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.     

Barriers to collaboration on behalf of children with challenging behaviours: a large qualitative study of five constituent groups

Inter‐agency collaboration is seen as an effective way to support children and families with multiple and complex needs. Children in out‐of‐home care, especially those exhibiting challenging and disruptive behaviour, often require the services of multiple agencies. Ninety‐two South Australian stakeholders experienced in supporting children in out‐of‐home care were interviewed about their experience of collaborative practice, using the specific example of supporting children with extremely challenging behaviour. Participants were teachers, foster parents, child welfare workers, child mental health professionals and residential care workers. Thematic analysis revealed several tensions inherent in such collaboration. Results are discussed in terms of their unique implications for managing challenging behaviour, and suggestions are made for improving collaborative approaches to behaviour and multi‐agency practice.     

Children's understanding of mental ill health: implications for risk and resilience in relationships

Research shows that having a parent with a mental health problem has associated risks for children, but some families seem very resilient and do not always suffer these difficulties. In order for social workers to be able to support the development of resilience in families who appear to be at risk, we need to understand what factors may ameliorate some of these risks. Research seems to suggest that children who can conceptualize their parent's mental health problem as something 'outside' their representation of that parent as an attachment figure are likely to have better outcomes than children who see the mental-health problem as part of, and embedded within, their representation of that parent. However, in order to develop an understanding of how this conceptualization affects attachment relationships and outcomes, we need to know what children understand by mental ill health. We also need to consider how this conceptualization might be changed, and it appears that parents, other attachment figures and other support figures may play a key role here. This paper provides a selective review of the research area and discusses the mechanisms which may govern this complex process. The review concludes with recommendations for future research and practice.     

A Collaboratively Designed Child Mental Health Service Model: Multiple Family Groups for Urban Children with Conduct Difficulties

This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.     

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.     

Absent presence: the ongoing impact of men's violence on the mother–child relationship

This paper draws from interviews with 45 mothers and 52 children who participated in an action research project to develop activities to support women and children in the aftermath of domestic violence. A thematic analysis was used to analyse the data and explore the question: In what ways does the perpetrator of abuse remain present in the lives of women and children following separation? The paper invites workers to recognize the distortions created by domestic violence that may need to be identified and addressed in the aftermath of violence. The ways in which past trauma, erosion of self‐esteem and the undermining of the mother–child relationship continues to create a shadow across the present relationship are identified. The continued presence of the perpetrator of abuse through child contact arrangements and ongoing harassment is also highlighted. The ‘absent presence’ of the abusive partner is posited as a concept to assist workers with a framework through which to understand problems in the mother–child relationship which emerge when living with and separating from a violent partner. The paper has implications for social workers orientating practice to focus on perpetrator accountability and support strengthening the mother–child relationship.     

“She was accused of colluding with the mother”; the training and support needs of parent‐and‐child foster carers: A qualitative study

Parent‐and‐child foster placements are used to accommodate parents with their children, either when the mother is a looked‐after child or as a setting for a parenting assessment. Despite this being a specialized role with significant potential for affecting outcomes for disadvantaged families, there is currently a lack of accessible learning opportunities for foster carers on the physical and mental well‐being of women with complex needs such as a history of domestic abuse, substance abuse, perinatal mental ill‐health, or having a learning disability. Parent‐and‐child carers experience some unique stresses and value the support of others with similar experiences; this kind of peer support is currently largely absent. This qualitative study has used ten focus groups with foster carers, eight interviews with mothers, and nine interviews with supervising social workers, to inform the development of an online learning resource and a social media‐based peer support network for parent‐and‐child foster carers.     

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.     

Mothering after child removal: Living under the rule of Greek gods

Many women who experience mental illness are mothers. Evidence suggests that the role of mother is of great importance and value to these women, yet they are more likely than other women to have their children removed from their care. Little is known about the experiences of these mothers after their children are removed. This paper presents a phenomenological analysis of in‐depth interviews with 8 women to answer the following question: How do mothers living with severe mental illness experience mothering after removal of their children by child protection services? The analysis showed that mothering continued to be a major life role for these women, but the way they enacted this role was transformed. Their mothering was now constrained and prescribed by external agents, likened to Greek gods, which imposed both boundaries to what they could do and an obligation to prove themselves worthy. Like Greek gods, these external agents were seen as all powerful, unpredictable, and flawed. The study highlights the need for child protection services and support services to recognize and support noncustodial mothering activities.     

Parenting and child experiences in shelter: A qualitative study exploring the effect of homelessness on the parent–child relationship

Depending on the data source, between half a million and 2.48 million children in families experience homelessness each year in the United States. Recent data suggest that approximately half of all homeless children are under the age of 6. A considerable body of quantitative research has documented the occurrence of poor outcomes associated with childhood homelessness in the domains of social–emotional development, physical and behavioral health, academic achievement, and family stability. This qualitative study presents results from 19 interviewers with formerly homeless parents reflecting upon how the experience of being homeless affected their young children and their ability to parent. Findings are contextualized within an attachment perspective. Parental reported effects included confusion, sadness, anxiety or depression, withdrawal, lack of appetite, aggression, and disregard for authority. Parents also talked about the disempowering experience of parenting while in shelter. Unexpectedly, parents of infants said their children were not affected by homelessness, and few parents identified the need for mental health services for their children. The experiences of parents with whom we spoke provide invaluable insight into what shelter staff, social service agencies, philanthropy, policymakers, and researchers can do to support and respect the parent–child relationship in families who are experiencing homelessness.     

