Urban and Rural Differences in the Provision of Health Insurance Coverage for Children of Divorce

Abstract

Using data from divorce case records in New Hampshire this study examined urban and rural differences in the provision of health insurance coverage for children of divorce. In the overall sample of cases (N= 474) results from a chi-square test found rural children (N= 123) to be nearly twice as likely to be uninsured than urban children (N= 351). Results from the logistic regression in the urban county found fathers' and mothers' incomes to increase the log odds of children having access to health insurance. Mothers' employment also increased the log odds of children being insured. In the rural county fathers' earnings and mothers' employment increased the log odds of children having access to health insurance. Pre-school age (0-5) decreased the log odds of children being insured. Implications for family practitioners in rural areas are discussed.     

Children’s Mental Health Providers’ Perceptions of Mental Health Literacy Among Parents and Caregivers

Mental health disorders are prevalent among children, yet many do not receive treatment. Parents and caregivers play a vital role in recognizing mental health disorders in children and accessing treatment. But a substantial number of parents lack essential knowledge of children’s mental health disorders, including risk factors, symptom recognition, and treatment options. Little focus has been given to parents in the children’s mental health literacy literature. The purpose of this article is to begin filling that gap by using a survey to describe the perceptions of child and family mental health providers’ perceptions regarding the amount, accuracy, and origin of mental health literacy in the parents of the children they treat. The impact of those perceptions on the work of providers is also explored. Eighty-seven mental health providers completed a survey to assess their perceptions of parent mental health literacy in the area of children’s mental health. Providers perceived parent mental health literacy as low, inaccurate, and inconsistent. In addition, providers indicated that parents rely on informal sources of support, such as friends and family for information about children’s mental health. Implications for social work researchers, practitioners, and the children and families they serve are discussed.     

Evaluation of a Training to Reduce Provider Bias Toward Pregnant Patients With Substance Abuse

The objective of this article is not to present a scientific or systematic study, but to provide an initial framework for designing a training workshop to enhance health practitioners’ (nurses, social workers, physicians, etc.) knowledge regarding substance abuse treatment and to decrease their bias toward substance-abusing women, particularly pregnant women in rural communities. We incorporated the 4 Transdisciplinary Foundations from the Substance Abuse and Mental Health Services Administration Competencies Model, with specific competencies targeted that related to provider bias. After the conference, 52 of the 70 participants completed a questionnaire to self-assess knowledge level and confidence in skill related to substance abuse management. Participant mean scores were statistically significantly higher following the conference than 1 week prior (p < .001) in the area of “gender difference with substance abuse,” moving from an average of 2.6 to 4.5 on a 5-point Likert scale. Our conference was successful in increasing attendees’ knowledge about gender difference and substance abuse among pregnant patients.     

Viewing psychopathology through a trauma lens

Many symptoms and behaviors associated with a range of psychiatric disorders, including those not designated as trauma- or stressor-related, result from unprocessed and unintegrated traumatic experiences, requiring therapeutic assessments and interventions that consider the complex dynamics brought on by trauma. While the focus on symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM) may lead practitioners away from a consideration of etiology when choosing interventions, the exclusions of “disorders of extreme stress not otherwise specified” in DSM-IV and “developmental trauma disorder” from DSM-5 may further predispose practitioners to disregard traumatic etiology and symptoms when assessing, diagnosing, and treating clients. Because a majority of recipients of public mental health services suffer deleterious effects from trauma exposure, social work and other mental health professionals have an ethical responsibility to incorporate trauma-based screenings, assessments, and interventions with clients. Thus, trauma-informed evaluation and treatment approaches must be included in graduate curricula, practitioners must seek continuing education to supplement their knowledge and practice skills, and agency administrators must provide inservice training to professional staff.     

