Supporting families: Outcomes of placement in voluntary out-of-home care for children and young people with disabilities and their families

Parents caring for children and young people with disabilities typically have extensive additional demands on their time and resources. This added pressure can significantly impact well-being and mental health. In extreme circumstances, parents may seek an out-of-home placement for their child. Previous research has looked into factors that influence decisions for families to place their child into out-of-home care but little is known about outcomes for these young people and their families. The Supporting Families study aimed to explore the impact of a voluntary out-of-home placement on young people with disabilities, and consequences for their families. Fourteen parents/carers, twenty six case managers, six accommodation services' managers, and four young people with disabilities participated in face-to-face and telephone interviews and focus groups. Participants reported a range of outcomes for young people in care. Positive outcomes included increased levels of respect for themselves and others, an improvement in independent living skills, and reductions in challenging behaviours. Negative outcomes centred on their experiences of grief, loss and rejection, as well as behavioural problems. Positive and negative outcomes were also found for families. For many parents/carers there was a reduction in perceived stress and caring load, as well as improved mental health and wellbeing for them and the child's siblings. However, parents/carers often experienced ongoing feelings of guilt, grief and loss. The study adds to knowledge about outcomes of being in voluntary out-of-home care for this small but vulnerable group of young people in care and their families.     

Children and Families Seeking Asylum in Northern Norway: Living Conditions and Mental Health

The mental health of children seeking asylum and their families is a somewhat neglected area of research. Research on refugee children and children living with adversities suggests that environmental factors are crucial in preventing mental health problems. In this study, we aim to identify central environmental conditions that affect the mental health of children living with their families at governmental asylum processing centres in northern Norway. This study has a qualitative design, and is based on 11 focus group interviews with the staff at asylum processing centres. The interviews were transcribed verbatim and analysed focusing on important risk and protective factors for mental health problems presented by the informants. The results highlighted time spent at asylum centres and the parent's mental health as the most important risk factors. Schooling, activities, general living conditions and poor economy were also seen as crucial. The findings suggest that these children are indeed vulnerable, and at high risk of developing mental health problems. Their rights are, however, open to local interpretations, and they fall between two stools; their right to proper health care, and national and international immigration policies.     

Evaluating a multiple-family group access intervention for refugees with PTSD

The purpose of this study was to analyze the effects of a multiple-family group in increasing access to mental health services for refugees with posttraumatic stress disorder (PTSD). This study investigated a nine-session multiple-family group called Coffee and Families Education and Support with refugee families from Bosnia-Herzegovina in Chicago. Adults with PTSD (n = 197) and their families were randomly assigned to receive either the intervention or a control condition. The results indicated that a multiple-family group was effective in increasing access to mental health services and that depression and family comfort with discussing trauma mediated the intervention effect. Further well-designed studies of family interventions are needed for developing evidence-based interventions for refugee families.     

Japanese expert public health nurses empower clients with schizophrenia living in the community

1. Home visiting psychiatric public health nurses are integral to expanding community-based mental health services for Japanese citizens living with schizophrenia and other mental illnesses. 2. Interviews with experienced psychiatric public health nurses revealed empowerment as the basic social process that guides their practice. Five empowering practice domains foster client autonomy. 3. Psychiatric public health nurses work with families, neighbors, educators, and employers to enable their clients' healthy living in the community.     

Mental health issues and the foster care system: an examination of the impact of the Adoption and Safe Families Act

Although marriage and family therapists are being called on to help at-risk families, some say that clinicians have insufficient knowledge about the impact of policies on families involved in the foster care system. The purpose of this qualitative investigation was to identify how the Adoption and Safe Families Act informs decision making, to recognize trends in decisions regarding termination of parental rights of parents with mental health issues, and to explore treatment issues of families involved in the foster care system. Results indicate that court cases decided after the implementation of the Adoption and Safe Families Act are likely to result in termination of parental rights. Implications for clinicians and researchers are discussed.     

Community Needs Assessment

Abstract

Comprehensive geriatric assessments of older adult residents of a senior-only development of New York City Housing Authority (NYCHA) conducted by a physician-investigator found that the majority of senior residents suffer from chronic health conditions such as cardiovascular, arthritis, diabetes, take more than five medications, have scored high on body mass index and are at nutritional risk. Surprisingly majority of residents function on their own and need no help in instrumental activities of daily living (IADL) and activities of daily living (ADL). They have very good mental health and only a very small proportion suffer from depression.

