Responding to Adolescent Violence in the Home – A Community Mental Health Approach

Family violence perpetrated by adults is increasingly understood as a health issue, and we argue that this pertains even more strongly to violence by adolescents. The co-dependence of the parent–child bond, lack of maturity in the adolescent, and often related issues of disability or mental illness make these young people both complex and also vulnerable. This research paper reviews the current literature relating to adolescent violence in the home, identifies known best practice, and evaluates the importance of taking a family-focused, therapeutic approach to adolescent family violence, in place of a punitive one. It describes the use of a co-design workshop to unpack gaps in service provision and develop a potential family focused model of care to address the needs both of young people who use violence, and their families. The findings indicate that an inclusive family approach is a key element in addressing adolescent violence in the home across a spectrum of behaviours and mental health care needs. The use of a coordinated, family-inclusive response through mental health care services is recommended to address the complexity of this issue, as well as to provide support both to adolescents and to their families and carers.     

Improving child welfare services with family team meetings: A mixed methods analysis of caseworkers' perceived challenges

Various forms of family team meetings have been increasingly employed in child welfare systems to empower families and provide effective individualized services through community partnerships. However, many family team meetings often fail to achieve their intended goals mainly due to ongoing challenges that team members face. Using data from a survey of caseworkers, this study examined dynamic processes of family team meetings to improve child welfare service outcomes, specifically focusing on caseworkers' perceived challenges. Also, responses to an open ended question were reviewed using content analysis to identify similar or different challenges encountered by diverse team members. Survey data were analyzed using path analysis and found that logistical barriers tended to decrease both family and stakeholder engagements, which in turn made child welfare services less accessible, less utilized, and less effective for children and families. Content analysis revealed that caseworkers perceived disagreement/conflict and knowledge deficits about child welfare as common challenges for all team members. This paper concludes with practice implications suggesting ways to minimize challenges identified and maximize the effectiveness of a family team meeting.     

Framework for culturally competent decisionmaking in child welfare

This article provides a framework to understand the cultural, social, political, and economic factors that affect decisionmaking when working with ethnically and racially diverse families in the child welfare system. The article describes external factors affecting the decisionmaking process, including community environment, agency structure, and family characteristics. It then reviews the core stages of the casework process, describing key decisions during intake, assessment, service planning, implementation, evaluation, and closure. Although the framework is based on casework process in the child welfare system, it can be adapted to other child-serving systems, including education, mental health, and juvenile justice.     

Wraparound Services: An Effective Intervention for Families Impacted by Severe Mental Illness

ABSTRACT

Children and families impacted by severe mental illness (SMI) have multiple strains that effect family functioning, child safety, and parental rights. Traditional services for children and families struggling with severe mental illness have not achieved success in improving family functioning and keeping families intact. Wraparound is a philosophy and a system of care with a promising evidence base that could enhance collaboration of child welfare, mental health, and community services to work more effectively with families impacted by SMI.     

Poverty and placement outcomes of Intensive Family Preservation Services

It is argued that Intensive Family Preservation Services (IFPS) often fail to prevent the out-of-home placement of children because family poverty impedes long-term effectiveness of the interventions. Current research is examined to demonstrate that families with lower socioeconomic status have higher rates of substitute care placement and that many IFPS families do not have the minimum income commonly assumed necessary to facilitate successful therapeutic interventions. Research also shows that poverty contributes to child abuse and neglect, to mental health problems, and to juvenile delinquency, resulting in a disproportionate representation of poor children in the three child systems. Until family poverty is significantly reduced, IFPS will continue to have disappointing results for a sizeable portion of their clientele.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Building effective working relationships across culturally and ethnically diverse communities

Amherst H. Wilder Foundation's Social Adjustment Program for Southeast Asians is implementing two collaborative, best practice, mental health and substance abuse prevention service models in Minnesota. It faced several issues in effectively bridging multiple cultural groups, including building a diverse collaborative team, involving families and youth, reconciling cultural variation in meeting styles, and making best practice models culturally appropriate. Researchers and program staff used multiple strategies to address these challenges and build successful partnerships. Through shared goals, flexibility, and a willingness to explore and address challenges, collaboratives can promote stronger relationships across cultural communities and improve their service delivery systems.     

Integrating a family-centered approach into social work practice with families of children and adolescents with disabilities

This article identifies a family-centered practice construct for working with children and adolescents with disabilities and their families. The experiences of these families have shifted considerably over the past 30 years. A legislative and historical context provides the basis for an understanding of present policies and practices that influence current approaches to service delivery. Though family-centered practice is emphasized in various practice settings, there is still a need to integrate this philosophy into social work practice with children and adolescents with disabilities and their families. In order to enhance the ability of the social worker to integrate this construct into practice, a framework for exploring the experiences of children, adolescents and families is provided. This framework provides an overview of factors related to the individual child, the family and siblings for the social worker to consider when working with these families. The social worker's role as collaborator, advocate, team member and family resource is highlighted.     

Family Structure and Child Well‐being: Integrating Family Complexity

Although children's family lives are diverse, the measurement of children's living arrangements has lagged, focusing on the relationships of children to parents while largely ignoring sibling composition. Using data from the 2008 Survey of Income and Program Participation (N = 23,985) the authors documented patterns of family complexity among a nationally representative sample of children ages 0–17 living in a range of family structures. They also examined the independent and joint associations of family structure and family complexity on child economic well‐being. Family complexity was independently related to economic disadvantage, namely, a lower income‐to‐needs ratio and a higher likelihood of public assistance receipt. The role of family complexity was partially contingent on family structure, with the positive association between family complexity and receipt of public assistance more pronounced for children in families with 2 married biological parents. This study demonstrates the utility of integrating family structure and family complexity in studies of children's well‐being.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania,Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family-inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family-inclusive approach. Future research could focus on attaining a more in-depth understanding of individual family member experiences with a view to improving SST delivery.     

