Mental Needs of Aboriginal Foster Parents

Aboriginal foster parents were surveyed about their mental needs. Each was asked “What do you need mentally to be a good foster parent?”. A total of 58 unique responses were made. They were grouped together by participants and the grouping data were analyzed using multidimensional scaling and cluster analysis. Seven concepts resulted from the analysis. The concepts included: knowledge, breaks, recognition, optimism, discipline, patience and determination. Results were compared and contrasted with the fostering literature.     

Social Work Practices for Young People with Complex Needs: An Integrative Review

The aim of this integrative review is to investigate research of social work practices for adolescents and young adults with complex needs. The research questions are: What are the major themes in studies of practices for young people with complex needs? How do studies suggest that complex needs can be met in ways that are beneficial for young people? A young person with complex needs is in this review defined as an adolescent or young adult who, due to mental ill-health in combination with different types of social vulnerabilities, is receiving assistance from multiple welfare services. Searches were conducted in seven databases. These searches resulted in a sample of 1677 records, published 2007–2016, which in the screening process were reduced to 24 publications, all peer-reviewed articles. The participants in the studies in the articles consisted of young people, parents and professionals from mainly Anglo-Saxon countries. The articles were analyzed with qualitative summative content analysis. Three empirically generated themes were found in studies of work practices targeting young people with complex needs: collaboration-, relationship- and empowerment-oriented practices. In conclusion, the practices contain a wide variety of features, but with the joint aim of acknowledging young people’s needs. The results can be used by practitioners and policymakers to further the development of services for youth with mental ill-health and social vulnerabilities, who use multiple welfare services.     

A Child‐inclusive Family Intervention in a Community Adult Mental Health Service

In this paper we describe an intervention that focuses on the needs of children in families where a parent has a mental illness and attends a community adult mental health setting. After a brief outline of the literature, we present a family approach that includes children and young people, their parents and grandparents. Case studies then illustrate the work as a ‘best practice’ for parents who are clients in community adult mental health services.     

Outcomes of Parent–Child Interaction Therapy in an urban community clinic: A comparison of treatment completers and dropouts

This study examined outcomes of Parent–Child Interaction Therapy (PCIT) for 52 clinically referred children with oppositional behavior and their parents treated in an urban, community mental health clinic serving demographically (i.e., income level, ethnicity) diverse families. Standardized observations of parent–child interactions and parent reported measures of child behavior were collected at pre- and post-treatment. We addressed two primary research questions: (1) What are pre-treatment predictors of treatment completion? (2) What are treatment outcomes both for families who successfully completed PCIT and for treatment dropouts? Multiple logistic regression results showed a significantly greater likelihood of treatment completion related to higher parent education, male child gender, and two parent households. Among families who completed treatment, pre–post data demonstrated significant parent change in observed skill use and improvement in parent reported disruptive behaviors with medium to large effect sizes. Findings also documented early treatment benefits for families who completed the first phase of PCIT but dropped out in the final phase prior to meeting full graduation criteria. We discuss the findings and implications for community-based applications of PCIT in the context of community mental health's mission to provide effective treatment and maximize community access to services.     

Mental Illness and the Criminal Justice System

This is the second essay in a two‐part series exploring the relationships between mental illness, criminal behavior, and the criminal justice system. The number of mentally ill persons in prisons and jails has increased substantially over the last several decades, and there are currently more people with mental illness behind bars than there are in mental hospitals. In this essay, we place these trends within a broader historical context of the social control of mental illness in the United States. We identify how and why mentally ill persons have come to be overrepresented in the criminal justice system and highlight the unique challenges this population poses for police, courts, and correctional facilities. Finally, we review several recent innovations in policy and practice that may help alleviate that burden of criminal justice involvement on mentally ill offenders, as well as the burden of mentally ill offenders on the criminal justice system.     

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.     

