Attachment and Coping Strategies in Middle Childhood Children whose Mothers Have a Mental Health Problem: Implications for Social Work Practice

Mental health has implications for the quality of relationshipswithin a family, particularly between parents and children,but also between other family and non-family members. Previousresearch has investigated parental reports of attachment infamilies with mental health problems, but relationship representationsas experienced by these children, especially in middle childhood,have not been so frequently investigated. An understanding ofchildren’s representations of attachment relationshipsand the different coping strategies that may result is importantfor social work practice when offering support, not only tothe children, but also other family members. Methods of investigatingattachment, such as the Separation Anxiety Test, have been usedto understand the relationship issues, fears and coping strategiesof other vulnerable children, and this study was designed specificallyto investigate relationship issues in middle childhood childrenwhose mothers had previously been hospitalized with mental healthproblems. We found that these children tended to be less emotionallyopen and secure, and generated fewer adaptive coping strategiesthan children whose mothers had never had mental health problems.Other themes also emerged from the interviews, such as a senseof trust in the parent–child relationship and the ‘containment’of fears. Implications for social work practice are discussed.     

Paternal Risk Factors for Child Maltreatment and Father's Participation in a Primary Prevention Program in Germany

ABSTRACT

Across the globe, the research into the influence of paternal risk and protective factors on the family, as well as on the involvement of fathers in family-related interventions, is lacking. This study utilized 506 families and examined the characteristics of fathers in psychosocially stressed families and associations between paternal risk factors (PRFs: mental health disorder, physical health disorder, young paternity, unemployment, absence of father) and family risk factors (FRFs: problematic financial situation, problematic housing situation, social isolation) for child maltreatment. The identification of PRFs and FRFs was carried out using information from consultations with social education workers and from a risk inventory completed by the mothers. The data analysis revealed an increased incidence of economic problems found in families with fathers having mental health issues, fathers under the age of 22, and unemployed fathers or single mothers. Other factors such as social isolation occurred more often in families with a single mother. The present study underlines the importance of a father's involvement for young families. Future research and program recommendations should always systematically include the father's role in family-related interventions.     

Practice challenges at the intersection of child protection and mental health

This paper examines the complexity of collaboration between child protection and mental health services, where a parent has a mental illness and there are protection concerns for children. The paper reports on data from focused in‐depth interviews with 36 child protection workers, adult mental health workers and child and youth mental health workers. Data were analysed thematically, using NVivo to facilitate data management and analysis. Two dimensions were identified. The first, the process of collaboration, relates to four factors that assisted the collaborative process: communication, knowledge, role clarity and resources. The second dimension considers the challenges presented to collaborative work when a parent has a mental illness and a child is in need of protection, and identifies issues that are inherent in cases of this kind. Two types of challenge were identified. The first related to characteristics of mental illness, and included the episodic and/or unpredictable nature of mental illness, incorporating information from psychiatric and parenting capacity assessments, and the provision of ongoing support. The second type of challenge concerned the tension between the conflicting needs of parents and their children, and how this was viewed from both the adult mental health and the child protection perspective. Implications for policy and practice are identified in relation to the need for service models that provide ongoing, flexible support that can be intensified or held back as needed.     

Support for and From Aging Mothers Whose Adult Daughters are Seriously Mentally Ill

This article discusses, from the grandmother’s perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52–90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.     

Social Support and Coping in Families Facing Prostate Cancer

ABSTRACT

To date, little research has been conducted to examine the experiences of Asian and Native Hawaiian families in facing prostate cancer. A survey was conducted with 100 participants (including both survivors and family members) of Native Hawaiian, Japanese, Chinese, Filipino, and Caucasian ancestry in Honolulu, HI. Results indicated differences in the ways that survivors and their family members cope with the illness. While treatment-related variables played a significant role in coping among survivors, family members’ experiences were more likely to be predicted by the relationship they maintained with the survivor. Implications for improving current practice and the need for future research to establish effective strategies to assist prostate cancer survivors and their family members will be addressed based on the results of this study.     

Vital Conversations with Family in the Nursing Home: Preparation for End-Stage Dementia Care

Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits. This 6-month, prospective, randomized trial tested the effect of an intervention consisting of a face-to-face, structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia. A comparison group received only social contact via telephone. Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals, and provision of psychosocial support. Psychosocial support was also provided via telephone at three 2-month intervals. Family members participated in three telephone interviews: baseline, 3, and 6 months. Specific advance directives for persons with dementia were extracted from medical records. Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point, and they were more likely to have decided on medical options listed in residents' advance directives (Do Not Resuscitate, Intubate, Hospitalize) over time. Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia.     

