Cover Page The handle http://hdl.handle.net/1887/51103

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Cover Page

The handle http://hdl.handle.net/1887/51103 holds various files of this Leiden University dissertation

Author: Goemans, A.

Title: The development of children in foster care Issue Date: 2017-06-27

(2)

147 36<&+262&,$/6&5((1,1*

AND MONITORING FOR CHILDREN ,1)267(5&$5(36<&+20(75,&

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be downloaded at www.childpsych.org.uk.

$FNQRZOHGJHPHQW7KLVSURMHFWZDVSDUWO\IXQGHGE\/HLGHQ8QLYHUVLW\)XQG9DQ6WHHGHQ Advance online publication

*RHPDQV$7DUUHQ6ZHHQH\09DQ*HHO0 9HGGHU33V\FKRVRFLDOVFUHHQLQJDQG

PRQLWRULQJIRUFKLOGUHQLQIRVWHUFDUH3V\FKRPHWULFSURSHUWLHVRIWKH%ULHI$VVHVVPHQW&KHFNOLVW

in a Dutch population study. Advance online publication. doi: 10.1177/1359104517706527

7

(3)

148 ABSTRACT

Children in foster care experience much higher levels and rates of psychosocial GLIÀFXOWLHVWKDQFKLOGUHQIURPWKHJHQHUDOSRSXODWLRQ*RYHUQPHQWVDQGFKLOGZHOIDUHVHUYLFHV

have a responsibility to identify those children in care who have need for therapeutic services.

7KLVFDQEHDFKLHYHGWKURXJKV\VWHPDWLFVFUHHQLQJDQGPRQLWRULQJRISV\FKRVRFLDOGLIÀFXOWLHV

among all children in foster care. However, general screening and assessment measures such as WKH6WUHQJWKVDQG'LIÀFXOWLHV4XHVWLRQQDLUH6'4DQG&KLOG%HKDYLRU&KHFNOLVW&%&/PLJKW

QRWDGHTXDWHO\VFUHHQIRUWKHUDQJHRIGLIÀFXOWLHVH[SHULHQFHGE\IRVWHUFKLOGUHQ7KH%ULHI

$VVHVVPHQW&KHFNOLVWVIRU&KLOGUHQ%$&&DQG$GROHVFHQWV%$&$DUHPHDVXUHVGHVLJQHG

WRVFUHHQIRUDQGPRQLWRUDWWDFKPHQWDQGWUDXPDUHODWHGGLIÀFXOWLHVDPRQJFKLOGZHOIDUH

SRSXODWLRQV 7KH SUHVHQW SDSHU UHSRUWV SV\FKRPHWULF SURSHUWLHV RI WKH %$&& DQG %$&$

HVWLPDWHGLQDSRSXODWLRQVWXG\RI'XWFKIRVWHUFKLOGUHQ7KHVHUHVXOWVVXJJHVWWKH%$&&

DQG%$&$SHUIRUPERWKVFUHHQLQJDQGPRQLWRULQJIXQFWLRQVZHOO7KHLUVFUHHQLQJDFFXUDF\

LQWHUQDOUHOLDELOLW\DQGFRQFXUUHQWYDOLGLW\DUHFRPSDUDEOHWRWKRVHHVWLPDWHGIRUWKH6'4

within the same child and adolescent sample. Future research is needed to assess the value of WKH%$&FRPSDUHGWRRWKHUPHDVXUHVDQGWRYDOLGDWHFXWSRLQWVIRUWKH%$&7KLVVWXG\IXUWKHU

HVWDEOLVKHVWKH%$&$DQG%$&&DVYDOLGDQGXVHIXOPHQWDOKHDOWKVFUHHQLQJDQGPRQLWRULQJ

measures for use with children and adolescents in foster care.

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149

7

INTRODUCTION

&KLOGUHQLQIDPLO\IRVWHUFDUHPDQLIHVWKLJKUDWHVRIFOLQLFDOO\VLJQLÀFDQWSV\FKRVRFLDO

GLIÀFXOWLHV,QFRQWUDVWWRFKLOGUHQIURPWKHJHQHUDOSRSXODWLRQIRVWHUFKLOGUHQDUHFKDUDFWHUL]HG

E\KLJKOHYHOVRILQWHUQDOL]LQJDQGH[WHUQDOL]LQJEHKDYLRUSUREOHPV&DUERQHHWDO

*RHPDQV 9DQ *HHO 9DQ %HHP 9HGGHU 3ULWFKHWW HW DO ([DFW QXPEHUV

GLIIHUDFURVVVWXGLHVEXWSHUFHQWDJHVRIIRVWHUFKLOGUHQZLWKFOLQLFDOO\VLJQLÀFDQWPHQWDOKHDOWK

SUREOHPVKDYHEHHQUHSRUWHGWREHRYHURQHWKLUG0DDVNDQWHWDODOPRVWKDOI%XUQV

HWDORUHYHQRYHU7DUUHQ-6ZHHQH\ +D]HOO$UHFHQWPHWDDQDO\VLV

UHSRUWHGDSSUR[LPDWHO\RIWKHIRVWHUFKLOGUHQVKRZLQJPHQWDOKHDOWKSUREOHPV9DVLOHYD

3HWHUPDQQ7KHVHKLJKQXPEHUVVXJJHVWDVWURQJQHHGIRUPHQWDOKHDOWKVHUYLFHVIRU

foster children. An important challenge in this respect is the discrepancy between the need IRUDQGUHFHLSWRIPHQWDOKHDOWKVHUYLFHVIRUFKLOGUHQLQFDUH%XUQVHWDO-DQVVHQV 'HERXWWH6WDQOH\5LRUGDQ $ODV]HZVNL(VWLPDWHVRIWKHSURSRUWLRQRIWKRVH

children who have need for mental health services (denominator), who do not actually receive DVHUYLFHQXPHUDWRUYDU\FRQVLGHUDEO\UDQJLQJIURP7DUUHQ6ZHHQH\WRDOPRVW

%XUQVHWDO-DQVVHQV 'HERXWWH7KLVGLVFUHSDQF\LVDFRQVHTXHQFHRID

variety of circumstances, one of which is system-wide failure to detect and monitor psychosocial GLIÀFXOWLHV 7DUUHQ6ZHHQH\ HW DO 2QH RI WKH VKRUWIDOOV RI FXUUHQW VFUHHQLQJ DQG

monitoring practices in foster care is the limited availability and use of measures that are valid IRUWKLVSDUWLFXODUSRSXODWLRQ&KDPEHUVHWDO'HQWRQHWDO7DUUHQ6ZHHQH\

2007). This is also true for the Netherlands, where recent guidelines for foster care policy and practice emphasize the importance of screening and monitoring, but where there is a lack of VSHFLDOL]HGPHDVXUHVIRU\RXWKLQIRVWHUFDUH'H%DDWHWDO7KHFXUUHQWVWXG\DLPV

to take a step toward improved screening and monitoring of foster children by reporting WKH SV\FKRPHWULF SURSHUWLHV RI DQ H[LVWLQJ PHDVXUH WKH %ULHI $VVHVVPHQW &KHFNOLVW 7DUUHQ

6ZHHQH\EIRUVLJQDOOLQJSV\FKRVRFLDOGLIÀFXOWLHVRIFKLOGUHQDQGDGROHVFHQWVLQIRVWHU

care in the Netherlands.