The majority of the residents has a personal physician and is covered by Medicare. All of the residents are of low income, 38 percent of the residents living on Supplemental Security Income (SSI) and the rest living on Social Security. Racially/Ethnically 66 percent of seniors are Black, 26 percent are Hispanics, 8 percent are White and less than 1 percent are other. Forty-seven percent of the residents are 75 years in age and over.     

Medical care, living conditions, and children's well-being

We examine the effect of medical care and living conditions on children's physical and psychological well-being. We develop a causal model in which living conditions (including the socioeconomic status of the family and the social-psychological aspects of family functioning) may affect well-being both directly, and indirectly through medical care. We find that families in the higher social classes and families that function well tend to go to large prepaid groups where they receive good medical care. High quality technical care of illness, in turn, improves physical health. The quality of psychotherapeutic care, on the other hand, has no effect on psychological well-being. For this aspect of health, the effect of living conditions is largely direct, rather than indirect by way of medical care. Families characterized by high levels of functioning have children who are psychologically healthy. In addition, physical health affects psychological well-being, but not vice versa.     

Homeless mothers and depression: misdirected policy.

This paper is a critique of recent service-intensive shelter programs for homeless mothers and the policies that underlie these shelters. We first document the process by which mental health problems and family homelessness became so closely but mistakenly linked. We then demonstrate empirically that shelter programs for homeless families nonetheless presume that mental health problems are part of the causal nexus of family homelessness and indiscriminately deliver mental health services to homeless mothers. Simultaneously, shelter programs encourage the isolation of their residents from what they presume to be their "problematic" social networks. We show that, while mental health services had little impact on depression levels among homeless mothers, isolation from social networks did increase depression among homeless mothers. Our findings suggest that policy should put more emphasis on rapid reintegration into the community through providing housing, and it should put less emphasis on providing services.     

Family Support in Nursing Homes Serving Residents with a Mental Health History

Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were found to be in regular contact with their relatives and supportive of their care. In nursing homes, daily contact, an ongoing relationship, involvement in assessment, and being responsible for the resident constitute the model family support. This study advances the understanding of family support in nursing homes and conveys information to guide practice through proposing ways to enhance family support and involvement in nursing homes.     

Inter‐professional working in child protection with families with long‐term and complex needs

Within the United Kingdom there is growing awareness of the need to identify and support the small number of children who are living in families experiencing multiple problems. Research indicates that adverse experiences in childhood can result in poor outcomes in adulthood in terms of lack of employment, poorer physical and mental health and increases in social problems experienced. It is acknowledged that most of these children are known to child welfare professionals and that some are referred to social services, subsequently entering the child protection system. This paper reports research conducted with 28 experienced child welfare professionals. It explores their views about families known to the child protection system with long‐term and complex needs in relation to the characteristics of children and their families; the process of intervention with families; and the effects of organisational arrangements on practice. The research indicates that these families are characterised by the range and depth of the problems experienced by the adults, such as domestic violence, mental health difficulties and substance misuse problems, and the need for professionals to have good inter‐personal skills and access to specialist therapeutic services if families are to be supported to address their problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Family involvement in adolescent substance abuse treatment and recovery: What do we know? What lies ahead?

Families represent the most important resources that young people have in their journey through treatment toward recovery. Unfortunately, family members are often seen as part of the problem and not as part of the solution to adolescent alcohol and other drug (AOD) treatment and recovery. This attitude and misperception can be changed through education, outreach, and engagement of family members. Family involvement and creating a parent-professional collaborative partnership is a step toward improving the outcomes for adolescents in need of treatment and recovery. It is crucial that families understand the treatment process, as well as the hope, process, and reality of recovery. Without information families may not understand the importance of a treatment and recovery plan for their adolescent, the potential adverse consequences, and the impact of these AOD problems on other family members. Families need to learn the continuum of services and supports available, and how family participation improves treatment outcomes and strengthens the recovery process. Family involvement should be an essential part of intake, treatment, and recovery planning, as well as the foundation for effective parent–professional partnerships.     

Community need for university-based mental health services: identifying the top 5

The purpose of this study was to determine the community need for mental health and health promotion services provided by advanced practice nursing faculty at a small university in the midwestern United States. Fifty participants from a three-county service area were selected to complete a needs assessment survey. Survey results indicated strong community need for primary mental health services for low-income residents, older adults, pregnant women, and families with children. Mental health services (particularly for depression), health promotion, wellness information, and primary mental health care were among the leading areas of need. In addition, low-cost mental health services were identified as the most significant need, which was magnified in the underserved, Hispanic population.     

