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.     

Stilling the tremors: Resurrecting HIV services in Haiti's post‐earthquake tent cities

The January 12, 2010 earthquake in Haiti severely undermined HIV service provision in the country. Almost 10 percent of Haitians were displaced and now live in temporary tent communities. Little is known about how HIV services are being provided to Haitians with HIV in these encampments. This study addresses this lacuna by conducting a process evaluation of the manner in which a collaboration among Haitian community‐based HIV service providers, a US‐based HIV service provider, and a US‐based academic research team resurrected HIV services in the encampments. Efforts to set up HIV services in the encampments proceeded through three stages: (i) an initial crisis response that activated established networks and identified feasible goals; (ii) the development of services by building research capacity, conducting needs assessments, addressing logistical challenges, and establishing community‐based services; and (iii) the sustaining of the initiative by targeting resources and negotiating in the political arena. Implications of the protocol for future efforts are discussed. Key Practitioner Message: ● Resurrecting HIV services in post‐disaster zones; ● Utilizing cross‐country, provider–academic partnerships to develop service capacity; ● Targeting structural barriers to establish HIV services in resource‐poor settings.     

A racial comparison of Family Group Decision Making in the USA1

This study examined Family Group Decision Making (FGDM) among a nationally representative sample of African‐American and White children investigated for maltreatment in the US. While FGDM was developed for work with ethnic minority families, there is no research on how this is being carried out in the US, where African‐American children are overrepresented in child welfare services. The study views racial differences in child, caregiver and maltreatment characteristics related to FGDM; composition of FGDM meetings; service referrals and receipt; and service satisfaction. Data are from the National Survey of Child and Adolescent Well‐being (NSCAW), a study of 5501 children ages 0–14. Current analyses include African‐American and White children (n= 4129). Stratified, bivariate and multivariate regression analyses were used. Results showed that while race was not related FGDM receipt, different characteristics lead to FGDM among African‐American and White families. Surprisingly, caregivers report feeling no more involved in decision‐making in association with FGDM. FGDM is provided at low rates overall (10%) and less frequently among White caseworkers. Child access to mental health services increases in relation to FGDM. Implications are discussed.     

Analysis of the implementation of a social protection initiative to admit the poorest of the poor to mutual health funds in Burkina Faso

To enable mutual health funds to extend coverage to poor people, the Mutual Health Support Network (Réseau d’appui aux mutuelles de santé – RAMS) in 2012 launched an initiative in collaboration with the Ministry of Social Action and Solidarity (ministère de l’Action sociale et de la Solidarité nationale – MASSN) in Burkina Faso. This article reveals difficulties in the initiative's implementation, which resulted in the continued exclusion of poor people from health services. Poor people were required not only to make co‐payments, but also to accept a limitation of coverage to three episodes of illness per year. Additional challenges to service takeup were the geographical distance of the homes of some beneficiaries covered by a mutual fund agreement from a health centre and the failure by some health workers and managers of pharmacies to recognize the mutual membership card. A formal framework was lacking that brought together all the actors involved in planning and implementing the initiative. Those involved did not all have the same information. Each structure performed the tasks within its scope, according to its own interests, but without consulting the other parties, and there was no platform for discussing implementation difficulties.     

An Analysis of Selected Pension and Health Care Initiatives for Informal Sector Workers in India

India's demographic trends portend moderately rapid ageing of the population. This, combined with the limited coverage of pension and health care programmes in terms of population, types of risks covered, and benefit levels has led to greater urgency in extending the coverage and reform directions of the current pension and health care programmes. This article analyses three pension and health care initiatives in India directed at the workers and their families engaged in the informal sector. The first initiative, India's National Social Assistance Programme (NSAP), undertaken in 1995 provides budget‐financed transfers targeted at older persons. It is funded by the Union government but implemented by the state governments. The second initiative, called Swavalamban, was started in 2010, but has been subsumed under Atal Pension Yojana (APY), in the 2015–16 budget. Both are voluntary co‐contributory initiatives aimed at providing access to retirement income to low‐income individuals (government co‐contributing with the individual). Unlike Swavalamban, the APY initiative has provisions for minimum guaranteed pension benefits, with contributions required by the members adjusted accordingly. Effectiveness in increasing enrollment and in sustaining contributions over a longer period will impact on the extent of retirement income security obtained by the members. The third initiative, Rashtriya Swasthya Bima Yojana (RSBY), is insurance‐based and aims to provide hospital care to low‐income households. The article argues that for improving outcomes of these initiatives, more effective implementation, greater fiscal resources, and an integrated and systemic approach which is aided by technology‐enabled platforms such as Aadhaar, will be needed.     