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clinical/developmental assessment, or screening that has acceptable accuracy. However, because the former would require considerable expansion of specialised assessment services for children in care, as well as associated workforce training, this goal is perhaps more DVSLUDWLRQDOWKDQDFKLHYDEOHLQWKHVKRUWWHUP3UHVHQWO\WKHUHIRUHV\VWHPDWLFLGHQWLÀFDWLRQLV

best achieved through mental health and developmental screening, wherein screening serves DVWKHÀUVWVWHSLQDPXOWLVWDJHDVVHVVPHQWDSSURDFKDQGFKLOGUHQZKRVFUHHQSRVLWLYHDUH

WKHQUHIHUUHGIRUPRUHGHWDLOHGDVVHVVPHQW%H\RQGWKHLQLWLDOLGHQWLÀFDWLRQRIVXFKGLIÀFXOWLHV

child welfare services also have an ongoing duty of care to monitor children’s development and mental health throughout their time in care. Research has shown that foster children’s GHYHORSPHQWGRHVQRWQHFHVVDULO\LPSURYHZKLOHLQIRVWHUFDUH*RHPDQVHWDO6RHYHQ

if the initial screening gave no reason for further assessment, foster children’s development

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150

needs to be closely monitored to ensure their well-being. For both screening and monitoring it is important to make use of measures which have good psychometric properties. For the purpose of screening good screening accuracy is paramount, with high screening sensitivity, and good VSHFLÀFLW\LQRUGHUWRLGHQWLI\SV\FKRVRFLDOGLIÀFXOWLHVRIIRVWHUFKLOGUHQ

Psychosocial Screening and Brief Monitoring Measures for Foster Children

7KH 6WUHQJWKV DQG 'LIÀFXOWLHV 4XHVWLRQQDLUH 6'4 *RRGPDQ LV IUHTXHQWO\

used as a child mental health screening measure in the Netherlands and elsewhere in Europe, both for children at large and for vulnerable populations such as children in foster care. There LVUHDVRQDEOHHYLGHQFHWKDWWKHFDUHUUHSRUW6'4WRWDOGLIÀFXOWLHVVFRUHSURYLGHVDQDFFXUDWH

VFUHHQ IRU HOHYDWHG DQGRU FOLQLFDOOHYHO PHQWDO KHDOWK GLIÀFXOWLHV DPRQJ FKLOGUHQ LQ FDUH

*RRGPDQ *RRGPDQ/HKPDQQ+HLHUYDQJ+DYLN +DYLN0DUTXLV )O\QQ

+RZHYHUWKLVKDVQRWGLVSHOOHGFRQFHUQWKDWWKH6'4DQGRWKHUVWDQGDUGFKLOGPHQWDO

KHDOWKFKHFNOLVWVVXFKDVWKHFDUHUUHSRUW&KLOG%HKDYLRU&KHFNOLVW&%&/$FKHQEDFK

may fail to identify some children in care who need clinical services. Three recent reviews highlight an increased focus on mental health screening for vulnerable children exposed to VHYHUH VRFLDO DGYHUVLW\ LQFOXGLQJ PDOWUHDWPHQW 'HQWRQ HW DO /HZLV 0LOQH

&ROOLQ9p]LQD7KHVHUHYLHZVFRQFOXGHGWKDWLQDGGLWLRQWRJHQHUDOVWDQGDUGPHQWDO

KHDOWKPHDVXUHVVXFKDVWKH6'4DQGWKH&%&/DVVHVVPHQWRIFKLOGUHQLQFDUHVKRXOGLQFOXGH

PHDVXUHVRIYDULRXVDWWDFKPHQWDQGWUDXPDUHODWHGGLIÀFXOWLHVWKDWDUHFKDUDFWHULVWLFRIWKLV

SRSXODWLRQ :KLOH WKH 6'4 DQG &%&/ KDYH JRRG SV\FKRPHWULF SURSHUWLHV WKH\ PLJKW QRW

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7KHUH DUH RQO\ D IHZ VSHFLDOL]HG PHDVXUHV WKDW IRFXV RQ SV\FKRVRFLDO GLIÀFXOWLHV

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$VVHVVPHQW &KHFNOLVWV IRU &KLOGUHQ %$&& DQG $GROHVFHQWV %$&$ 7DUUHQ6ZHHQH\

2013b), which are twenty item checklists derived respectively from the Assessment Checklist IRU &KLOGUHQ $&& 7DUUHQ6ZHHQH\ DQG WKH $VVHVVPHQW &KHFNOLVW IRU $GROHVFHQWV

$&$7DUUHQ6ZHHQH\D7KH$&&DQG$&$DUHHPSLULFDOO\GHULYHGFDUHJLYHUUHSRUW

psychiatric rating scales designed to measure problematic behaviors, emotional states, and UHODWLRQDO GLIÀFXOWLHV H[SHULHQFHG E\ FKLOGUHQ LQ FDUH DQG VLPLODU YXOQHUDEOH SRSXODWLRQV

LQ FRPSUHKHQVLYH FOLQLFDOSV\FKRVRFLDOGHYHORSPHQWDO DVVHVVPHQWV 7KH %$& PHDVXUHV ZHUH

developed for use as screening and brief monitoring measures by children’s agencies, also FRYHULQJDWWDFKPHQWDQGWUDXPDUHODWHGGLIÀFXOWLHV,QWKH$XVWUDOLDQGHYHORSPHQWVDPSOHV

WKH%ULHI$VVHVVPHQW&KHFNOLVWV%$&SURYLGHGDFFXUDWHVFUHHQLQJIRUHOHYDWHGDQGFOLQLFDO

OHYHOPHQWDOKHDOWKGLIÀFXOWLHVDPRQJFKLOGUHQLQFDUHFRPSDUDEOHWRWKDWSURYLGHGE\ERWK

WKH&%&/DQGWKH%ULHI3UREOHP0RQLWRU%30DVKRUWIRUPRIWKH&%&/7DUUHQ6ZHHQH\

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monitoring for foster children, their psychometric properties need to be further established 'HQWRQHWDO7DUUHQ6ZHHQH\E*LYHQWKH\DV\HWKDYHRQO\EHHQHVWDEOLVKHG

for the Australian development samples, there is need for further population-level research to identify their psychometric properties when used elsewhere in the world. Given there is a need IRUVSHFLDOL]HGVFUHHQLQJDQGPRQLWRULQJRIIRVWHUFKLOGUHQLQWKH1HWKHUODQGV'H%DDWHWDO

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151

7

2015) the most feasible option seems to translate the measures and adapt them for use in the Dutch foster care context.