THE "PSYCHOSOMATIC FAMILY" RECONSIDERED: DIABETES IN CONTEXT

Minuchin, Rosman and Baker's (1978) Psychosomatic Families is widely cited as a demonstration that the physiological disturbance of some diabetic patients serves a function in their families. We found that the original data did not provide such a demonstration. We examined the psychosomatic family model in light of recent developments in the study and treatment of diabetes. We concluded that the model decontextualizes the family and assigns to it characteristics that are more appropriately seen as reflections of the disease process, the family coping tasks this entails, and the nature of the family's relationship with the health care system. The need for new open-systems models of the family's role in diabetes is discussed .     

The intersection of extreme poverty and familial mental health in the United States

Approximately 22% of children in the United States live in poverty, with high rates of caregiver depression and child disruptive behavior disorders (DBD). The current study aims to explore the relationships between living in extreme poverty and both child and parent mental health. Data are comprised of findings from the first effectiveness study of the 4Rs and 2Ss intervention, in addition to preliminary data from an implementation study currently underway (n = 484). Families with an annual income of less than $9,999 reported significantly greater child DBD scores and prevalence of clinically significant levels of caregiver depressive symptoms compared to income levels over $10,000. Findings support the recommendation for parental mental health to be attended to within the context of child mental health services.     

Do work commutes moderate the association between perceived neighborhood disorder and psychological distress?

ABSTRACT

Although numerous studies show that living in a neighborhood that is characterized by disorder (crime and dilapidation) can be psychologically distressing, very few studies have considered the element of exposure time or duration of exposure to adverse neighborhood environments. In this paper, we explore the intersection of commuting, mental health, and the subjective experience of neighborhood disadvantage and impoverished community life. Using data from the Welfare, Children, and Families project (2001), a probability sample of 1057 low-income women with children living in Boston, Chicago, and San Antonio, we test whether the association between neighborhood disorder and psychological distress is moderated or attenuated by commuting time and distance. Our results show that although neighborhood disorder is associated with higher levels of anxiety, depression, and somatization, disorder tends to be less distressing for residents who are able to spend time away from these environments through longer commuting times and distances. In other words, working away from one’s neighborhood of residence may help to mitigate the adverse psychological consequences of neighborhood disorder. Our findings support previous research on the stress process and neighborhood disorder. Our work builds on the commuting literature by re-conceptualizing commuting time and distance as protective resources for disadvantaged populations.     

"An Old Way to Solve an Old Problem": Provider Perspectives on Recovery-Oriented Services and Consumer Capabilities in New Mexico

The goal of recovery has emerged as a core value in the reformation of public and private mental health services in the last twenty years. However, definitions of recovery remain as varied as methods of implementation. Through an ethnographic lens, we examine meanings of recovery in the context of a major statewide reform of mental health services in New Mexico, focusing specifically on provider-voiced concerns regarding recovery and recovery-oriented care. We argue that the concept of recovery functions as a symbol that seemingly reconciles the long-standing tension between biological and social explanations of mental illness. Drawing upon provider perspectives, we also discuss concerns that popular rhetoric about recovery may mask some needed fundamental changes to transform the mental health system to a recovery orientation. Finally, we consider recovery from a capabilities standpoint and discuss how this view lends itself to addressing both individual and social components of mental illness.     

Divorce and Family Structure in Norway: Associations With Adolescent Mental Health

The aim of this study was to examine the association between family structure and adolecent mental health, after the considerable increase in divorced parents choosing joint physical custody (JPC) in Norway. Data stem from the youth@hordaland study, a population-based survey conducted in Norway in 2012. A total of 7,707 adolescents (47% male) 16 to 19 years old were included in this study. The adolescents were classified into 6 family structures. Mental health was measured using the Strengths and Difficulties Questionnaire (SDQ). No significant differences between nondivorced families (reference) and JPC were observed. Adolescents from single-parent and stepfather families scored significantly higher on all 3 SDQ scales, and adolescents from stepmother families scored significantly higher on the SDQ total and SDQ externalizing scales. In conclusion, the results of this study indicated that adolescents living in JPC did not have more adjustment problems compared to their peers living in nondivorced families.