Examining Multisystem Youth Mental Health and Well-Being Through a Mixed Methods Lens

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This may impact their relationships, coping skills, and general well-being. Previously, research has studied foster care and juvenile justice youth; however, limited research exists on multisystem youth’s mental health experiences. This study aimed to examine multisystem youth’s protective factors and barriers, particularly their mental health and personal relationships. The study utilized a mixed-methods approach to collect data from multisystem youth in Texas. Quantitative data were collected via a cross-sectional questionnaire, where participants were asked to respond to questions about their demographics, attitudes, and behaviors about their system-involved experiences (N = 1,464, 14–20 years old, x̄ age: 16.35; 49.2% females). Qualitative data was collected via nine focus groups where participants spoke about their life experiences in foster care and their dual involvement in the juvenile justice system (N = 39, 28% females, 66% Hispanic/44% White). Qualitative results indicated that multisystem youth experience challenges in regard to building and maintaining healthy relationships as well as identifying and gaining access to support systems. Quantitative results suggested that depression, self-esteem, positive coping skills, and negative coping skills are impacted by most of the study’s predictor variables. Finally, gender differences were observed among males and females at different stages of the predictor variables. Implications and future directions for research are discussed. multisystem youth mental health well-being mixed-methods protective factors Figures Figure 1 Introduction Youth involved in more than one type of social system (e.g., foster care and juvenile justice systems) are often referred to as multisystem youth, crossovers, or joint cases. In the United States, about 30% of all youth in the United States are multisystem youth, given their involvement in both foster care and the juvenile justice systems during their lifetime (Trejos-Castillo & Noriega, 2020 ). In the foster care system alone, there are an estimated 423,997 foster children in the United States, ranging in ages from infancy to 18 years old and across all racial and ethnic identities (Child Welfare Information Gateway, 2021 ). However, some states, such as Texas, do not collect data on youth that are simultaneously involved in both systems, which can result in the absence of exact figures representative of this population (Rose, 2016 ). Similarly, data collection on entry/reentry of services, relocation within and across states, and placement of stay is limited and can further contribute to the limited data available on this population (Herz, 2012 ). As a result, estimates of youth involved in both systems can vary widely across studies (Vidal, Connell, Prince, Tebes, 2019 ). Nonetheless, multisystem youth encounter unique challenges that require policymakers and practitioners to develop systems of care that can adequately address their needs (Ungar, 2015 ). Multisystem youth may become involved with multiple systems in a variety of ways. One common pathway is youth entering the foster care system due to the presence of abuse or neglect in their home, without having a history of involvement in the criminal justice system. Due to these new circumstances, youth may engage in behavior that could result in their involvement in the juvenile justice system. For example, Secondly, youth entering the juvenile justice system may also have a history of prior involvement in the foster care system, which leads to these youth becoming multisystem. A third pathway is when youth entering the juvenile justice system are determined to have experienced events that lead to youth being referred to the foster care system (Connections with Youth in the Child Welfare System, n.d.). These various pathways to becoming a multisystem youth may carry additional consequences, including in areas of mental health and well-being. Exploring mental health is particularly important for multisystem youth. For example, foster youth experience frequent changes in their primary caregivers, this instability can be detrimental to their ability to form relationships and attachments (Bederian-Gardner, Hobbs, Ogle, Goodman, Cordón, Bakanosky, Narr, Chae, Chong, & NYTD/CYTD Research Group, 2018). For instance, while transitioning across multiple systems, youth can may receive home placements with biological family members, get adopted, be transitioned out of the child welfare system, or be placed on supervision (Trejos-Castillo, Lopoo, & Dwivedi, 2020 ). These frequent changes in caregivers can result in school relocations, which can harm youths’ well-being and disrupt their relationships with teachers and peers (Bederian-Gardner, et al., 2018 ). Youth involved in the criminal justice system also experience challenges in their overall well-being and development. According to a recent statistic, a total of 696,620 youth were arrested in the United States in 2019 alone (OJJDP, 2021). More than half of those involved in the juvenile justice system were involved in the child welfare system at some point (Thomas, 2016 ). In comparison to youth who are involved in only one system, multisystem youth encounter greater challenges and are involved in the criminal justice system at higher rates (Yang, McCuish & Corrado, 2020 ). Research suggests that youth in the child welfare system are prone to transitioning into the juvenile justice system (Kim, Garcia, Jung, Barnhart, 2020 ). These youth have heightened needs for mental health services, yet there remains limited understanding of their utilization of mental health services. A recent study explored how multisystem youth from 2003 and 2012 utilized mental health services and suggested that 75% of them accessed services, with growing trends over time. Older males and those who lives at home were less likely to seek mental health services and support. Among those who did receive services, older youth, those from minority backgrounds, and those living at home received services at lower rates, despite them having similar mental health needs. Findings from the study indicated that although utilization of mental health services is increasing among multisystem youth, access to these services is impacted by various factors such as (Kim, Garcia, Jung, Barnhart, 2020 ). Although multisystem youth are a vulnerable group of youth that encounter multiple adversities and trauma, little is understood about their diverse needs and how they enter the juvenile justice or foster care systems (Vidal, Connell, Prince, Tebes, 2019 ). A recent study explores the existing literature on multisystem youth, outlining how childhood adversity can impact later development, and introduced pathways into multisystem involvement and potential intervention. The literature suggests that multisystem youth are overlooked in research. Specifically, there are limited evidence-based practices tailored to multisystem youth, the lack of standardized screening procedures, insufficient collaboration across systems, and inadequate tools to assess complex trauma and exposure among this population (Vidal, Connell, Prince, Tebes, 2019 ). In addition to research exploring the utilization of mental health services among multisystem youth (Brown, Courtney, & McMillen, 2015 ), current literature explores family instability and its negative impact on mental health, specifically for foster youth (Jelleyman & Spencer, 2008 ; Keller, Cusick, & Courtney, 2007 ; & Bederian-Gardner, et al., 2018 ), but it does not adequately consider multisystem youth in its examination. When youth are simultaneously involved in multiple systems, such as foster care and the juvenile justice system, they may experience further adverse experiences that may negatively affect youth’s well-being and development. Therefore, it is critical to examine the experiences of multisystem youth and how these simultaneous experiences impact their mental health, attachments, and relationships. This paper expands the findings of a qualitative study that examined the mental and reproductive health needs of multisystem youth and provided insights into their experience via in-depth interviews*. The qualitative study identified institutional challenges that affect multisystem youth’s mental health and suggests that disparities in mental and reproductive health may contribute to criminalization, victimization, and stigmatization of youth involved in multiple systems. It also identified partnerships across systems as key avenues for addressing such disparities in overall mental and reproductive health. This current study explores the broader context of multisystem youth’s wellbeing, beyond mental and reproductive health. It focuses primarily on the mental health of multisystem youth by examining multisystem youth’s experiences to build on insights from the previous study. Further, it utilized the qualitative findings to expand on constructs related to pregnancy perceptions, relationships, and supports. When considering gender, females involved in multiple systems often report higher rates of mental health challenges (Odgers, Robins, & Russell, 2010 ). As such, they may have more complex needs. Similarly, females in the system experience increased conflict and hostility, which can include physical and emotional abuse (Maschi, Schwalbe, Morgen, Gibson, & Violette, 2009 ). Despite this, females may be less likely to have their needs met within these systems (Odgers, Robins, & Russell, 2010 ). Conversely, it’s critical to note that males are often overrepresented in these systems, particularly males of color (Redding & Arrigo, 2005 ). Historically, the literature notes that males are more likely to be involved in delinquent activities and substance use, as opposed to females, and that exposure to risk may be great for males (Fagan, Van Horn, Hawkins, & Arthur, 2007 ). However, some researchers have long noted that although males are more likely to exhibit greater behavior problems upon entering systems, their behaviors may be more likely to improve over time (Chamberlain & Reid, 1994 ). Recent studies have outlined that violence is increasingly pervasive among young males and it can be regarded as a highly common trauma among young males and boys (Walsh, 2020 ). However, current literature continues to challenge the perspective that males may be more violent or aggressive, suggesting that the traditional view of male violence may be driven by a toxic culture of masculinity or a simple need for survival (Magnus & Scott, 2021 ). These gender disparities may impact the experiences of males and females within the child welfare and juvenile justice systems and require continued investigation. As such, this research intentionally considers gender’s role on the experiences and wellbeing of multisystem youth and aims to contribute to the growing body of literature that explores these nuances. Although several frameworks and perspectives can be utilized to study the mental health and well-being of multisystem youth, a positive youth development (PYD) perspective can effectively highlight protective factors and strengths within these multisystem youth. PYD surfaced in the 1990’s as an alternative to the deficit models of adolescent development (Burkhard, Robinson, Murray, & Lerner, 2020 ) and links ecological contexts to the creation of experiences, supports, and opportunities to enhance developmental outcomes of youth (Benson, Scales, Hamilton, & Sesma, 2006 ). It is rooted in the belief that youth are resources to society, rather than sources of concern (Damon, 2004 ). This perspective is particularly useful in understanding the experiences of multisystem youth because, despite the many challenges they face, multisystem youth possess many strengths. Given these strengths, utilizing a positive youth development framework is ideal for ensuring that communities and practitioners are supporting multisystem youth and providing them with opportunities to develop their skills, increase their self-efficacy, and contribute to their communities in order to thrive. Specifically, PYD has been used to promote positive outcomes for multisystem youth by focusing on their strengths and building their resilience to improve their wellbeing and ability to thrive. One of the core principles of PYD highlights the importance of promoting positive relationships between youth and caring adults. Research has shown that positive relationships with adults can serve as protective factors for youth who are experiencing challenges in other areas of their lives (Eccles & Gootman, 2002 ). Utilizing a strengths-based approach to defining and understanding developmental processes allows PYD interventions to reflect the experiences of youth more accurately and to appropriately examine the ways in which strengths can serve as protective assets. Thus, this study intends to examine possible protective factors that can help promote positive well-being among multisystem youth. Background The selection of the study’s quantitative variables was informed both by the themes identified in the qualitative data analysis as well as grounded in a PYD perspective. We incorporated self-control, pregnancy perceptions, relationships with caregivers, drug use, perceived social capital, relationship communication, looking forward and career and education planning as predictor variables, given that the literature supports these variables’ predictive relationship with outcomes like deviant behaviors, depression, risky sexual behaviors, relationships, well-being, and making positive decisions (Masselink, Van Roekel, & Oldehinkel, 2018 ). Similarly, when considering the predictor variables introduced, self-esteem and positive coping skills have long been considered critical outcomes that may protect youth against negative outcomes and life stressors (Zimmerman, Copeland, Shope, & Dielman, 1997 ). By examining multisystem youth’s mental health under a PYD perspective, we aimed to explore assets and strengths as positive predictors of well-being, specifically of the study outcome variables (depression, self-esteem, positive coping skills, and negative coping skills) (Burkhard, Robinson, Murray, & Lerner, 2020 ). Outcome variables were informed by qualitative themes such as internalizing behaviors and positive and negative coping skills. This approach focuses on the individual and external characteristics that youth possess that may better allow them to thrive and have positive outcomes. Individual characteristics, including self-control, perceived social capital, pregnancy perceptions, looking forward and career and education planning, are essential to examine given their relationships with the study outcomes and their ability to help us better understand potential protective factors for youth outcomes and positive coping skills. Specifically, self-control has been shown to forecast greater psychosocial outcomes and wellbeing among youth, particularly those from low socioeconomic backgrounds (Miller, Chen, & Brody, 2015). Additionally, perceived social capital can serve as a protective asset that may influence youth well-being and health (Dufur, Thorpe, Barton, Hoffman, & Parcel, 2019). When examining pregnancy perceptions, literature highlights their ability to protect against negative outcomes for youth particularly in shaping motivation to use contraception to avoid unplanned pregnancy (Skinner, Smith, Fenwick, Hendriks, Fyfe, & Kendall, 2009 ). Lastly, literature has long highlighted the role of career and