Current Study

The present study examined the psychometric properties (screening accuracy, UHOLDELOLW\DQGFRQFXUUHQWYDOLGLW\RIWKH%$&&DQGWKH%$&$EDVHGRQGDWDREWDLQHGLQ

the third wave of a longitudinal population study of Dutch children and adolescents in foster FDUH7KHFXUUHQWVWXG\DQDO\VHGSHUWLQHQWSV\FKRPHWULFSURSHUWLHVRIWKH%$&WRHVWDEOLVKLWV

validity for two separate purposes: screening and monitoring.

7KHYDOLGLW\RIWKH%$&·VWHVWVFRUHVDVDscreening measure was estimated from its screening accuracy in relation to various clinical and social welfare dichotomous outcome FULWHULD%HFDXVHWKHPRVWLPSRUWDQWSXUSRVHRIVFUHHQLQJLVWRLGHQWLI\FKLOGUHQZKRKDYHQHHG

IRUWKHUDSHXWLFDQGFOLQLFDOVXSSRUWVHUYLFHVZHH[DPLQHGKRZDFFXUDWH%$&PHDVXUHVFODVVLI\

whether or not foster parents and/or foster children received additional support services or interventions. A secondary purpose of screening is to identify foster placements that require additional support services to reduce the risk of placement disruption. Children’s behavior SUREOHPV DUH UHODWHG WR IRVWHU SDUHQW VWUHVV +XUOEXUW HW DO 9DQGHUIDHLOOLH HW DO

DQGWKH\DFFRXQWIRUDQLQFUHDVHGULVNRIIRVWHUSODFHPHQWGLVUXSWLRQ%URZQ %HGQDU

)DUPHUHWDO:HWKHUHIRUHDOVRH[DPLQHGWKHDFFXUDF\RIWKH%$&PHDVXUHV

to identify whether or not foster parents’ had increased levels of foster parents’ stress and whether or not foster parents considered quitting foster care. The screening accuracy of the

%$&PHDVXUHVZHUHDOVRFRPSDUHGZLWKWKH6'4EHFDXVHWKH6'4LVDQRIWHQXVHGVFUHHQLQJ

and monitoring tool in child welfare and mental health services.

7RH[DPLQHWKHYDOLGLW\RIWKH%$&·VWHVWVFRUHVDVmonitoring measures, we examined its reliability by looking at Cronbach’s alpha. Furthermore, we examined the concurrent validity E\DQDO\]LQJWKHDVVRFLDWLRQVEHWZHHQ%$&VFRUHVDQG6'4VFRUHVDQGSDUHQWDOVWUHVV:H

H[SHFWHGKLJKFRUUHODWLRQVEHWZHHQ%$&VFRUHVRQWKHRQHKDQGDQG6'4SUREOHPVFDOHVDQG

SDUHQWDOVWUHVVRQWKHRWKHUKDQG:HH[SHFWHGORZFRUUHODWLRQVEHWZHHQ%$&VFRUHVDQG6'4

prosocial scores. In addition, concurrent validity was examined by looking at the association RI%$&VFRUHVZLWKDGGLWLRQDOVXSSRUWVHUYLFHVIRUWKHIRVWHUFKLOGDQGWKHIRVWHUIDPLO\,WZDV

hypothesized that foster families and foster children receiving additional support services KDYHKLJKHU%$&VFRUHV*RHPDQV9DQ*HHO 9HGGHU-RQHVHWDO1HZWRQHW

al., 2000).

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152 METHOD

Participants and Index Children

Index children were aged between 4 and 17 years, residing in regular full-time family foster care. For the purpose of the present analyses, the larger study sample (N = 219, UHVSRQVHUDWH LVGLYLGHGLQWRVHSDUDWHFKLOGDQGDGROHVFHQWVDPSOHVUHÁHFWLQJWKH

%$&&\HDUVDQGWKH%$&$\HDUVDJHUDQJHV&KDUDFWHULVWLFVRIWKHFKLOGDQG

adolescent samples, including information about their foster parents, are presented in Table 7.1.

Table 7.1. Characteristics of the samples.

4-11 years (BAC-C sample) n = 118

12-17 years (BAC-A sample) n = 101

Categories N (%) n missing

(%)

N (%) n missing (%)

Age – M (SD)¹ - 7.80 (2.15) ¹ 14.25 (1.68) ¹

Gender Girls

%R\V

Placement history –

M (SD)¹ - 1.17 (1.66) ¹ 1.04 (.99) ¹

Duration placement

– M (SD)¹ - 47.77 (31.67) ¹ 66.82 (51.31) ¹

Type of foster family Kinship

Non-kinship

Family composition Two parent family

6LQJOHSDUHQWIDPLO\

%LRORJLFDOFKLOGUHQ

foster parents (at T1) No

<HV

Other foster children

(at T1) No

<HV

Foster parent thinks about quitting foster care

Often 6RPHWLPHV

%DUHO\

Never I don’t know

Foster parent is

planning on quitting <HVFRQFUHWHSODQV

<HVQRFRQFUHWH

plans NoI don’t know

Legal framework Voluntary

Mandated

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153

7

Instruments

Brief Assessment Checklists.7KH%$&&DQGWKH%$&$DUHEULHILWHPPHQWDO

health screening and monitoring scales, that yield a single score ranging from 0-40 (Tarren- 6ZHHQH\E7KHPHDVXUHVFRQWDLQQRVXEVFDOHVDQGDUHSUHVHQWHGLQWZRSDUWV3DUW

1 contains less critical, higher incidence items rated on a 3-point Likert scale: 0 (not true

(partly truemostly true) in the last four to six months. Part 2 contains more critical, lower incidence items rated on a different 3-point Likert scale: 0 (did not occuroccurred once

2 (occurred more than onceLQWKHODVWIRXUWRVL[PRQWKV6DPSOHLWHPVDUH¶&UDYHVDIIHFWLRQ·

¶7RR IULHQGO\ ZLWK VWUDQJHUV· DQG ¶6H[XDO EHKDYLRU QRW DSSURSULDWH IRU KHUKLV DJH· ,Q WKH

$XVWUDOLDQ GHYHORSPHQW VDPSOHV WKH %$&& DQG %$&$ ZHUH KLJKO\ DFFXUDWH LQ VFUHHQLQJ

IRU &%&/ $&& DQG $&$ FOLQLFDO UDQJH VFRUHV $8& ! DQG PRGHUDWHO\ DFFXUDWH LQ

screening for caregiver-reported referrals to clinical services (AUC = 0.74-0.79) (Tarren- 6ZHHQH\D8VLQJDVWULFWWUDQVODWLRQEDFNWUDQVODWLRQSURWRFROWKH%$&PHDVXUHVZHUH

independently translated into Dutch by three staff members from the Institute of Education DQG &KLOG 6WXGLHV $IWHU GLVFXVVLRQ DQG DJUHHPHQW WKH 'XWFK YHUVLRQV ZHUH LQGHSHQGHQWO\

EDFNWUDQVODWHGE\WKUHHRWKHUVWDIIPHPEHUV$OOWUDQVODWRUVZHUHÁXHQWLQ'XWFKDQG(QJOLVK

After discussion and agreement about the back-translations, they were compared with the original versions of the checklists by the scale developer, who approved the translation after DGMXVWPHQWRIDIHZPLQRUSRLQWV07DUUHQ6ZHHQH\SHUVRQDOFRPPXQLFDWLRQ6HSWHPEHU

2015).

