This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network. |
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Children and Families: Descriptive and Outcome DataDescriptive data, including demographic, diagnostic, and functional characteristics, and service histories were collected on children receiving services through the system-of-care initiative (descriptive sample). Outcome data were collected on a sample of children in all grantee sites to determine how the system of care affects children and families (outcome sample). Child and family outcome data included child's clinical and social functioning, educational performance, restrictiveness of child's placement, family involvement, and child and family satisfaction. Standardized instruments, common to the field of children's mental health services, were used to collect these data. Outcome and descriptive data were collected upon intake into the system of care. Outcome data were also collected at six months, at twelve months, and annually as long as the child remains in services. The program required that all children enrolled in CMHS-funded services have a serious emotional disorder. This was defined as anyone who had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified in the DSM-IV (APA, 1994). In addition, the disorder resulted in functional impairment which substantially interfered with or limited one or more major life activity. Other criteria that were considered in the selection of children included involvement with multiple child-serving systems and heightened risk for out-of-home placement. The evaluation design required that grantees serving fewer than 400 children in the outcome sample include all children and families who consented to participate. For those grantees serving between 400 and 4,000 children, an outcome sample of 400 children was drawn. For those grantees serving over 4,000 children, a 10 percent sample was drawn. In practice, sampling strategies and numbers of participants in the outcomes study varied significantly across the sites. Demographic Profiles Table 4 outlines the demographic characteristics of the children and families participating in the CMHS evaluation as of August, 1997. Demographic characteristics of the children in the sample were consistent with proportions reported in the children's mental health literature (Lefkowitz and Tesiny, 1984; Deaux, 1985; Eme, 1984; Farrington, 1987). The age of the children enrolled in the descriptive study ranged from less than 1 year to 22 years of age. As noted in Table 3, the mean age of the children enrolled in this evaluation was 12.7 years of age. Males made up just under two-thirds of the evaluation sample. The racial/ethnic distributions for the evaluation sample indicated that 17 percent of the children were African American. Studies report that children and youth of color are more likely to be referred for service by external agencies (e.g., schools, juvenile justice, courts, child protective services) than their white counterparts (Takeuchi, Bui, & Kim, 1993). Figure 2 illustrates the racial/ethnic distributions of children who were referred by their parents or themselves (i.e., self referral) and those who were referred by external agencies such as schools and mental health agencies (i.e., external referral). There was a significant difference between the racial/ethnic distributions of the two groups (i.e., self referral vs. external referral)(1). In the self referral group, a predominant 71 percent of the children were White, 15 percent were African Americans, and only 3 percent were Hispanic. In contrast, a little over 50 percent of the children in the external referral group were White, 25 percent were African Americans, and 10 percent were Hispanic. The link between economic hardship and mental health problems is strongly reflected in the adult literature (Burns, in press; Costello and Angold, 1995; McAdoo, 1986; Dressler, 1985; Belle, Longfellow, & Makosky, 1982: Neff & Husaini, 1980). This relationship is assumed to extend to the children of families living in poverty through the indirect effects of parental distress, reduced nurturance, and lack of security (McLoyd, 1991; Patterson, 1988). Little is known about how poverty affects mental health--whether it precipitates the onset of mental health problems, lengthens the duration, or increases the potential for recurrence (Belle, 1990). Given these facts it is important to note that 63 percent of the families in the descriptive sample reported incomes below the Poverty Guidelines for 1996 of the U.S. Department of Health and Human Services. The literature reports that, on the whole, children living in single-parent families are more likely to experience poverty than children living in two-parent homes. This association is strongly reflected in the descriptive sample. Forty-nine percent of the children enrolled in the descriptive study were living in families maintained by mothers, compared to a national average of 27 percent (i.e., 1994 CPS estimates). Of those children living in poverty, 73 percent were living in families maintained by mothers, as compared to 22 percent of those children living with both parents, and five percent living with their fathers(2). The links between poverty and employment can be assumed. Employment opportunities for mother-maintained households that are challenged by a child's serious emotional disturbance are likely to be limited, and likely as well, to extend the duration of poverty and add to the overall family stress. Figure 3 illustrates the poverty levels for two-parent, mother-, and father-maintained households. On the whole, two-parent families reported higher income levels. It is important to keep in mind that while the system-of-care approach may be an effective mental health service model, continued economic hardship for families may also influence