education planning and the ability to look forward to the future as protective assets for youth outcomes (Resnick, 2000). These individual factors described may impact youth perceptions and outcomes and understanding these relationships can be useful in helping promote positive outcomes for multisystem youth. Consistent with Gottfredson & Hirschi’s general theory of crime (Gottfredson & Hirschi, 1990 ) literature on self-control among youth suggests that low self-control is the primary cause of crime and that youth with lower levels of self-control are more likely to engage in deviant behaviors (Vera & Moon, 2013 ), which could be associated with negative coping skills, depressive symptoms, and lower levels of self-esteem. When examining social capital, literature notes that it arises through relationships between youth and their peers, families, and others in their communities (Nor, Alias, & Musa, 2018 ). Considering social capital can help inform multisystem youth well-being as it provides insights into how youth are engaging with the social settings in which they grow up. Social capital can be achieved through school-level relationships, such as relationships between students and peers and students and teachers. Community-level social capital is dependent on the relationships youth have with those in their communities (Tuominen & Haanpää, 2021). How youth perceive their social capital is crucial to examine as it may provide insights into the relationships youth have with adults and peers in their environment. Pregnancy perceptions are important to consider when examining the well-being of youth as they may impact youth’s behaviors. For instance, positive perceptions of teenage pregnancy that may romanticize the joy parents have when having children may influence youth to engage in risky sexual behaviors, without fearing pregnancy. Some youth perceive pregnancy as a way to achieve independence, maintain a relationship with their partner, receive love or attention, prove their ability to be a parent, or to improve their current family dynamics by becoming closer to their families (Corcoran, Franklin, & Bell, 1997; Gallup-Black & Weitzan, 2004; Kegler, Bird, Kyle-Moon, et al., 2001; Unger, Molina, & Teran, 2000; as cited in Herrman, 2007). Consequently, perceiving teenage pregnancy as a life challenge may encourage youth to delay pregnancy. Some studies suggest that youth attribute teen pregnancy to diminished social life and isolation, negative stigma, challenges in juggling school, work and parenting, limited financial resources resulting in financial stress, parental disapproval and less opportunities for personal and career development (Jewell, Tacchi, & Donovan, 2001; Kegler et al.; National Campaign to Prevent Teen Pregnancy, 1999; Rosengard, Pollok, Weitzen, Meers, Phipps, 2006; Wiemann, Rickert, Berenson, et al., 2005; as cited in Herrman, 2007). Such perceptions may not only relate to pregnancy itself but may impact the ways in which youth behave in relationships or their engagement in risky sexual or social behaviors, such as unprotected sex or substance use. Additionally, having positive expectations and the ability to look positively towards one’s future helps facilitate youth’s positive development and contributes to their general well-being (Stoddard & Pierce, 2015 ). Looking forward to the future and having positive expectations refers generally to the extent to which youth can achieve positive outcomes or skills in their future. Generally, higher levels of hope and purpose in life are predictive of youth’s ability to look positively towards their future. By examining youths’ ability to look forward to the future, we hope to better understand the ways youth perceive their abilities to thrive as adults and create positive and healthy lives (Stoddard & Pierce, 2015 ). Secondly, career and education planning, which may include an exploration of both oneself and of the careers that youth may be interested in pursuing, is linked to youths’ ability to make positive decisions about their education and may result in positive youth outcomes. Lastly, planning may help increase youths’ motivation towards school. Such positive impacts may not only directly impact youths’ future careers and educational outcomes, but they may have positive impacts on other parts of their lives and wellbeing (Shen, 2021 ), such as their self-esteem. Thus, examining career and education planning can contribute to the understanding of multisystem youth’s outcomes. External factors such as drug use, relationships with caregivers and relationship communication have also been related to study outcomes and examining them can further contribute to our understanding of multisystem youth’s experiences and outcomes. Substance abuse among adolescents is linked to higher rates of depression (Kaminer, Connon, & Curry, 2007) and while some youth may resort to drug use as a negative coping skill, they may in turn further develop negative coping skills as a result of substance abuse. The relationship between drug use and self-esteem is supported in the literature, however much of it focuses on self-esteem as a protective factor for drug use (Khajehdaluee, Zavar, Alidoust, & Pourandi, 2013 ). This relationship is well documented for people of color and multiracial youth (Fisher, Zapolski, Sheehan, & Barnes-Najor, 2017 ), but not commonly examined for multisystem youth. It’s important to also examine whether refraining from drug use may serve as a protective factor for self-esteem among multisystem youth. Examining the relationship between drug use and coping skills may help us understand whether refraining from drug use could potentially protect youth from other negative coping skills, depression, and low levels of self-esteem. Lastly, exploring caregiver relationships is essential to understanding youth outcomes. Youth with access to positive interactions with caregivers, they are more likely to have positive outcomes and secure relationships with adult caregivers may help them develop and thrive (Sandstrom & Huerta, 2013 ). Research supports the notion that strong social supports protect adolescents against negative coping skills, such as smoking or drug abuse (Kann, Kinchen, Williams, Ross, Lowry, & Grunbaum, 2000). Therefore, the presence of positive caregiver relationships may serve as a potential protective factor for youth outcomes, such as depression, self-esteem, and coping skills, and conversely, negative caregiver relationships may serve as predictors of negative outcomes. Furthermore, forming healthy relationships with friends, caregivers, teachers, and others, is an essential part of adolescence. As adolescents navigate relationships, they explore and shape their identities. Relationships with caring adults are considered building blocks for all other relationships that youth have. Positive relationship communication skills, such as learning how to navigate conflict, trusting others, giving consent, etc. are crucial to help adolescents form healthy relationships. The quality of communication in relationships may impact the ways in which youth build relationships and the quality of these relationships may then impact their wellbeing. Method A sequential explanatory mixed methods design (Creswell & Plano Clark, 2017), framed in the PYD perspective, was used to examine individual (self-control, pregnancy perceptions, perceived social capital, looking forward and career and education planning) and external (drug use, relationships with caregivers and relationship communication) characteristics of well-being and their associations between depression, self-esteem, positive coping skills and negative coping skills. Qualitative data were first analyzed to better understand the experiences of multisystem youth in relation to their wellbeing to ensure that the voices and experiences of participants led our analysis and interpretation, and that quantitative data did not diminish the real experiences of participants, but rather enhanced them. A second phase of analysis tested initial qualitative findings by exploring quantitative results. By doing so, we examined parallel constructs in both the quantitative and qualitative data. The research team and authors of the paper certify that the study was approved by a university Institutional Review Board (IRB) and that all procedures and research practices abided by IRB standards. Participants were recruited to participate in the study with the help of a non-governmental organization (NGO) that liaised with foster care and juvenile justice centers in Texas. The study invited foster youth with a lifetime history and involvement in the juvenile justice system at the time of the study to participate. If participants agreed to become involved, they were contacted to participate in focus groups using pseudo names to protect their identity. Qualitative Measures and Procedure Qualitative data comprised of participants recruited from the participants in the quantitative study. Nine focus groups were conducted with multisystem youth who had a minimum of five years of total lifetime involvement in both foster care and juvenile justice systems. Participants spoke about their life experiences across these systems and their ages ranged from 14–17 years old (N = 39, 28% females, 66% Hispanic;44% White). Focus groups were between 45–150 minutes in length, depending on youths’ level of engagement and willingness to discuss their experiences. During focus groups, researchers used a guide of general questions to probe participants about their personal experiences with both the foster care and juvenile justice systems. Questions also asked participants to share their experiences and thoughts about their physical and mental health, as well as their relationships with those providing them with care in these systems. A sample size of 39 (28% female; 87% Hispanic/Latino), was determined by saturation (Guest, Bunce, & Johnson, 2006 ) and consisted of youth ages 14–17 years old). Per recommendations provided by Patton ( 2015 ) and Yin ( 2011 ), the research team determined the sample by utilizing purposive sampling to identify participants who had direct experiences across multiple systems and thus included them in the sample as they could provide the team with insights on mental health issues. Quantitative Measures and Procedure Purposive sampling was used to collect survey data among multisystem youth (N = 1,464, 14–20 years old, x̄ age: 16.35; 49.2% females) with at least 5 years of experience in the foster care and juvenile justice systems across Texas. The survey was administered via paper and pencil and was tested by coresearchers to ensure that it would not take participants more than 20 minutes to complete. We collected demographic data like age, gender, and race/ethnicity. Independent variables included scales measuring low self-control (4 items; α = .67); pregnancy perception (7 items; α = .70); relationship with caregiver (17 items; α = .86); drug use (9 items; α = .92); perceived social capital (4 items; α = .83); relationship communication (18 items; α = .85); looking forward (8 items; α = .87), and career & education planning (9 items; α = .89). Dependent variables included scales measuring depression (19 items; α = .87); self-esteem (10 items; α = .85); positive coping skills (10 items; α = .80); and negative coping skills (10 items; α = .79). Qualitative Data Analyses All focus groups were recorded and transcribed verbatim to include exact language used by participants and the facilitator. Transcriptions were reviewed multiple times and coded to capture themes across participants and focus groups. The research team utilized Thematic Network Analysis (TNA) to extract themes and sub-themes and to identify links across themes with the support of the ATLAS.ti 8.0 software (Attride-Stirling, 2001 ). First, the research team reviewed the transcribed data, to ensure accuracy. Second, researchers read the transcriptions and extracted key words and participant statements, which were grouped by theme or general topic (i.e., supportive relationships). Next, the transcriptions were reviewed again to ensure accuracy of initial themes identified and to assist researchers in developing more concrete organizing themes. After the organizing themes were identified, the team clustered them into thematic networks. When coding and analyzing the data, graphical representations of the organizing and global themes were developed using Atlas.ti.8.0. Two coders peer-reviewed and conducted member checking of the data, themes, and other elements to ensure coding validity and trustworthiness. To avoid redundancy, only one figure is included in this study as it is reflective of the final thematic network analysis. Quantitative Data Analyses Prior to running analysis, the data was screened to identify potential errors. Frequencies and descriptive statistics were run on all variables to account for missing responses and errors in the data. Additionally, reliability tests were run on all scales to ensure adequate alphas and correlations were run to ensure that study variables were correlated in the expected directions. Some responses were reverse coded to account for errors in the direction of the response – for examples some items in the depression scale included higher values resulting in lower depression so we recoded those to ensure that higher values meant higher levels of depression. A series of multiple regressions by gender were conducted via Statistical Package for Social Sciences (SPSS) on outcome variables: depression, self-esteem, and positive and negative coping skills. Predictor variables included low self-control, pregnancy perception, relationships with caregivers, drug use, perceived social capital, relationship communication, looking forward to the future, and career and education planning. Quantitative analysis was conducted using SPSS version 28.0. Ethics The research team and authors of the paper certify that the study was approved by a university Institutional Review Board (IRB) and that all procedures and research practices abided by IRB standards. Participants were recruited to participate in the study with the help of a non-governmental organization (NGO) that liaised with foster care and juvenile justice center in Texas. The study invited foster youth with a lifetime history and involvement in the juvenile justice system at the time of the study to participate. If participants agreed to become involved, they were contacted to participate in a focus group or the survey using pseudo names to protect their identity. Participants were not offered compensation for their participation. Qualitative Results Thematic networks identified include various themes (See Fig. 1 ). Multisystem youth frequently addressed relationship building limitations, strained supports systems, internalizing behaviors, positive coping skills, and negative coping skills. Each theme was addressed by at least 34% of participants (See Table 1 ). Relationship building included subthemes of unhealthy home environments, lack of trust, and abuse/violence. Strained support systems included subthemes of isolation and loneliness, lack of understanding from caregivers and adults, and a lack of guidance and/or stability. Internalizing behaviors included subthemes of depression symptoms and emotional distress. Positive coping skills included subthemes of gaining life skills, improving one’s life and future, and experiencing a sense of agency, whereas negative coping skills included behavior problems, criminal activity, misuse of drugs and medication, and early pregnancy and young parenting. Most participants