Finding the right connections: Peer support within a community‐based mental health service

Gray M., Davies K., Butcher L. Finding the right connections: Peer support within a community‐based mental health service This article reports on a qualitative study that examined the organisational enablers and barriers to implementing peer support work in an Australian, rural, community‐based mental health service. Interviews with 19 peer and non‐peer staff were conducted to identify attitudes towards peer support and whether there were organisational values, practices and strategies that might support the implementation of peer support. The findings revealed that peer support workers were valued for their ability to build trusting connections with clients and to accept client choice in a non‐judgemental way. However, peer support workers tended to ‘fill service gaps’ within intensive, administrative case‐management environments. These findings highlight the importance of an organisational‐wide approach to integrating peer support, where the responsibilities for adopting new ways of working fall to all staff, not just the peer support workers themselves. Key Practitioner Message: ? Practitioners placed high value on the peer support workers on their teams due to their unique personalised engagement with clients; ? The roles of peer support workers were poorly understood by team members; ? Organisational integration of peer support principles could improve the way all staff engage with clients to reflect a recovery orientation.     

Thrown back: Reintegration experiences of National Guard/Reserve mothers of young children

Few studies have examined the experiences and perceptions of servicewoman mothers and their children, even as an increasing number of them have experienced deployment and combat exposure. The present paper describes a qualitative study that explored National Guard/Reserve (NG/R) mothers' experiences with mothering and co‐parenting during reintegration and their perceived priorities, supports, challenges and needs. Interpretive phenomenological analysis of seven in‐depth qualitative interviews produced themes including reunion and loneliness, the importance of time, help seeking and gendered experiences. Notably, all participants transitioned immediately back into primary caregiver roles upon homecoming, and several described how difficult it was to readjust while privately dealing with unmet mental health needs. Findings underscore the importance of a flexible suite of service options that meet key needs, most importantly, child care, social–emotional support for children and peer‐based parenting support specific to servicewoman mothers. For NG/R mothers, who may live far from base, community‐based services are essential, but as participants described, civilian social workers and other professionals must develop specialized knowledge, skills and experience to provide appropriate support.     

Foster carer perceptions of support and training in the context of high burden of care

The challenges of providing sensitive and structured care for children in foster care go well beyond normative experiences of parenting. The present paper describes a mixed‐methods study of foster carers' perceived need for support and training, referenced to estimates of their burden of care. Semi‐structured interviews were conducted with 17 foster carers in the Canterbury region of New Zealand. Carers' perceived need for support and training were identified through qualitative analysis of interviews using domain analysis method. Carers' burden of care was estimated from the Parenting Stress Index and from a measure of carers' encounters with children's emotional, behavioural and relationship difficulties that was designed for the present study (the Caregiver Behavioural Encounters Index). Foster carers reported substantive, unmet needs for support and training. Foster carers also reported high parenting stress and encounters with a wide range of children's mental health difficulties, including both uncommon and severe difficulties, which together represent an exceptional burden of care. Carers' highest priority need was for training and support on managing and responding to children's mental health difficulties, while their greatest existing support came from Caregiver Liaison Social Workers and other carers. The findings suggest a number of critical implications for practice.     

Perspectives of South African caregivers in receipt of Child Support Grants: Implications for family strengthening interventions

Cash transfers have delivered measurable benefits for poor and vulnerable children in low‐ and middle‐income countries. However, on its own, a cash transfer is insufficient to promote holistic child well‐being. In the quest for appropriate complementary family support services, known as ‘cash plus’ programing, this qualitative study sought to explore the perspectives of a group of South African caregivers, all of whom were in receipt of a Child Support Grant (CSG), in relation to their own caregiving and family functioning. Critical areas of support to families were identified to further scale up the already positive impacts of the CSG, such as mental health services, social supports for caregivers, decreasing levels of poverty and growing caregiving knowledge and skills. Key conclusions are that improving the quality and integration of public services and developing culturally appropriate and evidence‐based family strengthening programmes are critical to complement and boost the positive impacts of the CSG.     