Brief admission program. An alliance of inpatient care and outpatient case management

1. Brief planned and crisis admissions to an inpatient psychiatric unit are presented as a component supportive of outpatient care and case management for chronically mentally ill patients. 2. Typical patients admitted to this inpatient short-term program are those experiencing a life stress or temporary crisis; chronically mentally ill patients who cycle and experience exacerbations of their illness; and those who need to make the transition from an acute inpatient unit to community living. 3. The Brief Admission Program treats the individual's response to and the consequences of a lifelong illness and enables the patient to return to his previous level of functioning and continue necessary outpatient treatment.     

Exploring Knowledge through Peer Tutoring in a Transitional Learning Community: An Alternative Way of Teaching Counseling Skills to Students in Social Work Education

This article is a critical review of Crossing Bridges, a Department of Health training pack for those working with 'mentally ill' parents and their children. The author argues, on the basis of both personal and professional experience, that although the pack pays lip-service to the significance of structural factors, the training resources are primarily rooted in an individual and family-focused pathology model of mental illness. Three arguments are put forward for the necessity of a wider framework: the significance of shame and stigma to those experiencing mental distress and their families; the predominance of understandings of mental illness that translate social phenomena into individualised problems, notably genetic explanations and attributions of risk and dangerousness; and the contribution of motherhood to the experiencing of mental distress in women. Initiatives within the mental health survivor movement are highlighted as examples promoting positive images of mental distress, and the implications of the issues raised for social work education are considered. The article concludes that efforts to help the children of 'mentally ill' parents, not to mention the parents themselves, must incorporate wider strategies to promote openness, respect, acceptance and ultimately, social inclusion, of those who experience mental distress.     

Parent Marital Quality and the Parent–Adolescent Relationship: Effects on Adolescent and Young Adult Health Outcomes

Although a number of studies examined the implications of marital disruption for adolescent well-being, few studied the implications of marital relationship quality on health outcomes for children in married-couple families. The present study examines how parent marital quality among intact families interacts with the quality of parent–adolescent relationships to predict physical health, mental health, and substance use in middle adolescence and early adulthood. The study uses data from the NLSY97 cohort, a nationally representative sample of adolescents who are being followed into adulthood. Predictors include the quality of the parent marital relationship, the quality of the parent–adolescent relationship, marital structure, and a number of contextual covariates and control variables. Combined parent marital quality and parent–adolescent relationship groups were developed using latent class analyses and were used to predict positive and negative health behaviors during the teen and early adult years. Results indicate that adolescents in families experiencing poor marital quality fared worse on physical health, mental health, and substance use outcomes. In addition, adolescents who reported poor relationships with at least one of their parents fared worse on outcomes. Adolescents whose parents have low-quality relationships and also have poor parent–adolescent relationships tended to fare least well across health measures. Adolescents whose parents have a high-quality relationship and who have a good parent–adolescent relationship with both parents consistently had the best outcomes. Overall, poor relationships consistently undermine mental health, physical health, and substance use. Family religious activities also consistently predict better health outcomes.     

The career of the mentally ill: an integration of psychiatric, labeling/social construction, and lay perspectives

This paper provides a new way of conceptualizing the career of the mentally ill. Most persons who experience an episode of a serious mental disturbance lead a normal life, while a few persons lead lifetimes that revolve around their mental disorders. The processes leading to either result can only be understood by integrating the traditional labeling and psychiatric perspectives with lay understandings of the concepts of "mental illness" and "nervous breakdowns." A selection of key concepts from these perspectives leads to a better understanding of the different paths persons take as they move through the pre-patient, inpatient, and post-patient phases of the "career of the mentally ill." This perspective makes understandable a number of counterintuitive relationships. For example, it explains why most hospitalized mental patients (1) have a negative stereotype of the "mentally ill," (2) do not perceive themselves as "mentally ill, yet (3) perceive themselves as benefiting from treatment, and (4) do not progress into a career of secondary deviance.     

