Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

Queering Child and Adolescent Mental Health Services: The Subversion of Heteronormativity in Practice

This article explores the exercise of heterosexist‐infused power relations within a Child and Adolescent Mental Health Services (CAMHS) inpatient unit in the UK. The ways in which heterosexism may wield its power within CAMHS in conjunction with the support of sexism, adultism, classism and sanism are discussed. That is, this article contributes to the understanding and subverting of heteronormativity in practice. With this focus in mind, other forms of intersecting oppressions are detailed to highlight the role they play in both controlling young people and teaching them about the workings of patriarchy and social norms. The aim of the article is to contribute to the disruption of the heteronormativity inherent in the arrangements within CAMHS and the dominant normative practice that produces multiple subjectivities in this setting.     

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.     

Collaborative Data-Mining in an Adolescent Mental Health Service

Summary

As full participants in a collaborative clinical data-mining project intended to promote staff reflection and to improve services, clinicians discovered just how valuable their practice expertise was in maintaining project relevance. In this paper, they describe challenges they faced as non-experienced researchers and writers and how their practice skills enabled them to overcome these challenges. Benefits derived include: enhanced skills (in both practice and research), sensitization to previously overlooked areas of practice, and an increased sense of professionalism.     

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.     

Adolescent Attachment Trajectories With Mothers and Fathers: The Importance of Parent–Child Relationship Experiences and Gender

This longitudinal study investigated how attachment with mothers and fathers changes during adolescence, and how gender and parent–child relationship experiences are associated with attachment trajectories. The relative importance of specific positive and negative relationship experiences on attachment trajectories was also examined. An initial sample of 223 adolescents reported on relationship experiences and attachment avoidance and anxiety with mothers and fathers in Grades 6, 8, 10, and 12 (final N = 110; M_age = 11.90 years at onset, SD = .43). Mothers and fathers reported on relationship experiences with adolescents. Hierarchical linear modeling showed that security with parents increased during adolescence. Positive relationship experiences (companionship, satisfaction, approval, support) predicted increases in security, and negative experiences (pressure, criticism) predicted decreases in security. Females reported less avoidance than males.     

Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Many foster parents are ill prepared to meet the behavioral needs of children placed in their homes. Research suggests they lack training in evidence-based behavioral interventions and feel unsupported by child welfare professionals. Given the complex needs of foster children and increased rates of placement disruption for foster children with behavior problems, implementation of effective interventions is essential. However, little is known about foster parents' receptivity to these types of interventions. In this qualitative study, we examine urban foster parents' perceptions of the specific elements of parent management training (PMT), an evidence-based treatment for disruptive behaviors that teaches parents to improve desired behaviors and decrease oppositional behaviors by rewarding positive behaviors (positive reinforcement) and responding to negative behaviors with mild, consistent punishments such as timeout or a privilege removal. We present data from four focus groups (N = 38). While the questions focused on parent's perceptions of PMT, responses often related to parent interactions with agency staff. Four strong themes emerged from the data. First, foster parents discussed a need for more support and training in how to address children's behaviors, but also had concerns that some PMT discipline techniques would be ineffective based on their past experiences with foster children. Second, they described how staff communication skills and allegations of child abuse could affect parents' motivation to continue fostering. Third, they expressed a need for more detailed information about children's histories and visits with biological families as the lack of information contributed to difficulty in meeting foster children's needs. They suggested that joint training of foster parents and staff in the intervention could improve their ability to work together to support the child's positive behaviors. Finally, parents reported little involvement in child mental health services and doubted the effectiveness of the mental health services their foster children received.     

网络依赖与心理健康的关系--一项以大学生为对象的调查研究

引言 随着信息技术革命的到来,网络的使用在全世界飞速发展.与此同时,与网络使用有关的问题也越来越受到人们的关注.当很多人面对大量的信息感到困惑和茫然时,另一些人则因为他们在网上的新发现而欣喜若狂,甚至不愿离线.也就是说,有人非常依赖网络,就象赌博上瘾一样.这种现象被称为"网络依赖"(Internet Addiction Disorder)--一种行为依赖或者称为科技依赖,并且受到了心理学家们的关注.     

Latent Classes of Adolescent Sexual and Romantic Relationship Experiences: Implications for Adult Sexual Health and Relationship Outcomes

Adolescents’ sexual and romantic relationship experiences are multidimensional but often studied as single constructs. Thus, it is not clear how different patterns of sexual and relationship experience may interact to differentially predict later outcomes. In this study we used latent class analysis to model patterns (latent classes) of adolescent sexual and romantic experiences, and then examined how these classes were associated with young adult sexual health and relationship outcomes in data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We identified six adolescent relationship classes: No Relationship (33%), Waiting (22%), Intimate (38%), Private (3%), Low Involvement (3%), and Physical (2%). Adolescents in the Waiting and Intimate classes were more likely to have married by young adulthood than those in other classes, and those in the Physical class had a greater number of sexual partners and higher rates of sexually transmitted infections (STIs). Some gender differences were found; for example, women in the Low-Involvement and Physical classes in adolescence had average or high odds of marriage, whereas men in these classes had relatively low odds of marriage. Our findings identify more and less normative patterns of romantic and sexual experiences in late adolescence and elucidate associations between adolescent experiences and adult outcomes.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