and constrain optimal mental health outcomes. Identifying Children Challenged with Serious Emotional Disturbance Diagnostic information was collected upon children's entry into system-of-care services in order to assess their level of severity and to ensure that children received services that were appropriate for their diagnoses and/or problems. Criteria for diagnostic assignment was based on the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV; APA, 1994). Of the 21,432 children in the descriptive sample who had been assigned a primary diagnosis, thirty-five percent had a diagnosis of conduct-related behaviors (29 percent conduct disorder; six percent adjustment disorders). Depressive/Dysthymia and anxious symptomatologies yielded 27 percent and seven percent of the primary diagnoses, respectively. Intake data also indicated that 13 percent of the sample had a primary diagnosis of attention deficit/hyperactivity disorders. Psychotic disorder was reported as a primary diagnosis for 2 percent of the child/adolescent sample. The remaining primary diagnostic categories (assigned to 17 percent of the sample) included but are not limited to substance use and eating, somatic, and speech disorders, as well as enuresis, encopresis, and phobia. Thirty percent of the children in our sample (6,405 children) with a primary diagnosis also had a secondary diagnosis. Of these children, 18 percent had a secondary diagnosis of conduct disorder, and another 18 percent of these children had a secondary diagnosis of substance use disorder. These findings are consistent with recent research among clinical samples which indicate that adolescents with behavioral and substance use disorders tend to have other psychiatric disorders as well (Grilo, Becker, Fehon, Edell, McGlashan, 1996; Grilo, Walker, Becker, Edell, McGlashan, 1997; Wilens, Biederman, Abrantes, Spencer, 1997). Children entered into the system of care through a variety of doorways. Referrals from mental health agencies provided the largest proportion of the sample (22 percent), closely followed by schools (21 percent), and social services agencies (17 percent). Eleven percent of the children in the sample were directed to mental health services through the courts and correctional institutions. Eleven percent of the children were referred to the system-of-care services by their parents. Figure 4 illustrates the proportion of children referred for services by each referral source. Risk Factors for Serious Emotional Disturbance In addition to the demographic variables discussed above, certain family characteristics are often associated with serious emotional disturbance. Childhood exposure to violence, sexual abuse, physical abuse and neglect, and substance use are linked in the literature with emotional and psychological distress (McLoyd, 1991; Patterson, 1980). Family characteristics, such as a history of mental health concerns, family violence, and felony convictions are also believed to be associated with child and adolescent emotional disturbance. Sixty-eight percent of the families responding to questions about their experiences concerning child risk factors identified one or more child risk factors including: physical abuse, sexual abuse, previous psychiatric hospitalization, sexual abusiveness, suicide attempt, drug and alcohol use, and history of running away. Figure 5 depicts the proportion of children with a history of these risk factors. What is not depicted in the graph is the proportion of children who have more than one risk factor--20 percent identified two such factors, and another 22 percent indicated three or more child risk factors. Overall, 83 percent of the descriptive sample reported the presence of one or more family risk factors, including: family history of substance abuse, family history of violence, previous mental health concerns, previous psychiatric hospitalization, felony conviction, sibling history with foster care placement, and sibling history of institutionalization. As illustrated in Figure 6, family history of substance use, violence, and mental health concerns were among the most frequently reported risk factors. As with child risk factors, many families reported multiple risk factors--21 percent indicated two family risk factors and another 40 percent indicated three or more risk factors. It is important to note that the number of subjects available for specific analyses varied across the descriptive sample. Relatively complete data was available for basic demographic and diagnostic information, while information on family income, family composition, referral sources, and risk factors was obtained for subsets only. Cautious interpretation is warranted in evaluating the utility of these smaller sets of data for all children with serious emotional disorders. Functional and Behavioral Outcome Measures: Clinical Assessment As discussed previously, while descriptive data were collected on all children referred to the program, outcome data were collected only on a subsample of the children who had consented to participate in the longitudinal outcome study. Of those children participating in the outcome study, follow-up data were collected only on those who were still receiving services under the program at the time of follow-up data collection. Therefore, in comparing functional and clinical outcomes at baseline and six months, the number of children included in the analyses vary. The differences in these numbers was dependent upon families willingness to participate (both at baseline and at follow-up), the length of stay in the program, the availability of follow-up data at the time of this report, and other factors such as the amount of missing data from the sites. In the absence of a comparison sample of children who did not experience system of care service delivery, it is not possible to determine whether the gains