Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

Applying health determinants and dimensions in social work practice

Dimensions and determinants related to physical health, mental health and well-being can be used as tools in social work practice. These frameworks are useful for assessment, planning and intervention activities in complex client situations, alerting social workers to consider diverse features and processes that influence well-being in people's lives. They can be applied in social work with individuals, families, groups, and communities. In our view health and well-being need to be viewed holistically, broadly and in each unique situation, changing over time over the life course. Literature based on key word searches of concepts we use in our teaching and research and that has informed our conceptualisation of dimensions and determinants in physical health, mental health and well-being, is reviewed. A case illustration is presented to illustrate how the dimensions and determinants are used to inform practice and compare and apply alternative frameworks. Finally, the implications of these and other frameworks for social work, not only in health care settings, but also in other fields of social work practice, are discussed.     

Collaborative care for individuals with bipolar disorder or schizophrenia and co-occurring physical health conditions: A systematic review

While rates of chronic physical health conditions are increasing for the general population, individuals with severe mental illness are at greater risk. Co-occurring mental and physical health conditions are associated with poor health care utilization, socioeconomic, and patient-reported health status outcomes. This study used systematic review procedures to investigate the effectiveness of collaborative care models for improving the health of adults with bipolar disorder or schizophrenia and co-occurring chronic physical health conditions. Six studies met inclusion criteria, and included outcomes related to quality of life, physical health, and mental health. Collective and study-level results are reported and discussed, including implications for social work practice and research.     

Mobile crisis services for children and families: Advancing a community-based model in Connecticut

The purpose of this paper is to describe a best practice model of care for children's mobile crisis services in Connecticut: Emergency Mobile Psychiatric Services (EMPS). EMPS responds to homes, schools, emergency departments and other community locations to provide children and their families with mobile crisis stabilization, assessment and brief intervention, and referral and linkage to ongoing care. The system is comprised of a statewide network of contracted providers, a statewide Call Center to manage and triage incoming referrals, and a Performance Improvement Center to provide data analysis, reporting, quality improvement, and standardized training. Data collected since 2009 demonstrate high service utilization, consistently high mobility rates, and rapid response times as well as statistically significant improvements in child outcomes. The paper discusses the role of mobile crisis services within a comprehensive continuum of behavioral health care for children and families.     

Motivations to Pursue Accreditation in Children's Mental Health Care: A Multiple Case Study

Accreditation is a growing, worldwide phenomenon that has spread to a range of industries and fields, including nonprofit social services and mental health care. Thousands of organizations are accredited, but it is not known what is driving the growth of this phenomenon. Using a multiple case study design, this exploratory study aimed to understand children's mental health agencies' motivations to pursue accreditation. In‐depth interviews, focus groups, document reviews, and limited observations were conducted at five children's mental health agencies that had recently undergone or were undergoing the Council on Accreditation process. Agencies were influenced by external factors, such as policies that require accreditation, wanting to assert their positions in the field, and the need to increase funding opportunities. Other factors were internal, related to agency leadership using accreditation as a platform for change and agencies' genuine intent to improve services. Implications for agencies, accreditors, and future research are offered.     

Training for collaboration: collaborative practice skills for mental health professionals

The purpose of the study was to identify skills that mental health practitioners need for successful collaborative practice in medical settings. Known experts in the field of collaborative health care completed a survey designed to elicit their suggestions about what is needed for successful collaborative care practice. Through qualitative analysis, a set of 56 skills was developed. These skills are organized into three general categories of competency: (a) skills for working in a medical setting; (b) skills for working with patients; and (c) skills for collaborating with healthcare providers.     

Consensus or contention: an exploration of multidisciplinary team functioning in an Irish mental health context

Multidisciplinary teams (MDTs) are conventionally recommended in mental health care literature as an important way to offer holistic treatment provision to patients. This study aims to explore multidisciplinary teamwork in contemporary mental health settings, particularly what aids and hinders the process of multidisciplinary teamworking, and the social work contribution in such teams. In order to attain an in-depth exploration of these phenomena, a single case study design was employed. Within this design, data were generated through semi-structured interviews and structured observation of a mental health MDT in Ireland. These data were analysed using interpretative phenomenological analysis. The research highlights how the concept of mental illness is contested within this MDT, with the medical model dominant within an environment of fluid working arrangements. Professional role blurring and stereotyping were found to impact the division of labour on this team, with role negotiation found to be an integral part of retaining a professional's practice identity. This research raises concerns for social work's capacity to function within mental health MDTs in Ireland, and highlights ways in which social work educators might respond in order to empower Irish social workers to meet the challenges of mental health multidisciplinary teamworking.     

Externalizing problems in young foster children: Prevalence rates,predictors and service use

Objective

Examining the prevalence of externalizing problems, their predictors and mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Method

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children's externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in linear regression.

Results

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

Conclusions

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children's externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.     