Patterns of family service needs and caregiver–child relationships among families at risk of child welfare involvement

Caregivers at risk of involvement in the child welfare system report high levels of need for multiple types of services, and their children have high levels of mental health need. Caregivers from families with more service needs, as well as unmet needs, are less likely to be engaged with child welfare services and may have diminished capacity to care for their child. This study takes a family‐centered approach by using latent class analysis to identify patterns of both caregiver and child service needs among families at risk of child welfare involvement. Using data from the LONGSCAN consortium (N = 957), we identified 4 classes of service needs among child welfare‐involved families. We then examined differences between the 4 classes based on demographics, maltreatment histories, unmet service needs, and caregiver–child relationship. The caregivers were split fairly evenly among the 4 classes: low needs, medical needs, poverty support, and high needs. There were significant differences between classes on assessed variables, with higher levels of needs associated with diminished caregiver–child relationships.     

Indirect effects of the Family Check‐Up on youth extracurricular involvement at school‐age through improvements in maternal positive behavior support in early childhood

Extracurricular involvement in the school‐age years has widespread potential benefits for children's subsequent socioemotional development, especially for low‐income youth. However, there is a dearth of research on interventions aimed at increasing school‐age extracurricular involvement in low‐income youth. Thus, the present study aimed to test the collateral effect of a brief, family‐focused intervention for low‐income families, the Family Check‐Up, on children's school‐age extracurricular involvement via improvements in maternal positive behavior support (PBS) in early childhood. The sample (n = 630, 50% female, 50% White, 28% Black/African American) represented a subsample of families from the Early Steps Multisite Study. At the age of two, families were randomly assigned to the Family Check‐Up or Women, Infants, and Children Nutritional Supplement Services as usual. Mother‐child dyads participated in observed interaction tasks at child ages 2 and 3 that were subsequently coded to assess PBS. Primary caregivers reported on children's school‐age extracurricular involvement at ages 7.5, 8.5, and 9.5. Results indicated that although there was not a direct path between intervention status and children's school‐age extracurricular involvement, a significant indirect path emerged from intervention group to changes in PBS between ages 2 to 3 to children's school‐age extracurricular involvement. The results are discussed in terms of implications for designing preventive interventions in early childhood that promote extracurricular involvement at school‐age, particularly for children at risk for maladaptive outcomes.     

Does partnership funding improve coordination and collaboration among early childhood services? – Experiences from the Communities for Children programme

Partnerships among service providers are an important aspect of human service delivery, including in the early childhood and family service sector. There is extensive international literature on factors contributing to partnerships – also termed service coordination, collaboration or integration – but little evidence of partnership outcomes exists where partnerships are a funded and mandatory component of large‐scale programmes. This paper reports findings from an evaluation of the Australian Government's Communities for Children (CfC) programme. Under CfC, partnerships were mandated and funded, and the evaluation findings show that the programme resulted in an increased number of agencies working together to support families with young children (0–5 years) and that working relationships between agencies improved. The effectiveness of these partnerships depended on funding for partnership activities and on organisational and practical factors.     

国外社区心理健康服务及其对我国社区心理健康服务的借鉴

社区心理健康在发展国外相对完备,从国外社区心理健康的产生和发展、理论基础和服务体系出发,探讨其对我国社区心理健康服务的借鉴作用,最后对我国社区心理健康服务提出构想：政策的实际支持、提高公众的心理健康意识、建立完整的心理健康服务体系、加强其他部门合作。     

Discrimination in child protection work: recurring themes in work with Asian families

When the relationships within the institutions and social practices of a society cannot be explained by the intentions, good or bad, of individual men and women, they can be described as structural ( Weedon 1987 , p. 3). This paper reports on research in a Midlands Social Services Department which examined child protection practice in relation to Asian families who had attended case conferences. The research shows that in spite of the good intentions of many individual workers, Asian families experienced a discriminatory service. Discriminatory policies and practices were perpetuated at an organizational level. Three themes from the research are explored: the use of interpreters, the accommodation of children, and the lack of attention to the mental and physical health of the child's mother and father. Each theme is explored to highlight the issues which Asian families faced and the problems which created barriers to good practice.     