reported here are due solely to the system of care or other factors, or whether these gains are greater than what would have been experienced with other treatments. Preliminary analyses comparing children who participated at intake and six months to children who participated only at intake were conducted to further understand biases associated with variable completion rates. These analyses revealed that children who left the evaluation and presumably received no further services in systems of care beyond the first six months had lower levels of functional impairment and behavioral problems at intake than those who completed the intake and six-month evaluation. That is, individuals who remained in the evaluation and continued to participate in system-of-care services appeared to be more behaviorally and functionally impaired than those who participated at intake, but were not available for the six-month evaluation. Behavior and level of functioning were assessed in the evaluation by the Child and Adolescent Functional Assessment Scale (CAFAS) (Hodges, 1990), the Child Behavior Checklist (CBCL) (Achenbach, 1991), and the Youth Self-Report (YSR, for children 11 years of age and older) (Achenbach & Edelbrock, 1987). These assessments provided a check on the match between the target population prescribed in the CMHS initiative and the children receiving services across the system-of-care grantees. The CAFAS was designed to assess the degree of a child's or adolescent's psychosocial functioning across five areas: (1) role performance (community, school, and home); (2) thinking; (3) behavior towards others and self (i.e., self-harm); (4) moods and emotions; and (5) substance use. The difficulties caregivers had in providing for the child's basic needs was also assessed as part of the CAFAS. The CAFAS was informed by parent reports, child self-reports, and clinical assessment regarding the child during the previous 30 days. The CAFAS yielded scores for each of the eight psychosocial subscales and generated a total score that indicated the child's lowest level of functioning during the past three months. Figure 7 illustrates the changes in the CAFAS role performance scores from intake to six months(3). The significant decrease in the children's role performance scores indicated that, on average, children made significant improvement in their behaviors at schools, in the communities, and at home since the three subscales directly assessed children's behaviors in these three settings. Total CAFAS score is used to assess children's overall functioning. While the overall average total score changed significantly from 64.4 at intake to 53.5 at six months(4), intake and follow-up scores vary for different subgroups. For example, Figure 8 illustrates the difference in total CAFAS scores at intake and six months for male and female children(5). CAFAS scores at intake and six months also differed by age (Figure 9). Older children entered services with more severe challenges. The youngest group of children (0-5 years old) made significantly more progress from intake to six months than the other three age groups(6). Similarly, our analysis showed that children who exhibited the greatest improvement in school performance between intake and six months, also made the greatest improvement in their total CAFAS score(7), as illustrated in Figure 10. Analyzing the data in aggregate obscures these subgroup differences. Children who had fewer contacts with law enforcement were also reported to have made significant improvement in their overall functioning. Figure 11 shows that, overall, children who reported fewer law enforcement contacts at six months than at intake made the greatest progress in their total CAFAS score from intake to six months, as compared to children who reported no reduction in contacts with law enforcement(8). (For this analysis, total CAFAS score does not include the community role subscale, since it is a direct assessment of children's behaviors in the community.) As described earlier, 30 percent of the children in the sample had multiple diagnoses. Our analysis of CAFAS scores showed that these children entered the system of care with more challenges (Figure 12). Both children with and without multiple diagnoses made significant improvement in functioning and social behaviors from intake to six months(9). Although the rates of improvement are similar between children with a single diagnosis and those with any secondary diagnosis, the rate of improvement for children whose secondary diagnosis is substance use is significantly greater (Figure 13)(10). As with all children with multiple diagnoses, children whose secondary diagnosis is substance use enter the system with more challenges than children with a single diagnosis. The CBCL is a widely used measure in children's mental health. Information is collected directly from the parent or caregiver concerning the child's behavior during the past six months. The CBCL is comprised of 118 problem behavior items categorized as internalizing or externalizing behaviors. Internalizing behaviors include sadness, depression, and detachment. Externalizing behaviors include oppositional and argumentative behaviors. In addition, 20 social competence items are used to measure behaviors related to school, peer relationships, and social involvement. From these items, the CBCL scoring procedures generate standardized scores for syndrome subscales (i.e., withdrawal, anxious/depressed, somatic, social, attention, delinquent, thought, aggressive) and scale scores for competence, internalizing behavior, externalizing behavior, and a total problem score. Standardized scores above 63 are considered in the clinical range (i.e., indicating emotional and behavioral problems serious enough to warrant clinical services). Table 5 provides the comparisons between intake and six