Supporting Vulnerable Families Through School-Based Mental Health Services: Results of Caregiver and Teacher Focus Groups

Family perspectives facilitate participation and positive outcomes in child mental health treatment. In schools, families and teachers must cooperate to best meet children's mental health needs, also making teacher perspectives important. In this study, caregivers and teachers participated in focus groups following the pilot year of a school-based mental health (SBMH) project. Participants noted successes and challenges of the project and suggested improvements. Although this study focuses on the SBMH project, many of the study implications are applicable to other school mental health programs and may be of value to school and community practitioners.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Healthcare providers' perspectives on parental health literacy and child health outcomes among Southeast Asian American immigrants and refugees

Low health literacy has emerged as an important area of research because of its close link with health disparities. In this study, we used a qualitative approach to investigate healthcare providers' perspectives on the health literacy of immigrant and refugee parents and its association with children's health. Sixteen health and mental health professionals serving immigrant and refugee parents and children in various clinical settings were recruited through a purposive sampling method and interviewed. Six broad themes were identified: (1) multi-dimensional components of parental health literacy; (2) parent characteristics and native country experiences; (3) host systems and their interactions impact on parental health literacy; (4) diverse aspects of help-seeking; (5) culture-based parental help-seeking; and (6) child health outcomes. Within these larger themes, the complexity of parental health literacy and its various effects on children's health outcomes among immigrant and refugee parents were evident. Future research includes more population-based quantitative studies of parental health literacy and culturally relevant clinical approaches among immigrant and refugee parents.     

The Association between head Start Enrollment and Children's Mental Health Scores

This study examined the association of the children's entry age and enrollment duration of Head Start on children's mental health, using secondary data analysis. Children were of three groups: one group of children entered Head Start at age 3 and maintained enrollment for 1 year (Group 1), the second group of children entered Head Start at age 4 and stayed for 1 year (Group 2) and the third group of children entered at age 3 and stayed in Head Start for 2 years (Group 3). Research questions are (1) Do child and family characteristics have any association with mental health scores? (2) Do children's mental health scores differ among the three groups? Compared with children who entered at age 4 and stayed for 1 year, children who entered Head Start at age 3 and stayed in Head Start both for 1 year and for 2 years had higher mental health scores. Controlling for other factors, boys and children with special needs had higher mental health scores. Black and dual bilingual children had lower mental health scores.     

The mental health recovery movement and family therapy, part II: a collaborative, appreciative approach for supporting mental health recovery

A continuation of Part I, which introduced mental health recovery concepts to family therapists, Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts. This approach draws primarily upon postmodern therapies, which have numerous social justice and strength-based practices that are easily adapted in recovery-oriented contexts. The model outlined in this article includes an overview of the recovery partnership (i.e., therapeutic relationship), mapping recovery (i.e., assessment and case conceptualization), recovery planning (i.e., treatment planning), facilitating recovery (i.e., intervention), accessing resources (i.e., case management), recovery maintenance, and service contexts as well as a case study.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.     

Managed care and the rationalization of mental health services

Managed care represents a response to the wider institutional demand for technical rationality and efficiency, and it may be in conflict with professionally generated logics of mental health care which emphasize the delivery of quality care, as well as providing services to all who need care. The organizational and policy conundrum is to balance conflicting institutional demands for efficiency (cost savings) and effectiveness (access and quality). This paper examines managed care in one public sector mental health care system that has attempted to incorporate the principles of managed care into a community based system of care and to overcome the potential contradictions between demands for efficiency and professional logics of care. Both qualitative and quantitative data are used to examine changes in organizational structure and service offerings; providers' experience of managed care, and the effect of managed care on working conditions and work experiences, and changes in the goals of the organization as measured by the specification of client outcomes. I find that, while increased performance accountability and outcome assessment (in keeping with demands for efficiency) have the potential to improve mental health care services, in fact, providers report that the primary effect of managed care has been an emphasis on cost containment, and there has been a corresponding de-emphasis on the provision of community based services for clients with long term care needs. However, there is potential for professional logics to be maintained by larger institutional forces demanding quality care.     

The impact of fathers on maltreated youths' mental health

Men are increasingly the heads of single parent households, yet are often excluded from child welfare research and practice. To better serve all families in the child welfare system, it is necessary to understand the impact of primary caregiving men on children's wellbeing. In this study we investigated the longitudinal effects of primary caregiving fathers' mental health and substance use on child mental health, and examined possible differences by child age and gender. Regression analyses were conducted with the sample of 322 youth living with a male primary caregiver at the first wave of data collection from the National Survey of Child and Adolescent Wellbeing-II (NSCAW-II). We found that father depression at baseline consistently predicted child mental health outcomes three years later, even after accounting for demographics and baseline child mental health. Surprisingly, fathers' substance use did not predict child mental health, and interactions with child age and gender were not significant. Our findings are consistent with a small but growing literature suggesting that efforts to improve engagement of and attention to fathers within research, clinical and policy efforts are likely to be worthwhile.     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

A comprehensive health service evaluation and monitoring framework

ObjectiveTo develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services.MethodA targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders.ResultsThe framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable.ConclusionData collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle.