The impact of serial transitions on behavioral and psychological problems among children in child protection services

This study focuses on the impacts of serial transitions on externalized and internalized behavior disorders, anxiety, and depression among children in child protection services. The research was carried out with a sample of 741 children. The findings demonstrate that the number of times a family is blended is a stronger predictive factor for children's adjustment than is the family structure at the time of the interview. In predicting externalized and internalized behavior problems among children, however, the effect of family structure disappears in favor of the variables associated with family functioning and family climate.     

Caregiver perceptions of empowerment and self-efficacy following youths’ discharge from residential care

ABSTRACT

Residential care is one of the most restrictive out-of-home care settings; however, this is a temporary placement and youth eventually reintegrate into the home and community setting. Reintegration presents many challenges, and aftercare becomes critical for maintaining youth gains and promoting family stability. Aftercare programs and supports should align to individual family needs that entail understanding individual and familial characteristics. Previous studies have explored characteristics related to family functioning, mental health, behavior, and perceptions of need during reintegration; yet little is known regarding how affective characteristics (i.e., self-efficacy, empowerment) factor into reintegration, or the implications this may have for providers. The purpose of this study was to address this gap by exploring empowerment and self-efficacy in caregivers (N = 120) who had a child return home within 1 month of departing residential care. Overall, caregivers reported high levels of empowerment and self-efficacy during the initial transition period. Significant differences for empowerment and self-efficacy were present in characteristics such as race, income, number of children in the home, and free/reduced lunch status.     

Needs assessment of youths in residential child care in Portugal / Evaluación de necesidades de jóvenes en acogimiento residencial en Portugal / Evaluación de necesidades de jóvenes en acogimiento residencial en Portugal

Residential child care in Portugal is the most common protection measure in cases of family separation, since family foster care is still very rare. However, little is known about the needs of these children and young people. The purpose of this study is to describe the profile of adolescents close to legal adulthood who are in residential care, comparing it with a Spanish sample. The sample is composed of 345 young people aged 16 to 17 on whom information has been collected regarding their history of protection, family background, schooling, mental health and offending behaviour. A Spanish sample was selected as a comparison group (N = 384). The results reveal the complexity and special seriousness of the profile of young people in residential care in Portugal compared to a Spanish sample, highlighting a high presence of mental health problems and especially suicidal behaviours. Given these results, efforts should be focused on developing specialized residential care programmes adapted to the specific needs of these young people.     

Counseling Brazilian Undergraduate Students: 17 Years of a Campus Mental Health Service

Objective: The authors reviewed demographic and clinical characteristics of undergraduates at a Brazilian public university (UNICAMP) who visited the campus mental health service (SAPPE) and compared their demographics with those from all undergraduate students enrolled in the university. Participants: The authors looked at data from all undergraduates who sought counseling or mental health care at SAPPE over a 17-year period (N = 2,203; 1987-2004). Methods: They obtained this information from clinical charts and a UNICAMP database. Results: Women, students from other Brazilian states, students living in the campus residence hall, and students whose main source of income was a scholarship were overrepresented. Female student-clients complained about family conflicts more frequently than did their male counterparts, and male student-clients reported concern about poor academic performance more frequently than did their female counterparts. Conclusions: Sex, living in a university residential facility, and reliance on a scholarship grant were predictive of undergraduates' mental health-seeking behavior and pattern of complaints.     

Preventing the residential placement of young children: A multidisciplinary investigation of challenges and opportunities in a rural state

Estimates suggest that most children placed in state custody have mental or behavioral health problems. Many of these children are difficult to place with foster families and ultimately are referred for residential care. Residential care is expensive relative to other alternatives and the effects on child outcomes do not seem to justify the expense. This study identifies systemic factors contributing to the residential placement of young children and opportunities for service improvement in a rural state. Key informant interviews and surveys were used to synthesize a broad array of professional perspectives. Remarkable consensus across multiple groups suggests that young children are best served in a family setting. Strategies to reduce residential placement and improve outcomes of young children are discussed.     

Family Functioning and Satisfaction of Former Residents of a Non-Therapeutic Residential Care Facility: An Exploratory Study

ABSTRACT

Recently there has been a resurgence in discussions among government policy-makers regarding the use of non-therapeutic residential care as an alternative to kinship and family foster care. If informed decisions are to be made regarding foster care alternatives, evaluation is needed of how children fare in residential care facilities. This study looks at the family relationships and life satisfaction of 76 adults who resided in a residential care facility as children. The overall positive results suggest that the negative reputation of non-therapeutic residential care facilities may not be wholly deserved. The authors hope that this information can assist social workers and policy-makers in making important decisions about the appropriate use of residential care with our country's future population of foster care children.     

