Lise M. Youngblade, PhD Department of Human Development and Family Studies

1. Positive Youth Development for Children and Youth with Special Health Care Needs (CYSHCN) and Their Families Lise M. Youngblade, PhD Department of Human Development and Family Studies Colorado State University

2. Positive Youth Development • Number of comprehensive models available to predict problem behavior and, more recently, the promotion of optimal development • Models take into account the multiple layers of individual’s environment and developmental context • E.g., families, schools, peers, neighborhoods

3. Positive Youth Development • Optimal development owes not simply to reduction in negative behavior, but growth of strengths and competencies that prepare youth for the future

4. Positive Youth Development • Critical dimensions of important social contexts related to positive youth development • Connection, regulation, autonomy • Safety, supervision, monitoring • Resources and opportunities for skill building • Integration across settings • When these are evident, youth thrive

5. Positive Youth Development • 4 concerns • Single vs multiple contexts • Inclusion of multiple positive and negative developmental outcome measures • Samples • Generalizability to CYSHCN

6. Goals • Used 2003 National Survey of Children’s Health to illustrate some of these points • Focused on adolescence • Interest in comparing risk and promotive factors for families with adolescent with identified special health care needs (ASHCN) and families with no identified ASHCN on range of positive and negative outcomes

7. Hypotheses • Differences in outcome based on ASHCN status • Negative contextual factors associated with negative behavioral outcomes and inversely related to positive outcomes; vice versa for positive contextual factors • All levels (family, school and community, and health care) significantly associated with outcomes • Explored salience of contextual variables based on ASHCN status

8. Methods • 2003 NSCH: random-digit-dial sample, households with children < 18 years of age • Parent/guardian respondents • 102,353 completed interviews (55% response rate) • Estimates based on sampling weights generalize to noninstitutionalized population of children in each state and nationwide

9. Study Sample • 42,305 adolescents, aged 11-17 years • Demographics • Mean age: 13.94 years (se=.017 yrs) • 51% female • Generally healthy (mean: 3.38, se.008, scale 0-4) • 21% met screening criteria for special health care need • 19% African American; 81% White or other • 15% Hispanic • 62% Highest level household education was > high school • 53% were two-parent homes • Income: • 16% below 100% FPL • 56% between 100-400% FPL • 28% above 400% FPL

10. Outcome Variables • Positive Indicators • Social Competence • Health Promoting Behavior • Self-esteem • Negative Indicators • Externalizing Behavior • Internalizing Behavior • Academic Problems

11. Outcome Variables

12. Family Promotive Family Engagement Family Closeness Healthy Role Modeling Household rules Communication skills Child safety at home Coping well with parenthood Emotional support available Family Risk Family Aggression Parent Aggravation Negative Health Modeling Predictor Domains

13. Family Variables *

14. School/Neighborhood Promotive School and neighborhood safety Connectedness Health Care Usual source of care School/Neighborhood Risk Negative Neighborhood Influence School violence Predictor Domains

15. School/Neighborhood Variables

16. Usual Source of Care

17. Methods • 6 regressions run separately for sample of families with ASHCN and families with no ASHCN • All variables entered simultaneously

18. Variance Explained in Model

19. Regression Results • Overall impressions • Risk and promotive factors function in the way hypothesized • Not much difference for most of the predictors between ASHCN and non-ASHCN • Most of the coefficients are rather small (although statistically significant) • Some interesting findings however

20. Regression Results • Parent-child closeness is strong predictor of self-esteem and less problematic academic outcomes • For both ASHCN and non-ASHCN, but more so for ASHCN • Parent-child communication promotes social competence and less externalizing behavior • For both ASHCN and non-ASHCN, but more so for ASHCN

21. Regression Results • Parent aggravation had one of the most consistent effects, all of which were amplified for families with ASHCN • Less social competence • Lower self-esteem • Greater externalizing behavior • Greater internalizing behavior • Greater academic problems

22. Regression Results • School violence and bullying was strongly related to less self-esteem, greater internalizing behavior, and more academic problems for ASHCN and non-ASHCN • Also evinced a small but positive relation to social competence in ASHCN (but opposite in non-ASHCN), which may indicate resilience in some children

23. Regression Results • Usual source of care had similar results for both ASHCN and non-ASHCN • Greater social competence • Less externalizing and internalizing behavior, and fewer academic problems

24. What does this suggest? • Efforts to ameliorate problem behavior, as well as promote healthy and competent behavior, need to include multiple salient contexts • Despite mean level differences in outcome variables, the processes and resources necessary to promote optimal development are very similar for CYSHCN and children without special needs

25. What should we pay attention to? • Multiple resources, supports, connections are important for positive youth development • When such provisions are available, youth thrive, but it is also true that when youth thrive, systems serving youth benefit • Focus on measuring and reducing negative behavior (externalizing, internalizing, school problems) BUT also increasing positive outcomes (self esteem, social competence, health promoting behavior)

26. Taking it to the Streets • Screen • Identify CYSHCN (MCHB CSHCN Screener) • Identify insurance (or lack of) and usual source of care • Support • Support families to support youth: this is a public health message! • Pay attention to parent aggravation and frustration • Accentuate the positive: closeness and communication • Support youth to succeed • Accentuate the positive: self esteem and social competence • Promote • Usual source of care • Medical home (www.medicalhomeinfo.org) • Connections between families, schools, health system • Safe schools: bullying is a public health concern • Resources • Assets for Youth (Search Institute) • National Survey of Children’s Health (SLAITS) • Communities that Care (Univ. of WA Seattle Social Development Project)

27. Thank you!