Adversity and children experiencing family homelessness: implications for health

This study tests links between adversity and health problems among children in family emergency housing. Children who experience family homelessness are at risk to also experience high levels of stress, health problems, and need for pediatric care. Understanding the connection between stress and health holds the potential to reduce persistent health disparities. Analyses tested whether experiencing a greater number of stressful life events during the early years of life was related to worse health conditions, emergency health-care utilization, and hospitalizations. Parents noted children’s experience of negative stressful life events, health problems, emergency room (ER) use, and hospitalization. Two cohorts of kindergarten-aged children staying in emergency family housing participated in the study in 2006–2007 (n?=?104) and in 2008–2009 (n?=?138), with the results examined separately. In both cohorts, more health problems were acknowledged for children exposed to more negative stressful life events. Stressful life events were not related to ER use but did relate to hospitalization for the 2006–2007 cohort. Results affirm links between stress in early childhood and health problems among children living in emergency housing. Findings are consistent with the hypothesis that adversity in early childhood contributes to income and racial disparities in health.     

Why do children placed out-of-home because of parental substance abuse have less mental health problems than children placed for other reasons?

The purpose of this paper was to compare children placed out-of-home because of parental substance abuse (PSA) with children placed for other reasons (NPSA), and to explore the association between PSA and mental health problems in a Norwegian sample of 6- to 12-year-old children in out-of-home care (N = 109). Several group differences were found related to the children themselves, their families and the Child Welfare case. The PSA children had less total difficulties, conduct problems and emotional problems than the NPSA children assessed by the teachers on the Revised Rutter Scale. However, both groups had far more mental health problems than children in general. The most important variable explaining the group difference in all subgroups of mental health problems was the extent of prosocial behavior in the children, but being placed for behavioral problems also explained a significant part of total difficulties and conduct problems. Variables like gender, discipline problems and socioeconomic conditions did not have a significant effect. The conclusion of the study was that prosocial behavior might be regarded as an important protective factor against mental health problems, which is an argument for investing in programs focusing on enhancing the placed children's mastering strategies.     

Public health research – multidisciplinary,high-benefit,undervalued

The major health problems faced by policy-makers and practitioners at national and local levels require public health approaches. However, public health research is the “poor relative” of biomedical research: it is worthy, but not rich. In the European Commission's health research programme, biomedicine gets 90% of the funding, whereas public health research gets less than 10%. This pattern is repeated nationally in most countries, reflecting public policies to support industries – pharmaceuticals, biotechnology, medical devices – where profits are to be made, rather than not-for-profit, public health research. SPHERE, a study coordinated through the European Public Health Association, conducted bibliometric analyses across public health research themes and mapped the European and national structures and priorities for research. Whilst most European countries have national strategies (and some programmes) for public health, few have public health research strategies and the coordination of public health research is weak. Three further studies are being undertaken. In STEPS, the contribution of civil society organizations in the new EU member states to public health research will be discussed at national workshops with the ministries of health, the science/research councils and the national public health associations. In PHIRE, thematic Sections and the national member associations together evaluate the impact of European-funded health projects within member states. In FAHRE, the specific theme of food and health will be addressed, bridging industry and non-profit research sectors. Arguments for public health research can be made through lobbying at European level, but researchers and practitioners also need to influence the development of public health research within individual countries – leading to a European Public Health Research Area.     

The Impact of Low Socioeconomic Status and Perceived Discrimination on Parental Perceptions of the Well-Being of Latino Children

This exploratory study examined the impact of low socioeconomic status (SES) and perceived discrimination on Latino parents’ perceptions of their children’s mental health issues. Anti-immigrant policies and negative public discourse lead to perceived discrimination among Latinos, which may impact mental health. Participants (106), surveyed in 2011, were Latino, predominantly female, had a mean of 14 years living in the United States, and less than 9 years of education. The results of multivariate ordinary-least-squares regressions indicated that participants with lower levels of SES had significantly greater (p < .05) perceptions that their children were angry, had separation anxiety from parents, were fearful, and avoided social situations. Higher levels of perceived discrimination were significantly related (p < .05) to participants’ perceptions of fear among their children. Social service providers must assess for possible mental health issues and develop culturally appropriate intervention strategies to effectively address these issues with parents and children.     

The Child Health Disadvantage of Parental Cohabitation

This study uses Fragile Families data (N = 2,160) to assess health differences at age 5 for children born to cohabiting versus married parents. Regression analyses indicate worse health for children born to cohabiting parents, including those whose parents stably cohabited, dissolved their cohabitation, and married, than for children with stably married parents. The findings also suggest that stable cohabitation is no better for child health than cohabitation dissolution. Child health is better among those whose cohabiting parents marry than for those whose parents remain stably cohabiting, which indicates a possible health advantage of parental marriage, even if it occurs after the child's birth.     