Children's and young people's participation within child welfare and child protection services: a state‐of‐the‐art review

This state‐of‐the‐art literature review, based on a literature search of multiple scientific bibliographic databases, aims to shed light on what is known about barriers and factors facilitating child participation within the child protection and child welfare services from both children's and social workers' perspectives. The personal relationship between the child and the social worker is mentioned as one of the most important facilitators for participation, although multiple barriers in creating this relationship are demonstrated by both children and case managers and social workers. In studies, children say they should always participate while social workers and case managers identify many situations where, according to them, participation is inappropriate. Professionals' objections to participation mainly stem from the socio‐cultural image of children as vulnerable and in need of adult protection, and a lack of understanding of what participation actually entails. Interventions to strengthen participation should be directed at making social workers and case managers aware that children are knowledgeable social actors.     

Impact of Mid-Life Symptoms of Alcoholism on the Health and Wellbeing of Aging Parents of Adults with Disabilities

The study examined the effect of adult children’s disability on parents’ physical health in later life and the extent to which parents’ symptoms of alcoholism in mid-life moderates the link between children’s disability and later life parental health. Analyses are based on data from the Wisconsin Longitudinal Study. The analytic sample included parents of children with developmental disabilities (n = 145) or mental health problems (n = 200) and 2,432 parents of unaffected children. The results showed that the negative health consequences in later life of having a child with a developmental disability were greater for those who showed more symptoms of alcoholism in mid-life. However, symptoms of alcoholism in mid-life did not significantly moderate the impact of an adult child’s mental health problems on parents’ later life physical health. The findings suggest a potential area where gerontological social workers could intervene, given the negative impact of symptoms of alcoholism on the health of aging parents of children with a disability who may be significantly more susceptible to the negative health impacts of alcohol compared to their younger counterparts.     

Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

ABSTRACT

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.     

Child protection social workers' constructions of children and childhood: An integrative review

Social workers' constructions of children and childhood are central to how professionals interact with children and support their needs. The aim of this integrative review was to provide a comprehensive portrayal of child protection social workers' constructions of children and childhood. We analysed and synthesized 35 empirical studies with samples of social workers in the child protection domain where issues regarding the child or the child's situation were the study focus. The findings show that children and youth are constructed as a generalized group viewed in light of their parents. We see a fragmented and context‐free child produced by causal shortcuts strongly informed by specific and, at times, simplified and biased psychological knowledge. Moreover, we identify constructions of the child in need of protection and thereby position children as objects for intervention, separating that from children as subjects in their own rights. Although the participatory child is visible in the data material, the actual practice of involving children seems arbitrary.     

Gaining knowledge about parental mental illness: how does it empower children?

This study examined the utility of a digital video disc (DVD) intervention, designed to educate children, whose parents have depression and/or anxiety. Twenty‐nine children completed pre‐ and post‐DVD exposure questionnaires, on mental health knowledge and help seeking, and 18 were interviewed about their experiences and use of the DVD. Post‐DVD, children's knowledge of mental illness improved. The DVD also challenged mental illness misconceptions. Most children preferred watching the DVD with a parent. The study explains how children utilize information about mental illness.     

Experiences of child welfare social workers in addressing substance use among maltreated young mothers to prevent child maltreatment

Substance use during the perinatal period and while parenting can pose a significant risk to children's safety and well-being. Mothers who have experienced child maltreatment are more likely to use substances than mothers without a history of maltreatment. This study explores how child welfare social workers experience supporting young, maltreated mothers struggling with substance use to prevent the intergenerational transmission of child maltreatment. Semi-structured in-depth interviews were conducted with four social workers working with young mothers with a history of maltreatment and substance use. Interpretative Phenomenological Analysis revealed two themes: (1) grappling with system challenges and (2) supporting strategies for disrupting intergenerational transmission of child maltreatment. The results highlight the need for systemic changes around support for social workers who work with young mothers who use substances and have a history of maltreatment, and substance use treatment and mental health programs themselves. Mothers need access to prenatal programs that are trauma-informed, non-judgemental and that support participants' basic needs and parenting skills.     

On the margins of the child protection system: creating space for relational social work practice

In the UK, a threshold divides between two categories of children, child protection (CP) and child in need. Each category tends to be treated as a homogeneous entity, despite containing heterogeneous levels and forms of risk and need. CP practice, accompanied by regulation, protocols and procedures, aspires to achieve a coordinated multi‐agency response to identified concerns with available resources targeted towards this category. However, it is well known that those children assessed as falling just below the CP threshold can still have high levels of need and risk, requiring a level of social work involvement beyond the low‐resource and low‐oversight model that generally accompanies a child in need categorisation. This paper probes an approach to practice, which divides levels of risk within the child in need category enabling adequate, coordinated support and oversight to be provided for children and families with complex needs. Evidence from our study evaluating this approach suggests that a simple protocol provided a clear process within, which social workers and agency partners felt confident and safe to practice outside of the formal CP framework. The protocol prevented drift and helped to create a space within, which relational social work practice flourished.     

‘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.