Helping parents with mental illnesses and their children: a call for family-focused mental health care

1. Large numbers of individuals with mental illnesses are parents to minor children. 2. Recommendations to improve services suggest that services provided by the adult mental health system and child service agencies be coordinated. 3. Nursing care intersects both the adult and child systems, and nurses have the expertise to offer a variety of services. 4. There is an urgent need to improve family-focused mental health nursing care to benefit parents with mental illnesses, their children and families, and the overall community and society.     

Constructing the ‘ideal’ family for family‐centred practice: challenges for delivery

Family‐centred practice positions families as the key decision‐makers, central to and experts in the wants and needs of their child. This paper discusses how families interviewed for a Western Australian study describe their relationships with a range of allied health professionals in the paediatric disability sector. The allied health professionals, in turn, describe how they characterize the role of families caring for children with disabilities. We argue that the successful implementation of family‐ centred principles in service delivery need to move beyond the individualizing of responsibility and acknowledge the structural and systemic limits to family‐centred practice, as well as the social complexity within which diverse families live.     

Social insurance and children: The relationship between Social Security,economic well-being,and family context among child recipients

The relationship between social insurance, which provides families protection against certain risks, and child economic security is understudied. Using the 2004 Survey of Income and Program Participation (SIPP) matched to Social Security Administration benefit records, this article investigates the economic welfare effects of the child component of the US Social Security program. We examine how the poverty rate of child beneficiaries would change, absent Social Security income, and how heavily the family incomes of these children rely on it, by family characteristics. Our findings reveal that Social Security plays an important role in mitigating economic insecurity among children deprived of a wage-earning parent through disability, death, or retirement. Family structure, earnings, and employment status are identified as key factors moderating the effect of Social Security on child recipients’ financial circumstance.     

Integrating a Family-Centered Approach into Social Work Practice with Families of Children and Adolescents with Disabilities

Abstract

This article identifies a family-centered practice construct for working with children and adolescents with disabilities and their families. The experiences of these families have shifted considerably over the past 30 years. A legislative and historical context provides the basis for an understanding of present policies and practices that influence current approaches to service delivery. Though family-centered practice is emphasized in various practice settings, there is still a need to integrate this philosophy into social work practice with children and adolescents with disabilities and their families. In order to enhance the ability of the social worker to integrate this construct into practice, a framework for exploring the experiences of children, adolescents and families is provided. This framework provides an overview of factors related to the individual child, the family and siblings for the social worker to consider when working with these families. The social worker's role as collaborator, advocate, team member and family resource is highlighted.     

Evidence-based Medicine and Child Mental Health Services

There is increased focus on using research evidence to guide clinical practice in the provision of child mental health services, to allocate resources and to make policy decisions. Emphasis has been placed on randomised controlled trials, which are clearly vital. However, given the complexity of children's lives and the multiple systems relevant to their care, it is important to consider alternative research designs and to think creatively about outcomes. In the context of difficulties with random allocation a number of quasi-experimental designs are described that may more closely reflect actual clinical work. In the context of ecological theory, the importance of taking a systems level approach to evaluation is highlighted, with examples from the US. Finally, the ways in which qualitative outcomes measures can be used to sensitively describe the effects of treatment are outlined, and their potential for giving voice to children and families as consumers of mental health services. These suggestions aim to lessen the tension between the requirements of the scientific investigations of treatment effectiveness and the realities of clinicians' daily experiences.     

Multiple family groups: an engaging intervention for child welfare-involved families

Differences between child welfare- and non-child welfare-involved families regarding barriers to child mental health care, attendance, program satisfaction, and relationship with facilitators are examined for a multiple family group service delivery model aimed at reducing childhood disruptive behaviors. Although child welfare-involved caregivers reported more treatment barriers and less program satisfaction than non-child-welfare-involved families, no significant differences exist between groups on average total sessions attended and attendance rates over time.     

How do you solve a problem like Maria? Family complexity and institutional complications in UK social work

ABSTRACT

This paper draws on UK data from an international, comparative project involving eight countries. The study examined how social workers’ conceptions and definitions of family impact on the way they engage with complex families, and how social policies that frame social work context impact on the way social workers engage with families. Focus groups were held in which social workers from four service areas (child welfare, addictions, mental health and migration) were asked to discuss a case vignette. Several factors were embedded in the vignette to represent a realistic situation a social worker may come across in their day-to-day work. Social workers clearly identified the complexity of the family’s situation in terms of the range of issues identified and candidate ‘causes’. However, typical first responses were institutional, looking for triggers that would signify certainty about their, or other agencies’ involvement. This resulted in a complicated story, through which the family was disaggregated into individual problem-service categories. This paper argues that understanding these processes and their consequences is critical for exploring the ways in which we might develop alternative, supportive professional responses with families with complex needs. It also demonstrates how organisational systems manifest themselves in everyday reasoning.     

Preserving Family Therapy's Legacy

Originating as a plenary address, this article reviews the enduring contribution of family therapy, and asks how it might best be preserved into the future, given that family therapy itself is no longer seen as ‘newsworthy’. The author makes three recommendations: that all future social workers be trained to conduct a three‐session structured family assessment; that all future family therapists be required to participate in a Yalom‐type group therapy experience; and that one member of every child mental health and child protection team be trained to convene and chair interagency case conferences capable of building trust and working towards open communication. A rationale for the three recommendations is provided, in terms of key principles common to family and group work.