Family Support and Empowerment: Post Autism Diagnosis Support Group for Parents

Receiving a diagnosis of an autism spectrum disorder often elicits strong emotional reactions from parents of the diagnosed child. Follow-up services and continued support for these families is a necessary component to help families adapt and meet their and their children's needs. This pilot study measured the effects of a six-session, co-facilitated, support group on the advocacy skills and self-efficacy of parents coping with a child's diagnosis. Statistically significant increases in the average mean scores for the three subscales of the Family Empowerment Scale were found. Implications for practice and research are discussed.     

The Role of the Facilitator in Support Group Development

Support groups for family members of persons with mental illness have become common in the past fifteen years. Much has been written about appropriate formats and content for such groups, and research indicates that persons who participate in them frequently receive important benefits. However, less has been written about the process of effectively recruiting members for groups. Family members, for various reasons, are often reluctant to take the step of joining a support group. In this paper, the authors report their experience in organizing a support group for siblings and adult children of persons with mental illness. The role of the facilitator is highlighted, which was found to be essential in helping interested but ambivalent prospective members eventually join the group.     

‘Not a good person’: family stigma of mental illness from the perspectives of young siblings

The purpose of this paper is to critically examine family stigma as one form of the stigma of mental illness in child and youth mental health. Presented are the outcomes of a thematic content analysis of in‐depth, semi‐structured interviews conducted with seven (n = 7) young siblings, ages 13 to 21 years old, with a brother or sister identified as having a mental‐health issue. The focus of the interviews was on the ways the siblings experienced their other sibling's mental health and how those experiences shaped their sense of self and family. From the analysis, young siblings had predominately negative experiences, struggled with making sense of their brother or sister and the family as ‘flawed’ against the mental illness as ‘bad’ and experienced considerable family stress and overt family stigma. Current practice theories fail to consider the complexity of these factors and, in doing so, fail to adequately explain the nature and extent to which stigmatization occurs for immediate family members. The importance of peer support and understanding stigma in social work practice with children and their families is discussed.     

Coping with Chronic Renal Failure

Summary This paper presents the findings of a small-scale study in whichtwenty renal patients on home dialysis were interviewed. Thedata are analysed in relation to coping strategies, coping stylesand illness roles. Some implications for theories of coping,illness roles and social work are examined.     

Goal setting in recovery: families where a parent has a mental illness or a dual diagnosis

Goal setting is an important element within mental health recovery models; however, parenting and children are rarely recognized in such approaches. This study outlines a family recovery planning model where a parent has a mental health or dual substance and mental health problem. The differences between family types (parent with a mental illness or parent with dual diagnosis) and family members (parent and children) are illustrated in terms of goals across 11 domains. There were a total of 33 parents and 50 children from 10 mental illness and 10 dual diagnosis families. Education and specifically mental health knowledge are important goals across all families and appear especially important for children whose parent has a dual diagnosis. Specific goals and achievement levels for each type of family and parents and children are also outlined. Clear areas for action by clinicians and family members are indicated by this study.     

Hospice care for the child with AIDS

Hospice care was established to provide palliative (i.e., noncurative) services for the dying and their families. The advent of the AIDS epidemic has posed a challenge to hospice care, particularly for the child dying of the disease, and has adapted to modified palliative services. Parents, with a child dying of AIDS, must deal with many issues of disclosing the disease status to the child, coping with the emotions of losing a child, and when and where to incorporate hospice services into the dying process. Optimizing home based hospice care involves; (1) Nutritional management, (2) Prevention of opportunistic infections, (3) Pain management, and (4) Protection of Non-HIV positive members of hospice care. For the dying, hospice strives to achieve a peaceful death and provide supportive intervention for the survivors.     

Care-giving Coping Strategies Among Mothers with Chronically Ill Children

ABSTRACT

The purpose of the study is to identify the types of stresses experienced and the coping strategies used by mothers who are responsible for providing care to their chronically ill and disabled children. A qualitative approach was selected to systematically document the experiences and highlight individual coping strategies. Purposive sampling was used in this qualitative pilot study, fifteen (15) mothers who were known to the researcher as well as two schools that specifically cater for children with disabilities were selected to participate in the study. Thirty questionnaires were handed out of which fifteen were returned. Data was collected using the coping Health Inventory for Parents (CHIP) to measure the extent to which parents perceived a number of coping strategies to be helpful in coping with the chronic illness of their child (ren). The scale comprised 45 items with 3 subscales. The results highlighted the types of stresses that were experienced by the mothers and the coping strategies practiced by these mothers when caring for their disabled children. Mothers who care for chronically ill children are faced with daily stress that relates to care as well as their personal life.     