indicated that protective factors, such as relationships with caregivers and communication in relationships, were essential to their ability to increase their coping skills, reduce depressive symptoms, and decrease internalizing behaviors like depression. Relationships with caregivers and adults and support systems were often reported as key indicators of positive outcomes and youth reported the importance of relationships in supporting their well-being. While social capital and self-control were not explicitly highlighted in the qualitative results, their inclusion in the quantitative data and analysis are justified by their salience in the literature and their observed relationships with study outcomes. Table 1 Subtheme frequencies by participants Theme Total (out of 38) Percentage (out of 38) Depression Symptoms 13 (5 females) 34.21% (38% females) Early pregnancy and young parenting 14 (4 females) 36.84% (28% females) Criminal activity 15 (2 females) 39.47% (13% females) Lack of trust 17 (6 females) 44.74% (35% females) Drugs and medication 21 (7 females) 55.26% (33% females) Internalizing Behaviors 23 (5 females) 60.53% (22% females) Gaining life skills 25 (5 females) 65.79% (20% females) Abuse & violence 26 (9 females) 68.42% (35% females) Instability 26 (9 females) 68.42% (35% females) Isolation/Loneliness 27 (8 females) 71.05% (30% females) Lacking guidance 28 (7 females) 73.68% (25% females) Agency 28 (7 females) 73.68% (25% females) Emotional Problems 28 (8 females) 73.68% (29% females) Strained Support Systems 29 (8 females) 76.32% (28% females) Lack of understanding from adults/caregivers 30 (9 females) 78.95% (30% females) Unhealthy home environment 31 (10 females) 81.58% (32% females) Improving life and future 32 (7 females) 84.21% (22% females) Relationship building Limitations 33 (10 females) 86.84% (30% females) When examining the first theme of relationship building limitations, shown in Fig. 1 , one participant articulated the importance of relationships with caregivers and adults and the impact it has on them by sharing, “I think the problem is not having somebody in every foster youth’s life that actually cares and supports them…” They elaborated on this lack of connection and ability to develop trusting relationships in a healthy environment by sharing their desire for greater connection. The participant shared, “…what if a foster parent sat down with me and told me hey you know, don’t be so vulnerable because you don’t know where love is or you don’t have a mom or dad or you don’t have your family around umm this is how you’re supposed to be in a relationship whether it’s with a friend, a professional or an intimate relationship like stuff like that how to be vulnerable uh which uh which situations to be vulnerable in… I wanna feel a connection with somebody because you’ve never had that before.” The second them identified, strained support systems, elaborated on the first theme and articulated the lack of support groups available. Participants shared their desire for support groups beyond those at home and ones that extended to school or their professional lives. A participants noted that, “…the most important thing for me as I transitioned out of foster care was being able to have a support group and not only in professional areas of my life, but, you know, in personal at school you know having really good friends and making connections with actually other foster youth cuz uhh some of my best friends now are former foster youth and we kinda just push each other, push each other to reach higher to achieve more and I think that’s important to make those connections so I think that just having some supportive people in your life”. This desire to connect with other adults and peers was consistently expressed by participants and revealed feelings of isolation, loneliness, a lack of guidance, and often lack of trust and understanding from their caregivers or other adults. The lack of opportunity to build support networks and relationships can leave muti-system youth at an increased risk of developing depression symptoms, such as described by another participant who stated, “But like I said most of it was just you know. I really didn’t have nothing. I felt like I didn’t have nothing to look forward to just like the fact that of everything. Know I was going through and not really having that support.” Participants continued to state the importance of having someone present and supportive in their lives: “I would be nine and like I said I’d just didn’t feel like I was even important. I was… I would say I had an assembly at school and like I would want them to go over you know what I mean those little things like that. I was just wanted to make them proud and it was like I wasn’t noticed or for anything that I did, so I just felt discouraged.” The third theme of internalizing behaviors, including depression symptoms and emotional destress, were closely tied to previous themes of relationship building limitations and strained support systems. Internalizing behaviors were reflected by participants across various domains of their lives. One participant reflected on their relationship with their foster family and shared that “…they always making me feel stress…I’m always having problems, I was depressed, I’m always in my room, not doing nothing…” Similarly, other participants shared feelings of stress, anger, and frustration when trying to connect with their foster families and attempting to cope with the struggles of everyday life. However, some participants chose to discuss depressive symptoms experienced by their peers of family members as opposed to reflecting on their own. One shared that “my sister and my brother are depressed over their childhood, because they kept that anger towards them while they were in the system.”. Despite these internalizing behaviors, several participants exhibited positive coping skills in different areas of their lives which resulted in the identification of the fourth theme. One shared how they attempted to positively impact the lives of their siblings by supporting and encouraging them to avoid negative coping skills. The participant said, “He [sibling] needs that attention, you know, to where he can come out of that and understand that you [he] is more important that the street, you [he] deserves more than those drugs.” Others shared a desire to be motivated and to do well in life so that their siblings can have a positive role model: “I know my sister look up to me and I don’t want my little brother he grows up to look up to me and I am doing stupid stuff”. The desire to serve as a positive role model was among other coping skills that helped participants avoid negative coping skills. Others shared that they cope by surrounding themselves with good friends and peers or by doing well in school. However, despite the presence of positive coping skills among participants, several expressed a difficulty with coping which often resulted in negative coping (the final theme in Fig. 1 ). Some shared how their inability to control their anger resulted in negative behaviors and others share how substance use was a way to cope. “…I know how to control it [their anger] but usually someone gets involved and then…I get angry. I usually let it cool of…”. Those who expressed negative coping skills related to anger and aggression were aware that these behaviors were negative ways to cope, and they sought to improve. One reflected on how they wished they avoided violence and anger and didn’t follow the behaviors of others. When reflecting on substance use, several shared that medications they receive while in the foster care system numbed their pain. One shared how “You’re like a zombie just walking around…just to deal with those feelings and stuff and just cover up stuff.”. Similarly, other reflected on their childhood and shared that “…my childhood was a buncha fighting, drug use alcoholism…”. Although participants desired to refrain from using substances and resorting to violence or unsafe sexual activity to cope, they often shared that their pain was too complicated and difficult to cope with and choosing positive options wasn’t always attainable to them in the moment. Quantitative Results Study results for the multiple regression for males and females are depicted in Table 2 . The multiple regression for depression revealed that career and education planning was not a significant contributor to depression levels among multisystem males and females, respectively (ß = − .021, p = .095; ß = − .029, p = .152). As expected, lower self-control (ß = .201, p < .001; ß .104, p < .001) positive perceptions of teen pregnancy (ß = .049, p < .001; ß = .046, p < .01), negative levels of perceived relationship with caregiver (ß = − .103, p < .01; ß = − .051, p < .001), higher levels of drug use (ß = .127, p < .001; ß = .091, p < .001), lower perceived social capital (ß = − .014, p < .01; ß = − .079, p < .001), lower levels of relationship communication (ß = − .060, p < .01; ß = − .132, p < .001), and decreased levels of looking forward to the future (ß = − .026, p < .01; ß = − .070, p < .001) were significantly related to male and female depression levels. Table 2 Regression results for study predictors Low Self-Control Males Females B SE b p B SE b p Depression .201 .037 .231 .000* .104 .042 .108 .000* Self-Esteem − .099 .050 .090 .058 − .012 .026 .020 .570 Positive Coping Skills − .125 .055 .096 .006* − .077 .053 .064 .742 Negative Coping Skills .012 .050 − .009 .007* .014 .046 .011 .045* Pregnancy Perception B SE b p B SE b p Depression .049 .031 .072 .000* .046 .037 .058 .003* Self-Esteem .049 .042 − .056 .865 .070 .044 .079 .094 Positive Coping Skills − .038 .046 − .037 .029* − .040 .046 − .040 .998 Negative Coping Skills .114 .042 .102 .000* .140 .041 .135 .000* Caregiver Relationship B SE b p B SE b p Depression − .103 .024 − .196 .002* − .051 .026 − .089 .000* Self-Esteem .014 .033 − .022 .017* .053 .031 .000 .011* Positive Coping Skills .031 .036 .040 .000* .038 .033 .053 .000* Negative Coping Skills − .008 .033 − .010 .000* − .053 .029 − .072 .858 Drug Use B SE b p B SE b p Depression .127 .127 .020 .000* .091 .023 .171 .000* Self-Esteem − .025 .028 .041 .225 − .006 .027 − .010 .537 Positive Coping Skills − .121 .030 .171 .000* − .036 .029 .054 .970 Negative Coping Skills .439 .028 .575 .000* .403 .025 .580 .000* Perceived Social Capital B SE b p B SE b p Depression − .014 − .014 .023 .001* .079 .027 − .133 .000* Self-Esteem .051 .032 − .078 .017* .053 .032 − .081 .015 Positive Coping Skills .243 .035 .311 .000* .195 .034 .262 .000* Negative Coping Skills − .117 .032 .139 .012* − .049 .030 .063 .742 Relationship Communication B SE B p B SE b p Depression − .060 − .060 .037 .006* − .132 .045 − .140 .000* Self-Esteem .010 .051 − .010 .762 .047 .053 .045 .340 Positive Coping Skills .018 .057 − .016 .001* .041 .056 .034 .000* Negative Coping Skills − .035 .052 − .028 .005* − .012 .050 − .010 .668 Looking Forward to Future B SE b p B SE b p Depression − .026 − .026 .034 .001* − .070 .041 − .094 .000* Self-Esteem .092 .046 − .115 .234 .146 − .176 .058 .001* Positive Coping Skills .091 .051 .096 .000* .149 .051 .158 .000* Negative Coping Skills − .062 .047 − .061 .053 − .033 .0.45 .034 .398 Career/Education Planning B SE b p B SE b p Depression − .021 − .021 .026 .095 − .029 .027 .053 .152 Self-Esteem .100 .035 .162 .096 .024 .032 .040 .434 Positive Coping Skills .018 .039 .025 .001* .032 .034 .048 .000* Negative Coping Skills − .080 .036 .102 .000* − .039 .030 .055 .000* For self-esteem, relationship with caregivers (ß = .014, p < .05; ß = .053, p < .05) and perceived social capital (ß = .051, p < .05; ß = .053, p < .05) were significant contributors for high self-esteem among multisystem youth. However, looking forward to the future was a significant contributor for high self-esteem among multisystem youth females (ß = .092, p < .01), but not for males (ß = .092, p = .234). Lower levels of self-control (ß = − .099, p = .058; ß = − .012, p = .570), perceptions of teen pregnancy (ß = .049, p = .865; ß = .070 p = .094), drug use (ß = − .025, p = .225; ß = − .006, p = .537), relationship communication (ß = .010, p = .726; ß = .047, p = .340), and career/education planning (ß = .100, p = .096; ß = .024, p = .434) were not significant contributors to self-esteem among multisystem males and females. For positive coping skills, gender differences were found. Only among multisystem males, lower levels of self-control (ß = − .125, p < .01; ß = − .077, p = .742), negative perceptions of teen pregnancy (ß = − .038, p < .05; ß = − .040, p = .998), and lower levels of drug use (ß = − .121, p < .001; ß = − .036, p = .970) were significant to positive coping skills. For both males and females, positive levels of perceived relationship with caregiver (ß = .031, p < .001; ß = .038, p < .001), higher perceived social capital (ß = .243, p < .001; ß = .195, p < .001) relationship communication (ß = .018, p < .01; ß = .041, p < .001), as well as increased levels of looking forward to the future (ß = .091, p < .001; ß = .149, p < .001 ) and career/education planning (ß = .018, p < .01; ß = .032, p < .001) were significant to positive coping skills. Gender differences were also found in negative coping skills, where significant contributions to negative coping skills were found for males only in lower levels of perceived relationship with caregiver (ß = − .008, p < .001; ß = − .053, p = .858), perceived social capital (ß = − .117, p < .05; ß = − .049, p = .742), and relationship communication (ß = − .035, p < .01; ß = − .012, p = .668). For both males and females, higher levels of low self-control (ß = .012, p < .01; ß = .014, p < .05) pregnancy perception (ß = .114, p < .001; ß = .140, p < .001) and drug use (ß = .439, p < .001; ß = .403, p < .001), and lower levels of career/education planning (ß = − .080, p < .001; ß = − .039, p < .001) contributed significantly to multisystem youth’s negative coping skills. Discussion The study’s results highlight the significance of individual and external factors in influencing the behavioral health outcomes of multisystem youth, emphasizing the need for comprehensive interventions that address both personal strengths and environmental supports. Consistent with the literature (Masselink, Van Roekel, & Oldehinkel, 2018 ), the quantitative results reveal that lower levels of self-control, negative perceptions of teen pregnancy, negative relationship with caregivers, higher levels of drug use, lower perceived social capital, lower levels of relationship communication, and decreased levels of looking forward to the future are significantly associated with higher levels of depression among both male and female adolescents. Additionally, the study's findings support the literature's emphasis on the importance of positive relationships with caregivers and perceived social capital in promoting high self-esteem among multisystem youth (Sandstrom & Huerta, 2013 ). Furthermore, the results indicate that positive coping skills are positively associated with positive relationship with caregiver, higher perceived social capital, effective relationship communication, and optimistic outlook towards the future, while negative coping skills are associated with lower levels of self-control, negative perceptions of teen pregnancy, higher levels of drug use, and poorer career and education planning, consistent with existing research (Kann et al., 2000; Vera & Moon, 2013 ). The qualitative findings further suggest the importance of relationships with caregivers, social support networks, and positive outlook towards the future in mitigating