Inter‐agency joint protocols for safeguarding children in social care and adult mental‐health agencies: a cross‐sectional survey of practitioner experiences

Parental mental illness, substance misuse and domestic violence are common risk factors for the maltreatment and neglect of children. Safeguarding children is everyone's responsibility, including professionals working primarily with adults. In the UK, Local Safeguarding Children Boards (LSCBs) were established to ensure that all agencies work together to safeguard children. Many LSCBs developed multi‐agency joint protocols to enhance collaboration, but there is limited evidence of their effectiveness. This paper reports findings from a cross‐sectional survey of practitioner self‐reported experiences of joint protocols, which was conducted in one inner London borough, to evaluate their impact on professional practice. A self‐complete questionnaire administered to all professionals in adult mental‐health and children's social care services in the borough yielded a response from 119 practitioners. The survey found that the protocols had been widely disseminated and provided clear guidance to practitioners. Practitioners perceived that they had increased awareness of the risk factors for safeguarding children and some had used the protocols to help them gain access to services for their clients. Practitioners also perceived that they had improved inter‐agency working between children's social care and adult mental‐health services. However, respondents indicated that positive interpersonal contact with practitioners from other agencies was equally important in promoting joint working and inter‐agency collaboration.     

Effects of Placement Changes on Health Insurance Stability Among a National Sample of Children in the Child Welfare System

ABSTRACT

Children in the child welfare system have entitlements to health insurance coverage—critical because of their considerable physical and mental health needs—based largely on their placement status. This study conducted path and transitions analyses on data from the National Survey of Child and Adolescent Well-Being (3,801 children followed-up for 3 years) to examine the interplay between placement changes and insurance stability. Children maintained in-home at Wave 1 had significantly lower odds of being insured (OR = 0.7); children transitioning from out-of-home placement to in-home care had significantly lower odds of maintaining insurance coverage (OR = 0.6). Child welfare workers working with children maintained in-home and those being reunified should safeguard the children's insurance status. Policy makers should consider extension of categorical eligibility to all children presenting to child welfare agencies in order to assure access to needed services for these vulnerable children.     

The Social Construction of Reality in the Realm of Children's Mental Health Services

ABSTRACT

Across the United States, systems of care have emerged to provide mental health care to children and their families; fragmentation inhibiting the success of collaboration by stakeholders is common and compromises these systems of care. Survey data were collected from 1,428 respondents in a Midwestern state to examine problems that exist within systems of care from the perspective of the different stakeholder groups. Stakeholder group membership was based upon the respondent's employment or involvement within various child-serving systems and included those in child welfare, juvenile justice, and education, mental health providers, and consumers (i.e., caregivers/parents). Group differences revealed patterns of “finger pointing” by the stakeholder groups on where specific problems exist within systems of care. The findings provide insight into how the social construction of service delivery and practice emerges as stakeholder groups describe, understand, and evaluate problems within the system of care as a function of their own practice location within the system of care. Future research should consider exploring methods that might minimize the competitive nature of disparate child-serving systems and its potentially negative impact upon system performance and treatment outcomes.     

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

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

Do we care? Adult mental health professionals' attitudes towards supporting service users' children

The impact of parental mental health is well known, but children's very existence may fail to be recognized by adult mental‐health services. This study aimed to explore attitudes of mental‐health professionals in one outer London borough regarding support needs of mental‐health service users' children to highlight potential barriers to identifying or meeting their support needs. All statutory mental‐health teams in the borough participated in a cross‐sectional survey. The response rate was 62.8% (n = 94) out of 150. The sample consisted of a diverse range of professionals from both inpatient and community settings. The main finding was that practitioners were overwhelmingly in favour of supporting children. However, attitudes and practices were significantly associated with profession, setting and whether the respondent was a care coordinator. Demographic characteristics or experience was not associated with attitudes. Perceived barriers to supporting children are highlighted. In particular, the mental‐health professionals in our sample considered supporting children important but did not necessarily consider it their role to do so. Training is required to raise awareness about this issue.     

Assessing Health Care Needs Among Street Homeless and Transitionally Housed Adults

ABSTRACT

This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions.     

A family support service for homeless children and parents: user and staff perspectives

Children and their parents who become homeless constitute a group of families with a complex range of social care and health needs, including mental health difficulties. In response to this, a local authority housing department established a family support team (FST) that provides assessment and detection of a range of problems, support to parents and children, parenting interventions for child behavioural problems, liaison with other agencies, and referral to specialist services when appropriate. The aim of this study was to establish the perceptions of parents and staff on their experience of the service, and ways of improving it in the future. The study adopted a developmental evaluation approach and used multiple methods, including in‐depth interviews with families; diaries; reflective activities; participatory learning and action; and observation of the FST. The study mapped the innovative service and captured the range of skills in the team and the complexity of agencies the team interacted with. It also identified areas for further development in terms of the mental health needs of children and parents who have become homeless.     

The mental health status of Latino children in the public child welfare system: a look at the role of generation and origin

As the number of Latino children in public child welfare continues to grow, it is necessary to understand how their mental health is faring. The paper examines emotional and behavioural needs among Latino children who had contact with the public child welfare system. The purpose of this longitudinal study was twofold: to examine the severity of emotional and behavioural problems, and to assess the predictive role of generation status and Latino origin. Latent growth models were completed using the National Survey on Children and Adolescent Well‐Being. The predictive model for the externalizing CBCL scale revealed that generation status and Latino origin were significant predictors. At baseline, Puerto Rican children exhibited higher rates of externalizing problems compared with Mexican children. Over time children who were first/second generation tended to have lower scores compared with the third‐plus generation children. Implications for practise are discussed.     

Who Takes Care of Education? Looked after children's perceptions of support for educational progress

This paper documents the views of a sample of 80 children and young people, aged 10–18 years, living in foster and residential care placements in England, regarding their educational experience whilst being looked after. The children were interviewed as part of an ongoing evaluation of the Taking Care of Education project, a development programme designed to facilitate improvements in the education of looked after children, co‐ordinated by the National Children's Bureau and funded by the Gatsby Charitable Foundation. Interviews with the sample asked children to assess their current educational progress and identify individuals who supported or hindered their education, as well as the availability of educational support in care placements. Teaching staff were frequently mentioned as providers of support, whilst social workers were often associated with hindering educational progress. Children and young people had access to a range of educational supports in care placements, and these were more widely available in residential settings than in foster care. Children offered a range of pertinent suggestions as to how the educational experience of those in the public care system might be improved.     

An agenda for future research regarding the mental health of young people with care experience

Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high-quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under-studied populations; under-studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.     

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

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

Relative foster care: An emerging trend in foster care placement policy and practice

Abstract

Increases in the foster child population, at a time when terminations in foster care placement have decreased along with a decline in the number of non‐related foster parents, has resulted in an increasing use of relative foster care placement. Relative care as an emerging trend in foster care placement, is not without controversy. Its merits, however, should be assessed in terms of its benefits to the children in care, the fiscal and organizational costs, and the problems it creates for the child welfare system. This paper reviews what is known about the characteristics of relative caregivers and the children in their care. Federal and state policies that affect the use of relatives as an alternative placement resource for children are described. The available data regarding the length of time in placement, number of placements, physical, mental health and educational and permanency outcomes for children placed with relatives are discussed. Implications for practice are drawn and areas for further research are suggested.     

Pre–Post Release Health in US Adult Male Convicts

Abstract

This study sought to determine whether need for healthcare and reported health status among adult men (N?=?1,113) in US Federal prisons (in 12 states) changed from pre-release to 15?months after release by analyzing data collected by the Serious and Violent Offender Reentry Initiative (SVORI). Specifically, the study was guided by three questions: (1) were there changes in treatment for specific diseases; (2) were there changes in health status, need for care, and access to and satisfaction with healthcare; and (3) did various social determinants of health predict any of the health outcomes at 15-month follow-up. The analysis of SVORI data found that men reported lower physical and mental health status and declines in receiving treatment following release, but greater satisfaction with healthcare. Further, analysis found the best predictors of health status as being satisfied with access to health care as well as employment. The greatest declines were in mental health treatment, however those ceasing treatment did not report worse physical health status, mental health scores, housing, employment, or recidivism. Future research is needed to determine the significance of the link between employment, satisfaction with access to health care, and health status among ex-prisoners.     

Unexpected Caregiving in Later Life: Illuminating the Narratives of Resilience of Grandmothers and Relative Caregivers through Photovoice Methodology

ABSTRACT

This research study implements photovoice methodology with unexpected caregivers to illuminate the lived experiences of female grandparents and relative caregivers who are raising young children in the later stages of their life. As they enter older adulthood, grandmothers are increasingly finding themselves taking care of their children’s children for various reasons, including, but not limited to, their adult child’s incarceration, mental health issues, drug and alcohol addiction, or child abuse or neglect. Informed by various feminist theoretical lenses, we use photovoice methodology to highlight the narratives of resilience and explore the ways in which grandmothers re-conceptualize their roles and identity as an unexpected caregiver and the sources of strength and resilience that inform the ways in which they navigate the various circumstances in their lives.     

Assessing PTSD and resilience for females who during childhood were exposed to domestic violence

This study examined 68 females, who as children were exposed to domestic violence, to explore childhood risk and protective factors and their relationship to adult levels of post‐traumatic stress disorder (PTSD) and resilience. Independent sample t‐tests indicated significant differences in PTSD levels between participants with and without police involvement during childhood. There were also significant differences in PTSD levels between participants who reported their mothers had mental‐health problems with those who did not. Additionally, participants whose mothers had full‐time steady employment had significantly higher resilience than those with mothers who did not work or worked inconsistently. Implications include advancing ecological theory and conceptual insights regarding childhood risk and protective factors and their association to adult psychological distress and hardiness for daughters exposed to their mothers' intimate partner violence.     

Foster carer perceptions of support and training in the context of high burden of care

The challenges of providing sensitive and structured care for children in foster care go well beyond normative experiences of parenting. The present paper describes a mixed‐methods study of foster carers' perceived need for support and training, referenced to estimates of their burden of care. Semi‐structured interviews were conducted with 17 foster carers in the Canterbury region of New Zealand. Carers' perceived need for support and training were identified through qualitative analysis of interviews using domain analysis method. Carers' burden of care was estimated from the Parenting Stress Index and from a measure of carers' encounters with children's emotional, behavioural and relationship difficulties that was designed for the present study (the Caregiver Behavioural Encounters Index). Foster carers reported substantive, unmet needs for support and training. Foster carers also reported high parenting stress and encounters with a wide range of children's mental health difficulties, including both uncommon and severe difficulties, which together represent an exceptional burden of care. Carers' highest priority need was for training and support on managing and responding to children's mental health difficulties, while their greatest existing support came from Caregiver Liaison Social Workers and other carers. The findings suggest a number of critical implications for practice.     

Predictors of Posttraumatic Growth Among Adult Tsunami Survivors: The Role of Employment,Religion, and Family Attributes

ABSTRACT

This study examined the positive effects of trauma exposure among adult survivors of the 2004 Indian Ocean tsunami and was guided by a bioecological framework. A total of 301 adults from India were assessed for posttraumatic growth and a set of demographic, individual, family, and social capital variables. Hierarchical regression analysis revealed that religion, employment, family type, family flexibility, and family communication were significant predictors of posttraumatic growth. Contrary to expectations, individual factors and social capital did not contribute to posttraumatic growth. Findings imply that helping survivors make meaning out of their traumatic experience may facilitate posttraumatic growth. Intervention to promote increased employment opportunities and family resources is highly recommended for adult trauma survivors. Future trauma research should explore the role of perceived as well as actual familial and community resources, in addition to personal resources, in fostering posttraumatic growth.     

Coping Strategies Among Mothers of Chronically Ill Children: A Case Study in Malaysia

ABSTRACT

 The purpose of this study is to identify the stresses and coping strategies of five mothers in caring for their chronically ill and disabled children. These mothers were receiving services from a nonprofit hospital in Malaysia. Through an in-depth case study design, the findings indicated that emotional stress caused high levels of depression, which decreased life satisfaction that led to poorer physical health. Issues explored included employment, noncooperation of family members, as well as factors related to the mother's individual abilities and how these factors might affect maternal caregiving. Recommendations for future research include identifying probable psychosocial stresses and other associated factors while emphasizing the importance of community-based programs that minimize these stresses.     

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.