4-11 years (BAC-C sample) n = 118

12-17 years (BAC-A sample) n = 101

Categories N (%) n missing

(%)

N (%) n missing (%) Planning to stay in

the foster family <HV

NoNot clear yet I don’t know

Planning for

UHXQLÀFDWLRQ <HV NoI don’t know

Intervention foster

parents <HV

No

Intervention foster

child <HV

No

Parental contact (at

T1) <HV

No

1For numerical variables mean (M) and standard deviation (SD) are presented instead of N Table 7.1. (continued)

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154

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DVRQHRIWZRFKLOGSV\FKRVRFLDORXWFRPHPHDVXUHVDORQJZLWKWKH%$&7KH6'4ZDVSUHYLRXVO\

WUDQVODWHGDQGYDOLGDWHGIRUXVHLQWKH1HWKHUODQGV9DQ:LGHQIHOWHWDO7KH6'4

comprises 25 items which are rated on a 3-point Likert scale: 0 (not truesomewhat true

(certainly true). In line with previous research (Goodman et al., 2010) and based on the syntax SURYLGHGE\WKH6'4ZHEVLWHKWWSZZZVGTLQIRFRPS\VGTLQIRFS\ZHFRPELQHGWKH

25 items into three subscales – prosocial behaviors, internalizing problems, and externalizing SUREOHPV 7KH 6'4 WRWDO GLIÀFXOWLHV VFRUH LV REWDLQHG E\ DGGLQJ WKH DOO LQWHUQDOL]LQJ DQG

externalizing item scores, yielding a possible score ranging from 0 to -40. Previous studies KDYHVKRZQWKDWWKH6'4LVDYDOLGVFUHHQLQJPHDVXUH9DQ:LGHQIHOWHWDOZLWKJRRG

convergent and discriminant validity for the subscales (Goodman et al., 2010). The Dutch YHUVLRQRIWKH6'4KDVEHHQIRXQGWRKDYHDFFHSWDEOHWRJRRGSV\FKRPHWULFSURSHUWLHV0XULV

et al., 2003).

Parenting stress. 3DUHQWLQJ VWUHVV WKDW LV VSHFLÀF WR FDULQJ IRU WKH LQGH[ FKLOG ZDV

PHDVXUHGZLWKWKHDEEUHYLDWHGYHUVLRQRIWKH1LMPHHJVH2XGHUOLMNH6WUHVV,QGH[126,.

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126,.FRQVLVWVRISDUHQWLQJVWUHVVUHODWHGLWHPVZKLFKDUHUDWHGRQDSRLQW/LNHUWVFDOH

ranging from 1 (totally disagree) to 6 (totally agree). Parents answer the items in reference to DVSHFLÀFFKLOG6DPSOHLWHPVDUH¶&KLOGGRHVWKLQJVWKDWERWKHUPHDJUHDWGHDO·RU¶&KLOG

LVPRUHRIDSUREOHPWKDQH[SHFWHG·7KHLWHPVRIWKH126,.DUHGHULYHGIURPVFDOHVZKLFK

KDYHEHHQVKRZQWRKDYHJRRGFRQFXUUHQWDQGGLVFULPLQDQWYDOLGLW\)XUWKHUPRUHWKH126,.

KDVEHHQIRXQGWRKDYHKLJKLQWHUQDOFRQVLVWHQF\'H%URFNHWDO+DVNHWWHWDO

Other survey questions. Foster parents provided information about the foster child (e.g., age, gender, placement history, duration of the current placement), foster family (e.g., kinship or non-kinship, thinking about quitting foster care) and foster placement (e.g., legal framework, and interventions aimed at foster parents and/or foster children). Regarding the questions about interventions, foster parents were asked to indicate whether or not there had been any form of additional support during the last six months of the current foster placement.

,W ZDV FODULÀHG WKDW WKLV FRQFHUQHG WKHUDS\ WUDLQLQJ DQG LQWHUYHQWLRQ RYHU DQG DERYH WKH

regular support from the foster care institution.

Procedure

The present study reports the results of the third wave of a larger longitudinal study on the development of children in foster care. The aim of the longitudinal study was to establish why some foster care trajectories are more successful in terms of children’s development and SUHYHQWLQJEUHDNGRZQWKDQRWKHUV7KH6'4ZDVLQFOXGHGLQHDFKVWXG\ZDYHZKLOHWKH%$&

was only included in the third wave. The study waves were spaced six months apart, with the being conducted in October 2014. The study design was approved by the Leiden University (WKLFV5HYLHZ%RDUG

Foster parents were recruited as study participants to report on a foster child (the

‘index’ child) in their care, as well as their own caregiving, parental stress, and intentions to FRQWLQXHIRVWHULQJ)DPLOLHVZLWKPXOWLSOHIRVWHUFKLOGUHQZHUHDVNHGWRÀOORXWWKHTXHVWLRQQDLUH

IRURQHIRVWHUFKLOGRQO\WRHQVXUHLQGHSHQGHQWREVHUYDWLRQV:HLQYLWHGDOOIRVWHUFDUHDJHQFLHV

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155

7

LQWKH1HWKHUODQGVDQGVHYHQDJHQFLHVDJUHHGWRSDUWLFLSDWH7KHPDLQUHDVRQFLWHG

for non-participation was that they had already participated in other foster care related research, and wanted to prevent overloading their foster families. The participating foster care agencies informed their foster parents about the goal of the study, and obtained an informed consent from those parents who wished to participate. The researchers only received contact information for those foster parents who consented to participate. Foster parents of children in both short-term and long-term placements were eligible to participate, but those caring for children in ‘crisis’ placements were excluded. For the third wave of the study (October 2015), ZH DSSURDFKHG IRVWHU SDUHQWV WR FRPSOHWH HLWKHU DQ RQOLQH TXHVWLRQQDLUH RU

ZKHUHHPDLORULQWHUQHWDFFHVVZDVQRWDYDLODEOHDSDSHUTXHVWLRQQDLUH$OOLQYLWHG

foster parents were informed that participation was voluntary and that they could end their SDUWLFLSDWLRQDWDQ\PRPHQW,WZDVFODULÀHGWKDWDOOLQIRUPDWLRQJLYHQE\WKHIRVWHUSDUHQWV

WRWKHUHVHDUFKWHDPZRXOGEHKDQGOHGFRQÀGHQWLDOO\DQGWKDWWKHUHVHDUFKZDVSHUIRUPHG

independently of the foster care agencies. After the invitation, two reminders to complete the questionnaire were sent, on a two-week interval. Three weeks after the last reminder, the online questionnaire was closed. A family excursion to an amusement park and several gift YRXFKHUVZHUHUDIÁHGRIIDPRQJSDUWLFLSDWLQJIRVWHUIDPLOLHV