months CBCL syndrome scales for the CMHS outcome sample. A syndrome is a collection of related symptoms. Note that decreases in scores indicate improvement in problem behaviors. With the exception of somatic complaints, the mean of all syndrome scores at intake were above clinical ranges, suggesting that the evaluation sample met target population criteria. On average, children made significant improvement in all problem areas from intake to six months(11). Figure 14 shows the changes in the children's internalizing, externalizing, and total problem behaviors from intake to six months(12). At intake, 52 percent of the children scored above the clinical range for internalizing behavior, 66 percent attained clinical range scores for externalizing behavior, and 69 percent of the children attained clinical range scores on the CBCL total problem scale. As previously discussed, conduct-related behaviors accounted for 35 percent of the primary diagnoses for the evaluation sample at intake. These diagnoses appear to be supported by both the CAFAS and the CBCL intake data. The school and home role performance subscales, behavior toward self and others subscales on the CAFAS measure, and the CBCL delinquent, aggressive syndrome scales, and externalizing subscales account for the highest proportions of children participating in this evaluation. Initial analyses revealed that child risk factors were associated with clinical range scores on both the CBCL and the CAFAS. Children with multiple child risk factors (see Figure 5) were more likely to have higher scores on both the CBCL and the CAFAS. Figure 15 illustrates this linear relationship. It also shows that despite the differences in their scores at intake, children's mean scores for each risk group improved significantly from intake to six months(13). As expected, children with no child risk factors had lower CBCL scores at intake and at six months than children with one or more risk factors. Children with more family risk factors (see Figure 16) were also reported to have greater clinical challenges. Again, mean scores in each risk group improved significantly from intake to six months in their problem behaviors(14). Education Educational data were collected primarily through face-to-face interviews with the child's primary caregiver. Because of the difficulty in obtaining information directly from schools, sites with multiple regions and many school districts rely exclusively on these interviews to obtain educational information. Others with a relatively small number of school districts may use school records or interviews with school personnel (such as teachers or counselors) as a secondary source of educational information. Educational data from the outcome sample revealed that at intake, 46 percent of the children received their education in regular classrooms with no special education supports. Thirty-two percent of the children did, however, have assistance from a classroom aide in addition to the teacher. Twenty percent of the children were placed in special education classrooms. Of the children who were placed in special education classrooms at intake, within six months 13 percent were transferred to regular classrooms with some special education support. These children also improved their school performance significantly from intake to six months(15). Figure 17 shows the changes in school performance from intake to six months for those children placed in special education classrooms at intake. Children in the primary grades were less likely to have an Individualized Education Plan (IEP) than children in the higher grade levels. Children in the elementary grades (i.e., three through six) were more likely to have an IEP than any other group in the sample. Only 77 children (two percent) were reported to have formally dropped out of school. Thirty-six percent of the children had an IEP that reflected serious emotional disturbance. Seventeen percent of the sample had an IEP for challenges other than mental health concerns, and 38 percent of the children had no IEP. Nine percent of the children's IEP status was pending. At intake, 73 percent of the children in the outcome sample attended school on a regular basis (i.e., 76-100 percent of the time), while about ten percent attended infrequently (i.e., 1-50 percent of the time). Figure 18 illustrates the change in school attendance from intake to six months. While the majority of the children in the outcome sample attended school on a regular basis both at intake and at six months, there was still a significant increase in the number of children who attended school regularly at six months, as compared to those at intake(16). As expected, school attendance and school performance were strongly associated with each other(1). Overall, children's school performance improved from intake to six months(2). At intake 55 percent of the children made average or above average school grades, and the percentage increased significantly to 62 percent at six months. Figure 19 indicates the relationship between school attendance and grade average at six months. Even though the majority (i.e., 72 percent) of the children making below average grades at six months attended school on a regular basis, like the other children making average or above average grades, it is important to point out that this group of children were those with greater challenges at intake. Sixty-two percent of these children entered the system-of-care services with three or more family and child risk factors. At six months, 51 percent of these children were either in a regular classroom with special education help or in some kind of special education classrooms. The average of their total CAFAS score at six months was 55.4, much higher than the clinical cut-off point of 40. At six months, 29 percent of these children were diagnosed with ADHD, and 30 percent were diagnosed with a conduct-related disorder. Preliminary analyses indicated that children coming into mental health services with primary problems associated with noncompliance, truancy, and a history of running away were at the greatest risk for poor school performance and attendance. Significant correspondence among grade-level performance, attendance patterns, and subscale scores on the CBCL and the CAFAS was noted in examining the intake data. School attendance was inversely correlated with the CAFAS school role performance and total scale scores, and with the externalizing behavior scale on the CBCL indicating that as problem behavior increased, attendance decreased. Plausible explanations for this relationship include the fact that truancy is often considered a form of acting out, consistent with the behaviors and functional level tapped by the CAFAS and CBCL scales mentioned above. Grades were also inversely related with the same scales. Additionally, the CBCL internalizing scale was also negatively associated with grade performance, meaning that children with lower grade performance were more likely to experience feelings of sadness, depression, and withdrawal. This finding is supported in the school performance literature (Harter, 1985; 1986). Contacts with Law Enforcement Like educational information, interviews were conducted with the primary caregiver to obtain juvenile justice information such as the number of the child's law enforcement contacts. Again, with the variability of site characteristics, some sites were able to use as a secondary source of information such data as court records or interviews with probation officers, while others obtained information solely from interviews with the primary caregiver. In general, contacts with law enforcement and other juvenile justice information were more difficult to obtain because of difficulties in obtaining court records. Reports on 15 percent of the children indicated some contacts with law enforcement at the time of intake. Of these only about half of the reports showed subsequent contacts and half showed no subsequent contacts between intake and six months. Data indicated that 13 percent of the sample had one or more adjudicated misdemeanors, and six percent had an adjudicated felony charge. Data revealed that 84 percent of the sample had no arrests that led to conviction, while 16 percent had one or more arrests that led to conviction. Figure 20 illustrates the changes in contacts with law enforcement from intake to six months. Living Arrangements Stability of living arrangements is one of the key indicators among the outcome measures. At intake, 61 percent of the children were reported to have lived in just one living arrangement, and the other 39 percent were reported to have lived in two to eight different living arrangements. Figure 21 illustrates the changes in number of living arrangements at six months for the group of children who lived in multiple living arrangements at intake. Forty-nine percent of the children who lived in multiple living arrangements at intake, lived in just one living arrangement after they had been enrolled in the system-of-care services for six months. Among the children who lived in just one living situation at intake, 89 percent remained in just one living arrangement at six months. Twenty-five percent of the evaluation sample reported that their current living arrangement at both intake and six months was with two biological parents. Forty-two percent of the sample were living with a single parent at intake, as well as at six months. Satisfaction With Services Although considered an important area of inquiry, the research on the relationship between satisfaction and clinical outcomes has been far from conclusive. For one possible theory, the link between satisfaction and clinical outcome has two parts. When caregivers are satisfied with the services their children receive, it is expected that (a) they will keep their children in services longer, and (b) continued treatment should lead to improved clinical outcomes (e.g., Breda, & Bickman, 1997; Pekarik, 1992). Another theory suggests that the greater the clinical improvement, the more satisfied clients should be. Although findings have been mixed, some research in the adult field has supported the view that clients who reported greater satisfaction tended to stay in services longer (Gaston, & Sabourin, 1992). Some supporting evidence to this view has also been found in the children's field, indicating that caregiver reports of satisfaction are related to their children's length of treatment (Breda, & Bickman, 1997; Brannan, Sonnichsen, & Helfinger, 1996). Regarding the relationship between improved clinical outcomes and reported satisfaction, however, the link has not been well-established. Although findings have been mixed, the relationship between satisfaction and significant clinical improvement services, as determined through therapist ratings or objective standardized tests, has most often been found to be minimal or non-existent (Attkisson, & Zwick, 1982; Pekarik, & Wolff, 1996). While there appears to be a strong relationship between self-perceptions of improvement and clinical improvement (e.g., Seligman, 1995), there is evidence that these self-perceptions are more like satisfaction in their nature, than they are like clinical improvement (Lambert, Salzer, & Bickman, 1998). After a child has been enrolled in the system-of-care services for about six months, families were asked their opinions of the services the child received, and whether they were satisfied with their child's progress in the previous six months. In general, most of the families were satisfied with the services their children had received, and they felt involved in their children's treatment program. Three quarters of the families rated service as good or