depressive symptoms and fostering resilience among multisystem youth, aligning with the primary themes identified in the literature review (Stoddard & Pierce, 2015 ; Herrman, 2007). The findings shed light on the various challenges that multisystem youth face, which emphasizes the importance of understanding their experiences across social systems (Trejos-Castillo & Noriega, 2020 ). Building on recent literature (Burkhard et al., 2020 ), this study explored the mental health and wellbeing of multisystem youth utilized a mixed-methods approach. Quantitative analysis revealed significant associations between mental health outcomes and various factors, such as negative perceptions of teen pregnancy, strained caregiver relationships, substance use, limited outcook on the future, and lower levels of self-control, all of which were consistently linked to higher levels of depression and negative coping. Such findings articulate the dynamic interplay of individual, family, and environmental factors in shaping the trajectories and wellbeing of multisystem youth. Further, gender differences highlighted that various factors influence self-esteem and coping skills across males and females. Although positive caregiver relationships and perceived social capital were associated with greater self-esteem for males and females, they had a greater impact on looking forward to the future specifically for females. These patterns highlight the need for tailored approaches and interventions when working with multisystem youth – specifically ones that intentionally recognize the nuances across gender. This study also introduced gender differences among males and females, particularly in the ways in which they experienced negative and positive coping skills. Given that males and females are often placed in different facilities within systems, its critical for future studies to examine how these differences may impact coping skills. This study also revealed that females may be more likely that males to utilize the ability to look forward to the future as a protective measure. Given its suggested relationship with greater self-esteem among females, future studies and interventions should consider how this potential strength and protective factor can be applied to positively impact males and their self-esteem. Multisystem youth in this study identified various mental health and well-being needs that may be adequately addressed by agencies, child welfare providers, advocates, and families. They possess several assets that may contribute to a positive increase in their overall well-being. Particularly, fostering positive relationships with caregivers and positive communication in relationships may help improve mental health and outcomes. Foster care and criminal justice placements should consider the importance of positive relationship building and its potential impact on multisystem youth with future adults and other social relationships. Improving relationships with caregivers and increasing social capital may contribute to more positive self-esteem among multisystem youth, and thus intervention and prevention programming may benefit from emphasizing these assets. Programs that highlight multisystem youth’s financial capabilities and self-sufficiency at an early age may help improve social connectedness with providers and advocates (Salazar, Lopez Spiers, Gutschmidt, & Monahan, 2021). Variance in findings across genders may suggest that programming targeted towards multisystem youth should consider the diverse experiences within and across genders. Additionally, relationships with caregivers and adults, as well as positive support systems, were shown to be predictive of positive outcomes. While this is well documented in the literature among multisystem youth, this study further iterates the importance of providing multisystem youth with the access to and ability to develop relationships with trusted adults and caregivers and to receive the opportunities to nurture these relationships with support systems. Strengths and Limitations This mixed-methods design is a primary strength of the study as it allowed researchers to explore multisystem youths’ experiences by drawing on their qualitative, rich and diverse experiences as well as quantitative data that captured relationships between predictor and outcome variables. Imploring the help of an NGO to recruit youth directly from foster care and juvenile justice systems was another key strength of our study. This helped ensure that youth gained researchers’ trust, as they were recruited in part by individuals they already trusted, as well as recruiting youth who were directly involved in multiple systems at the time of data collection. However, our study included majority male participants. While this may be a direct reflection of more males being multisystem involved, future studies could intentionally sample more females to capture more of their experiences. Specifically, their experiences may provide more nuanced insights, particularly given that these systems segregate youth by gender and often place youth into foster homes and juvenile centers by gender. Lastly, while out recruitment efforts helped ensure trust among participants, they may have limited our sample to youth engaged and involved in the NGO and this may have skewed our data, particularly in potentially collecting data from those who have consistent engagement and support as multisystem youth. Capturing the experiences of youth not being supported by an NGO, or who are more isolated in these systems, may provide deeper understandings of multisystem youths’ lives. Declarations Funding : This research was funded in part by the U.S. Department of Health and Human Services, Administration for Children, Youth and Families, Personal Responsibility Education Program (PREP) Competitive Grants under the Affordable Care Act (ACA) HHS-2012-ACF-ACYF-AK-0284. Declaration of Competing Interest: The authors report no conflicts of interest. Ethics Approval The research team and authors of the paper certify that the study was approved by a university Institutional Review Board (IRB) and that all procedures and research practices abided by IRB standards. Consent Informed consent was obtained from all individual participants included in the study. Author Contribution ETC: Data Collection, Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing — review & editing.RZ: Conceptualization, Methodology, Visualization, Resources, Writing – original draft, Writing – review and editing, Formal Analysis, Project Management.IN: Conceptualization, Methodology, Investigation, Visualization, Resources, Writing – review and editing, Formal Analysis.All authors reviewed the manuscript Ethical Considerations : This study was conducted in accordance with ethical standards and requirements established by the Institutional Human Subjects Review Board at Texas Tech University, Study IRB505094 entitled: “ Between Foster Care and the Juvenile Justice System- Understanding the Challenges of Multi-Systems-Cross-Over Youth .” All participants, and their legal guardians when applicable, were fully informed about the study’s purpose, confidentiality measures, and their right to withdraw at any time without penalty. 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T., & Dielman, T. E. (1997). A longitudinal study of self- esteem: Implications for adolescent development. Journal of Youth and Adolescence, 26 (2), 117–141. https://doi.org/10.1023/A:1024596313925 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7321970","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500640424,"identity":"52e36c43-3af9-4f4a-95c2-db191ace3fb6","order_by":0,"name":"Elizabeth Trejos-Castillo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIie3Rv0oDMRzA8V/4QV1SsubAvkMk4B96eK9ypdC+goNISiBdTlzrW3SSji2BuNwDuIl0Fs7Ngv9yd2KncI6C+ZIMCb/PEAIQi/3FDogCv0A0JwrA2nsME2wJF82QJ4nBLuL3nviE6yAMUVe7VXp1AsxV1WGayccbx+FiOFIBkmiijq7LCT9TiLcLOhndOexxKKdBIixRed9YLtaISKnNj2tCjA2SzJPNu/lsyRu1mTQ1+QgTgWSm+2bdEqCWLHs1UWHCLdE4KMfJ0qIkhX/Lwo3lae6mMkTYfL59eV6dM3E/28KuSDOmN08P1eVwECL7mg8qvg955/hPr78fjcVisf/TF9hOUHyUWiZsAAAAAElFTkSuQmCC","orcid":"","institution":"Texas Tech University","correspondingAuthor":true,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Trejos-Castillo","suffix":""},{"id":500640425,"identity":"0c0ff638-ef15-46e2-8a7f-e7ecb9177289","order_by":1,"name":"Rula Zaru","email":"","orcid":"","institution":"University of Maryland, Baltimore County","correspondingAuthor":false,"prefix":"","firstName":"Rula","middleName":"","lastName":"Zaru","suffix":""},{"id":500640426,"identity":"a829823b-efc4-4f53-94b3-3ef8724dee50","order_by":2,"name":"Ivette Noriega","email":"","orcid":"","institution":"Case Western Reserve University","correspondingAuthor":false,"prefix":"","firstName":"Ivette","middleName":"","lastName":"Noriega","suffix":""}],"badges":[],"createdAt":"2025-08-07 21:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7321970/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7321970/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89656785,"identity":"bdd71d8b-89b2-4a96-9765-345668c3bf66","added_by":"auto","created_at":"2025-08-22 10:31:29","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":288296,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eQualitative Thematic Networks and Subthemes\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7321970/v1/eb5fde06b6a7305835208bda.jpeg"},{"id":104403924,"identity":"73d6beb6-bd1e-4443-a619-f9178923022a","added_by":"auto","created_at":"2026-03-11 12:19:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1247165,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7321970/v1/7290356c-47fb-43f5-aa2e-e63096e953dc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examining Multisystem Youth Mental Health and Well-Being Through a Mixed Methods Lens","fulltext":[{"header":"Introduction","content":"\u003cp\u003eYouth involved in more than one type of social system (e.g., foster care and juvenile justice systems) are often referred to as multisystem youth, crossovers, or joint cases. In the United States, about 30% of all youth in the United States are multisystem youth, given their involvement in both foster care and the juvenile justice systems during their lifetime (Trejos-Castillo \u0026amp; Noriega, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In the foster care system alone, there are an estimated 423,997 foster children in the United States, ranging in ages from infancy to 18 years old and across all racial and ethnic identities (Child Welfare Information Gateway, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, some states, such as Texas, do not collect data on youth that are simultaneously involved in both systems, which can result in the absence of exact figures representative of this population (Rose, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Similarly, data collection on entry/reentry of services, relocation within and across states, and placement of stay is limited and can further contribute to the limited data available on this population (Herz, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). As a result, estimates of youth involved in both systems can vary widely across studies (Vidal, Connell, Prince, Tebes, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Nonetheless, multisystem youth encounter unique challenges that require policymakers and practitioners to develop systems of care that can adequately address their needs (Ungar, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMultisystem youth may become involved with multiple systems in a variety of ways. One common pathway is youth entering the foster care system due to the presence of abuse or neglect in their home, without having a history of involvement in the criminal justice system. Due to these new circumstances, youth may engage in behavior that could result in their involvement in the juvenile justice system. For example, Secondly, youth entering the juvenile justice system may also have a history of prior involvement in the foster care system, which leads to these youth becoming multisystem. A third pathway is when youth entering the juvenile justice system are determined to have experienced events that lead to youth being referred to the foster care system (Connections with Youth in the Child Welfare System, n.d.).\u003c/p\u003e\u003cp\u003eThese various pathways to becoming a multisystem youth may carry additional consequences, including in areas of mental health and well-being. Exploring mental health is particularly important for multisystem youth. For example, foster youth experience frequent changes in their primary caregivers, this instability can be detrimental to their ability to form relationships and attachments (Bederian-Gardner, Hobbs, Ogle, Goodman, Cord\u0026oacute;n, Bakanosky, Narr, Chae, Chong, \u0026amp; NYTD/CYTD Research Group, 2018). For instance, while transitioning across multiple systems, youth can may receive home placements with biological family members, get adopted, be transitioned out of the child welfare system, or be placed on supervision (Trejos-Castillo, Lopoo, \u0026amp; Dwivedi, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These frequent changes in caregivers can result in school relocations, which can harm youths\u0026rsquo; well-being and disrupt their relationships with teachers and peers (Bederian-Gardner, et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eYouth involved in the criminal justice system also experience challenges in their overall well-being and development. According to a recent statistic, a total of 696,620 youth were arrested in the United States in 2019 alone (OJJDP, 2021). More than half of those involved in the juvenile justice system were involved in the child welfare system at some point (Thomas, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In comparison to youth who are involved in only one system, multisystem youth encounter greater challenges and are involved in the criminal justice system at higher rates (Yang, McCuish \u0026amp; Corrado, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResearch suggests that youth in the child welfare system are prone to transitioning into the juvenile justice system (Kim, Garcia, Jung, Barnhart, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These youth have heightened needs for mental health services, yet there remains limited understanding of their utilization of mental health services. A recent study explored how multisystem youth from 2003 and 2012 utilized mental health services and suggested that 75% of them accessed services, with growing trends over time. Older males and those who lives at home were less likely to seek mental health services and support. Among those who did receive services, older youth, those from minority backgrounds, and those living at home received services at lower rates, despite them having similar mental health needs. Findings from the study indicated that although utilization of mental health services is increasing among multisystem youth, access to these services is impacted by various factors such as (Kim, Garcia, Jung, Barnhart, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough multisystem youth are a vulnerable group of youth that encounter multiple adversities and trauma, little is understood about their diverse needs and how they enter the juvenile justice or foster care systems (Vidal, Connell, Prince, Tebes, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). A recent study explores the existing literature on multisystem youth, outlining how childhood adversity can impact later development, and introduced pathways into multisystem involvement and potential intervention. The literature suggests that multisystem youth are overlooked in research. Specifically, there are limited evidence-based practices tailored to multisystem youth, the lack of standardized screening procedures, insufficient collaboration across systems, and inadequate tools to assess complex trauma and exposure among this population (Vidal, Connell, Prince, Tebes, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition to research exploring the utilization of mental health services among multisystem youth (Brown, Courtney, \u0026amp; McMillen, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), current literature explores family instability and its negative impact on mental health, specifically for foster youth (Jelleyman \u0026amp; Spencer, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Keller, Cusick, \u0026amp; Courtney, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; \u0026amp; Bederian-Gardner, et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), but it does not adequately consider multisystem youth in its examination. When youth are simultaneously involved in multiple systems, such as foster care and the juvenile justice system, they may experience further adverse experiences that may negatively affect youth\u0026rsquo;s well-being and development. Therefore, it is critical to examine the experiences of multisystem youth and how these simultaneous experiences impact their mental health, attachments, and relationships.