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.     

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.     

Mental health and educational difficulties in children in contact with Children's Social Services

The British Child Mental Health Survey 1999 collected data from 10 438 children aged 5–15 years, selected at random from the child benefit register. At 2 and 3 years, all those with a psychiatric disorder and a random third without were followed up with further detailed interviews about the services contacted if parents reported service contact or if parents expressed concern about their child's mental health at baseline and follow‐up, but reported no service use. We compared children in contact with Children's Social Services with children in contact with Child and Adolescent Mental Health Services (CAMHS) or no services. The children in contact with Children's Social Services had a high level of psychopathology and considerable educational difficulties. Despite this, they often had no contact with CAMHS or access to provision for special educational needs. It also became clear that parents were often using Children's Social Services as a first‐line service, i.e. a way of trying to access help. The results provide us with an interesting insight into the level of need of those children in contact with Children's Social Services and we hope to stimulate discussion about how liaison between all the services children access can better provide for their needs.     

Experiencing breast cancer in the context of mental illness in New Zealand

ABSTRACT

This study aimed to explore the experiences of women with mental illness who had also experienced breast cancer diagnosis and treatment, in particular, to identify barriers and facilitators to cancer treatment. Semi-structured interviews were conducted with ten breast cancer survivors who had had contact with secondary mental health services prior to their cancer diagnosis. Thematic analysis was used to identify key themes. Participants described positive experiences of cancer treatment, expressing surprise at both how well they coped with diagnosis and treatment and how well they were treated by services. Many contrasted this with their less positive experience of mental illness and mental health services. The women interviewed were active participants in their cancer treatment and did not report feeling stigmatised because of their mental health experiences. A lack of connection between cancer and mental health services was described, but this was not regarded as necessarily a bad thing. This study begins to counter the stereotypes of the difficult patient or the person unable to understand and cooperate in their own care which are prevalent in the literature. Further work is needed to understand the reasons for disparities in cancer outcomes.     

Positive Connections: a programme for children who have a parent with a mental illness

Mental health professionals working with parents who suffer from a mental illness often overlook the children within the family. Children whose parents are mentally ill face numerous obstacles to their own emotional development and these children are at higher risk for developing mental illnesses than other children. These risks can be decreased if protective or positive interventions are available for the children. This article will describe the development and implementation of Positive Connections, an effective intervention programme specifically designed for children whose parents have been diagnosed with a mental disorder. The effectiveness of this programme has been evaluated using both qualitative and quantitative research strategies, and the results are presented.     

Mental health of parents with young children in Hong Kong: the roles of parenting stress and parenting self-efficacy

This study aimed to explore the sources of parenting stress and the mental health of parents with kindergarten and primary school children in Hong Kong. It also examined the intervening effects of parenting self-efficacy on mental health of parents. Results indicated that parents who perceived their children as more demanding, less acceptable and less reinforcing had more parenting stress. Those who found their parental roles to be more restrictive also had more parenting stress. Lastly, parenting self-efficacy moderated the effects of parenting stress on the mental health of parents. Cultural and social factors were put forward to explain these findings and suggestions were made towards reducing the parenting stress experienced by parents with younger children in Hong Kong.     

Predictors of mental health literacy among parents of youth diagnosed with mood disorders

Research reveals limited knowledge of children's mental health among caregivers. This paper identifies predictors of mental health literacy among parents of children diagnosed with mood disorders that are seeking or already receiving help. Secondary data analysis using multivariate regression was conducted on data from a randomized, controlled efficacy trial with a sample of 165 children. Mental health literacy was higher for parents who were female, white, higher educated and had children who were older, had a bipolar diagnosis or received more services. Lifetime experience with mental health disorders also predicted literacy. Public mental health efforts are needed to raise caregiver mental health literacy.     

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.     

Intergenerational pathways leading to foster care placement of foster care alumni's children

This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between poorer father's functioning to greater alumni depression, which was in turn associated with negative social support, and then a greater likelihood of child out‐of‐home placement. Other parent to alumni paths were that poorer father functioning was associated with alumni anxiety and post‐traumatic stress disorder (PTSD), and poorer mother's mental health was associated with PTSD; however, anxiety and PTSD were not implicated as precursors of foster care placement of the child. Findings support the need for increased practice and policy support to address the mental health needs of parents of children in or at risk of foster care, as well as the children themselves, as family history may have a lasting influence on quality of life, even when children are raised apart from biological parents.     