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.     

Adapting private family time in child protective services decision-making processes

The Family Group Conference (FGC) is grounded in a rights-based framework, whereby children and their families have the right and responsibility to be primary decision-makers when child protection issues arise, and the statutory agency has the responsibility to convene the entitled members of the family network to lead the decision-making. A distinct core component of FGC—private family time (PFT)—allows families to discuss the information and formulate their responses and plans privately during conferencing. This paper describes how a large child welfare agency in the United States adapted PFT in two ways: (1) including a parent advocate (PA) and (2) abbreviating the amount of time allowed for this discussion. Given the lack of empirical research on the PFT component, this qualitative exploratory study sought to understand the functions and perceived impacts of PA-supported PFT during initial child protective services (CPS) conferences at which decisions of child removal or placement were being contemplated. PFT served multiple beneficial functions and impacted families in several positive ways: families gained greater awareness of safety concerns, felt empowered and confident in the preferred safety and service plan, became increasingly engaged and involved in the case decision-making process and ultimately felt less apprehensive.     

Emotional labour and befriending in family support and child protection in Tower Hamlets

This paper describes the emotional labour and befriending of families in East London by Family Support Workers (FSWs). The study is derived from an evaluation of the Family Welfare Association's Tower Hamlets Family Support Service. A key finding is that engaging the emotions of families enables high quality and effective support in the family home. FSWs win trust and elicit narratives from families, particularly from mothers and children. The narratives of families are a rich source of informing better practice. In line with Government objectives, the participatory work of FSWs helps to balance understanding on family support, health and child protection. According to Government and research, the early identification of child protection issues is particularly important in mitigating their worst effects. FSWs gain trust and early disclosure on child protection cases. This prevents child care problems from deteriorating into child protection issues. FSWs also act as informal advocates and help to balance social service assessments with the views of families. FSWs take a proactive, non‐stigmatizing, non‐intrusive approach to families. FSWs are sensitive and responsive to the emotions, ethnicity and specific needs of families.     

Children's Disclosure and Secrecy: Links to Maternal Parenting Characteristics and Children's Coping Skills

The relations between maternal parenting characteristics, child disclosure and secrecy, and child outcomes (positive and negative strategies for coping with distress), were examined in a study of 140 children (10–12‐year‐olds) and their mothers. Child disclosure and secrecy were shown to be distinct but related constructs with authoritativeness predictive of disclosure and dispositional anger predictive of secrecy. These relations held even when child compliance was included as a control variable. Mothers' authoritative parenting predicted disclosure which in turn predicted children's use of positive coping strategies. Mothers' dispositional anger predicted secrecy which mediated the relation between maternal anger and children's use of negative coping strategies. Results are discussed in terms of parent–child communication and opportunities for mothers to use knowledge gained from child disclosure to teach children successful ways of dealing with distress.     

Adult children of parents with mental illness: Family stigma and coping on sense of self

Family stigma is associated with persistent negative outcomes among adult children of parents with mental illness (ACOPMI). Loss of sense of self has been reported by ACOPMI; however, the role of family stigma on sense of self remains unclear. Additionally, research suggests coping behaviour (i.e. adaptive or maladaptive) influences the effect of stigmatization on sense of self. This study investigated the impact of family stigma and coping on sense of self among ACOPMI (N = 134, 63.4% female). As hypothesized, high family stigma was associated with weak sense of self (p < 0.001), and ACOPMI who endorsed adaptive coping demonstrated higher sense of self than those who coped maladaptively (p < 0.001). Further, coping moderated the relationship between family stigma and sense of self (p < 0.001). Unexpectedly, this relationship was only significant for ACOPMI with adaptive coping skills (p < 0.001). At higher levels of stigmatization, post hoc analysis revealed coping styles did not exert an influence on sense of self. Results suggest family stigma contributes to loss of sense of self among ACOPMI, with adaptive coping being protective only at lower levels of family stigma. Findings highlight the need for a systemic approach to eradicate family stigma.