Measuring Children's Church‐Based Social Support: Development and Initial Validation of the Kids’ Church Survey

Given the importance of considering context in development, the goal of the present study was to develop and provide initial validity evidence for the Kids’ Church Survey (KCS), a new measure of children's church‐based social support. Data were collected from 1253 children ages 6–14 attending mainline Protestant, evangelical Protestant, and Catholic churches. Parallel and exploratory factor analyses supported a three‐factor solution: received (emotional) church support, perceived church support from peers, and perceived church support from adults. Confirmatory models conducted with independent samples provided an excellent fit for the data. All three scales evidenced acceptable internal (.78–.92) and test–retest (.88–.95) reliability. Measurement invariance was demonstrated across genders and age groups, with the exception of the perceived peer support scale, which was not invariant across ages. The KCS was sensitive to between‐church differences in children's programs and incrementally predicted self‐esteem, prosocial behavior, and spirituality. Applications for researchers, mental health practitioners, and clergy are discussed.     

Perceived Maternal Autonomy Support and Early Adolescent Emotion Regulation: A Longitudinal Study

This study investigated longitudinal associations between perceived maternal autonomy‐supportive parenting and early adolescents' use of three emotion regulation (ER) styles: emotional integration, suppressive regulation, and dysregulation. We tested whether perceived maternal autonomy support predicted changes in ER and whether these ER styles, in turn, related to changes in adjustment (i.e., depressive symptoms, self‐esteem). Participants (N = 311, mean age at Time 1 = 12.04) reported on perceived maternal autonomy support, their ER styles, and adjustment at two moments in time, spanning a one‐year interval. Cross‐lagged analyses showed that perceived maternal autonomy support predicted increases in emotional integration and decreases in suppressive regulation. By contrast, emotional dysregulation predicted decreases in perceived autonomy‐supportive parenting. Further, increases in emotional integration were predictive of increases in self‐esteem, and decreases in suppressive regulation were predictive of decreases in depressive symptoms. Together, the results show that early adolescents' perception of their mothers as autonomy‐supportive is associated with increases in adaptive ER strategies and subsequent adjustment.     

A family support service for homeless children and parents: user and staff perspectives

Children and their parents who become homeless constitute a group of families with a complex range of social care and health needs, including mental health difficulties. In response to this, a local authority housing department established a family support team (FST) that provides assessment and detection of a range of problems, support to parents and children, parenting interventions for child behavioural problems, liaison with other agencies, and referral to specialist services when appropriate. The aim of this study was to establish the perceptions of parents and staff on their experience of the service, and ways of improving it in the future. The study adopted a developmental evaluation approach and used multiple methods, including in‐depth interviews with families; diaries; reflective activities; participatory learning and action; and observation of the FST. The study mapped the innovative service and captured the range of skills in the team and the complexity of agencies the team interacted with. It also identified areas for further development in terms of the mental health needs of children and parents who have become homeless.     

Mental health and social support: a pioneering study on the physically disabled in southern China

This is a pioneering study examining the effect of different types of social support on the mental health of the physically disabled in mainland China. With a random sample of 204 physically disabled people in Guangzhou, the biggest metropolis in southern China, results of this study showed that perceived social support was more effective in maintaining the mental health of the physically disabled than received social support. With respect to received social support, the attitude of the supporters, satisfaction with the support, the reciprocity of support relationships and the personal agency of the support recipients were found to be predictive of mental health. However, received daily-care support unexpectedly showed a significantly negative effect on mental health, while received economic and emotional support appeared to be irrelevant to the mental health of the physically disabled.     

Engaging on the ‘front line’: exploring how family support teams construct meaning in their work with young mothers

This paper explores the provision of family support services for young mothers within a Sure Start Children's Centre, drawing on data collected within a larger study. It identifies how the family support team attempted to build supportive relationships with young mothers between the ages of 16 and 19 years. The findings presented here draw on narrative interviews (n = 10) and focus group interviews (n = 2) with the family support team that included early years workers, family support workers and their managers. The findings captured how the participants actively resisted the stigma (Goffman 1963) of teenage motherhood in order to support young mothers in gaining the necessary skills and knowledge to care for their child. Drawing on the findings, this paper argues that the building of a supportive relationship enables a young mother to construct positive counter‐narratives about her parenting experience. This suggests that the family \to offer informal early support to young mothers who are at risk of more formal intervention. However, the complexity of this task should not be underestimated because in doing this, the family support team must at all times ensure the well‐being and safety of the child.     