Statistical Analyses

7KH%$&·VYDOLGDWLRQDVDVFUHHQLQJPHDVXUHLVHVWDEOLVKHGWKURXJKHVWLPDWHVRIVFUHHQLQJ

accuracy, as indicated by the area under the ROC (Receiver Operating Characteristics) curve, or area under the curve (AUC). The AUC statistic indicates the extent of trade-off between VHQVLWLYLW\DQGVSHFLÀFLW\ZKHQVFUHHQLQJIRUYDULRXVGLFKRWRPRXVUHIHUHQFHFULWHULD$Q$8&

of .5 means that there is no discrimination (e.g., true- and false-positive proportions are HTXDODQGDQ$8&RIPHDQVWKDWWKHUHLVSHUIHFWGLVFULPLQDWLRQ6ZHWV7KH%$&·V

validation as a monitoring measure rests on classical validity and reliability data. The present analyses were carried out with a view to estimating internal reliability (Cronbach’s alpha), item YDOLGLW\DQGFRQFXUUHQWYDOLGLW\%$&6'4DQG%$&126,LQWHUVFDOHFRUUHODWLRQV

(11)

156 RESULTS

The distributions (mean, standard deviation and range) and internal consistency of the PHDVXUHGVFDOHVFRUHVDUHOLVWHGIRUWKHWZRDJHJURXSVLQ7DEOH%$&&DQG%$&$LWHP

score characteristics (mean, standard deviation and corrected item-total correlation) are listed LQ7DEOHVDQGUHVSHFWLYHO\%DVHGRQWKHVXJJHVWHGFXWSRLQWRIÀYH7DUUHQ6ZHHQH\

2013b), over three quarters of children and adolescents were screened positive for clinically- PHDQLQJIXOPHQWDOKHDOWKGLIÀFXOWLHV%$&& %$&$ 0HDQ6'4VFRUHVIRU

both child and adolescent samples fall within the borderline range (Goedhart et al., 2003).

7KHSURSRUWLRQVRIFKLOGVDPSOH6'4VFRUHVLQWKHQRUPDOERUGHUOLQHDQGFOLQLFDOUDQJHVZHUH

DQGUHVSHFWLYHO\7KHSURSRUWLRQVRIDGROHVFHQWVDPSOH6'4VFRUHVLQ

WKHQRUPDOERUGHUOLQHDQGFOLQLFDOUDQJHVZHUHDQGUHVSHFWLYHO\0HDQ

SDUHQWDOVWUHVVOHYHOVDVHVWLPDWHGE\126,.VFRUHVIRUIRVWHUSDUHQWVRIWKHFKLOGM = 57.69, SD = 22.43) and adolescent (M = 57.54, SD = 29.11) samples were both within the ‘average’

range. The proportions of foster parents of children who reported ‘below average’ (0-42),

¶DYHUDJH·DQG¶DERYHDYHUDJH·SDUHQWDOVWUHVVZHUHDQG

UHVSHFWLYHO\)RUWKHDGROHVFHQWVDPSOHWKHSURSRUWLRQVZHUHDQG

respectively.

Table 7.2. Distributions and internal consistency of study measure scale scores.

4-11 year (BAC-C sample), n = 118

11-17 year (BAC-A sample), n = 101

Min- max

M SD ɲ Min-

max

M SD ɲ

%$&%ULHI$VVHVVPHQW&KHFNOLVW 1-33 12.09 8.16 .89 0-33 11.45 7.76 .87 126,.3DUHQWLQJ6WUHVV 25-120 57.69 22.43 .94 15-117 57.54 29.11 .97 6'47RWDOEHKDYLRXUSUREOHPV 1-30 12.93 7.00 .85 1-31 11.74 6.87 .84

6'4,QWHUQDOL]LQJ 0-15 4.67 3.55 .74 0-15 5.48 4.05 .77

6'4([WHUQDOL]LQJ 1-18 8.26 4.65 .85 0-18 6.28 4.11 .81

6'43URVRFLDOEHKDYLRXU 0-10 7.36 2.12 .74 0-10 11.73 2.55 .78

(12)

157

7

Table 7.3. BAC-C item characteristics.

Dutch BAC-C sample (n = 118)

NSW CICS BAC-C sample (n = 347)¹

Item mean score (SD)

Preva- lence²

Correc- ted item-total corre- lation³

Item mean score (girls/

boys)

Correc- ted item-total corre- lation³ 1 Can’t concentrate, short

attention span 1.15 (.78) 76.3 .39 .84/1.16 66 .44

2 Craves affection 1.41 (.72) 84.7 .27 1.06/.90 64 .58

3 Eats too much .34 (.62) 26.2 .23 .37/.35 25 .32

4 Fears you will reject her/him .97 (.73) 72.0 .64 .42/.38 31 .54

5 Hides feelings .78 (.78) 56.8 .56 .22/.19 37 .60

6 Is convinced that friends will

reject her/him .45 (.59) 39.8 .58 .29/.22 20 .57

7 Lacks guilt or empathy .67 (.74) 50.8 .53 .52/.63 39 .57

8 Prefers to be with adults,

rather than children .32 (.64) 23.1 .54 .54/.34 32 .49

9 Relates to strangers ‘as if they

were family’ .61 (.79) 42.3 .66 .73/.69 47 .55

10 6HHPVLQVHFXUH .75 (.72) 59.3 .40 .53/.56 44 .60

11 6WDUWOHVHDVLO\¶MXPS\· .46 (.71) 33.0 .56 .49/.38 33 .52

12 6XVSLFLRXV .52 (.77) 34.7 .69 .24/.34 22 .56

13 Too dramatic (false emotions) .55 (.77) 38.1 .70 .61/.41 35 .59 14 Too friendly with strangers .58 (.79) 39.8 .62 1.02/1.00 68 .46

15 Too jealous .64 (.79) 44.1 .70 .57/.47 40 .58

16 Treats you as though you were the child, and she/he was the parent

.33 (.64) 23.7 .39 .40/.29 26 .44

17 Uncaring (shows little concern

for others) .31 (.61) 23.7 .47 .29/.53 31 .50

18 Distressed or troubled by

traumatic memories .78 (.88) 47.4 .53 .40/.40 28 .51

19 Does not show pain if

physically hurt .29 (.63) 19.5 .31 .16/.23 15 .33

20 6H[XDOEHKDYLRUQRW

appropriate for her/his age .18 (.48) 13.5 .38 .27/.17 14 .50

1'DWDGHULYHGIURPWKH&KLOGUHQLQ&DUH6WXG\FDUULHGRXWLQ1HZ6RXWK:DOHV16:$XVWUDOLD

,WHPPHDQVDQGSUHYDOHQFHZHUHUHSRUWHGSUHYLRXVO\7DUUHQ6ZHHQH\EZKLOHFRUUHFWHGLWHP

WRWDOFRUUHODWLRQVDUHSXEOLVKHGIRUWKHÀUVWWLPH

2 Item prevalence is the percentage of children with item scores of 1 (‘partly true’) or 2 (‘mostly true’).

3 Correlation between the item score ant the ‘total score minus the item score’ (i.e., item-rest correlation).

(13)

158

Table 7.4. BAC-A item characteristics.