Practice challenges at the intersection of child protection and mental health

This paper examines the complexity of collaboration between child protection and mental health services, where a parent has a mental illness and there are protection concerns for children. The paper reports on data from focused in‐depth interviews with 36 child protection workers, adult mental health workers and child and youth mental health workers. Data were analysed thematically, using NVivo to facilitate data management and analysis. Two dimensions were identified. The first, the process of collaboration, relates to four factors that assisted the collaborative process: communication, knowledge, role clarity and resources. The second dimension considers the challenges presented to collaborative work when a parent has a mental illness and a child is in need of protection, and identifies issues that are inherent in cases of this kind. Two types of challenge were identified. The first related to characteristics of mental illness, and included the episodic and/or unpredictable nature of mental illness, incorporating information from psychiatric and parenting capacity assessments, and the provision of ongoing support. The second type of challenge concerned the tension between the conflicting needs of parents and their children, and how this was viewed from both the adult mental health and the child protection perspective. Implications for policy and practice are identified in relation to the need for service models that provide ongoing, flexible support that can be intensified or held back as needed.     

How do Australian adult mental health clinicians manage the challenges of working with parental mental illness? A phenomenological study

Adult mental health clinicians face a range of challenges that hinder their use of family‐focused practices when working with consumers who are parents. The purpose of this study was (a) to examine clinicians' experiences when working with parents and (b) identify strategies they found to be effective when working with parents. Eleven Australian mental health clinicians were recruited who regularly worked with consumers who are parents. Semistructured interviews were conducted within a qualitative paradigm and analysed using interpretative phenomenological analysis. Themes were identified which related to (a) managing sensitive parenting conversations, (b) making decisions about child safety in unclear or unpredictable situations, and (c) working with child protection services. Participants had developed strategies for managing the challenges of the first two practice issues and suggested organizational changes that could facilitate collaboration with child protection services. The findings highlight that the challenges of working with parents with mental health issues cannot be addressed with a one‐size‐fits‐all approach. Initiatives to facilitate the effective support of parents and their children need to be informed by contextual factors, including clinical practice.     

Goal setting in recovery: families where a parent has a mental illness or a dual diagnosis

Goal setting is an important element within mental health recovery models; however, parenting and children are rarely recognized in such approaches. This study outlines a family recovery planning model where a parent has a mental health or dual substance and mental health problem. The differences between family types (parent with a mental illness or parent with dual diagnosis) and family members (parent and children) are illustrated in terms of goals across 11 domains. There were a total of 33 parents and 50 children from 10 mental illness and 10 dual diagnosis families. Education and specifically mental health knowledge are important goals across all families and appear especially important for children whose parent has a dual diagnosis. Specific goals and achievement levels for each type of family and parents and children are also outlined. Clear areas for action by clinicians and family members are indicated by this study.     

Relation between young children's anger and fathers' mental health during the COVID-19 epidemic: Moderating role of gender and child number

The father–child interaction deserves attention during the COVID-19 epidemic. This study administrated the Child Anger Questionnaire and the SCL-90 Symptom Checklist to collect primary data from 1862 fathers of Chinese young children during the COVID-19 outbreak, examined the relation between young children's anger and their fathers' mental health, and verified whether the relation was moderated by the gender or the child number. The results demonstrated that the detection rate of anger among Chinese young children was 60.08%, the scores of SCL-90 factors of their fathers were significantly lower than the Chinese normal adult male norms and those of infant parents, and the anger of young children had a significant effect on their fathers' mental health. Gender and child number moderated this relation. It is of great significance to strengthen the attention to the anger of young children and the mental health of fathers during the period of public health emergencies, and to promote the harmonious interpersonal relationship between young children and their fathers.     

Assisted Living Facility Administrator and Direct Care Staff Views of Resident Mental Health Concerns and Staff Training Needs

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.     

Are the Homeless Mentally Ill?

In Australia, it is widely believed that most homeless people have mental health issues and that mental illness is a primary cause of homelessness. This paper uses information from a study of 4,291 homeless people in Melbourne to investigate these propositions. The research found that 15 per cent of the homeless had mental health issues prior to becoming homeless. This challenges the community perception that mental illness is the primary cause of homelessness. The research also found that 16 per cent of the sample developed mental health issues after becoming homeless. Homelessness causes mental health issues for some people, particularly anxiety and depression. The claim that most homeless people are mentally ill sends the wrong message to policy makers about the services that are needed to assist homeless people.     

Supporting foster and kinship carers to promote the mental health of children

The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care.     

‘Not a good person’: family stigma of mental illness from the perspectives of young siblings

The purpose of this paper is to critically examine family stigma as one form of the stigma of mental illness in child and youth mental health. Presented are the outcomes of a thematic content analysis of in‐depth, semi‐structured interviews conducted with seven (n = 7) young siblings, ages 13 to 21 years old, with a brother or sister identified as having a mental‐health issue. The focus of the interviews was on the ways the siblings experienced their other sibling's mental health and how those experiences shaped their sense of self and family. From the analysis, young siblings had predominately negative experiences, struggled with making sense of their brother or sister and the family as ‘flawed’ against the mental illness as ‘bad’ and experienced considerable family stress and overt family stigma. Current practice theories fail to consider the complexity of these factors and, in doing so, fail to adequately explain the nature and extent to which stigmatization occurs for immediate family members. The importance of peer support and understanding stigma in social work practice with children and their families is discussed.