The well‐being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington,New Zealand

Little is known about how mental health services consider the parenting role and the well‐being of children when assessing parents with acute mental illness. This paper investigated how crisis mental health services addressed child well‐being in the Wellington region, New Zealand. This mixed‐method case study included: (i) an audit of the electronic clinical records of all adults presenting to the crisis assessment team; (ii) interviews with 22 key informants; and (iii) a documentary review. We found that data about children were not systematically collected. Less than half of (49 of the 104) the records of patients who were parents included information on their child's well‐being; only six (6%) contained a specified plan for action. The focus for services was the adult patient. Key informants were unclear about their role. They identified inadequate training and institutional support, inflexible funding models and limited availability or inappropriateness of referral services as problems. They saw a need for children to become more visible, for collaborative working to improve the use of existing services and for new funding models, resources and roles. Existing national policy documents contained little guidance and no practice guidelines were in use. These were lost opportunities to improve support for the parenting role and promote child well‐being.     

Grandparent support and mental and behavioural health in middle childhood

This study explored the significance of grandparents in middle childhood and assessed the level of grandparental support provided to children in relation to other social network members. The association between grandparental support and grandchildren's mental and behavioural health was also examined. We conducted structured interviews with 120 grade 4 and 5 learners (mean age = 10.41 years) from four schools in Cape Town, South Africa. Results indicated that subsequent to parents, children perceived grandparents as the most important and close relationship category. Furthermore, grandparents provided the highest levels of support to grandchildren after parents. Grandmothers provided more support than grandfathers. No associations between grandparental support and children's internalizing and externalizing behaviours were found. However, results revealed that grandparental support was positively associated with children's prosocial behaviour, independent of child gender, and the amount of support provided by other relationship categories (p = .04). Findings underscore a need for research to move beyond the nuclear family when considering potential influences on children's well‐being.     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

High Life Satisfaction: Exploring the Role of Health,Social Integration and Perceived Safety among Mexican Midlife and Older Adults

We sought to investigate the relationship of high life satisfaction with important physical health, mental health, social integration and perceived safety factors among midlife and older Mexican adults. We examined 2,200 midlife and older adults (aged 50–101 years) from the Mexican arm of the Study on global AGEing and adult health (SAGE) and used binary logistic regression models to identify key factors associated with high LSA. Our final logistic regression model revealed self-rated health, affect, interpersonal activities and perceived safety on street to be significantly associated with high life satisfaction. Results from this study add to the nascent literature on subjective well-being of midlife and older Mexicans. Although social work with older adults is not well established in Mexico, researchers and practitioners should collaborate on the development and implementation of social worker-led strategies for prevention and intervention to enhance well-being among midlife and older Mexicans.     

Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years

The deinstitutionalization of mental health care has changed the responsibilities of involved authorities and has led to a continuous need for new treatment forms and interventions. This article describes this development in Europe, and in particular how these new conditions have been handled in Sweden over the past 20 years at the level of governmental policy‐making. Three major policy documents from 1994, 2009 and 2012 were included in this study. To increase our understanding of the policies' contents, we have used theoretical concepts concerning governance, implementation and political risk management. Although our main interest was to find out how the government handles interventions for users of the mental health care system, we found that the policy work is progressing stepwise. The first document, from the deinstitutionalization era, did not discuss interventions clearly. Instead, it was mainly concerned with both practical and economical areas of responsibility. The second document, from the post‐deinstitutionalization era, was more focused on what services should be delivered to the users, while the most recently published document to a greater extent addressed the question of how the support is supposed to be designed. The trend in European community mental health policy has been to advocate services in open forms that are integrated into the society's other care systems. This is also the case in Sweden, and continuous work is being done by the government to find strategies to support the development, and to meet the needs at both political and local levels.     

Do we care? Adult mental health professionals' attitudes towards supporting service users' children

The impact of parental mental health is well known, but children's very existence may fail to be recognized by adult mental‐health services. This study aimed to explore attitudes of mental‐health professionals in one outer London borough regarding support needs of mental‐health service users' children to highlight potential barriers to identifying or meeting their support needs. All statutory mental‐health teams in the borough participated in a cross‐sectional survey. The response rate was 62.8% (n = 94) out of 150. The sample consisted of a diverse range of professionals from both inpatient and community settings. The main finding was that practitioners were overwhelmingly in favour of supporting children. However, attitudes and practices were significantly associated with profession, setting and whether the respondent was a care coordinator. Demographic characteristics or experience was not associated with attitudes. Perceived barriers to supporting children are highlighted. In particular, the mental‐health professionals in our sample considered supporting children important but did not necessarily consider it their role to do so. Training is required to raise awareness about this issue.     