Dutch BAC-A sample (n = 101)

NSW CICS BAC-A sample (n = 230)¹

Item mean score (SD)

Correc- ted item-total corre- lation³

Item mean score (girls/

boys)

Correc- ted item-total corre- lation³ 1 Constantly seeking excitement

or ‘thrills’ .41 (.64) 32.7 .25 .32/.34 30 .44

2 Craves affection 1.12 (.73) 79.0 .08 .80/.57 46 .37

3 Does not share with friends .44 (.70) 31.7 .49 .30/.43 29 .41

4 Does not show affection .62 (.77) 44.5 .49 .42/.52 37 .34

5 Feels victimized or

misunderstood .68 (.80) 47.5 .65 .28/.46 37 .54

6 Gorges food .38 (.63) 29.7 .29 .31/.50 28 .42

7 Hides feelings 1.02 (.75) 73.3 .53 .79/.80 56 .44

8 Impulsive (acts rashly, without

thinking) .67 (.72) 52.5 .57 .68/.95 68 .69

9 Lacks guilt or empathy .75 (.82) 51.5 .68 .62/.76 50 .60

10 Relates to strangers ‘as if they

were family’ .53 (.75) 38.0 .43 .36/.42 30 .50

11 Resists being comforted when

hurt .36 (.59) 29.7 .41 .31/.39 30 .32

12 6KRZVLQWHQVHDQG

inappropriate anger .41 (.62) 33.6 .64 .42/.63 47 .69

13 Too friendly with strangers .45 (.72) 32.0 .53 .61/.52 50 .43

14 Too jealous .40 (.67) 29.7 .59 .40/.42 26 .45

15 Tries too hard to please other

young people .58 (.78) 40.0 .60 .53/.47 40 .37

16 :LWKGUDZQ .52 (.70) 40.6 .34 .39/.44 28 .29

17 Appears dazed, ‘spaced out’

(like in a trance) .50 (.77) 32.6 .30 .34/.24 24 .40

18 Intense reaction to criticism .90 (.87) 57.5 .65 .58/.65 41 .61 19 6H[XDOEHKDYLRUQRW

appropriate for her/his age .16 (.49) 11.0 .38 .19/.14 8 .33

20 6XGGHQRUH[WUHPHPRRG

changes .58 (.80) 38.6 .48 .42/.35 34 .57

1'DWDGHULYHGIURPWKH&KLOGUHQLQ&DUH6WXG\FDUULHGRXWLQ1HZ6RXWK:DOHV16:$XVWUDOLD

,WHPPHDQVDQGSUHYDOHQFHZHUHUHSRUWHGSUHYLRXVO\7DUUHQ6ZHHQH\EZKLOHFRUUHFWHGLWHP

WRWDOFRUUHODWLRQVDUHSXEOLVKHGIRUWKHÀUVWWLPH

2 Item prevalence is the percentage of children with item scores of 1 (‘partly true’) or 2 (‘mostly true’).

3 Correlation between the item score and the ‘total score minus the item score’ (i.e., item-rest correlation).

(14)

159

7

Psychometric Properties of the BAC as Screening Measures

ROC analyses were carried out separately for the child and adolescent samples, H[DPLQLQJ%$&DQG6'4VFUHHQLQJSURSHUWLHVDJDLQVWWKUHHUHIHUHQFHFULWHULD5HFHLYLQJ

LQWHUYHQWLRQVHUYLFHV+LJKSDUHQWDOVWUHVVLQFDULQJIRUWKHLQGH[FKLOGDQG5LVNWKHIRVWHU

SDUHQWZLOOTXLWIRVWHULQJ7DEOHOLVWVWKH$8&VDQGFRQÀGHQFHOLPLWVIRUWKHVH52&DQDO\VHV

DORQJZLWKFRPSDULVRQ$8&VREWDLQHGIRUWKH%$&DQG%30LQWKH$XVWUDOLDQGHYHORSPHQW

VDPSOHV7DUUHQ6ZHHQH\E7KHUHVXOWVVKRZWKDWVFUHHQLQJDFFXUDFLHVRIWKH%$&DUH

FRPSDUDEOHEHWZHHQWKH'XWFKDQGWKH1HZ6RXWK:DOHVVDPSOHDQGWRWKH'XWFK6'4

Psychometric Properties of the BAC as Monitoring Measures

7KHLQWHUQDOFRQVLVWHQF\&URQEDFK·VDOSKDRIWKH%$&&DQG%$&$VFRUHVZHUH

DQGUHVSHFWLYHO\ZKLOHWKHLQWHUQDOFRQVLVWHQF\RIWKH6'4WRWDOGLIÀFXOWLHVVFRUHVLQWKH

same child and adolescent samples were .85 and .84 respectively. The correlation matrix for WKHVWXG\PHDVXUHVFDOHVFRUHV%$&6'4126,.LVSUHVHQWHGLQ7DEOHZLWKFRUUHODWLRQV

for the child sample set out below the diagonal and those for the adolescent sample above WKHGLDJRQDO0RGHUDWHWRVWURQJFRUUHODWLRQVZHUHIRXQGEHWZHHQ%$&&DQG6'4VFDOHV

WRWDO GLIÀFXOWLHV VFRUH LQWHUQDOL]LQJ SUREOHPV H[WHUQDOL]LQJ SUREOHPV SURVRFLDO EHKDYLRUV ZLWKKLJKHUVFRUHVRQWKH%$&VFDOHVUHODWHGWRKLJKHUVFRUHVRQWKH6'4SUREOHPVFDOHVDQG

ORZHU VFRUHV RQ WKH 6'4 SURVRFLDO EHKDYLRU VFDOH VHH 7DEOH 7KH FRUUHODWLRQV RI WKH

%$&PHDVXUHVZLWKWKH6'4WRWDOGLIÀFXOWLHVVFRUHZHUHWKHVWURQJHVWZLWKIRUWKH%$&&

Table 7.5. 6FUHHQLQJDFFXUDF\DUHDXQGHUWKH52&FXUYH&RQÀGHQFH,QWHUYDOEHWZHHQ

brackets).

Interventions Parental stress Risk of quitting care Children

'XWFK%$&& .72 (.63, .81) .79 (.71, .88) .60 (.50, .71)

'XWFK6'4 .72 (.63, .81) .79 (.70, .88) .61 (.50, .72)

16:%$&& .74 (.69, .80) ^- -

16:%30 .75 (.70, .81) - -

Adolescents

'XWFK%$&& .76 (.66, .86) .87 (.80, .95) .73 (.63, .83)

'XWFK6'4 .77 (.67, .86) .83 (.75, .92) .67 (.55, .77)

16:%$&& .79 (.73, .85) - -

16:%30 .79 (.73, .85) - -

1'DWDGHULYHGIURPWKH&KLOGUHQLQ&DUH6WXG\FDUULHGRXWLQ1HZ6RXWK:DOHV$XVWUDOLDDQG

UHSRUWHGE\7DUUHQ6ZHHQH\E

(15)

160

DQGIRUWKH%$&$0RGHUDWHWRVWURQJFRUUHODWLRQVZHUHDOVRIRXQGEHWZHHQWKH%$&

PHDVXUHVDQGSDUHQWDOVWUHVV126,.+LJKHUVFRUHVRQWKH%$&PHDVXUHVZHUHUHODWHGWR

higher levels of parental stress.