\u003c/p\u003e\u003cp\u003eThis paper expands the findings of a qualitative study that examined the mental and reproductive health needs of multisystem youth and provided insights into their experience via in-depth interviews*. The qualitative study identified institutional challenges that affect multisystem youth\u0026rsquo;s mental health and suggests that disparities in mental and reproductive health may contribute to criminalization, victimization, and stigmatization of youth involved in multiple systems. It also identified partnerships across systems as key avenues for addressing such disparities in overall mental and reproductive health. This current study explores the broader context of multisystem youth\u0026rsquo;s wellbeing, beyond mental and reproductive health. It focuses primarily on the mental health of multisystem youth by examining multisystem youth\u0026rsquo;s experiences to build on insights from the previous study. Further, it utilized the qualitative findings to expand on constructs related to pregnancy perceptions, relationships, and supports.\u003c/p\u003e\u003cp\u003eWhen considering gender, females involved in multiple systems often report higher rates of mental health challenges (Odgers, Robins, \u0026amp; Russell, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). As such, they may have more complex needs. Similarly, females in the system experience increased conflict and hostility, which can include physical and emotional abuse (Maschi, Schwalbe, Morgen, Gibson, \u0026amp; Violette, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Despite this, females may be less likely to have their needs met within these systems (Odgers, Robins, \u0026amp; Russell, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Conversely, it\u0026rsquo;s critical to note that males are often overrepresented in these systems, particularly males of color (Redding \u0026amp; Arrigo, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Historically, the literature notes that males are more likely to be involved in delinquent activities and substance use, as opposed to females, and that exposure to risk may be great for males (Fagan, Van Horn, Hawkins, \u0026amp; Arthur, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). However, some researchers have long noted that although males are more likely to exhibit greater behavior problems upon entering systems, their behaviors may be more likely to improve over time (Chamberlain \u0026amp; Reid, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1994\u003c/span\u003e). Recent studies have outlined that violence is increasingly pervasive among young males and it can be regarded as a highly common trauma among young males and boys (Walsh, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, current literature continues to challenge the perspective that males may be more violent or aggressive, suggesting that the traditional view of male violence may be driven by a toxic culture of masculinity or a simple need for survival (Magnus \u0026amp; Scott, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These gender disparities may impact the experiences of males and females within the child welfare and juvenile justice systems and require continued investigation. As such, this research intentionally considers gender\u0026rsquo;s role on the experiences and wellbeing of multisystem youth and aims to contribute to the growing body of literature that explores these nuances.\u003c/p\u003e\u003cp\u003eAlthough several frameworks and perspectives can be utilized to study the mental health and well-being of multisystem youth, a positive youth development (PYD) perspective can effectively highlight protective factors and strengths within these multisystem youth. PYD surfaced in the 1990\u0026rsquo;s as an alternative to the deficit models of adolescent development (Burkhard, Robinson, Murray, \u0026amp; Lerner, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and links ecological contexts to the creation of experiences, supports, and opportunities to enhance developmental outcomes of youth (Benson, Scales, Hamilton, \u0026amp; Sesma, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). It is rooted in the belief that youth are resources to society, rather than sources of concern (Damon, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). This perspective is particularly useful in understanding the experiences of multisystem youth because, despite the many challenges they face, multisystem youth possess many strengths.\u003c/p\u003e\u003cp\u003eGiven these strengths, utilizing a positive youth development framework is ideal for ensuring that communities and practitioners are supporting multisystem youth and providing them with opportunities to develop their skills, increase their self-efficacy, and contribute to their communities in order to thrive. Specifically, PYD has been used to promote positive outcomes for multisystem youth by focusing on their strengths and building their resilience to improve their wellbeing and ability to thrive. One of the core principles of PYD highlights the importance of promoting positive relationships between youth and caring adults. Research has shown that positive relationships with adults can serve as protective factors for youth who are experiencing challenges in other areas of their lives (Eccles \u0026amp; Gootman, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Utilizing a strengths-based approach to defining and understanding developmental processes allows PYD interventions to reflect the experiences of youth more accurately and to appropriately examine the ways in which strengths can serve as protective assets. Thus, this study intends to examine possible protective factors that can help promote positive well-being among multisystem youth.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eThe selection of the study\u0026rsquo;s quantitative variables was informed both by the themes identified in the qualitative data analysis as well as grounded in a PYD perspective. We incorporated self-control, pregnancy perceptions, relationships with caregivers, drug use, perceived social capital, relationship communication, looking forward and career and education planning as predictor variables, given that the literature supports these variables\u0026rsquo; predictive relationship with outcomes like deviant behaviors, depression, risky sexual behaviors, relationships, well-being, and making positive decisions (Masselink, Van Roekel, \u0026amp; Oldehinkel, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Similarly, when considering the predictor variables introduced, self-esteem and positive coping skills have long been considered critical outcomes that may protect youth against negative outcomes and life stressors (Zimmerman, Copeland, Shope, \u0026amp; Dielman, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). By examining multisystem youth\u0026rsquo;s mental health under a PYD perspective, we aimed to explore assets and strengths as positive predictors of well-being, specifically of the study outcome variables (depression, self-esteem, positive coping skills, and negative coping skills) (Burkhard, Robinson, Murray, \u0026amp; Lerner, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Outcome variables were informed by qualitative themes such as internalizing behaviors and positive and negative coping skills. This approach focuses on the individual and external characteristics that youth possess that may better allow them to thrive and have positive outcomes.\u003c/p\u003e\u003cp\u003eIndividual characteristics, including self-control, perceived social capital, pregnancy perceptions, looking forward and career and education planning, are essential to examine given their relationships with the study outcomes and their ability to help us better understand potential protective factors for youth outcomes and positive coping skills. Specifically, self-control has been shown to forecast greater psychosocial outcomes and wellbeing among youth, particularly those from low socioeconomic backgrounds (Miller, Chen, \u0026amp; Brody, 2015). Additionally, perceived social capital can serve as a protective asset that may influence youth well-being and health (Dufur, Thorpe, Barton, Hoffman, \u0026amp; Parcel, 2019). When examining pregnancy perceptions, literature highlights their ability to protect against negative outcomes for youth particularly in shaping motivation to use contraception to avoid unplanned pregnancy (Skinner, Smith, Fenwick, Hendriks, Fyfe, \u0026amp; Kendall, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Lastly, literature has long highlighted the role of career and education planning and the ability to look forward to the future as protective assets for youth outcomes (Resnick, 2000). These individual factors described may impact youth perceptions and outcomes and understanding these relationships can be useful in helping promote positive outcomes for multisystem youth.\u003c/p\u003e\u003cp\u003eConsistent with Gottfredson \u0026amp; Hirschi\u0026rsquo;s general theory of crime (Gottfredson \u0026amp; Hirschi, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e1990\u003c/span\u003e) literature on self-control among youth suggests that low self-control is the primary cause of crime and that youth with lower levels of self-control are more likely to engage in deviant behaviors (Vera \u0026amp; Moon, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), which could be associated with negative coping skills, depressive symptoms, and lower levels of self-esteem. When examining social capital, literature notes that it arises through relationships between youth and their peers, families, and others in their communities (Nor, Alias, \u0026amp; Musa, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Considering social capital can help inform multisystem youth well-being as it provides insights into how youth are engaging with the social settings in which they grow up. Social capital can be achieved through school-level relationships, such as relationships between students and peers and students and teachers. Community-level social capital is dependent on the relationships youth have with those in their communities (Tuominen \u0026amp; Haanp\u0026auml;\u0026auml;, 2021). How youth perceive their social capital is crucial to examine as it may provide insights into the relationships youth have with adults and peers in their environment.\u003c/p\u003e\u003cp\u003ePregnancy perceptions are important to consider when examining the well-being of youth as they may impact youth\u0026rsquo;s behaviors. For instance, positive perceptions of teenage pregnancy that may romanticize the joy parents have when having children may influence youth to engage in risky sexual behaviors, without fearing pregnancy. Some youth perceive pregnancy as a way to achieve independence, maintain a relationship with their partner, receive love or attention, prove their ability to be a parent, or to improve their current family dynamics by becoming closer to their families (Corcoran, Franklin, \u0026amp; Bell, 1997; Gallup-Black \u0026amp; Weitzan, 2004; Kegler, Bird, Kyle-Moon, et al., 2001; Unger, Molina, \u0026amp; Teran, 2000; as cited in Herrman, 2007). Consequently, perceiving teenage pregnancy as a life challenge may encourage youth to delay pregnancy. Some studies suggest that youth attribute teen pregnancy to diminished social life and isolation, negative stigma, challenges in juggling school, work and parenting, limited financial resources resulting in financial stress, parental disapproval and less opportunities for personal and career development (Jewell, Tacchi, \u0026amp; Donovan, 2001; Kegler et al.; National Campaign to Prevent Teen Pregnancy, 1999; Rosengard, Pollok, Weitzen, Meers, Phipps, 2006; Wiemann, Rickert, Berenson, et al., 2005; as cited in Herrman, 2007). Such perceptions may not only relate to pregnancy itself but may impact the ways in which youth behave in relationships or their engagement in risky sexual or social behaviors, such as unprotected sex or substance use.\u003c/p\u003e\u003cp\u003eAdditionally, having positive expectations and the ability to look positively towards one\u0026rsquo;s future helps facilitate youth\u0026rsquo;s positive development and contributes to their general well-being (Stoddard \u0026amp; Pierce, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Looking forward to the future and having positive expectations refers generally to the extent to which youth can achieve positive outcomes or skills in their future. Generally, higher levels of hope and purpose in life are predictive of youth\u0026rsquo;s ability to look positively towards their future. By examining youths\u0026rsquo; ability to look forward to the future, we hope to better understand the ways youth perceive their abilities to thrive as adults and create positive and healthy lives (Stoddard \u0026amp; Pierce, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Secondly, career and education planning, which may include an exploration of both oneself and of the careers that youth may be interested in pursuing, is linked to youths\u0026rsquo; ability to make positive decisions about their education and may result in positive youth outcomes. Lastly, planning may help increase youths\u0026rsquo; motivation towards school. Such positive impacts may not only directly impact youths\u0026rsquo; future careers and educational outcomes, but they may have positive impacts on other parts of their lives and wellbeing (Shen, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), such as their self-esteem. Thus, examining career and education planning can contribute to the understanding of multisystem youth\u0026rsquo;s outcomes.\u003c/p\u003e\u003cp\u003eExternal factors such as drug use, relationships with caregivers and relationship communication have also been related to study outcomes and examining them can further contribute to our understanding of multisystem youth\u0026rsquo;s experiences and outcomes. Substance abuse among adolescents is linked to higher rates of depression (Kaminer, Connon, \u0026amp; Curry, 2007) and while some youth may resort to drug use as a negative coping skill, they may in turn further develop negative coping skills as a result of substance abuse. The relationship between drug use and self-esteem is supported in the literature, however much of it focuses on self-esteem as a protective factor for drug use (Khajehdaluee, Zavar, Alidoust, \u0026amp; Pourandi, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). This relationship is well documented for people of color and multiracial youth (Fisher, Zapolski, Sheehan, \u0026amp; Barnes-Najor, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), but not commonly examined for multisystem youth. It\u0026rsquo;s important to also examine whether refraining from drug use may serve as a protective factor for self-esteem among multisystem youth. Examining the relationship between drug use and coping skills may help us understand whether refraining from drug use could potentially protect youth from other negative coping skills, depression, and low levels of self-esteem.\u003c/p\u003e\u003cp\u003eLastly, exploring caregiver relationships is essential to understanding youth outcomes. Youth with access to positive interactions with caregivers, they are more likely to have positive outcomes and secure relationships with adult caregivers may help them develop and thrive (Sandstrom \u0026amp; Huerta, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Research supports the notion that strong social supports protect adolescents against negative coping skills, such as smoking or drug abuse (Kann, Kinchen, Williams, Ross, Lowry, \u0026amp; Grunbaum, 2000). Therefore, the presence of positive caregiver relationships may serve as a potential protective factor for youth outcomes, such as depression, self-esteem, and coping skills, and conversely, negative caregiver relationships may serve as predictors of negative outcomes. Furthermore, forming healthy relationships with friends, caregivers, teachers, and others, is an essential part of adolescence. As adolescents navigate relationships, they explore and shape their identities. Relationships with caring adults are considered building blocks for all other relationships that youth have. Positive relationship communication skills, such as learning how to navigate conflict, trusting others, giving consent, etc. are crucial to help adolescents form healthy relationships. The quality of communication in relationships may impact the ways in which youth build relationships and the quality of these relationships may then impact their wellbeing.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eA sequential explanatory mixed methods design (Creswell \u0026amp; Plano Clark, 2017), framed in the PYD perspective, was used to examine individual (self-control, pregnancy perceptions, perceived social capital, looking forward and career and education planning) and external (drug use, relationships with caregivers and relationship communication) characteristics of well-being and their associations between depression, self-esteem, positive coping skills and negative coping skills. Qualitative data were first analyzed to better understand the experiences of multisystem youth in relation to their wellbeing to ensure that the voices and experiences of participants led our analysis and interpretation, and that quantitative data did not diminish the real experiences of participants, but rather enhanced them. A second phase of analysis tested initial qualitative findings by exploring quantitative results. By doing so, we examined parallel constructs in both the quantitative and qualitative data.\u003c/p\u003e\u003cp\u003eThe research team and authors of the paper certify that the study was approved by a university Institutional Review Board (IRB) and that all procedures and research practices abided by IRB standards. Participants were recruited to participate in the study with the help of a non-governmental organization (NGO) that liaised with foster care and juvenile justice centers in Texas. The study invited foster youth with a lifetime history and involvement in the juvenile justice system at the time of the study to participate. If participants agreed to become involved, they were contacted to participate in focus groups using pseudo names to protect their identity.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eQualitative Measures and Procedure\u003c/h2\u003e\u003cp\u003eQualitative data comprised of participants recruited from the participants in the quantitative study. Nine focus groups were conducted with multisystem youth who had a minimum of five years of total lifetime involvement in both foster care and juvenile justice systems. Participants spoke about their life experiences across these systems and their ages ranged from 14\u0026ndash;17 years old (N\u0026thinsp;=\u0026thinsp;39, 28% females, 66% Hispanic;44% White). Focus groups were between 45\u0026ndash;150 minutes in length, depending on youths\u0026rsquo; level of engagement and willingness to discuss their experiences. During focus groups, researchers used a guide of general questions to probe participants about their personal experiences with both the foster care and juvenile justice systems. Questions also asked participants to share their experiences and thoughts about their physical and mental health, as well as their relationships with those providing them with care in these systems. A sample size of 39 (28% female; 87% Hispanic/Latino), was determined by saturation (Guest, Bunce, \u0026amp; Johnson, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) and consisted of youth ages 14\u0026ndash;17 years old). Per recommendations provided by Patton (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and Yin (\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), the research team determined the sample by utilizing purposive sampling to identify participants who had direct experiences across multiple systems and thus included them in the sample as they could provide the team with insights on mental health issues.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eQuantitative Measures and Procedure\u003c/h3\u003e\n\u003cp\u003ePurposive sampling was used to collect survey data among multisystem youth (N\u0026thinsp;=\u0026thinsp;1,464, 14\u0026ndash;20 years old, x̄ age: 16.35; 49.2% females) with at least 5 years of experience in the foster care and juvenile justice systems across Texas. The survey was administered via paper and pencil and was tested by coresearchers to ensure that it would not take participants more than 20 minutes to complete. We collected demographic data like age, gender, and race/ethnicity. Independent variables included scales measuring low self-control (4 items; α\u0026thinsp;=\u0026thinsp;.67); pregnancy perception (7 items; α\u0026thinsp;=\u0026thinsp;.70); relationship with caregiver (17 items; α\u0026thinsp;=\u0026thinsp;.86); drug use (9 items; α\u0026thinsp;=\u0026thinsp;.92); perceived social capital (4 items; α\u0026thinsp;=\u0026thinsp;.83); relationship communication (18 items; α\u0026thinsp;=\u0026thinsp;.85); looking forward (8 items; α\u0026thinsp;=\u0026thinsp;.87), and career \u0026amp; education planning (9 items; α\u0026thinsp;=\u0026thinsp;.89). Dependent variables included scales measuring depression (19 items; α\u0026thinsp;=\u0026thinsp;.87); self-esteem (10 items; α\u0026thinsp;=\u0026thinsp;.85); positive coping skills (10 items; α\u0026thinsp;=\u0026thinsp;.80); and negative coping skills (10 items; α\u0026thinsp;=\u0026thinsp;.79). \u003cb\u003eQualitative Data Analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003e All focus groups were recorded and transcribed verbatim to include exact language used by participants and the facilitator. Transcriptions were reviewed multiple times and coded to capture themes across participants and focus groups. The research team utilized Thematic Network Analysis (TNA) to extract themes and sub-themes and to identify links across themes with the support of the ATLAS.ti 8.0 software (Attride-Stirling, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). First, the research team reviewed the transcribed data, to ensure accuracy. Second, researchers read the transcriptions and extracted key words and participant statements, which were grouped by theme or general topic (i.e., supportive relationships). Next, the transcriptions were reviewed again to ensure accuracy of initial themes identified and to assist researchers in developing more concrete organizing themes. After the organizing themes were identified, the team clustered them into thematic networks. When coding and analyzing the data, graphical representations of the organizing and global themes were developed using Atlas.ti.8.0. Two coders peer-reviewed and conducted member checking of the data, themes, and other elements to ensure coding validity and trustworthiness. To avoid redundancy, only one figure is included in this study as it is reflective of the final thematic network analysis.\u003c/p\u003e\n\u003ch3\u003eQuantitative Data Analyses\u003c/h3\u003e\n\u003cp\u003ePrior to running analysis, the data was screened to identify potential errors. Frequencies and descriptive statistics were run on all variables to account for missing responses and errors in the data. Additionally, reliability tests were run on all scales to ensure adequate alphas and correlations were run to ensure that study variables were correlated in the expected directions. Some responses were reverse coded to account for errors in the direction of the response \u0026ndash; for examples some items in the depression scale included higher values resulting in lower depression so we recoded those to ensure that higher values meant higher levels of depression. A series of multiple regressions by gender were conducted via Statistical Package for Social Sciences (SPSS) on outcome variables: depression, self-esteem, and positive and negative coping skills. Predictor variables included low self-control, pregnancy perception, relationships with caregivers, drug use, perceived social capital, relationship communication, looking forward to the future, and career and education planning. Quantitative analysis was conducted using SPSS version 28.0.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003eThe research team and authors of the paper certify that the study was approved by a university Institutional Review Board (IRB) and that all procedures and research practices abided by IRB standards. Participants were recruited to participate in the study with the help of a non-governmental organization (NGO) that liaised with foster care and juvenile justice center in Texas. The study invited foster youth with a lifetime history and involvement in the juvenile justice system at the time of the study to participate. If participants agreed to become involved, they were contacted to participate in a focus group or the survey using pseudo names to protect their identity. Participants were not offered compensation for their participation.\u003c/p\u003e"},{"header":"Qualitative Results","content":"\u003cp\u003eThematic networks identified include various themes (See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Multisystem youth frequently addressed relationship building limitations, strained supports systems, internalizing behaviors, positive coping skills, and negative coping skills. Each theme was addressed by at least 34% of participants (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Relationship building included subthemes of unhealthy home environments, lack of trust, and abuse/violence. Strained support systems included subthemes of isolation and loneliness, lack of understanding from caregivers and adults, and a lack of guidance and/or stability. Internalizing behaviors included subthemes of depression symptoms and emotional distress. Positive coping skills included subthemes of gaining life skills, improving one\u0026rsquo;s life and future, and experiencing a sense of agency, whereas negative coping skills included behavior problems, criminal activity, misuse of drugs and medication, and early pregnancy and young parenting. Most participants indicated that protective factors, such as relationships with caregivers and communication in relationships, were essential to their ability to increase their coping skills, reduce depressive symptoms, and decrease internalizing behaviors like depression. Relationships with caregivers and adults and support systems were often reported as key indicators of positive outcomes and youth reported the importance of relationships in supporting their well-being. While social capital and self-control were not explicitly highlighted in the qualitative results, their inclusion in the quantitative data and analysis are justified by their salience in the literature and their observed relationships with study outcomes.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eSubtheme frequencies by participants\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (out of 38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (out of 38)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (5 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.21% (38% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly pregnancy and young parenting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (4 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.84% (28% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCriminal activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (2 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.47% (13% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of trust\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (6 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.74% (35% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDrugs and medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (7 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.26% (33% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternalizing Behaviors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (5 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.53% (22% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGaining life skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (5 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.79% (20% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbuse \u0026amp; violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (9 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.42% (35% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (9 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.42% (35% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIsolation/Loneliness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (8 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.05% (30% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLacking guidance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (7 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.68% (25% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAgency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (7 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.68% (25% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (8 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.68% (29% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrained Support Systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (8 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.32% (28% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of understanding from adults/caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (9 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.95% (30% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnhealthy home environment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (10 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.58% (32% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImproving life and future\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (7 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.21% (22% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship building Limitations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (10 females)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.84% (30% females)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen examining the first theme of relationship building limitations, shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, one participant articulated the importance of relationships with caregivers and adults and the impact it has on them by sharing, \u0026ldquo;I think the problem is not having somebody in every foster youth\u0026rsquo;s life that actually cares and supports them\u0026hellip;\u0026rdquo; They elaborated on this lack of connection and ability to develop trusting relationships in a healthy environment by sharing their desire for greater connection. The participant shared, \u0026ldquo;\u0026hellip;what if a foster parent sat down with me and told me hey you know, don\u0026rsquo;t be so vulnerable because you don\u0026rsquo;t know where love is or you don\u0026rsquo;t have a mom or dad or you don\u0026rsquo;t have your family around umm this is how you\u0026rsquo;re supposed to be in a relationship whether it\u0026rsquo;s with a friend, a professional or an intimate relationship like stuff like that how to be vulnerable uh which uh which situations to be vulnerable in\u0026hellip; I wanna feel a connection with somebody because you\u0026rsquo;ve never had that before.