A multi-site study of the ACT Raising Safe Kids program: Predictors of outcomes and attrition

The present study examined the factors related to attrition and treatment outcomes in the ACT-Raising Safe Kids (ACT-RSK) program. ACT-RSK is a family violence and child abuse prevention program for parents and caregivers of young children. Sixty parents or caregivers of children aged 9 years or younger completed the ACT-RSK group program and the research measures. The study took place at 7 community-based sites in the midwestern United States. Program completers were significantly older than noncompleters, suggesting that parent age relates to attrition from this program. Pre/post comparisons indicated increased nurturing behavior, decreased harsh parenting, and decreased negative discipline, as well as decreased child behavior problems following completion of the ACT-RSK program. Parent age predicted children's outcomes, indicating better results for the children of older parents/caregivers. In addition, pre-test harsh parenting scores predicted children's outcomes, suggesting that families with relatively higher initial levels of parental psychological aggression and corporal punishment had more robust child outcomes following completion of the program.     

Conceptualizing psychosocial nursing in the jail setting

1. The deinstitutionalization movement led to the release of thousands of mentally ill patients, many of whom were incarcerated as a way of dealing with their disturbed behavior. More restrictive civil commitment laws have also contributed to the number of mentally ill who are incarcerated. 2. Health care and security can be perceived as competing interests in the correctional institution. These competing interests may also be perceived as sources of conflict because each interest aims towards divergent goals that interfere with the other. 3. A problem central to the inadequate services for the mentally ill offender is that few people are aware of the poor conditions for this population. Correctional and mental health organizations must educate the public about the plight of the mentally ill offender.     

Behaviors and Strategies Employed in Parental Alienation

Abstract

A survey study was conducted of adults who self reported being targets of parental alienation. Three research questions were addressed: (1) What alienating strategies were identified by the targeted parents and to what extent were these behaviors consistent with those identified by adult children of PAS? (2) Was gender of the targeted parent associated with number and/or type of strategy identified? And (3) What child and parent characteristics were associated with level of PAS (mild, moderate, severe) as described by the targeted parents? Ninety-seven individuals completed a written survey. One section of the survey asked participants to list every type of behavior that they believed the alienating parent used to effectuate the alienation. From prior research and review of the responses, a list of possible strategies was developed. The 1,300 actions described by the 97 participants were independently coded. Results revealed 66 types of strategies, 11 mentioned by at least 20% of the sample. There was considerable but not complete overlap in the strategies identified by the targeted parents with those described by adult children (from another study). There were no statistical differences in the number or type of strategy mentioned based on the gender of the targeted parent or the gender of the target child. Level of severity of PAS (mild, moderate, severe) as perceived by the targeted parent was associated with age and gender of the target child, with girls and older children being more likely to be reported as more severely alienated. These results provide a systematic examination of the different types of alienation strategies known to targeted parents and as such they offer several avenues for clinical interventions and future research.     

Deinstitutionalization: a public policy perspective

1. Deinstitutionalization was initiated in an era of social reform to protect the rights of the mentally ill; however, a strong research base was absent and led to major flaws in the policy's implementation. 2. The chronically mentally ill are frequently poor advocates for themselves and, without even the most simple needs fulfilled, end up homeless. 3. The homeless mentally ill require comprehensive support systems with assured continuity of care. An emerging concept to deal with this issue is that of case management. 4. The mental health professional can strive to influence future public policy as patient advocate and nonpartisan educator.     

A life course approach to understanding homelessness of shelter residents

ABSTRACT

Using in-depth interviews of 40 residents from a homeless shelter in El Paso, Texas in the United States, this study examines the etiology, processes, and patterns of homelessness by assessing those confronting homeless spells at different time points and for varying reasons. Our study is guided by the research questions: How did residents of homeless shelters experience transitions and turning points of homelessness? What were the coping resources that homeless people drew on to overcome life adversities? Overall, we found that risk accumulation as a result of different traumatic events, such as death of a family member, marital or relationship breakdown, victimization, unemployment, substance addiction, poor mental health, or discrimination confronted in varied contexts, could serve as precursors or consequences that exacerbated the housing crisis over the course of a life. We recommend that efforts geared toward remediating, alleviating, or preventing homelessness be life course driven. It is only through compassion and empathy rather than criminalizing and stigmatizing that we can help stop the triggers and spread of the downward spiral of homelessness.     