)XUWKHUPRUHZHWHVWHGZKHWKHU%$&VFRUHVZHUHDVVRFLDWHGZLWKDGGLWLRQDOLQWHUYHQWLRQ

or support services received during the placement. Independent sample t-tests revealed a VLJQLÀFDQWVPDOOWRPHGLXPHIIHFWRIDGGLWLRQDOVXSSRUWVHUYLFHVIRUFKLOGUHQt (116) = 2.319, p < .05, d = .43) and a large effects for adolescents (t (99) = 4.233, p < .001, d = .88), with FKLOGUHQRUDGROHVFHQWVUHFHLYLQJDGGLWLRQDOVXSSRUWVFRULQJKLJKHURQ%$&PHDVXUHVM_BAC-C

= 14.04, SD_BAC-C M_BAC-A = 15.24, SD_BAC-A =8.12) than children and adolescents not receiving additional support (M_BAC-C = 10.61, SD_BAC-C MB_AC-A = 8.85, SD_BAC-A= 6.36).

7KLV ZDV DOVR WUXH IRU WKH DGGLWLRQDO VXSSRUW VHUYLFHV IRU IRVWHU SDUHQWV %$&& t (116) = 3.489, p < .01, d %$&$t (98) = 3.245, p < .01, d = .86), with a medium to large effect for children, and a large effect for adolescents. Children or adolescents whose parents UHFHLYHGDGGLWLRQDOVXSSRUWVHUYLFHVVFRULQJKLJKHURQ%$&PHDVXUHVM_BAC-C = 15.79, SD_BAC-C M_BAC-A SD_BAC-A = 8.08) than children and adolescents whose parents did not receive additional support services (M_BAC-C = 10.66, SD_BAC-C M_BAC-A SD_BAC-A= 7.21).

Table 7.6. Correlations between BAC measures and NOSIK and SDQ.

1. 2. 3. 4. 5. 6.

126,.SDUHQWLQJ6WUHVV .597** .462** .540** -.412** .712**

6'47RWDOGLIÀFXOWLHVVFRUH .635** .838** .843** -.411** .795**

6'4,QWHUQDOL]LQJSUREOHPV .468** .805** .414** -.374** .690**

6'4([WHUQDOL]LQJSUREOHPV .598** .892** .448** -.318** .648**

6'43URVRFLDOEHKDYLRU -.546** -.426** -.307** -.406** -.518**

%ULHI$VVHVVPHQW&KHFNOLVW .643** .831** .757** .674** -.440**

Note8QGHUWKHGLDJRQDO%$&&FRUUHODWLRQV$ERYHWKHGLDJRQDO%$&$FRUUHODWLRQV

** p < .01

(16)

161

7

DISCUSSION

7KLV VWXG\ H[DPLQHG WKH SV\FKRPHWULF SURSHUWLHV RI WKH 'XWFK YHUVLRQ RI WKH %$&

PHDVXUHV 7KH DQDO\VHV VXJJHVW WKDW WKH %$&& DQG %$&$ SHUIRUP ERWK VFUHHQLQJ DQG

monitoring functions well among population samples of Dutch foster children and adolescents.

The measures’ reliability, concurrent validity, and screening accuracy are comparable to those HVWLPDWHGIRUWKH6'4LQWKHVDPHVWXG\VDPSOHVDVZHOODVWRWKRVHSUHYLRXVO\UHSRUWHGIRU

WKH$XVWUDOLDQGHYHORSPHQWVDPSOHV7DUUHQ6ZHHQH\E

:LWKUHVSHFWWRVFUHHQLQJSURSHUWLHVRIWKH%$&ERWKWKH%$&&DQG%$&$VFUHHQHG

for Dutch foster children and adolescents receiving clinical interventions and support services ZLWK FRPSDUDEOH DFFXUDF\ WR WKDW DWWDLQHG E\ WKH 6'4 RQ WKH VDPH VDPSOHV DV ZHOO DV

FRPSDUDEOHDFFXUDF\WRWKDWDWWDLQHGE\WKH%$&&DQG%$&$LQWKH$XVWUDOLDQGHYHORSPHQW

VDPSOHV7DUUHQ6ZHHQH\E:KLOHWKH'XWFKDQG$XVWUDOLDQVWXGLHVPHDVXUHGFKLOGUHQ·V

receipt of clinical services in different ways (such that the reference criterion may not be GLUHFWO\FRPSDUDEOHQHYHUWKHOHVVWKHSUHVHQWUHVXOWVVXJJHVWWKH'XWFKYHUVLRQVRIWKH%$&&

DQG%$&$FDQEHHPSOR\HGDVPHQWDOKHDOWKVFUHHQLQJPHDVXUHVIRUFKLOGUHQLQWKHFDUHRI

'XWFKVSHDNLQJIRVWHUSDUHQWV2QO\WKH$8&YDOXHRIWKH%$&&ZLWKUHVSHFWWRWKHULVNRI

TXLWWLQJFDUHZDVSRRU+RZHYHULWZDVHTXDOO\SRRUIRUWKH6'47KHSRRUVFUHHQLQJDFFXUDF\

for the risk of quitting care might be related to the quality of the indicator, with thinking or considering quitting foster care not being a good predictor of actual breakdown. Another explanation might be the fact that most foster children in our sample resided in long-term foster placements. Although there was large variation, foster children resided on average more than four and a half years with their current foster family which might indicate that they are stably settled in their foster families. A recent retrospective study examined both foster children’s behavior problems on admission and after six months in relation to breakdown, and IRXQGWKDWRQO\EHKDYLRUSUREOHPVRQDGPLVVLRQZDVVLJQLÀFDQWO\DVVRFLDWHGZLWKEUHDNGRZQ

9DQGHUIDHLOOLH*RHPDQV'DPHQ3LMQHQEXUJ 9DQ+ROHQVXEPLWWHG,WZRXOGEHRILQWHUHVW

WRH[DPLQHZKHWKHUWKHULVNRIEUHDNGRZQZKLFKLVPRVWSUHYDOHQWGXULQJWKHÀUVWPRQWKVRI

WKHSODFHPHQWFDQEHSUHGLFWHGLQDORQJLWXGLQDOVWXG\XVLQJDVFUHHQLQJPHDVXUHOLNHWKH%$&

:LWKUHVSHFWWRWKHSV\FKRPHWULFSURSHUWLHVRIWKH%$&DVDPRQLWRULQJPHDVXUHWKH

LQWHUQDOFRQVLVWHQF\RIWKH%$&PHDVXUHVZHUHJRRGSDUWLFXODUO\IRULWHPVFDOHV7KH\DUH

LGHQWLFDOWRWKRVHUHSRUWHGIRUWKH%$&&DQG%$&$LQWKH$XVWUDOLDQGHYHORSPHQWVDPSOHV

7DUUHQ6ZHHQH\EDQGWKH\DUHFRPSDUDEOHWRWKHLQWHUQDOFRQVLVWHQF\RIFKLOGDQG

DGROHVFHQW6'4WRWDOGLIÀFXOWLHVVFRUHVLQWKHFXUUHQWVWXG\7KH6'4WRWDOGLIÀFXOWLHVVFRUH

DOSKDVZHUHDWWKHXSSHUHQGRISUHYLRXVHVWLPDWHVRIWKHLQWHUQDOFRQVLVWHQF\RIWKH6'4

REWDLQHGLQVWXGLHVRIFKLOGUHQDWODUJH6WRQH2WWHQ(QJHOV9HUPXOVW -DQVVHQV:LWK

respect to concurrent validity, foster children and/or foster families who received additional VXSSRUWVHUYLFHVRULQWHUYHQWLRQVDOVRVFRUHGKLJKHURQWKH%$&)XUWKHUPRUHKLJKHUVFRUHVRQ

