Youth and Provider Perspectives on Social Service Providers' Roles in Mental Health Services

ABSTRACT

In 1994 and 1996, the Youth Services Project interviewed 792 youths from St. Louis City. Although the youths showed a high need for mental health services (20% met diagnostic criteria), less than half of the youths with problems received services. Past contact with a social service provider, but not a teacher, physician, etc., significantly predicted care for mental health problems (odds ratio = 1.5). Social service professionals (largely social workers) served more youths than did any other profession. Of youths with persistent problems, 25% received services from social service professionals, 3% from MD/PhD level psychiatrists or psychologists, 7% from primary care medical doctors, 12% from teachers/coaches, 15% from other helpers, and 37% received no services at all.     

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.     

The Buffering Role of Social Support on the Psychosocial Wellbeing of Orphans in Rwanda

Little is known about the buffering role of social support among orphans living in Africa. This study examined (1) how perceived social support (PSS) varied across orphan‐related characteristics (e.g., orphan status, such as single, maternal or paternal, and their living environments, such as in child‐headed households, on the street, in an orphanage or in a foster home) and (2) the relative importance of sources of PSS (relatives/community/adults and peers) and functional social support (emotional/informational/instrumental and social) and its association with emotional well‐being and mental distress. The participants included 430 orphaned Rwandan children and youth aged between 10 and 25 years (Mean age = 17.74), of whom (n = 179, 41.6%) were females and (n = 251, 58.4%) were males. Result showed that children living in an orphanage exhibited a higher level of PSS from all sources of social support than did children in other living environments. A higher level of PSS from relatives, communities and adults was associated with high level of emotional well‐being, and only adult support was associated with low level of mental distress. Furthermore, the functional PSS indicated that emotional support and companionship support were equally important in their association with higher levels of emotional well‐being and lower levels of mental distress. The findings highlight the importance of having different sources of social support and their functions in relation to psychosocial well‐being.     

The Use of Group Work to Fight Acute External Threats to a Community-Based Organization During Harsh Economic Times

This article addresses the use of group work in a community-based outpatient children's mental health agency to respond to financial threats by county and state government during the economic downturn of 2008–2009. Three specific threats that came within months of one another are discussed: (1) the threat to close down a chemical dependency treatment service for youth, (2) severe funding cuts to an outreach program for immigrant youth and their families, and (3) a state government plan to restructure/reform reimbursement for outpatient mental health services that promises to reduce access to care for underinsured families. Group work was used to organize, educate, and activate staff, board, community, and consumer groups, in large and small groups, to counter the threats and build a culture of advocacy. Lending a vision, empowering advocates, managing polarity, and shaping the advocacy message were essential elements of the advocacy process.     

Foster children as young adults: many motherless, fatherless or orphaned: a Swedish national cohort study

We examined prevalence of parental deaths among former out‐of‐home care youths at age 18 and 25, and odds of parental loss compared with peers from similar socio‐economic childhood backgrounds. The study utilized Swedish national register data for 12 entire birth cohorts (1972–1983), 35 550 former out‐of‐home care youths and 1 138 726 cohort peers without out‐of‐home care experiences. Logistic regression models were used to compute odds ratios for parental loss through death. It was especially common among former residents of long‐term out‐of‐home care to be motherless (11%), fatherless (11–13%) or orphaned (3–4%) at age 18, compared with non‐foster care peers (1%, 3% and 0.03%). Twenty‐six per cent had lost at least one parent (4% among non‐foster care peers). At age 25, the figures had increased considerably; 36% had lost at least one parent, compared with 7% in the majority population. Adjusted odds ratios for parental loss among long‐term care youth were strikingly high, particularly for having a deceased mother. In short‐term and intermediate care, most youths with deceased parents had suffered parental loss before entering foster care. For youth from long‐term care, parental death after start of placement was most common.     