Helping families where parents misuse drugs or alcohol? A mixed methods comparative evaluation of an intensive family preservation service

Option 2 is an intensive family preservation service for families with serious child protection concerns related to parental misuse of drugs or alcohol. A previous evaluation indicated that it reduced the number of children entering care and, as a result, produced cost savings; however, little data were gathered from families. This study involved interviews with 15 families (46 children) who had received the service, and a comparison group of 12 families (28 children) referred but not provided the service due to no workers being available. Outcomes and experiences were compared, on average, 5.6 years following referral. Findings included a significant reduction in children entering care, and improvements in relation to substance misuse, parental well‐being and family cohesion. There was no difference in emotional and behavioural welfare of children. Qualitative accounts were very positive about the impact of the service, identifying effective engagement of parents and key elements of good practice in supporting families to change. The findings provide additional support for suggesting that high quality, intensive interventions with families affected by parental substance misuse can be effective. Key lessons for current attempts to deal with the increase in children entering care and the English government's ‘troubled families’ initiative are considered.     

Racial and Ethnic Diversity in Senior Centers: Comparing Participant Characteristics in More and Less Multicultural Settings

The 2008 Health Indicators Project surveyed a probability sample (N = 1,870) of New York City senior center participants. Attendees of racially and ethnically diverse and nondiverse senior centers were compared across 5 domains: demographics; health and quality of life; social support networks; neighborhood perceptions and engagement; health service access/utilization. Although homogeneous and diverse center participants demonstrate similar health and quality-of-life outcomes, those from diverse centers demonstrate greater risk of social isolation, receive less family support, and more likely seek medical care from hospitals or community clinics. Implications and future directions for research, practice and policy are discussed.     

Contexts of Mother–Child Separations in Homeless Families

Families that contend with the losses, disruptions, and hardships occasioned by homelessness often experience dispersal of children as well. Although a federal initiative on homeless families identified family preservation as a focus of intervention development, there is little research to guide service efforts. This qualitative study of mother–child separations in homeless families with maternal mental health and/or substance use problems identifies precursors of separations (precarious housing, turbulent relationships, substance abuse by mothers and others, institutional confinement, and children's needs) and examines how mothers' responses to these events and conditions interact with social and institutional contexts to shape variations in the course and outcome of separations. Implications for research, services, and policies affecting homeless families are discussed.     

Associations between ongoing COVID-19 lockdown and the financial and mental health experiences of Australian families

In 2020, Australia's successful COVID-19 public health restrictions comprised a national “initial lockdown” (March–May) and “ongoing lockdown” (July–November) for metropolitan Victorian residents only. We evaluated associations between ongoing lockdown and family finances and mental health. In the June and September 2020 Royal Children's Hospital National Child Health Polls, caregivers of children in Victoria and New South Wales (NSW) reported the following: job/income loss; material deprivation (inability to pay for essential items); income poverty; mental health (Kessler-6); perceived impact on caregiver/child mental health; and caregiver/child coping. Data from caregivers (N = 1207/902) in June/September were analysed using difference-in-difference modelling (NSW provided the comparator). During Victoria's ongoing lockdown, job/income loss increased by 11% (95%CI: 3%–18%); Kessler-6 poor mental health by 6% (95%CI: −0.3%–12%) and perceived negative mental health impacts by 14% for caregivers (95%CI: 6%–23%) and 12% for children (95%CI: 4%–20%). Female (vs. male) caregivers, metropolitan (vs. regional/rural) families, and families with elementary school-aged children (vs. pre-/high-school) were the most affected. The ongoing lockdown was associated with negative experiences of mental health, employment and income, but not deprivation or poverty, likely because of government income supplements introduced early in the pandemic. Future lockdowns require planned responses to outbreaks and evidence-informed financial and mental health supports.     

Service users as gatekeepers in Children's Centres

Children's Centres are the latest in a line of initiatives designed to provide neighbourhood‐based family support. These are part of a spectrum of preventive services from Universalist (primary prevention) to permanence and rehabilitative work (quaternary). High levels of need confronted by tertiary Child Care Social Work and Child and Adolescent Mental Health Services, mean that the contribution of these centres at secondary level and responsiveness to its higher‐level needs, have become particularly important. At the same time, the involvement and perspectives of service users have become equally important in the evaluation and development of centres. Users, though, can help create the culture and expectations in centres just through the processes of interaction developed over time. However, although users have evaluated services for their openness, we know little about the part played by service users themselves – particularly through their informal interactions and culture – in the responsiveness of centres to higher‐need families for whom secondary level prevention is appropriate. This paper focuses on the part played by service users as gatekeepers showing they can play an important, and sometimes limiting, part in the responsiveness of centres. The theoretical and practical implications of this for prevention are discussed.     