The mental health problems of mothers experiencing the child protection system: identifying needs and appropriate responses

This article presents the findings of a small pilot study which examined the needs of 13 mothers with severe mental health problems whose children were involved in the child protection system. The use of the diagnosis of ‘personality disorder’ in relation to this group of women is discussed and the finding that all these women had experience of domestic violence is considered in the context of other research findings. The extent to which child protection social workers and mental health professionals worked together on these cases was explored and only limited evidence of good communication and collaboration was found. The need for effective inter‐professional and inter‐agency coordination is argued, but differing conceptions of maternal mental health problems and their relationship to children's needs may make for difficulties in professional communication and decision‐making. The article seeks to identify the differing approaches to maternal mental health problems which appear to be developing out of different groups of research studies and argues that practitioners need to be explicit in identifying their perspectives on the associated issues of maternal mental health problems and child protection. Copyright © 1999 John Wiley & Sons, Ltd.     

Psychological distress among mental health social workers

This study employs the General Health Questionnaire (GHQ-12) in order to examine psychological distress among Greek mental health social workers. The findings are examined in the light of the respondents' demographics, professional characteristics (educational background and work experience), work perspectives (job satisfaction and perceived work efficiency) and perceived financial strain. The study took place two years after austerity measures were imposed in the country. A self-addressed questionnaire employing 4-point Likert-type scale items was posted to 154 mental health social workers residing in an urban area in Greece. A statistical analysis of the 65 returned questionnaires identified frequencies and correlations in the corpus of the data. According to the findings, 15% of the practitioners were within the psychological distress range. When compared to their non-psychologically distressed counterparts, the psychologically distressed respondents were clearly differentiated according to their professional characteristics, work perspectives and perceived financial strain.     

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.     

Trying to understand: promoting the psychosocial well-being of separated refugee children

This paper explores a holistic relationship-based approach to promoting the well-being of separated refugee children in the UK. Based on children's testimonies and case examples gathered over the past 10 years, it provides an overview of the practical and emotional support needs of separated children, including the asylum process, education, social services support, accommodation and health, from the point of arrival in the UK and through the transition to adulthood. Reflecting on practice, the paper explores strategies for supporting children suffering mental distress and considers the critical role that practitioners can play in the healing process by helping children to make sense of their experiences. Finally, the paper discusses the importance of both professional and personal relationships in enabling children to develop a sense of belonging and providing opportunities to share and create positive memories, which can help them move beyond stories of loss towards a more hopeful future.     

A multi-dimensional assessment of the health needs of homeless infants and pre-school children in Phoenix

The dual purpose of this study was to identify the comprehensive health needs of a selected group of homeless children in Phoenix, Arizona, and to utilize the findings in developing needed services. A non-random sample of 60 infants and pre-school children were given on-site physical, dental, developmental, behavioral, and nutritional assessments. The study included Medicaid's Early Periodic Screening, Diagnosis, and Treatment procedures, complete oral screening, the Denver Developmental and Denver Articulation Screening Test, the Pre-school Behavior Inventory, and parental interviews. Fifty-eight of the 60 children screened needed further evaluation, treatment, or followup services. The most significant problems included low hematocrit readings, inadequate immunizations, and untreated medical and dental problems specific to this age group. Also identified were developmental delays and potential behavior problems. It is imperative that aggressive outreach and followup services be developed to reach homeless children and to insure that needed interventions are provided.     