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThe second them identified, strained support systems, elaborated on the first theme and articulated the lack of support groups available. Participants shared their desire for support groups beyond those at home and ones that extended to school or their professional lives. A participants noted that, \u0026ldquo;\u0026hellip;the most important thing for me as I transitioned out of foster care was being able to have a support group and not only in professional areas of my life, but, you know, in personal at school you know having really good friends and making connections with actually other foster youth cuz uhh some of my best friends now are former foster youth and we kinda just push each other, push each other to reach higher to achieve more and I think that\u0026rsquo;s important to make those connections so I think that just having some supportive people in your life\u0026rdquo;. This desire to connect with other adults and peers was consistently expressed by participants and revealed feelings of isolation, loneliness, a lack of guidance, and often lack of trust and understanding from their caregivers or other adults.\u003c/p\u003e\u003cp\u003e The lack of opportunity to build support networks and relationships can leave muti-system youth at an increased risk of developing depression symptoms, such as described by another participant who stated, \u0026ldquo;But like I said most of it was just you know. I really didn\u0026rsquo;t have nothing. I felt like I didn\u0026rsquo;t have nothing to look forward to just like the fact that of everything. Know I was going through and not really having that support.\u0026rdquo; Participants continued to state the importance of having someone present and supportive in their lives: \u0026ldquo;I would be nine and like I said I\u0026rsquo;d just didn\u0026rsquo;t feel like I was even important. I was\u0026hellip; I would say I had an assembly at school and like I would want them to go over you know what I mean those little things like that. I was just wanted to make them proud and it was like I wasn\u0026rsquo;t noticed or for anything that I did, so I just felt discouraged.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThe third theme of internalizing behaviors, including depression symptoms and emotional destress, were closely tied to previous themes of relationship building limitations and strained support systems. Internalizing behaviors were reflected by participants across various domains of their lives. One participant reflected on their relationship with their foster family and shared that \u0026ldquo;\u0026hellip;they always making me feel stress\u0026hellip;I\u0026rsquo;m always having problems, I was depressed, I\u0026rsquo;m always in my room, not doing nothing\u0026hellip;\u0026rdquo; Similarly, other participants shared feelings of stress, anger, and frustration when trying to connect with their foster families and attempting to cope with the struggles of everyday life. However, some participants chose to discuss depressive symptoms experienced by their peers of family members as opposed to reflecting on their own. One shared that \u0026ldquo;my sister and my brother are depressed over their childhood, because they kept that anger towards them while they were in the system.\u0026rdquo;.\u003c/p\u003e\u003cp\u003e Despite these internalizing behaviors, several participants exhibited positive coping skills in different areas of their lives which resulted in the identification of the fourth theme. One shared how they attempted to positively impact the lives of their siblings by supporting and encouraging them to avoid negative coping skills. The participant said, \u0026ldquo;He [sibling] needs that attention, you know, to where he can come out of that and understand that you [he] is more important that the street, you [he] deserves more than those drugs.\u0026rdquo; Others shared a desire to be motivated and to do well in life so that their siblings can have a positive role model: \u0026ldquo;I know my sister look up to me and I don\u0026rsquo;t want my little brother he grows up to look up to me and I am doing stupid stuff\u0026rdquo;. The desire to serve as a positive role model was among other coping skills that helped participants avoid negative coping skills. Others shared that they cope by surrounding themselves with good friends and peers or by doing well in school.\u003c/p\u003e\u003cp\u003e However, despite the presence of positive coping skills among participants, several expressed a difficulty with coping which often resulted in negative coping (the final theme in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Some shared how their inability to control their anger resulted in negative behaviors and others share how substance use was a way to cope. \u0026ldquo;\u0026hellip;I know how to control it [their anger] but usually someone gets involved and then\u0026hellip;I get angry. I usually let it cool of\u0026hellip;\u0026rdquo;. Those who expressed negative coping skills related to anger and aggression were aware that these behaviors were negative ways to cope, and they sought to improve. One reflected on how they wished they avoided violence and anger and didn\u0026rsquo;t follow the behaviors of others. When reflecting on substance use, several shared that medications they receive while in the foster care system numbed their pain. One shared how \u0026ldquo;You\u0026rsquo;re like a zombie just walking around\u0026hellip;just to deal with those feelings and stuff and just cover up stuff.\u0026rdquo;. Similarly, other reflected on their childhood and shared that \u0026ldquo;\u0026hellip;my childhood was a buncha fighting, drug use alcoholism\u0026hellip;\u0026rdquo;. Although participants desired to refrain from using substances and resorting to violence or unsafe sexual activity to cope, they often shared that their pain was too complicated and difficult to cope with and choosing positive options wasn\u0026rsquo;t always attainable to them in the moment.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eQuantitative Results\u003c/h2\u003e\u003cp\u003eStudy results for the multiple regression for males and females are depicted in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The multiple regression for depression revealed that career and education planning was not a significant contributor to depression levels among multisystem males and females, respectively (\u0026szlig; = \u0026minus;\u0026thinsp;.021, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.095; \u0026szlig; = \u0026minus;\u0026thinsp;.029, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.152). As expected, lower self-control (\u0026szlig; = .201, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; .104, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) positive perceptions of teen pregnancy (\u0026szlig; = .049, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = .046, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01), negative levels of perceived relationship with caregiver (\u0026szlig; = \u0026minus;\u0026thinsp;.103, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = \u0026minus;\u0026thinsp;.051, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), higher levels of drug use (\u0026szlig; = .127, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = .091, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), lower perceived social capital (\u0026szlig; = \u0026minus;\u0026thinsp;.014, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = \u0026minus;\u0026thinsp;.079, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), lower levels of relationship communication (\u0026szlig; = \u0026minus;\u0026thinsp;.060, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = \u0026minus;\u0026thinsp;.132, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and decreased levels of looking forward to the future (\u0026szlig; = \u0026minus;\u0026thinsp;.026, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = \u0026minus;\u0026thinsp;.070, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) were significantly related to male and female depression levels.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eRegression results for study predictors\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLow Self-Control\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.570\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.006*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.742\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.007*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.045*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePregnancy Perception\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.072\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.094\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.029*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.998\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver Relationship\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.017*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.011*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.072\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.858\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDrug Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.537\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.970\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.575\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.403\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.580\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerceived Social Capital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.017*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.012*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.742\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRelationship Communication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.006*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.340\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.005*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.668\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLooking Forward to Future\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.398\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCareer/Education Planning\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.152\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.434\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor self-esteem, relationship with caregivers (\u0026szlig; = .014, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; \u0026szlig; = .053, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) and perceived social capital (\u0026szlig; = .051, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; \u0026szlig; = .053, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) were significant contributors for high self-esteem among multisystem youth. However, looking forward to the future was a significant contributor for high self-esteem among multisystem youth females (\u0026szlig; = .092, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01), but not for males (\u0026szlig; = .092, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.234). Lower levels of self-control (\u0026szlig; = \u0026minus;\u0026thinsp;.099, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.058; \u0026szlig; = \u0026minus;\u0026thinsp;.012, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.570), perceptions of teen pregnancy (\u0026szlig; = .049, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.865; \u0026szlig; = .070 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.094), drug use (\u0026szlig; = \u0026minus;\u0026thinsp;.025, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.225; \u0026szlig; = \u0026minus;\u0026thinsp;.006, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.537), relationship communication (\u0026szlig; = .010, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.726; \u0026szlig; = .047, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.340), and career/education planning (\u0026szlig; = .100, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.096; \u0026szlig; = .024, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.434) were not significant contributors to self-esteem among multisystem males and females.\u003c/p\u003e\u003cp\u003eFor positive coping skills, gender differences were found. Only among multisystem males, lower levels of self-control (\u0026szlig; = \u0026minus;\u0026thinsp;.125, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = \u0026minus;\u0026thinsp;.077, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.742), negative perceptions of teen pregnancy (\u0026szlig; = \u0026minus;\u0026thinsp;.038, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; \u0026szlig; = \u0026minus;\u0026thinsp;.040, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.998), and lower levels of drug use (\u0026szlig; = \u0026minus;\u0026thinsp;.121, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = \u0026minus;\u0026thinsp;.036, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.970) were significant to positive coping skills. For both males and females, positive levels of perceived relationship with caregiver (\u0026szlig; = .031, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = .038, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), higher perceived social capital (\u0026szlig; = .243, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = .195, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) relationship communication (\u0026szlig; = .018, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = .041, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), as well as increased levels of looking forward to the future (\u0026szlig; = .091, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = .149, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001 ) and career/education planning (\u0026szlig; = .018, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = .032, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) were significant to positive coping skills.