The family caregiving context among adults with disabilities: A review of the research on developmental disabilities,serious mental illness,and traumatic brain injury

ABSTRACT

A majority of adults with serious disabilities are cared for in the home by family members. Guided by an ecological framework, this article presents the findings of a literature review of research on family caregiving and family support for adults with disabilities. This review included 33 research studies published between 2000 and 2015 focused on three disabilities: Developmental disabilities, serious mental illnesses, and traumatic brain injury. A synthesis of the findings underscores the critical role that family caregivers occupy in addressing the needs of their loved one with a disability; however, the needs of the caregiver are insufficiently met by existing service approaches. A better understanding of the unique needs and strengths of the family support context of caregivers and care recipients is needed, giving greater attention to ethnic, racial, and cultural considerations in future research.     

Psychiatric nursing in the 1990s & beyond.

In the decade of the '90s, psychiatric mental health nursing will need to take stock of itself--its practice, its education, and its research--if it is to successfully prepare for the changes in care of the mentally ill. Like psychiatrists, we will need to rethink our agendas in light of new science and technology and rationalize the mental health delivery system and our role in it through systematic research and advocate for a system that provides quality care for the chronically ill and the poor. In the next century, we will need to rethink the basics of nursing care and the leadership roles of nurses as hospitals and the doctor's role within them changes. Psychiatric mental health nurses will need to be at the forefront in advocating for a delivery system that listens to patients and families, that humanizes the dehumanizing experience of hospitalization. The challenges before us are formidable.     

ATTITUDES TOWARD THE MENTALLY ILL:

Labeling theory posits that people labeled mentally ill experience negative societal reactions. Past research on this question is contradictory, due primarily to methodological problems. This study overcomes some of these problems by having respondents indicate their willingness to interact with a person with a specific mental disorder, or with an identically behaving person with a specific physical disorder. As expected, respondents reject the mentally ill significantly more than identically behaving physically ill persons, as supports labeling theory. Respondents also consider the mentally ill less predictable and to have less positive outcomes than those with physical illness. These beliefs highly correlate with rejection and account for some, but not all, of the effects of label on rejection.     

Single Parent Widows:

This paper examines the stressors, appraisal of be- reavement, coping, resources, grieving responses and health of four types of single widow parents: widows raising dependent children; widows raising a handicapped child; independent older widows with children; and dependent, ill, older widows with a child. A review of literature on single parent widow families and data from the authors research on single parent widows served as a basis for this paper. Major gaps in knowledge include: limited research on single parent widow families including longitudinal and theory-based research; findings which are based on small samples of single parent widows who are often mixed with other single parent types; little research on single parent widows from Black, Hispanic and other ethnic groups; and few studies on resources used by widows. A secondary analysis of data from the authors research indicated characteristics of high- risk, vulnerable, and healthy single parent widow families. High-risk single parent widow families are characterized by: presence of mul- tiple stressors; intense grieving; appraisal of bereavement as a threat or harmful loss; use of less adaptive coping; limited use of resources;and poor health. Characteristics of vulnerable single parent widow families include: presence of stressors including an unresolved grieving process; negative appraisals of bereavement with hope for a more positive appraisal in the future; limited coping abilities; use of some resources such as helpful social supports; and less than op- timum health which can improve with intervention. Positive mean- ings of bereavement, use of adaptive ways of coping, a normal grieving process, use of many resources, and good health are charac- teristics which are prevalent in healthy single parent widow families. Themes in common to all four family types were: the grieving pro- cess; changes in roles and responsibilities; employment; loneliness; dating and remarriage; and caregiver stress. Directions for future research and implications for family professionals are discussed.     

Hidden Epidemic

Abstract

Rates of HIV infection among the seriously and persistently mentally ill contradict the widely held belief that this population is not at high risk for HIV exposure. The literature suggests that, in part, due to pervasive misconceptions around issues of sexuality and illicit drug use, HI V-positive, mentally ill individuals are not receiving appropriate care. This article focuses on the interplay of mental illness, HIV infection, and service provision through a review of the literature and the presentation of a case study. Available services are detailed and barriers to their success discussed. The importance of comprehensive community-based services specifically designed to address the multifaceted needs of this population is highlighted.