excellent. Thirty percent were very satisfied with their child's progress and another 36 percent were satisfied (see Figures 22 and 23). These high rates of family satisfaction may be due to the systems of care involving families in their treatment planning and care. The systems of care philosophy calls for active engagement of families in the decision-making process, solicitation of their ideas and opinions, and provision of unconditional care. In keeping with the findings of site visit teams, nearly three quarters of the families indicated high levels of input to their child's treatment planning. Over half of the families felt that they were always given a choice in decision-making related to their child's treatment planning and care (see Figure 24). The same proportion of families indicated that they were always asked for their ideas and opinions, working with case managers and other service providers to creatively select appropriate services (see Figure 25). Further, an additional 20 percent of families indicated that they were usually asked for opinions and generally involved in decision making, respectively. Another key indicator of family satisfaction was the high level of comfort families felt with their involvement in the system of care. Most families felt that opposing opinions or dissent would not result in negative repercussions for their children. Over three quarters of families felt they would receive care unconditionally and believed that the quality of their care would be high, regardless of their relationships or interactions with providers (see Figure 26). It should be noted that, due to the evaluation design, only families who remained in services completed satisfaction measures at the six-month follow-up point. It is likely that these families would report a higher level of satisfaction with services than families who entered the longitudinal outcome evaluation but did not participate at six months (LaSala, 1997). Satisfaction results should be interpreted cautiously, as they only apply to families who continue to receive services in systems of care. In addition, the limitations of the sample preclude any rigorous exploration of the relationship between clinical outcome and satisfaction in this evaluation. It is important to underscore the interim nature of these longitudinal data analyses. Service grants supporting systems of care that are participating in this evaluation will not complete their five-year cycle of funding until late 1999. Data presented in this report represent preliminary analyses of an ongoing program evaluation effort that will yield substantially higher numbers of participants across time as well as outcome results for addressing changes at one year and beyond. These preliminary analyses are encouraging, but it is possible that different patterns of change will emerge as more information accumulates in this large multi-site evaluation effort. Furthermore, the information presented here regarding longitudinal outcomes should be interpreted with caution due to the methodological challenges encountered in conducting this evaluation. First, a control group was not included in the initial program evaluation design. More controlled comparisons are currently underway in selected sites that will yield useful comparison information in the future. Second, completion rates for longitudinal data collection were lower than anticipated across sites. This suggests that the generalizability of the current outcome analyses may be limited to a select group of children with serious emotional disorders. Complete evaluation information in the future will provide more definitive outcome data for determining the qualifications that may need to be made regarding the utility of systems-of-care interventions for children with serious emotional disorders. These limitations and qualifications, however, should be balanced against the challenges encountered when conducting program evaluation in multiple settings that holds the promise of providing information directly applicable to real-world interventions for children with serious emotional disorders. End Notes 1. 2 = 134.239, df = 4, p = .000 2. 2 = 312.345, df = 2, p = .000 3. School Role Performance: t = 16.843, df = 2682, p < .000 4. Total CAFAS Score: t=19.959, df=2783, p<.000 5. GLM Repeated Measures - Total CAFAS Score x Sex: F=360.558, df=1/2611, p<.000- within group effect 6. GLM Repeated Measures - Total CAFAS Score x Age: F = 339.979, df = 1/3211, p = .000- within group effect 7. GLM Repeated Measures - Total CAFAS Score x School Grades: F=147.840, df=1/1340, p<.000- within group effect
8. GLM Repeated Measures - Total CAFAS Score x Contacts with Law Enforcement: F=51.779,
df=1/1482, p<.000- within group effect (Total CAFAS Score here doesn't include the subscale of community role since it is a direct assessment of children's behaviors in communities and would be a confounding factor if included.) 9. GLM Repeated Measures - Total CAFAS Score x Comorbidity: F = 417.059, df
= 1/2701, p = .000- within group effect 10. GLM Repeated Measures - Total CAFAS Score x Comorbidity Sub.: F = 101.099, df = 1/1817, p = .000- within group effect 11. Withdrawal: t = 11.066, df = 2034, p < .000; Somatic Complaints:
t = 7.677, df = 2037, p < .000; 12. Total Problem: t = 10.7147, df = 2038, p < .000; Internalizing
Behaviors: t = 13.315, df = 2034, p < .000; 13. GLM Repeated Measures - CBCL Total Problems x Number of Child Risk Factors:
F=208.899, df=1/1540, p<.000- within group effect 14. GLM Repeated Measures - CBCL Total Problems x Number of Family Risk Factors:
F=215.367, df=1/1567, p<.000- within group effect 15. t = -3.097, df = 300, p < .002 16. t = -3.416, df = 1779, p < .001 17. y12 = .372, p < .01 (intake school performance & school attendance) 18. t = -6.141, df = 1487, p < .000 |
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