Working the ‘spaces’ between policy and practice: the contributions offered by resilience theory and action research

The policy‐practice dimension often presents challenges particularly in the policy arena of child well‐being. Policy designers identify risk factors and design programmes intended to develop protective factors in areas of need. The 2004 Australian Communities for Children (CfC) initiative aimed to improve the social, health and educational outcomes for young children living in socio‐economically disadvantaged localities. Its method was to engage local community members to contribute towards developing protective factors. Rather than considering this national–local arrangement, an unworkable alliance, we examine the performance of CfC through three examples and demonstrate how resilience theory and action research can assist this programme achieve its social inclusion aims and well‐being outcomes. We choose not to disregard policy programmes like CfC, rather we emphasize the possibilities offered when working these complex spaces involving multiple and inherent contradictions. The spaces that often exist between the policy and its implementation are rethought to allow a greater opportunity for the growth of innovation and change.     

Facilitating access to services for children and families: lessons from Sure Start Local Programmes

With the introduction of the highly publicized Sure Start Local Programme (SSLP) initiative in 1998, the UK government introduced a community‐based set of provisions targeted at families with children under 4 years who were living in some of the 20% most deprived and disadvantaged geographical areas in England. These programmes were designed to combat the adverse effects of poverty and disadvantage on the long‐term outcomes for children and families. One challenging dimension for programme development has been the facilitation of access to the services on offer in these programmes. Drawing on findings from the implementation module within the government‐commissioned National Evaluation of Sure Start, this paper examines the way in which SSLPs have sought to facilitate access to services for their local communities and to encourage community members to take up and continue using those services. This paper presents a detailed overview of programme activity in respect of access. It identifies a continuum of access and a model of three styles of parental service use. The paper highlights the implications of the SSLP implementation process for the development of subsequent related initiatives such as children’s centres and extended schools.     

Does differential response make a difference: examining domestic violence cases in child protection services

Large numbers of domestic violence (DV) cases on child protection caseloads have necessitated the development of practices that address both DV and child safety. The first step in this process is to gain an understanding of the differences between DV‐involved cases and other forms of maltreatment. The implementation of a differential response service model in Ontario offered an opportunity to compare risk assessment ratings, service outcomes and recurrence and to identify pathways of DV cases through child protection services (CPS). A sample (n = 785) of child protection investigations over a 4‐month period was examined. Of these investigations, 26% cases were DV referred; 87% of the DV victims were mothers; perpetrating partners were mostly absent from investigations; non‐white families were more often investigated for DV than white families; and DV cases were more likely to remain open for ongoing CPS. Only one‐third of DV‐exposed children were assessed as having been harmed and most community referrals were made for the victim parent. Mothers were the primary target of investigation, remaining in CPS for extended service provision although recurrence rates were lower than found in other investigations. Results are discussed to inform investigative procedures, assessment and service response to more adequately respond to children and families when DV is present.     

From Official Supervision to Self‐monitoring: Privatizing Supervision of Private Social Care Services in Finland

In October 2011, a new Act on Private Social Care Services came into force in Finland. The Act included a provision on a ‘self‐monitoring plan’. According to the provision, providers of private social care services are required to draw up a self‐monitoring plan and to follow its realization. The plan must be kept publicly on view so that clients and their relatives can also keep an eye on the realization of self‐monitoring. In this article, self‐monitoring is first explained and then briefly analyzed against the background of a wider theoretical discussion on accountability. It is argued that the introduction of client involvement in the supervision of private social care services represents a new mechanism of accountability that is typical of the Post‐Keynesian welfare state. Because public authorities are no longer able to supervise the growing number of private social care service providers, the responsibility has been partly shifted to service providers themselves as well as to clients. However, it is argued that the idea of self‐monitoring lends itself poorly to ‘delegated’ private social care services, i.e. to services that are outsourced to private service suppliers. Supervision of private social care service providers should not be too eagerly delegated to service providers themselves, or to clients, because we are here dealing with the constitutional right to adequate social care services. Client involvement also involves numerous practical problems, as shown at the end of the article.     

The Organization of Decision-making and the Dynamics of Policy Drift: A Canadian Health Sector Example

This historical‐institutionalist case study of public–private change in the rehabilitation health sector in Ontario, Canada, seeks to build on literature about the politics of policy drift, particularly with respect to health care systems. Rather than turning to higher‐order institutional factors, such as federalism and overall financing agreements between states and the medical profession, or to economic indicators such as change in expenditures, however, it posits that the particularities of how welfare‐policy sectors are organized with respect to their decision‐making contribute to drift. Such organization is framed by two factors. The first is the set of rules by which the public–private boundary is drawn, and the second is the structuring of public institutions that set legislation and regulation, and organize the policy networks attendant on them, around these boundaries. The degree of coordination or fragmentation among these, this case suggests, is a factor in the politics and dynamics of drift.