Intervention research in couple and family therapy: a methodological and substantive review and an introduction to the special issue

This article serves as an introduction to this third version of research reviews of couple and family therapy (CFT) that have appeared in this journal beginning in 1995. It also presents a methodological and substantive overview of research in couple and family therapy from about 2001/2002 to 2010/2011 (the period covered in this issue), while also making connections with previous research. The article introduces quantitative research reviews of family-based intervention research that appear in this issue on 10 substantive areas including conduct disorder/delinquency, drug abuse, childhood and adolescent disorders (not including the aforementioned), family psycho-education for major mental illness, alcoholism, couple distress, relationship education, affective disorders, interpersonal violence, and chronic illness. The paper also introduces the first qualitative research paper in this series, as well as a paper that highlights current methodologies in meta-analysis. The first part of this article rates the 10 content areas on 12 dimensions of methodological strength for quantitative research and makes generalizations about the state of quantitative methodology in CFT. The latter part of the papers summarizes and makes comments on the substantive findings in the 12 papers in this issue, as well as on the field as a whole.     

Divorce in Research vs. Divorce in Media

What is the case for divorce? Researchers in the sociology of family tend to find that divorce's impact depends on what the comparison is: compared to a distressed marriage, divorce has its benefits. Meanwhile, policy makers and general audiences alike get much of their information about divorce research via the news media, where the negative consequences of divorce tend to be exaggerated, especially when comparisons, selection bias, or other research issues are neglected. Over the past 20 years, U.S. news coverage of divorce illustrates two key, intertwined topics: moral entrepreneurship using divorce as an issue and divorce research using (or not) careful methods of comparison. Three cases discussed below (in 1988–1989, 2002–2004, and 2008) illustrate these two themes. The underlying research on the health and mental health effects (including by gender) of divorce on children and adults reviewed in this article makes a case for divorce. The overlay of media reporting on divorce research illuminates the purpose for offering a case for divorce.     

Outcomes in the sociology of mental health and illness: where have we been and where are we going?

Sociologists of mental health and illness have traditionally used outcome measures that they have obtained from other disciplines, especially psychiatry and psychology. These include official statistics, symptom scales, and diagnostic measures. Answers to the central sociological question of how social arrangements affect mental health might require the development of explicitly sociological outcome measures. This introduction provides an overview of several issues that arise in grappling with this question. These include whether symptom scales or diagnoses best capture the mental health consequences of social arrangements; when single or multiple outcomes are necessary to compare the consequences of social arrangements across different groups; if sociologists should explore the positive as well as the negative consequences of social forces; and when sociological attention should be directed toward social-level as well as individual-level outcomes. The papers in this symposium that follow provide more detailed analyses of each of these issues.     

Can Family Relationships Explain the Race Paradox in Mental Health?

Biomedical research consistently finds that Blacks have worse physical health than Whites, an expected pattern given Blacks' greater exposure to psychosocial stress, poverty, and discrimination. Yet there is surprising lack of consensus regarding race differences in mental health, with most scholars finding similar or better mental health outcomes among Blacks than Whites. Past research often attributes this “race paradox in mental health” to the notion that Blacks have stronger family networks than Whites, yet few studies have explicitly tested whether stronger family relationships among Blacks (if they exist) can account for these findings. Using data from the 2003–2005 National Survey of American Life (N = 4,259) revealed that minimal race differences in family relationships fail to explain the race paradox in mental health. The results have implications for mental health measurement, the provision of culturally appropriate mental health care, and how scholars understand the nature of family relationships among Black Americans.     

Social Exclusion and Psychosis

SUMMARY

This article considers aspects of the possible impact of social exclusion upon psychosis and the implications of this for mental health social work practice. Against a background of calls for evidence based practice, and increasing recognition of the significance of theories and understandings as the foundations of practice, the article will first explore current and historical ways of viewing and intervening with the relationship between social adversity and mental health. Then, alternative understandings of this relationship, supported by recent research regarding the impact of trauma and extreme social adversity upon physiological and physical processes implicated in mental ill-health, will be discussed. These approaches have major implications for social work practice with psychosis, suggesting that experiences of trauma and disadvantage, and interventions seeking to alleviate the inner and outer effects of these experiences-tasks central to the social work remit-can make a significant difference to mental health outcomes. However, this is not to advocate a simple (albeit under-resourced) 'social solution'! On the contrary, the understandings underpinning these approaches recognise biological processes play a role in mental and physical ill-health: importantly, however, they can be shown to question the stigma traditionally attached to the concept of biological disorder in mental health, thus pointing to the value of a truly biopsychosocial approach with psychosis, involving fully holistic interventions that differ from those currently dominant, and which carry implications for more egalitarian worker-user relationships.     