\u003c/p\u003e\u003cp\u003eGender differences were also found in negative coping skills, where significant contributions to negative coping skills were found for males only in lower levels of perceived relationship with caregiver (\u0026szlig; = \u0026minus;\u0026thinsp;.008, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = \u0026minus;\u0026thinsp;.053, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.858), perceived social capital (\u0026szlig; = \u0026minus;\u0026thinsp;.117, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; \u0026szlig; = \u0026minus;\u0026thinsp;.049, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.742), and relationship communication (\u0026szlig; = \u0026minus;\u0026thinsp;.035, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = \u0026minus;\u0026thinsp;.012, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.668). For both males and females, higher levels of low self-control (\u0026szlig; = .012, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; \u0026szlig; = .014, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) pregnancy perception (\u0026szlig; = .114, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = .140, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and drug use (\u0026szlig; = .439, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = .403, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and lower levels of career/education planning (\u0026szlig; = \u0026minus;\u0026thinsp;.080, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u0026szlig; = \u0026minus;\u0026thinsp;.039, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) contributed significantly to multisystem youth\u0026rsquo;s negative coping skills.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study\u0026rsquo;s results highlight the significance of individual and external factors in influencing the behavioral health outcomes of multisystem youth, emphasizing the need for comprehensive interventions that address both personal strengths and environmental supports. Consistent with the literature (Masselink, Van Roekel, \u0026amp; Oldehinkel, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), the quantitative results reveal that lower levels of self-control, negative perceptions of teen pregnancy, negative relationship with caregivers, higher levels of drug use, lower perceived social capital, lower levels of relationship communication, and decreased levels of looking forward to the future are significantly associated with higher levels of depression among both male and female adolescents. Additionally, the study's findings support the literature's emphasis on the importance of positive relationships with caregivers and perceived social capital in promoting high self-esteem among multisystem youth (Sandstrom \u0026amp; Huerta, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Furthermore, the results indicate that positive coping skills are positively associated with positive relationship with caregiver, higher perceived social capital, effective relationship communication, and optimistic outlook towards the future, while negative coping skills are associated with lower levels of self-control, negative perceptions of teen pregnancy, higher levels of drug use, and poorer career and education planning, consistent with existing research (Kann et al., 2000; Vera \u0026amp; Moon, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The qualitative findings further suggest the importance of relationships with caregivers, social support networks, and positive outlook towards the future in mitigating depressive symptoms and fostering resilience among multisystem youth, aligning with the primary themes identified in the literature review (Stoddard \u0026amp; Pierce, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Herrman, 2007).\u003c/p\u003e\u003cp\u003eThe findings shed light on the various challenges that multisystem youth face, which emphasizes the importance of understanding their experiences across social systems (Trejos-Castillo \u0026amp; Noriega, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Building on recent literature (Burkhard et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), this study explored the mental health and wellbeing of multisystem youth utilized a mixed-methods approach. Quantitative analysis revealed significant associations between mental health outcomes and various factors, such as negative perceptions of teen pregnancy, strained caregiver relationships, substance use, limited outcook on the future, and lower levels of self-control, all of which were consistently linked to higher levels of depression and negative coping. Such findings articulate the dynamic interplay of individual, family, and environmental factors in shaping the trajectories and wellbeing of multisystem youth.\u003c/p\u003e\u003cp\u003eFurther, gender differences highlighted that various factors influence self-esteem and coping skills across males and females. Although positive caregiver relationships and perceived social capital were associated with greater self-esteem for males and females, they had a greater impact on looking forward to the future specifically for females. These patterns highlight the need for tailored approaches and interventions when working with multisystem youth \u0026ndash; specifically ones that intentionally recognize the nuances across gender. This study also introduced gender differences among males and females, particularly in the ways in which they experienced negative and positive coping skills. Given that males and females are often placed in different facilities within systems, its critical for future studies to examine how these differences may impact coping skills. This study also revealed that females may be more likely that males to utilize the ability to look forward to the future as a protective measure. Given its suggested relationship with greater self-esteem among females, future studies and interventions should consider how this potential strength and protective factor can be applied to positively impact males and their self-esteem.\u003c/p\u003e\u003cp\u003eMultisystem youth in this study identified various mental health and well-being needs that may be adequately addressed by agencies, child welfare providers, advocates, and families. They possess several assets that may contribute to a positive increase in their overall well-being. Particularly, fostering positive relationships with caregivers and positive communication in relationships may help improve mental health and outcomes. Foster care and criminal justice placements should consider the importance of positive relationship building and its potential impact on multisystem youth with future adults and other social relationships. Improving relationships with caregivers and increasing social capital may contribute to more positive self-esteem among multisystem youth, and thus intervention and prevention programming may benefit from emphasizing these assets. Programs that highlight multisystem youth\u0026rsquo;s financial capabilities and self-sufficiency at an early age may help improve social connectedness with providers and advocates (Salazar, Lopez Spiers, Gutschmidt, \u0026amp; Monahan, 2021).\u003c/p\u003e\u003cp\u003eVariance in findings across genders may suggest that programming targeted towards multisystem youth should consider the diverse experiences within and across genders. Additionally, relationships with caregivers and adults, as well as positive support systems, were shown to be predictive of positive outcomes. While this is well documented in the literature among multisystem youth, this study further iterates the importance of providing multisystem youth with the access to and ability to develop relationships with trusted adults and caregivers and to receive the opportunities to nurture these relationships with support systems.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eThis mixed-methods design is a primary strength of the study as it allowed researchers to explore multisystem youths\u0026rsquo; experiences by drawing on their qualitative, rich and diverse experiences as well as quantitative data that captured relationships between predictor and outcome variables. Imploring the help of an NGO to recruit youth directly from foster care and juvenile justice systems was another key strength of our study. This helped ensure that youth gained researchers\u0026rsquo; trust, as they were recruited in part by individuals they already trusted, as well as recruiting youth who were directly involved in multiple systems at the time of data collection. However, our study included majority male participants. While this may be a direct reflection of more males being multisystem involved, future studies could intentionally sample more females to capture more of their experiences. Specifically, their experiences may provide more nuanced insights, particularly given that these systems segregate youth by gender and often place youth into foster homes and juvenile centers by gender.\u003c/p\u003e\u003cp\u003eLastly, while out recruitment efforts helped ensure trust among participants, they may have limited our sample to youth engaged and involved in the NGO and this may have skewed our data, particularly in potentially collecting data from those who have consistent engagement and support as multisystem youth. Capturing the experiences of youth not being supported by an NGO, or who are more isolated in these systems, may provide deeper understandings of multisystem youths\u0026rsquo; lives.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cu\u003e:\u003c/u\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research was funded in part by the U.S. Department of Health and Human Services, Administration for Children, Youth and Families, Personal Responsibility Education Program (PREP) Competitive Grants under the Affordable Care Act (ACA) HHS-2012-ACF-ACYF-AK-0284.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research team and authors of the paper certify that the study was approved by a university Institutional Review Board (IRB) and that all procedures and research practices abided by IRB standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eETC: Data Collection, Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing \u0026mdash; review \u0026amp; editing.RZ: Conceptualization, Methodology, Visualization, Resources, Writing \u0026ndash; original draft, Writing \u0026ndash; review and editing, Formal Analysis, Project Management.IN: Conceptualization, Methodology, Investigation, Visualization, Resources, Writing \u0026ndash; review and editing, Formal Analysis.All authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Considerations\u003c/em\u003e\u003c/strong\u003e: This study was conducted in accordance with ethical standards and requirements established by the Institutional Human Subjects Review Board at Texas Tech University, Study IRB505094 entitled: \u0026ldquo;\u003cem\u003eBetween Foster Care and the Juvenile Justice System- Understanding the Challenges of Multi-Systems-Cross-Over Youth\u003c/em\u003e.\u0026rdquo; All participants, and their legal guardians when applicable, were fully informed about the study\u0026rsquo;s purpose, confidentiality measures, and their right to withdraw at any time without penalty. Written informed consent was obtained from each participant prior to their involvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e: Due to the sensitive nature of the questions asked in this study and participants\u0026rsquo; involvement in foster care and juvenile justice systems, data would remain confidential and would not be shared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAttride-Stirling, J. (2001). Thematic networks: An analytic tool for qualitative research. Qualitative Research, 1(3), 385\u0026ndash;405. https://doi.org/10.1177/146879410100100307.\u003c/li\u003e\n\u003cli\u003eBederian-Gardner, D., Hobbs, S. D., Ogle, C. M., Goodman, G. S., Cord\u0026oacute;n, I. M., Bakanosky, S., Narr, R., Chae, Y., \u0026amp; Chong, J. Y. (2018). 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A longitudinal study of self- esteem: Implications for adolescent development. \u003cem\u003eJournal of Youth and \u003c/em\u003e\u003cem\u003eAdolescence, 26\u003c/em\u003e(2), 117\u0026ndash;141. https://doi.org/10.1023/A:1024596313925\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"multisystem youth; mental health, well-being, mixed-methods, protective factors","lastPublishedDoi":"10.21203/rs.3.rs-7321970/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7321970/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e Exploring mental health among multisystem youth (i.e., those involved in both the juvenile justice system and foster care system) is critical as these youth may be at an increased risk of experiencing insecure housing, poverty, abuse, and limited social support. This may impact their relationships, coping skills, and general well-being. Previously, research has studied foster care and juvenile justice youth; however, limited research exists on multisystem youth\u0026rsquo;s mental health experiences. This study aimed to examine multisystem youth\u0026rsquo;s protective factors and barriers, particularly their mental health and personal relationships. The study utilized a mixed-methods approach to collect data from multisystem youth in Texas. Quantitative data were collected via a cross-sectional questionnaire, where participants were asked to respond to questions about their demographics, attitudes, and behaviors about their system-involved experiences (N\u0026thinsp;=\u0026thinsp;1,464, 14\u0026ndash;20 years old, x̄ age: 16.35; 49.2% females). Qualitative data was collected via nine focus groups where participants spoke about their life experiences in foster care and their dual involvement in the juvenile justice system (N\u0026thinsp;=\u0026thinsp;39, 28% females, 66% Hispanic/44% White). Qualitative results indicated that multisystem youth experience challenges in regard to building and maintaining healthy relationships as well as identifying and gaining access to support systems. Quantitative results suggested that depression, self-esteem, positive coping skills, and negative coping skills are impacted by most of the study\u0026rsquo;s predictor variables. Finally, gender differences were observed among males and females at different stages of the predictor variables. Implications and future directions for research are discussed.\u003c/p\u003e","manuscriptTitle":"Examining Multisystem Youth Mental Health and Well-Being Through a Mixed Methods Lens","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-22 10:31:24","doi":"10.21203/rs.3.rs-7321970/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d30849da-521d-4737-918a-e4386d00fc57","owner":[],"postedDate":"August 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-08T15:24:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-22 10:31:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7321970","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7321970","identity":"rs-7321970","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}