Effective services for improving education and employment outcomes for children and alumni of foster care service: correlates and educational and employment outcomes

Outcomes for youth from foster care have been found to be poor. The education and employment outcomes of youth and alumni of foster care served by transition programmes located in five major US cities were examined. Data were collected by case managers and reported to evaluators quarterly on 1058 youth from foster care for over 2 years. Job preparation, transportation, child care, education support services and life skills were the most common services provided to youth. During the 2‐year study period, 35% of participants obtained employment, 23% obtained a General Education Development or diploma, and 17% enrolled in post‐secondary education. It was found that the longer the youth were enrolled, the more education and employment outcomes they achieved. Further, job preparation and income support services were associated significantly with achieving any positive education or employment outcome. Results indicated that certain services provided over an extended period of time can improve outcomes for youth placed in foster care. For youth to achieve positive outcomes as they transition to adulthood, additional services are necessary. Other implications are discussed.     

Incorporating self‐determination into substance abuse prevention programming for youth transitioning from foster care to adulthood

Youth transitioning from foster care to adulthood are at higher risk for alcohol and substance abuse disorders than general population youth. At the same time, these youths are often recipients of strong clinical intervention, often at levels considered unnecessary, for other mental health or behavioural challenges. Because of this, there is sometimes resistance from providers to offer services such as substance abuse prevention programming as it may be seen as contributing to youths' overclinicalization, stigmatization, or retraumatization. Using thematic content analysis, this qualitative study analysed focus groups with community stakeholders providing recommendations on support services for youth transitioning from foster care to adulthood to derive strategies for delivering substance abuse prevention programming in a way that enhances youth self‐determination. Findings were organized by self‐determination theory's 3 key psychological needs: autonomy, competence, and relatedness. All three needs were represented in stakeholder recommendations, which were translated into strategies for bolstering youths' achievement of each need. Strategies include a mix of those already present in motivational interviewing‐based brief substance abuse prevention interventions as well as more unique strategies that are much less frequently employed but that may better meet the needs of youth with foster care experience.     

The Influence of Policy Context on Transition Age Foster Youths' Views of Self-Sufficiency

In this exploratory study, focus group methodology was used to examine the potential influence of policy context on informing transition age youth (TAY) views of self-sufficiency upon aging out of foster care. The authors purposively selected two different policy contexts concerning extended foster care: New York City and Los Angeles County. Compared to New York City, Los Angeles has a relatively newer policy concerning extending the age of foster care benefits to 21. Four focus groups were conducted (2 in each location) with TAY recruited from community-based foster care agencies. The total number of participants (aged 18–22) was 21 (13 in Los Angeles and 8 in New York). In both policy contexts, participants defined self-sufficiency mainly as economic independence and planning for success. However, while Los Angeles TAY emphasized a need to “strive through it,” meaning persevere through self-reliance, New York TAY believed that self-sufficiency could be at least partially achieved by leaning on others, including social services. The findings help to illustrate how varying policy landscapes, including those that are in flux, can shape client understandings of core beliefs related to service utilization and client–provider interactions. Implications for child welfare policy and practice are proposed.     

The Buffering Role of Social Support on the Psychosocial Wellbeing of Orphans in Rwanda

Little is known about the buffering role of social support among orphans living in Africa. This study examined (1) how perceived social support (PSS) varied across orphan‐related characteristics (e.g., orphan status, such as single, maternal or paternal, and their living environments, such as in child‐headed households, on the street, in an orphanage or in a foster home) and (2) the relative importance of sources of PSS (relatives/community/adults and peers) and functional social support (emotional/informational/instrumental and social) and its association with emotional well‐being and mental distress. The participants included 430 orphaned Rwandan children and youth aged between 10 and 25 years (Mean age= 17.74), of whom (n =179, 41.6 percent) were females and (n = 251, 58.4 percent) were males. Result showed that children living in an orphanage exhibited a higher level of PSS from all sources of social support than did children in other living environments. A higher level of PSS from relatives, communities and adults was associated with high level of emotional well‐being, and only adult support was associated with low level of mental distress. Furthermore, the functional PSS indicated that emotional support and companionship support were equally important in their association with higher levels of emotional well‐being and lower levels of mental distress. The findings highlight the importance of having different sources of social support and their functions in relation to psychosocial well‐being.     