Race,Substance Abuse,and Mental Health Disorders as Predictors of Juvenile Court Outcomes: Do They Vary By Gender?

Predicting juvenile court outcomes based on youthful offenders’ delinquency risk factors is important for the adolescent social work field as well as the juvenile justice system. Using a random sample of 341 delinquent youth from one Midwestern urban county, this study extends previous research by examining if race, substance abuse, and mental health disorders influence important delinquency outcomes (number of court offenses, felony conviction(s), probation supervision length, detention length, and number of probation services) differently for male and female juvenile offenders. Multivariate analysis findings revealed that race was significant only for males, and having a substance use disorder was a stronger predictor of delinquency outcomes for males; whereas, having a mental health disorder was a stronger predictor of delinquency outcomes for females. Implications for this research include the importance of early disorder identification and subsequent availability of gender-focused treatment.     

A 10 year follow-up study of young people reported missing to the police for the first time in 2005

Young people who go missing face significant risks and vulnerabilities, yet there has been limited research looking their longer-term criminal justice-related outcomes. The aim of this study was to explore the criminal justice and mental health-related trajectories of a random sample of 215 young people reported missing for the first time in 2005, followed up for a decade. Two thirds (64.7%) of the sample had accumulated an offence history and 68.4% a victimisation history. More than a third were reported missing multiple times; these youth were characteristically different to single episode missing persons with respect to police contacts and mental health-related vulnerability. Results highlight a significant level of mental health concern among a population that police are not adequately equipped to respond to. Further research is needed to better understand motivations for going missing and the extent of risks and vulnerabilities they face while missing and upon return.     

Resilience as Reflexivity: A New Understanding for Work with Looked-After Children

This article argues that the current model of resilience in the social work literature, through its predominant focus on outcomes and behaviours rather than the underlying processes of development involved, risks superficiality and appears to lack an underpinning psychological theory of the way in which resilience develops. In response, I propose a psychodynamic understanding of this process, which sees resilience as rooted in the capacity for reflexivity (defined here as an awareness of one's own mental state and the mental states of others), and which describes how this capacity develops. This holds that a strong-enough ego, with the capacity for resilience-as-reflexivity, is the necessary precursor of the child's ability to make use of positive experiences. This psychodynamic understanding of resilience development aims to give social workers a greater appreciation of how the mental health of children in the care system may have been affected by their experiences, and how they can be helped to develop the psychological foundations of resilience and therefore better mental health. I suggest that workers can use this understanding to assess the stage of resilience-development a child has reached, and to inform therapeutic work aimed at strengthening their resilience.     

Managerial audit and community mental health: a study of rationalising practices in Finnish psychiatric outpatient clinics

In many European welfare states the reform of mental health services has been accompanied by the implementation of new forms of governance, including the introduction of managerial audit systems. While such systems have been developed for ‘good causes’, such as quality assurance, financial management and monitoring staff performance, they may simultaneously produce diverse and contradictory effects on practice. The aim of this article is to examine the role of one managerial audit system, introduced in psychiatric outpatient clinics in central Finland, and assess its impact on practice. Reference is made to modernising mental health policy in the UK as that has producedsimilar practics outcomes. The research was an empirical study of practice using a mixed-method case study design involving documentary research and semi-structured interviews. Insights from Mitchell Dean's notion of governmentalisation of government were utilised in the analysis. It was found that, although the audit system primarily served administrative needs, it began to reshape practice by reinforcing certain modes of working and excluding others. The analysis of community mental health work in Finland, with similar trends in the UK, highlights the connection between documentation, resource allocation and managerial priorities that reinforce particular styles of practice. In community mental health services it would appear that the problems of professional practice have become the problems of administration.     

