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Background: The process of level of care (LOC) determination has been traditionally fraught with unreliability and lack of objectivity. There is a similar need for reliable objective LOC determination tools for youth in the juvenile justice systems, which have high prevalence of psychiatric disorders and unmet mental health needs and are disproportionately from minority backgrounds. The CASII has already demonstrated significant interrater reliability and validity in studies with mental health and child welfare populations. Method: In 2004 and 2005, the Tennessee CPORT team reviewed 206 youth in the juvenile justice system ages 13 and older, 92.8% male, with 37.4% Caucasian, 55.8% African American. Instruments used included the CASII, CAFAS, CBCL, YSR, TRF, and the CPORT Child and Family Indicators. Results: There was a significant correlation between all of the CASII subscales and the CAFAS Total Scores (Pearson coefficients 0.210 to 0.618). The CASII Total Score and the CASII LOC were both highly correlated to CBCL, the YSR, and the TRF total scores and sub-scales. Significant correlations between the CASII LOC were found in 10 of the 13 CPORT Child and Family Indicators, while actual LOC placement was significantly correlated with only 4 of the 13 dimensions. The actual LOC placement was significantly different than recommended CASII LOC (p < 0.0000), with the majority of recommended LOCs being lower. Conclusions: This LOC tool is demonstrating high levels of reliability and validity in different systems of care settings, including juvenile justice, child welfare, and mental health contexts. Use of the CASII could result in significant savings in resources that could be used to provide services for adolescent offenders, and in reduction in unnecessary restrictiveness of placements.

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Burgeoning numbers of child abuse and neglect reports throughout the developed world has prompted calls for preventive and early intervention measures to support and prepare families for parenting. Nurse home visiting is one form of service delivery gaining acceptance as an appropriate strategy. Although home visiting is not a new concept in service delivery, enthusiasm for home-visitation programmes has re-emerged not only in Australia in recent years, but in many other developed countries with initiatives being launched or recommended at state, national and international levels. This thesis presents a review of the tenets of home visiting and examines a home visiting intervention programme targeting children born into families with child abuse or neglect risk factors. A randomised controlled trial using a cohort of 181 families was undertaken to evaluate the impact of this home visiting programme. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting programme or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. This procedure was shown to have utility in the context of recruitment to a research trial, in that respondents were willing to disclose sensitive personal issues using this form of screening as the basis for targeted intervention. The home visiting programme examined by this study was also shown to have social validity, with mothers willing to accept this form of intervention from the immediate postnatal period. High retention and satisfaction rates strengthened this conclusion. The ability of this study to evaluate the effectiveness of the home visiting intervention programme may have been compromised by a range of contextual factors influencing programme outcomes detailed in this thesis. Nonetheless, the study found that, for a group of families reporting risk factors for child abuse and neglect potential, provision of an intensive home visiting intervention using nurses, social workers, and parent aides was not effective in producing more favourable adjustment to the parenting role over time compared with nonintervention or clinic based service provision. The intervention programme group participants gained knowledge of child development and child management skills during the early postnatal weeks while the comparison group participants developed knowledge and skills later in the first year of their infant's lift. Early adaptation to the parenting role, parenting knowledge, and skill acquisition bodes well for parent-infant attachment and the children's long-term health and developmental outcomes. However, a 12-month assessment of maternal, family, and child development variables did not demonstrate maintenance of a positive intervention impact on parenting stress, parenting competence, or quality of the home environment. Finally, predictive analysis of fictors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. These results not only demonstrate that there is a relationship between maternal, family and enviromnental factors identified in the immediate postnatal period, and adjustment to the parenting role, but also challenge demographic targeting for child abuse and neglect risk. Findings are discussed and placed within the context of previous research and reference is made to implications for future child health practice, development, and research. Recommendations arising from this discussion relate to both future research and community child health practice.

The purpose of this study was to determine whether participation in a Family Resource\Youth Services Center New and Expectant Parenting Series had an impact on maternal and child health knowledge of parents and their future behavior choices. The study had two components. First, a telephone survey was conducted with 40 past program participants asking them nine questions concerning behavior and lifestyle choices in regards to child safety, breast or bottle feeding, immunizations, car seat use, etc. Secondly, thirty participants were given a pretest and posttest questionnaire. As a control group, there were 25 Lamaze class participants, who also completed the pre-test and posttest questionnaires. The questionnaire was a 20 item multiple choice instrument (Learning About Parenting Survey or LAPS) which measured maternal and child health knowledge in such areas as family planning; informed parenting; maternal health; basic baby care; breast-feeding; bottle-feeding; first aid; child's health including immunizations, child safety; nutrition; child development and discipline. Analysis of covariance was performed using the LAPS raw scores from the posttests as the dependent variable, the pretest scores as the covariate and the treatment as the independent variable. The results showed no significant difference in parenting knowledge between the individuals enrolled in the Family Resource\Youth Services Center's New and Expectant Parenting Series and the comparison group who did not take the course.

Barnhälsovården i Sverige ska vara en resurs för alla familjer med barn upp till skolåldern. Syftet med studien var att undersöka hur adoptivföräldrar respektive biologiska föräldrar upplevde kontakten med barnhälsovården, vilka förväntningar de hade på barnhälsovården samt vilka olika insatser de blivit erbjudna. Dessutom undersöktes om föräldragrupperna hade olika behov när det gällde kontakten med barnhälsovården och hur de upplevde att deras behov uppfyllts. Studien är av kvalitativ design och intervjuer har genomförts både individuellt och i grupp med biologiska föräldrar och adoptivföräldrar. Resultatet visar att adoptivföräldrar förväntade sig och erbjöds färre insatser från barnhälsovården än biologiska föräldrar. En stor skillnad mellan grupperna var hur snart de träffade distriktssköterskan efter hemkomst med sitt barn, och hur ofta de besökte barnavårdscentralen. Biologiska föräldrar kunde bygga en förtroendefull relation med distriktssköterskan genom en tidig kontakt och täta besök i början. Adoptivföräldrarna saknade den möjligheten och upplevde dessutom att distriktssköterskan hade bristande kunskap om adoption och adoptivfamiljer. Tillsammans resulterade detta i att adoptivföräldrarna sällan sökte hjälp för annat än medicinska problem på barnavårdscentralen. Att adoptivföräldrarna erbjöds färre insatser skulle kunna bero på att barnhälsovårdens fokus låg på adoptivbarnets ålder vid hemkomst snarare än på familjens behov. / Child health services in Sweden are aimed at all families with children aged 0-6. The aim of this study was to investigate how adoptive parents and biological parents experience their contact with child health services, their expectations concerning the child health services and to what measures they had been invited. Furthermore it was investigated if the parent groups had different needs of the child health services and their experience of how these needs were supplied. The study has a qualitative design and individual interviews as well as group interviews have been conducted with biological parents and adoptive parents. The results show that adoptive parents expected and were offered less than biological parents from the child health services. There was a big difference between the parent groups in how soon they first met the district nurse after the family had returned home with their child, and how often they visited the child health centre. The biological parents could build a trusting relationship with the district nurse because they had an early start and frequent visits. The adoptive parents lacked this possibility and also felt that the district nurse lacked knowledge of adoption and adoptive families. Because of this the adoptive parents rarely sought help from the child health centre with other than medical problems. That the adoptive parents were offered less than biological parents were could depend on the focus of the child health services on the adoptive child´s age when the family returned home rather than on the needs of the family.