Interconnections among Homelessness,Family Separation,and Mental Health: Implications for Multi-Sectoral Social Services

This qualitative study explored the interconnections among the phenomena of homelessness, family separation, and mental health and substance abuse issues within the social services, geographic, and infrastructure context of northern Ontario. In-depth semi-structured interviews were conducted with thirteen participants. Findings revealed the effects of colonization in the form of poor and overcrowded housing conditions in the northern First Nations, difficulties in obtaining affordable and suitable housing in northern towns and cities, reliance on the scarce social services for survival, and valiant attempts to cope with the cold climate of northern Ontario. All participants reported multiple and intergenerational experiences of separation from family due to involvement of child welfare system, placement in residential schools, death of family member(s), flooding, and epidemics. Participants described their lifelong struggles with mental health and substance abuse issues. All three phenomena were tied together in various configurations of causes and consequences. The implications include the need for critical examination of the historical policies and practices, early intervention for mental health and substance abuse issues, greater support for youth transitioning out of care, creation of a continuum of housing options, collaboration across multiple social services sectors, and incorporation of Indigenous worldview and practices in the mainstream services.     

Youth and parent perceptions of aftercare supports at discharge from residential care

While much is known about youth struggles after reintegration into the home and community settings following stays in out‐of‐home care, little is known about appropriate supports for aftercare, or parent (see Note ¹ ) and youth perceptions during this critical transition period. This study seeks to begin to address these questions through surveys evaluating youth (n = 48) and parent (n = 48) perceptions of (i) transition planning, family preparedness and aftercare; (ii) youth preparedness for the transition period across major life domains (e.g. education, health care, relationships); and (iii) the importance of specific aftercare supports and services. Results indicate differences between youth and parents on perceptions of need for continued supports, likelihood of participation in aftercare programs; and youth preparedness for success in relationships, family and independent living domains. In contrast, similarities were found on youth and parent ratings regarding the importance of specific services and supports, with both groups indicating supports in education as most important and supports in mental health as least. Study limitations, future research and implications are provided.     

A Leadership Training Group for at Risk Fifth & Seventh Graders: Results from A Brief Strength-Based Group Program

ABSTRACT

An increasing number of youth are exhibiting social, emotional, and behavioral problems that hinder their ability to function at grade level. Subsequently, school mental health services have not been able to address the need for services particularly among students who are minority and poor. A mixed methodology study was conducted to determine the treatment outcomes from a brief strength-based leadership training group for primarily students who are African American and poor. Pre–post scores on three scales and focus group data revealed significant positive changes in regard to internal areas of functioning and social skills, anger management skills, and school attitude. Gender and age significantly impacted outcomes.     

The influence of social and ethnic segmentation on consultation in primary health care

This paper analyses the utilization of primary health care by a population of whom 28% were not born in Sweden. The study emphasizes the impact of demography, housing and economic factors on the structure of the residential area. Households with meagre financial resources, large families and most of the immigrant population were tenants in multiple-occupancy blocks. Further, when demographic development was analysed over a decade, high turnover and a low median age were found in 2 of the multiple-occupancy areas, indicating social instability. The study revealed a process of both socioeconomic and ethnic segmentation (non-spatial segregation in a residential area). The age- and sex-standardized relative risks (RR) showed that the population in subareas consisting of multiple-occupancy housing in socially unstable areas also had an increased risk of having to visit primary health care. There were no differences in the number of visits to primary health care between people born in Sweden and those born outside Sweden (relative risk (RR) = 1.09,95% confidence interval (CI) = 0.90–1.30), but those born outside Sweden more often made visits that lasted longer than 30 minutes (odds ratio (OR) = 3.75, 95% CI = 2.09–6.71).     