Stewardship of public assets under nonprofit conversion models: New York's Empire Blue Cross Blue Shield case study

This research describes a case study of the Empire Blue Cross Blue Shield conversion under way in New York. In January 2002, legislation approved the conversion and the disposition of $1 billion in assets: 95 percent for health care salaries and expenses and 5 percent for a foundation to promote health care for the poor. New York's approach is controversial. According to Greene and Sommerfield (2002), the New York Times considers it the largest fiscal gimmick in New York's history, and Consumers Union is challenging it in the courts, asserting the plan is illegal. This article describes New York's approach to nonprofit conversion, proposing that more research on conversions is needed and that case study research illustrating the way different states approach the issue has the potential to bring together researchers, practitioners, and policymakers in an important debate that will advance public policymaking that furthers the public good. Subsequently, on June 20, 2005, New York State's highest court dismissed the Consumers Union lawsuit, affirming the actions of the New York State legislature and bringing to an end nearly three years of state‐level litigation.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Dosage effects on school readiness: evidence from a randomized classroom-based intervention

Variations in the dosage of social interventions and the effects of dosage on program outcomes remain understudied. This study examines the dosage effects of the Chicago School Readiness Project, a randomized, multifaceted classroom-based intervention conducted in Head Start settings. Using a principal score matching method to address the issue of selection bias, the study finds that high-dosage levels of teacher training and mental health consultant class visits have larger effects on children's school readiness than the effects estimated through intention-to-treat (ITT) analyses. Low-dosage levels of treatment are found to have effects that are smaller than those estimated in ITT analyses or to have no statistically significant program effects. Moreover, individual mental health consultation services provided to high-risk children are found to have statistically significant effects on their school readiness. The study discusses the implications of these findings for research and policy.     

L’intergouvernementalité en reconstruction : le cas du Mexique

Since the 1930s, Mexico has had a dominant party, the Partido Revolucionario Institucional; and, despite the country’s federal constitution, decision-making has been so centralized that few powers have been left to the states. Recent attempts to break with this tradition and decentralize educational, health and welfare policy from the federal level to the states and big cities are examined. Three trends might unfold in the future: the establishment of an effective, multicentered decentralization; a surface decentralization without any real impact; or the fragmentation of policies and their impact. The foreseeable consequences of these three possibilities come under discussion. — Special issue: Latin America.     

To tell or not to tell: the impact of disclosure on sexual assault survivors' recovery

There is a growing body of research examining the disclosure of sexual assault. But the focus on time to first disclosure does not capture the whole picture. Survivors also differ in how long they continue to disclose, to whom they disclose, and the types of reactions received during disclosure. To provide a more comprehensive view of disclosure, this study sought to identify patterns of disclosure among a sample of 103 female sexual assault survivors recruited from the community. This study also sought to identify characteristics of each disclosure pattern, differences in how each disclosure pattern tends to unfold (e.g., who is told and how they react), and differences in how these disclosure patterns are related to physical and mental health outcomes. Results revealed four distinct disclosure patterns: nondisclosers, slow starters, crisis disclosers, and ongoing disclosers. Assault characteristics and rape acknowledgment distinguished nondisclosers and slow starters from the other two disclosure groups. Slow starters were also less likely to disclose to police and medical personnel and received negative reactions less frequently while nondisclosers experienced more symptoms of depression and posttraumatic stress than other groups. Implications of these findings for future research and practice are discussed.     

Healthcare providers' perspectives on parental health literacy and child health outcomes among Southeast Asian American immigrants and refugees

Low health literacy has emerged as an important area of research because of its close link with health disparities. In this study, we used a qualitative approach to investigate healthcare providers' perspectives on the health literacy of immigrant and refugee parents and its association with children's health. Sixteen health and mental health professionals serving immigrant and refugee parents and children in various clinical settings were recruited through a purposive sampling method and interviewed. Six broad themes were identified: (1) multi-dimensional components of parental health literacy; (2) parent characteristics and native country experiences; (3) host systems and their interactions impact on parental health literacy; (4) diverse aspects of help-seeking; (5) culture-based parental help-seeking; and (6) child health outcomes. Within these larger themes, the complexity of parental health literacy and its various effects on children's health outcomes among immigrant and refugee parents were evident. Future research includes more population-based quantitative studies of parental health literacy and culturally relevant clinical approaches among immigrant and refugee parents.     