Mental health outcomes among child welfare investigated children: In-home versus out-of-home care

BackgroundChild welfare has increasingly focused on alternatives to out-of-home (OOH) placement. In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.ObjectiveTo evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methodsWe examined a cohort of children (aged 1.5–18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.ResultsAmong the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).ConclusionsFor school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families.     

Predictors of Substance Use and Mental Health of Children of Divorce

Abstract

This short-term longitudinal study examined psycho-social influences on substance use and mental health among children of divorced parents. The sample consisted of ethnically diverse fifth and sixth grade students, and compared children of divorced parents (CODPs; N = 176), who were an average of four years post-divorce, with children of married parents (COMPs; N = 213) who had never divorced. CODPs reported more life stress, less problem-focused coping, and more substance-using friends and family members than COMPs. Further, these variables were significantly related to CODPs' greater reported substance use, aggressive behavior, and depression than COMPs cross-sectionally, and longitudinally, four months later. The results suggest the importance of including both substance use and mental health outcomes in preventive interventions for CODPs.     

Crowding in context: an examination of the differential responses of men and women to high-density living environments

This study examines the question of gender-equivalent outcomes of mental health and social behavior in the context of crowding stress. It tests the hypothesis that gender will influence the exhibition of stress outcomes resulting from exposure to high-density living environments, with women displaying internalized responses and men responding with externalized styles. Expanding on the types of gender-appropriate disorders examined in this area of research, I selected depression, aggression, and withdrawal as gender-specific disorders based on theory and prior research. Multilevel analyses of data from a survey of Toronto residents indicate that, while the effects of household density are conditioned by gender, support for the existence of gender-equivalent outcomes is mixed. While women living in crowded homes are more likely to be depressed, men exposed to high-density living environments do not report increased aggression. However, men report higher levels of withdrawal, and some males respond with both aggression and withdrawal.     

New Scoring Method of the Family Drawing for Sexually Abused Preschoolers

This study assesses whether the global psychological adjustment score on the family drawing, derived with a new scoring method, can predict the presence of internalized and externalized behavior problems among sexually abused children. A family drawing was completed by 78 sexually abused children, and three questionnaires were administered to the nonoffending parent. The results indicate that a poorer global psychological adjustment score on the family drawing is associated with a higher probability of clinical thresholds for internalized and externalized behavior problems in children who have been sexually abused, even when controlling for parents’ psychological distress, child's age, number of stressful events experienced by the child, and type of sexual abuse.     

The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

The Theory of Planned Behavior as it predicts potential intention to seek mental health services for depression among college students

ABSTRACT

Background: Between 9.5% and 31.3% of college students suffer from depression (American college health association national college health assessment II: reference group executive summary spring 2013. Amer. Coll. Health Assoc. 2013; Eagan K, Stolzenberg EB, Ramirez JJ, Aragon, MC, Suchard, RS, Hurtado S. The American freshman: national norms fall 2014. Higher Educ. Res. Inst.; 2015). Universities need to understand the factors that relate to care-seeking behavior. Objective: Across 3 studies, to relate attitudes, social norms, and perceived behavioral control to intention to seek mental health services, and to investigate barriers to care-seeking. Participants: University college students (N = 845, 64% female, 26% male, and 10% unspecified). Methods: New measures were created in Studies 1 and 2, and were examined using structural equation modeling in Study 3. Results: Partially consistent with the Theory of Planned Behavior (Ajzen, I, Fishbein, M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980), a model with an excellent fit revealed that more positive attitudes about care and higher perceived behavioral control directly predicted higher intention to seek mental health services. Conclusions: Educating college students about mental health disorders and treatments, enhancing knowledge about available services, and addressing limited access to long-term care might improve treatment rates for students suffering from depression.     

