondary schools in the Bratislava Self-Governing Region, Slovakia. Data were collected from a standard anthropometric examination, biochemical analysis of fasting venous blood, blood pressure measurement, physical fitness assessment, and a comprehensive questionnaire focused on selected lifestyle characteristics. Continuous metabolic syndrome score and paediatric simple metabolic syndrome scores were calculated. The criteria for the MS diagnosis according to the International Diabetes Federation (IDF) guidelines for children and adolescents were fulfilled in the whole sample by 38 (1.4%) adolescents; all were classified as overweight/obese. In the obese subgroup (n = 270), the MS prevalence rose to 13.3%. The largest number of adolescents was in the group without any of the MS components (67.5%). In the groups with 1, 2 or 3 MS components, males predominated; 0.6% of males and no females had 4 components of MS. The increasing number of individual components of MS is accompanied by a continuous increase (in the case of HDL-cholesterol - a decrease) of mean values mostly of blood lipid levels. Mean values of blood pressure (BP) and anthropometric parameters were highest in the group with three MS components. Significant correlations with body fat content or with selected lifestyle factors were not found. Using the continuous MS score calculation we found 31 adolescents, of whom 14 (45.2%) had only 1 or at most 2 MS components, i.e., they did not meet the criteria for the MS diagnosis. From the point of view of atherosclerosis prevention and early intervention, it is extremely important to monitor the MS prevalence in children and adolescents, especially in the current obesity pandemic. The paediatric MS score calculation is simple and accurate, allowing assessment of the severity of cardiometabolic risk in individuals even before the diagnosis of MS. The continuous MS score is useful in identifying individuals at increased risk and in the management of preventive health care for children and youth.

Children's right to participation in residential care: A staff-based study in Portugal.

Youth in residential care (RC) reveal high-risk trajectories, which require upholding their rights and providing them with opportunities to participate. We aimed to identify staff profiles focused on their perceptions of participation and the association with sociodemographic variables. This study included quantitative analysis of qualitative data collected from 87 professionals in the RC (Mage=38.92, SD=9.36). A variable-centered approach was applied to identify the associations between the categories and configurations of profiles, followed by a person-centered approach to group professionals who shared similar conceptual profiles. Three profiles were identified. The Full Participation profile (14.9%) involves those who conceive participation as ensuring that youth's views must be acted upon, and youth should participate in their education, play activities and RC issues to promote their empowerment. This cluster did not include participants from settings only for females, showing a greater proportion of males-only settings than the others. The Participation in the Case Plan profile described most professionals (56.3%), reporting that youth should participate in child protection cases and family contacts to foster their well-being and quality of RC. This cluster showed a greater proportion of female-only settings than did the others. The Blurred Participation profile (28.7%) represented a non-specific vision of how participation might work and showed a greater proportion of mixed settings than others. Most professionals focused on youth participation in case plans more than on their capacity to participate in all decisions and be empowered. Skilled professionals are required to encourage participation in RC.

Youth in foster care: Highlighting the importance of youth engagement in mental health treatment decisions

Youth in foster care: Highlighting the importance of youth engagement in mental health treatment decisions

The role of pediatric subspecialists in adolescent contraceptive care: knowledge, attitudes, and barriers.

Adolescents and young adults (AYA) with chronic medical conditions (CMC) have similar sexual behaviors to their healthy peers but are less likely to use contraception. Provision of CMC-specific sexual and reproductive health (SRH) care within pediatric subspecialty clinics may improve access for this population, although system and provider level barriers exist. The purpose of this cross-sectional study was to assess the attitudes, practices, and knowledge of SRH among providers in a variety of pediatric subspecialities. Listservs were used to recruit pediatric subspecialists caring for pregnancy capable AYA (12-24 years-old) who use teratogenic medications or have CMC that pose significant pregnancy health risk, as defined by the World Health Organization. Participants completed an online survey about their contraceptive attitudes and practices and rated their knowledge and comfort discussing contraception. A total of 510 pediatric subspecialists participated. Although 92% said addressing SRH is important for pediatric subspecialists, most believed their role included SRH discussion(78.1%) and referral(82.2%) rather than provision(12.1%). Only 4.3% felt totally comfortable with contraceptive counseling. Identified facilitators included time(64.2%), referral resources(67.5%), and training in contraceptive options(62.9%). Most participants would recommend long-acting reversible contraception if medically appropriate, but few reported confidence in their knowledge and ability to counsel about them. SRH is an important part of comprehensive care for youth with CMC. Discomfort and lack of knowledge decrease a provider's ability to confidently provide SRH care in subspecialty clinics. Expanding collaborations between subspecialty and SRH providers may increase access to quality SRH tailored to these young people's unique medical needs.

Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths.

Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not. Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503). Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01). These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.