Partnering for Mental Health Promotion: Implementing Evidence Based Mental Health Services Within a Maternal and Child Home Health Visiting Program

This article details the clinical foundations of a social work focused community-based participatory research project promoting women’s mental health during and around the time of pregnancy. Specifically, we discuss the theoretical, empirical and organizational implementation of an enhanced engagement model of mental health service delivery that integrates evidenced based practices into the structure and services of an existing non-profit maternal and child health home visiting agency. The model is grounded in literature addressing barriers to accessing mental health care among minority women living in low-income communities. We discuss informing the intervention through direct consumer involvement, as well the rationale supporting the inclusion of Interpersonal Psychotherapy and Cognitive Behavioral Therapy into the design and implementation of the model which emphasizes adequate training of staff with varying levels of mental health experience. Finally, we describe typical client situations and responses reflected by the Enhanced Engagement model and discuss future implications of this approach as a way to offer meaningful intervention to women and families who may not have access or eligibility to utilize specialty mental health services.     

Working‐Class Jobs and New Parents' Mental Health

Little research has explored linkages between work conditions and mental health in working‐class employed parents. The current study aims to address this gap, employing hierarchical linear modeling techniques to examine how levels of and changes in job autonomy, job urgency, supervisor support, and coworker support predicted parents' depressive symptoms in a sample of 113 dual‐earner couples interviewed five times across the transition to parenthood. Increases in job autonomy and decreases in job urgency predicted fewer depressive symptoms in fathers at 1 year postpartum. For mothers, coworker support predicted fewer depressive symptoms, and supervisor support mitigated the negative effects of job urgency on depressive symptoms. Higher work hours coupled with low job urgency predicted declines in mothers' depressive symptoms across the first year of parenthood. Our findings suggest that interventions that lead to greater autonomy, less job urgency, and more supportive work relations may enhance employee well‐being among working‐class families.     

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.     

Paths to Intimate Relationship Quality From Parent–Adolescent Relations and Mental Health

Using a developmental systems perspective and public‐use longitudinal data from participants currently in a romantic relationship at Wave 4 of the National Longitudinal Study of Adolescent Health (n = 2,970), the current study explored direct and indirect paths from parent–adolescent relationship quality to young adult intimate relationship quality. Structural equation modeling tested whether mental health (depressive symptoms and self‐esteem) in the transition to adulthood mediated the association between parent–adolescent relations and young adult intimate relations. The results indicated that higher quality parent–adolescent relations predicted higher self‐esteem and lower depressive symptoms during the transition to adulthood as well as higher young adult intimate relationship quality, controlling for adolescent mental health and parent–young adult relationship quality. Higher self‐esteem during the transition to adulthood was associated with greater intimate relationship quality, whereas greater depressive symptomatology predicted reduced intimate relationship quality. One significant indirect path emerged: parent–adolescent relationship quality → self‐esteem → intimate relationship quality.     

At Risk: The Relationship between Experiences of Child Sexual Abuse and Women's HIV Status in Papua New Guinea

Child sexual abuse in Papua New Guinea is a human rights issue as well as an indicator of HIV risk in women. This study aimed to develop knowledge about the link between violence experienced by women and their HIV status. The study used a mixed method approach to collect quantitative and qualitative data through structured interviews with a sample of 415 women across four provinces of Papua New Guinea: National Capital District, Western Highlands, Western, and Morobe. Participants were asked about violence they had experienced as children and in their adult relationships and the impact of the violence. The quantitative data was analyzed using SPSS, and qualitative data was coded using a thematic approach. Child sexual abuse was reported by 27.5% of the sample (n?=?114). Women reporting child sexual abuse were more likely to live in violent relationships, be HIV positive, and have a higher number of sexual partners.     

Exploring the Relationship Among Mental Health Concerns,Social Support,and Relationship Satisfaction in Female Same-Sex Couples

The purpose of this quantitative study was to examine the relationship among internal factors (mental health concerns) that affect relationship satisfaction and contextual factors (social support) that affect relationship satisfaction in female same-sex couples (N = 99). Correlation and regression analyses indicated significant relationships among the variables. Specifically, mental health concerns were negatively correlated with relationship satisfaction whereas social support was positively correlated with relationship satisfaction. Mental health concerns and social support were found to be significant predictors of relationship satisfaction. Implications for practitioners are provided.     

Parental Divorce and Child Mental Health Trajectories

A process‐oriented approach to parental divorce locates the experience within the social and developmental context of children's lives, providing greater insight into how parental divorce produces vulnerability in some children and resiliency in others. The current study involves prospectively tracking a nationally representative sample of Canadian children of ages 4–7 and living with two biological parents at initial interview in 1994 (N = 2,819), and comparing the mental health trajectories of children whose parents remain married with those whose parents divorce by 1998. Results from growth curve models confirm that, even before marital breakup, children whose parents later divorce exhibit higher levels of anxiety/depression and antisocial behavior than children whose parents remain married. There is a further increase in child anxiety/depression but not antisocial behavior associated with the event of parental divorce itself. Controlling for predivorce parental socioeconomic and psychosocial resources fully accounts for poorer child mental health at initial interview among children whose parents later divorce, but does not explain the divorce‐specific increase in anxiety/depression. Finally, a significant interaction between parental divorce and predivorce levels of family dysfunction suggests that child antisocial behavior decreases when marriages in highly dysfunctional families are dissolved.