There's More Than Meets the Eye: The Nuances of Case Management

In this exploratory study, 50 mental health case managers from 2 Midwestern states were interviewed to capture their observations about the consumers they serve; aspects of the job they like and dislike; and their beliefs about the concept, process, and possibility of recovery from mental illness. The nature of the professional relationship in case management is described from the perspective of these professionals, as well as the methods these informants identify as key to the helping process. It is argued that effective case management requires complex and nuanced professional skills that might go unrecognized and underappreciated in community mental health.     

An introduction to the Safe Schools/Healthy Students Initiative

The Safe Schools/Healthy Students (SS/HS) Initiative offers a unique opportunity to conduct large-scale, multisite, multilevel program evaluation in the context of a federal environment that places many requirements and constraints on how the grants are conducted and managed. Federal programs stress performance-based outcomes, valid and reliable data, addressing important problems, ensuring efficiency and fiscal responsibility, reducing burden on federal staff and grantees, and developing and disseminating useful solutions and recommendations. MANILA Consulting Group, Inc., (MANILA), in partnership with Battelle Centers for Public Health Research and Evaluation (Battelle) and RMC Research Corporation (RMC), has been conducting the SS/HS national cross-site evaluation, which involves the coordinated efforts of federal Project Officers, local education agencies, technical assistance providers, communication specialists, and national and local evaluators across a diverse set of socioeconomic and cultural contexts. To date, the national cross-site evaluation has provided data indicating that the SS/HS Initiative is, in fact, meeting these goals. Findings revealed that fewer students reported they had experienced violence and fewer students reported they had witnessed violence. Fully 96 percent of school staff said SS/HS had improved school safety. There was a 263 percent increase in the number of students who received school-based mental health services and a 519 percent increase in those receiving community-based mental health services. In addition, more than 80 percent of school staff reported that they saw reductions in alcohol and other drug use among their students. These encouraging results stress the need for ongoing coordination at all levels of the Initiative to continue to ensure safer schools and healthier students. This article provides an overview of the initiative and introduces four articles in this special issue.     

‘Doing Something Positive’: Volunteers’ Experiences of the Well-Being Benefits Derived from Practical Conservation Activities in Nature

There is a strong tradition in Britain of volunteering involving a wide range of activities and organisations. Increasingly volunteering is seen as a way of benefiting health and building sustainable communities. In a study in 2007 we aimed to address the research questions: what are the motivations for, barriers to, and benefits of formal practical environmental volunteering for those individuals involved? Qualitative and quantitative data collection was undertaken while spending a day each with ten volunteer groups as they undertook their practical conservation activities. In this paper we focus primarily on the physical, mental and social well-being benefits that volunteers derived from their activities. Our research involved 88 people volunteering regularly in a range of places from scenic natural landscapes to urban green spaces in northern England and southern Scotland. Respondents described a range of benefits they gained from their involvement including improved fitness, keeping alert, meeting others and reducing stress levels. We suggest that practical environmental volunteering has flexibility in the types of activity available and the time scale in which activities are undertaken and therefore can provide a range of physical, social and mental well-being benefits to people with very differing abilities and from different socio-economic backgrounds.     

Researching Asia's Third Sector

Most Asian countries have a strong third sector and a rich tradition of philanthropy. The varied array of social, economic, political, and third sector variables across the many countries of the region make Asia an ideal site for testing and developing third sector theory. The research infrastructure needed to sustain such a venture is beginning to form. The five papers published in this issue of Voluntas indicate some of the product, and the variety, of this growing body of research.     

Examining exposure to adverse childhood experiences and later outcomes of poor physical and mental health among South Carolina adults

Recent research on adverse childhood experiences (ACEs) has used factor analysis to categorize ACEs. Further research is needed to determine if these previously identified factors are related to specific health outcomes. Using data obtained from the 2014–2015 South Carolina Behavioral Risk Factor Surveillance System, this study assessed the association between categories (household dysfunction; emotional and physical abuse; sexual abuse) and combinations of categories of ACEs on mental and physical health outcomes in adulthood (n = 15,638). Respondents who had all three categories of abuse were much more likely to report poor health and mental distress. Sexual abuse in childhood increased the odds of reporting poor health and mental distress; some ACEs may have stronger associations to long term health than others. These findings can help lead to effective and targeted prevention or intervention strategies that incorporate the new insight on the combination of ACE categories that are likely to co-occur.