Gambling and the Health of the Public: Adopting a Public Health Perspective

During the last decade there has been an unprecedented expansion of legalized gambling throughout North America. Three primary forces appear to be motivating this growth: (1) the desire of governments to identify new sources of revenue without invoking new or higher taxes; (2) tourism entrepreneurs developing new destinations for entertainment and leisure; and (3) the rise of new technologies and forms of gambling (e.g., video lottery terminals, powerball mega-lotteries, and computer offshore gambling). Associated with this phenomenon, there has been an increase in the prevalence of problem and pathological gambling among the general adult population, as well as a sustained high level of gambling-related problems among youth. To date there has been little dialogue within the public health sector in particular, or among health care practitioners in general, about the potential health impact of gambling or gambling-related problems. This article encourages the adoption of a public health perspective towards gambling. More specifically, this discussion has four primary objectives:1. Create awareness among health professionals about gambling, its rapid expansion and its relationship with the health care system;2. Place gambling within a public health framework by examining it from several perspectives, including population health, human ecology and addictive behaviors;3. Outline the major public health issues about how gambling can affect individuals, families and communities;4. Propose an agenda for strengthening policy, prevention and treatment practices through greater public health involvement, using the framework of The Ottawa Charter for Health Promotion as a guide.By understanding gambling and its potential impacts on the public's health, policy makers and health practitioners can minimize gambling's negative impacts and appreciate its potential benefits.     

Pictures in the classroom: can teachers and mental health professionals identify maltreated children's drawings?

The aim of this paper is to investigate whether teachers and mental health professionals are able to identify drawings produced by maltreated children, at a level greater than chance, when these drawings are presented to them at the same time as drawings created by non‐maltreated matched control children. In a relatively small study, a group of 33 mental health practitioners (MHPs) and a group of 10 teachers were shown sets of drawings and asked whether they could identify the maltreated children's drawings. It was found that there was no significant difference between mental health practitioner and teacher groups in identifying child maltreatment from Favourite Kind of Day Drawings (FKDs) (Manning, 1987) and Kinetic Family Drawings (KFD) (Burns and Kaufman, 1970). The results also point to the KFD as a more reliable drawing technique, but only when it is known that maltreatment is definitely present, and in a situation with no a priori knowledge it should not be used for the identification of maltreatment. Copyright © 2000 John Wiley & Sons, Ltd.     

Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations?

For children in out-of-home care, a significant gap exists between those who need services and those who receive them. Screening all children in out-of-home care is recommended to reduce this gap. This study was designed to determine if recommendations from mental health and educational screening evaluations were related to service implementation for youth in out-of-home care. Screening evaluations were completed with 171 maltreated youth (ages 9 to 11) who had been placed in out-of-home care within the prior year. Written reports summarizing the findings were provided to children's caseworkers. Service utilization was assessed at baseline (T1; before screening reports were completed) and follow-up (T2; 9–12 months later) interviews. For children not already receiving services at T1, logistic regression analyses tested the association between T1 recommendations for services and new service implementation by T2. Mental health (youth-report) and educational (teacher-report) outcomes were analyzed separately. Screening evaluations identified 22% of children with unmet mental health needs and 36% with unmet educational needs at T1. Children who received a recommendation for new services (i.e., all of those with unmet needs) were more likely to receive mental health (OR = 2.50, p = .06) and/or educational (OR = 3.54, p = .04) services by T2 than children who did not receive recommendations for services. While recommendations increased the odds of receiving services, almost half of the children with unmet mental health needs did not receive services, and 84% of children with unmet educational needs did not receive services by T2. Much work remains to ensure youth receive needed services.     

Results from a psychometric assessment of a new tool for measuring evidence-based decision making in public health organizations

BackgroundIn order to better understand how to improve evidence-based decision making (EBDM) in state health departments, measurement tools are needed to evaluate changes in EBDM. The purpose of this study was to test the psychometric properties of a new measurement tool to assess EBDM in public health practice settings.MethodsA questionnaire was developed, pilot-tested and refined in an iterative process with the input of public health practitioners with the aim of identifying a set of specific measures representing different components of EBDM. Data were collected in a national survey of state health department chronic disease practitioners. The final dataset (n = 879) for psychometric testing was comprised of 19 EBDM items that were first examined using exploratory factor analysis, and then confirmatory factor analysis.ResultsThe final model from confirmatory factor analysis includes five latent factors representing components of EBDM: capacity for evaluation, expectations and incentives for EBDM, access to evidence and resources for EBDM, participatory decision making, and leadership support and commitment.ConclusionsThis study addresses the need for empirically tested and theory-aligned measures that may be used to assess the extent to which EBDM is currently implemented, and further, to gauge the success of strategies to improve EBDM, in public health settings. This EBDM measurement tool may help identify needed supports for enhanced capacity and implementation of effective strategies.