Psychological distress among women who were sexually abused as children

One of the aims of the study was to investigate how participants in self‐help groups (SHG) for women (n = 87) who had been sexually abused in childhood rated their mental health and to what extent they were at risk of developing posttraumatic stress disorder (PTSD). A further aim was to investigate the relationship between the ratings of mental health, occurrence of PTSD, women's interpersonal relationships, reasons for participating in an SHG and characteristics of the childhood sexual abuse (CSA). The participants completed questionnaires regarding their personal relationships, reasons for joining a group, abuse characteristics, mental health (Symptom Checklist‐90‐Revised) and PTSD (Impact of Event Scale‐Revised). The women showed poor mental health, and more than half of them were at risk of developing PTSD. Lack of social support and feelings of shame correlated with poor mental health, whereas guilt did not. Relationships with female friends had a positive association. Further research is needed to determine whether participating in an SHG could provide adequate social support and reduce feelings of shame, thereby contributing to the healing process in the aftermath of CSA. Key Practitioner Message: ? Child abuse is a significant component of the global burden of disease; ? Both social workers and public health care providers meet sexually abused girls and it is important that they have knowledge about the subject; ? An important clinical implication for adequate treatment would be to assess and recognise childhood sexual abuse and to link diagnosis to trauma.     

Factors influencing the acceptance of volunteer home-visiting support offered to families with new babies

This study investigated the characteristics of families with a new baby, screened to identify families with vulnerability, who did not take up the offer of home‐visiting support from a community volunteer. Using logistic regression, background factors were compared with those families receiving support. Those not receiving support, 59.1% of those referred, were more socially, educationally and economically disadvantaged, living in more disadvantaged neighbourhoods. Those who received support were more likely to have larger families, no local support network, or had family members with health or mental health problems. One in nine families referred had not been reached by the support service. In brief qualitative telephone interviews, mothers who did not take up the offer of support reported changing their mind, wanting to cope without help and in some cases feeling that the support offered did not meet their specific needs. Policy implications are suggested, in particular offering support to new parents thought to be vulnerable within a statutory framework, with sufficient infrastructure and resources to conduct outreach work. Research implications include making a concerted effort to find out about families who decide not to take part in service evaluation studies, or who drop out after initial agreement.     

Young people's and carers' perspectives on the mental health needs of looked-after adolescents

While the mental health needs of looked‐after young people have been described in a number of clinical studies, the views of looked‐after adolescents themselves concerning their mental health needs have only rarely been reported. This study used focus groups to elicit the ideas and experiences of looked‐after young people in two local authorities in England. Front‐line carers in the region were also surveyed. Young people and carers were agreed in highlighting the damaging effects of the discontinuity and change experienced in the looked‐after system. Young people emphasized the importance of exercising choice and control when seeking and receiving support and identified the value of positive role models provided by ‘survivors’ of the care system. Carers reported high levels of risk behaviour, particularly self‐harm, among young people in children's homes. These differing perspectives need to be openly acknowledged and negotiated within care settings in order that relevant and accessible therapeutic and support services can be offered to looked‐after adolescents.     

From closed ranks to open doors: Elaine and John Cummings' mental health education experiment in 1950s Saskatchewan

During late 1951 and early 1952, married couple, social biologist Elaine Cumming and psychiatrist John Cumming, led a mental health education experiment in Indian Head, Saskatchewan. The study, which was intended to inform strategies toward deinstitutionalization, sought to determine if attitudes regarding mental illness could be changed through commonly used educational practices. It was shaped by the shared interests of powerful philanthropic, charitable, psychiatric, academic and governmental bodies to create healthier citizens and a stronger democratic nation through expert knowledge. However, in addition to the disappointing findings indicating that attitudes remained unchanged, the town appeared to close ranks against the research team. Nonetheless, the Cummings' later association with sociologists at Harvard University enabled them to interpret the results in a way that lent the study credibility and themselves legitimacy, thus opening the door to their careers as very successful researchers and policy-makers.