跨国社会工作：全纳式模式

本文将对作为跨国社会工作模式的全纳式服务输出进行探索。全纳式模式（Wraparound Model）最初应用于社区儿童心理健康服务以及儿童保护行动中。这种模式可以有效的为需求复杂,并且需要多个服务提供者的客户及家庭进行服务规划。目前大多数社会工作属于国内或国际性输出,很少需要跨国完成,本文将就如何构建该模式以适应跨国移民的特殊需求（涉及非政府组织（NGO）和国际性非政府组织（INGO）的参与）进行概括,并说明其中主要的障碍和限制。     

It Takes a Village to Deliver and Test Child and Family-Focused Services

OBJECTIVES: The purpose of this article is to highlight the benefits of collaboration in child focused mental health services research. METHOD: Three unique research projects are described. These projects address the mental health needs of vulnerable, urban, minority children and their families. In each one, service delivery was codesigned, interventions were co-delivered and a team of stakeholders collaboratively tested the impact of each one. RESULTS: The results indicate that the three interventions designed, delivered, and tested are associated with reductions in youth mental health symptoms. CONCLUSION: These interventions are feasible alternatives to traditional individualized outpatient treatment.     

Transitions of Youth in Mental Health Residential Care to Less Restrictive Settings: The Role of Strengths and Gender

ABSTRACT

Changes in youth's behavioral/psychosocial functioning has been found to play an important role in the transitions from mental health residential care to less restrictive settings, and this functioning differs significantly by gender. However, there has been little attention paid to the roles played by psychosocial strength and gender in transitions out of residential care. The current study examined gender differences in the role of strengths in transitions to less restrictive settings using data on 675 youth's admission and discharge records collected from Illinois Residential Treatment Outcome System during 2005–2007 (Mean age = 15 years, SD = 2.0; 57.5% = boys). The results of multivariate logistic regression model indicated that positive recreational activities and lack of chronic illness were related to a higher likelihood of transitions to less restrictive settings among girls, while appropriate sexual development, psychological strengths, and strong spiritual/religious strengths were related to the transitions among boys. This study demonstrates the potential importance of youth strengths in the provision of mental health services and suggests a need to develop models of outcomes that take gender into account. Additional research based on multiple informants including youth self-report is needed to understand the role of gender in transitions out of residential care.     

The Relationship Between Homebound Older People and Their Home Care Workers,or "The Pas de Deux" of Home Care

The multiple components in the provision of home care services, as distinct from home health care, are examined in this paper. Specifically addressed are the unique aspects of the setting, the particular characteristics of the elderly in need of care, the challenges to the care provider, and the dynamics of the relationship between the recipient and provider of care. Data were obtained from a sample (n = 200) of inner-city hospital clinic patients, aged 65+, of which 34% (n = 68) were home care clients. Practitioners can best design successful home care programs if consideration is given not only to a person's physical needs but also to their individual characteristics and those of the home care provider.     

Breaking the mould: new trajectories in the domiciliary care of older people in Ireland

This article reviews the development of domiciliary care services for older people in Ireland over the last decade. It reveals three central developments, namely (i) the first steps, in the Irish context, towards a quasi-market; (ii) the introduction of cash-for-care and the subsequent notable segmentation of care tasks among three provider groups; and (iii) a rapidly increasing reliance on for-profit private home care providers. The authors conclude that while the Irish social care regime is still anchored in important ways in the primacy of informal (family) care and the subsidiarity principle, it has broken path-dependency by evolving towards an increasingly complex mix of public, not-for-profit and for-profit provision and financing. The most policy-relevant aspect of this new constellation is the lack of a regulatory framework that would enable the State to monitor the multiple and diverse providers with the view to ensuring the quality of home care services.