Impact of Psychological Disorders on Postpartum Mothers and Child: Current Issue in Remediation in India

ABSTRACT

India is a multicultural, multiethnic, pluralistic society with enormous socioeconomic disparities, and it is a formidable task to provide affordable and effective mental health care, especially to the remote rural corners of the country. The unfortunate aspect of the Indian mental health scenario is that there exists very poor awareness of the maternal health risks of the postpartum period. It is during this period that serious psychological disturbances can manifest and seriously jeopardize safe and normal motherhood. Currently, there is neither a national agenda for mental health care among pregnant and postnatal women nor a viable training program to equip health workers to recognize and manage postpartum psychological disorders. This article attempts to provide a viable module for training future health providers to gain an understanding of the illness pattern that constitutes postpartum disorders through experiential learning and problem solving.     

Mental health services for children and caregivers remaining at home after suspected maltreatment

ObjectiveBehavioral problems are common among children remaining at home after suspected maltreatment, but the effectiveness of current mental health services to improve these behavioral problems is unknown. The objective was to determine whether receipt of child and caregiver mental health services was associated with improvements in behavioral problems in maltreated children remaining at home.MethodsWe retrospectively analyzed Second National Survey of Child and Adolescent Well-being data. We included 1117 children ages 2–17 remaining at home after a maltreatment investigation, excluding children with missing outcome, covariate, or survey weight data. We compared mean Child Behavioral Checklist (CBCL) change scores from baseline to 18 months between children who did and did not receive mental health services, before and after adjusting for child, caregiver, and child welfare agency factors using survey-weighted linear regression.ResultsNearly one-quarter (22.6%) of children and 16.0% of caregivers received mental health services. Children receiving services had worse unadjusted baseline and 18-month CBCL scores than children not receiving services (all P < 0.001). Adjusted CBCL change scores revealed behavioral worsening among children receiving services but improvement among children not receiving services (all P < 0.001). However, children had improved behavior, regardless of their own service receipt, if their caregivers received services and reported an absence of depression at 18 months.ConclusionsChildren receiving mental health services had worse behavioral changes than children not receiving services. Caregiver receipt of services was associated with improved child behavior, suggesting that a family-centered approach may be most influential in improving behavioral outcomes among this population.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

Utilisation of Medical Services—Difficulties and Solutions

ABSTRACT

This paper attempts to look at how social workers and bilingual community workers work with the Chinese community in Sydney to address the inequalities in health amongst the Chinese and other eon-English speaking communities. These workers must use their knowledge and skills in radical practices to police health inequalities and accomplish change through the development of effective initiatives in promoting active participation amongst Chinese Australians and obtaining more public funding for transcultural health. Active participation can be promoted in four areas: the development of a charter of health rights for people of non-English speaking backgrounds (NESB), an increase in representation of people of NESB on health boards, an increase in the number of bilingual and bicultural professionals and the establishment of mechanisms for regular monitoring of medical care provision for people of NESB. More public funding for transcultural health can be secured through a number of political fund raising activities. These include: to develop both formal and informal relationship with and to be able to influence ministers, ministerial advisers and senior public servants; to gain representation on statutory boards and committees; and, to express the need for access and equity through the ballot boxes.     

Outcomes Measurement

SUMMARY

Outcomes measurement in health and mental health should be of vital concern to social workers since public support and financing will follow evidence of effectiveness. Social work in health and mental health requires a framework for conceptualizing outcomes measurement so that the profession can focus clearly on the work to be done in outcomes measurement. This framework should distinguish among the various ways that outcomes measurement can be used to advance policy, program and practice. This article discusses two applications of outcomes measurement, namely for improving policies and programs, and, second, for conducting outcomes research. Other dimensions that could be included in an outcomes measurement framework for social work in health and mental health are identified but not elaborated. The author's objective is to make a strong case for the role that outcomes measurement can play in both the improvement of social work policies and programs in health care, through performance measurement, as well as in advancing the healthcare knowledge base, through outcomes research.     

Pathogenic and Protective Relations in Alcoholic Families (II): Ritual Invasion,Shame, ACOA Traits,and Problem Drinking in Adult Offspring

ABSTRACT

This paper explores the relationship between the perception of ritual disruption by parental alcohol abuse in the family of origin and shame-based characteristics in adult offspring. The Ritual Invasion Scale was found to be related to self-reported depression, internalized shame, adult children of alcoholics traits, and problem drinking behavior.     

Where can I mourn? Psychodynamic contributions to working in residential child care

ABSTRACT

Loss permeates the experience of being placed in residential child care, yet residential workers are rarely trained to work with young people who are grieving the loss of family and home. This article will provide an overview of psychodynamic theories of mourning, and will discuss how grief work can be facilitated for children and youth in residential child care.