WKH%$&PHDVXUHVZHUHUHODWHGWRKLJKHUOHYHOVRIIRVWHUSDUHQW·VVWUHVVKLJKHUOHYHOVRI6'4

EHKDYLRUSUREOHPVDQGORZHUOHYHOVRI6'4SURVRFLDOEHKDYLRUVZLWKPHGLXPWRODUJHHIIHFW

VL]HV7KHFRUUHODWLRQVEHWZHHQ%$&PHDVXUHVDQG6'4WRWDOGLIÀFXOWLHVVFRUHZHUHSDUWLFXODUO\

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(17)

162

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0RUHRYHU WKH FRUUHODWLRQV EHWZHHQ WKH %$& PHDVXUHV DQG WKH 6'4 WRWDO GLIÀFXOWLHV VFRUH

in this study are very similar to the correlations which are generally found between the total SUREOHPVFRUHVRIWKH6'4DQG&%&/6WRQHHWDO7KHVHÀQGLQJVVXJJHVWWKH%$&&

DQG%$&$KDYHJRRGFRQFXUUHQWYDOLGLW\

Limitations and Implications for Future Research

:HFRXOGQRWPDNHVWDWHPHQWVDERXWWKHRSWLPDOFXWSRLQWVIRUWKH%$&PHDVXUHVLQ

this study. An initial look at the results suggests that when applying the suggested cut-point of ÀYH7DUUHQ6ZHHQH\EWKH%$&KDVDKLJKHUVHQVLWLYLW\WKDQWKHUHFRPPHQGHG6'4

cut-points for borderline/clinical range. However, future research should examine screening accuracy of these measures for Dutch children against further reference criteria, such as the

&%&/ WUDXPD DQG DWWDFKPHQW PHDVXUHV VXFK DV WKH $&& DQG PRUH VSHFLÀF UHFRUGLQJ RI

received interventions or support services.

$OWKRXJKWKH%$&DQG6'4PHDVXUHVSHUIRUPHGVLPLODUO\LQWKHSUHVHQWVWXG\DQG

showed comparable screening accuracy, further analysis is required to establish the extent to ZKLFKWKHSRVLWLYHVFUHHQVIRUHDFKPHDVXUHLGHQWLÀHVWKHVDPHYHUVXVGLIIHUHQWFKLOGUHQDQG

adolescents. This is not just determined by the cut-points employed for each measure. Even if the cut-points were calibrated to yield the same numbers and proportions of positive screens, WKHUHLVOLNHO\WREHVRPHGLVFUHSDQF\LQZKLFKFKLOGUHQDUHLGHQWLÀHGDVSRVLWLYHVFUHHQV7KLV

LVEHFDXVHWKH%$&DQG6'4DUHGHVLJQHGWRVFUHHQIRUGLIIHUHQWIRUPVRISV\FKRSDWKRORJ\

1HYHUWKHOHVVLQWKH$XVWUDOLDQGHYHORSPHQWVWXG\WKH%$&PHDVXUHVDFFXUDWHO\VFUHHQHGIRU

ERWK$&&$&$HOHYDWHGDQGFOLQLFDOUDQJHVFRUHVDQGIRUWKHHTXLYDOHQW&%&/ERUGHUOLQH

DQG FOLQLFDO UDQJH VFRUHV 6R ZH VKRXOG DOVR DQWLFLSDWH D IDLU GHJUHH RI RYHUODS EHWZHHQ

WKRVHFKLOGUHQZKRVFUHHQSRVLWLYHRQWKH%$&DQGWKRVHZKRGRVRRQWKH6'4$QLPSRUWDQW

question for future research therefore is whether screening accuracy for detecting mental KHDOWKGLIÀFXOWLHVDPRQJFKLOGUHQLQFDUHLVPHDQLQJIXOO\LPSURYHGE\XVLQJERWKWKH%$&DQG

6'4LQSODFHRIDVLQJOHVFUHHQLQJPHDVXUH"

Conclusions

&RQVLGHULQJ WKH UHVXOWV RQ WKH SV\FKRPHWULF SURSHUWLHV RI WKH %$& PHDVXUHV ERWK

%$&&DQG%$&$VHHPSURPLVLQJDQGXVHIXOWRROVIRUVFUHHQLQJDQGPRQLWRULQJLQWKHIRVWHU

care context of the Netherlands. However, more studies are necessary to more thoroughly assess WKHYDOXHRIWKH%$&QH[WWRH[LVWLQJVFUHHQLQJPHDVXUHVDQGWRYDOLGDWHRUMXVWLI\FXWSRLQWV

IRUWKH%$&)XUWKHUPRUHDVLGHIURPWKHGLVFXVVLRQDERXWZKLFKPHDVXUHVWRXVHIRUVFUHHQLQJ

DQGZKDWFXWSRLQWVWRVHWZHVKRXOGWDNHWKHKLJKVFRUHVRIIRVWHUFKLOGUHQRQWKH%$&DVD

VHULRXVVLJQDOZLWKUHVSHFWWRWKHLUSV\FKRVRFLDOGHYHORSPHQW7KHÀQGLQJVRIWKLVVWXG\LQGLFDWH

WKDWDODUJHJURXSRIIRVWHUFKLOGUHQPLJKWH[SHULHQFHVHULRXVSV\FKRVRFLDOGLIÀFXOWLHV7KLV

ÀQGLQJLVFRPSDUDEOHZLWKSUHYLRXVO\UHSRUWHG-DQVVHQV 'HERXWWH0DDVNDQWHWDO

0LQQLV3HORVL.QDSS 'XQQDQGIDLUO\VLPLODUWRWKHSHUFHQWDJHVRIFKLOGUHQ

ZLWKD&%&/WRWDOSUREOHPVFRUHLQWKHFOLQLFDOUDQJHLQWKH16:VDPSOH7DUUHQ6ZHHQH\

(18)

163

7

E6FUHHQLQJDQGWKHVSHFLÀFPHDVXUHVXVHGIRUVFUHHQLQJDUHLPSRUWDQWEXWLWLVHTXDOO\

LPSRUWDQWWRNQRZDERXWDQGLQYHVWLQIROORZXS6FUHHQLQJLVVXSSRVHGWREHWKHÀUVWVWHSLQ

a multistage assessment approach.

(19)