Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program

ABSTRACT

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors’ experiences working with this population.     

A learning collaborative approach to training school-based health providers in evidence-based mental health treatment

Collaborative care models among pediatric primary care and child and adolescent mental health providers are increasingly emphasized to improve quality of and access to mental health services. The current case example of a multi-site clinical training opportunity in school-based collaborative care settings illustrates the success of a learning collaborative approach to improve children's mental health care in schools. Quality improvement data from participating sites indicated an increase in use of evidence-based practices (i.e., “core skills”) and an improvement in quality service delivery indicators for children's mental health (i.e., screening, risk assessment, diagnostic processes, associated diagnostic coding, use of core skills, associated procedural coding, and follow-up assessment and referral) over time. Clinician self-report and chart review data are supplemented by qualitative data from site leader interviews conducted following completion of the project. Implications for mental health workforce development to improve the quality of care to children and adolescents in schools and other community mental health settings 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.     

Identified Problems and Service Utilization Patterns Among Kinship Families Accessing Mental Health Services

Abstract

This study examined the mental health problems and service utilization patterns of kinship families who accessed services in an urban outpatient child psychiatry clinic. A random sample of children who completed the intake process during a calendar year yielded 47 children, or 19% of the sample, whose primary caregiver was a relative, other than a biological parent; approximately half of those families were involved with the child welfare system. Data from an administrative database and from medical records describe the diagnoses, identified problems, and services used by the kinship families. Academic or school-related problems emerged as an identified problem in approximately half of the kinship cases, but school intervention was not a primary target for clinicians. The kinship sample was also compared with a random stratified sample of children who were living with primary caregivers other than kin. Kinship families were more likely to be African-American, but few differences were found between kin and non-kin cases on diagnoses and frequency, duration, or type of services received. The findings suggest that collaboration with schools might increase the engagement and retention of kinship families in mental health services.     

Caregivers' Endorsement of Barriers to Mental Health Services for Children and Youth in Child Welfare

The purpose of this study was to examine the three most common types of caregivers in the child welfare system (birth parents, relative caregivers, and foster parents), an active child welfare case, caregivers' endorsement of barriers to mental health services and mental health service use by caregivers for the children under their care. The sample consisted of 430 dyads (caregivers and their children). Results indicate that an active child welfare case, provider characteristics, and accessibility of services predicted mental health service use for children. Implications for the child welfare and mental health systems are discussed.     

Wraparound Services: An Effective Intervention for Families Impacted by Severe Mental Illness

ABSTRACT

Children and families impacted by severe mental illness (SMI) have multiple strains that effect family functioning, child safety, and parental rights. Traditional services for children and families struggling with severe mental illness have not achieved success in improving family functioning and keeping families intact. Wraparound is a philosophy and a system of care with a promising evidence base that could enhance collaboration of child welfare, mental health, and community services to work more effectively with families impacted by SMI.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

Challenges of Interdisciplinary Collaboration

Abstract

The realities of the 1990s, which include reduced funding and resources, the public's impatience with bureaucratic rigidity, and the empowerment of families who want timely and appropriate services, have created a favorable climate for collaborative, interdisciplinary practice. Collaborative, family-centered practice models are being promoted by family/child advocates and professionals. Yet child and family services, for the most part, continue to be provided in traditional ways using individual treatment and categorical services. However, federal child mental health funding is supporting community-wide, collaborative practice in twenty-one sites scattered across the United States. One site, in rural northeastern North Carolina, is unique as it includes a graduate-level, interdisciplinary academic component [East Carolina University's (ECU) Social Sciences Training Consortium (SSTC)] to train and support service providers and families, and to prepare master's level graduates to work in such innovative programs. Called PEN-PAL [an acronym for Pitt-Edgecombe-Nash (three NC counties) Public Academic Liaison] this university/interagency collaborative effort works in partnership with families to coordinate public and community services into a seamless system of care for children with severe emotional disturbances. This article is based upon a qualitative study of SSTC faculty members, and it chronicles the successes and difficulties encountered by faculty in the first year of a five-year collaborative process.     

Youth with Serious Mental Health Disorders: Wraparound as a Promising Intervention in New Zealand

Youth with serious mental health disorders present with a complexity of challenges for the mental health system, schools, youth justice, care and protection, and their communities. Research shows their needs are best achieved by providing coordinated intensive, multidisciplinary, and individualised services. This article outlines the prevalence and characteristics of youth with serious mental health disorders. It also discusses community‐based interventions used in New Zealand and their limitations. It introduces Wraparound, an intensive individualised coordination and care planning process as a promising practice for youth with serious mental health disorders and their families. Key principles and phases underpinning the Wraparound process are presented along with a case vignette to exemplify the process. Its theory of change, the challenges experienced in practice, and a brief overview of the evidence‐base are also discussed.     

Crossover Children: Examining Initial Criminal Justice System Contact Among Child Protection-Involved Youth

ABSTRACT

Child protection-involved youth face increased risk of criminal justice system contact. Such “crossover children” experience earlier police involvement and more serious criminal justice sanctions, yet little is known about their early offending. Using a cross-sectional sample of 300 crossover children before three Victorian Children's Courts in 2016–17, this mixed-methods study examines the nature and context of children's initial police charges. Findings indicate that crossover children are initially charged with disproportionately violent offending, and often incur first police charges around the time of initial care placement. For many, initial criminal justice contact occurred in the context of conflict with caregivers, ongoing maltreatment, and household adversity, or emotional and behavioural regulation challenges. Efforts towards preventing offending for child-protection-involved youth should focus on preventing childhood maltreatment, alongside targeting parent–child relationship challenges, and strengthening community and care system responses that address the impacts of complex trauma, mental health problems, and neurodisability.

IMPLICATIONS

• Compared to all sentenced children, those from statutory child protection backgrounds are charged with more serious offending at their first criminal court adjudication.

• Among “crossover children”, earlier police charges were seen for Indigenous children, those experiencing greater cumulative maltreatment, and children with emotional or behavioural challenges related to trauma, mental health, and neurodisability.

• Crossover children are most often first charged by police in the year before, and after, their first out-of-home care placement.

     

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

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

Context matters: The state of racial disparities in mental health services among youth reported to child welfare in 1999 and 2009

Upwards of 50% of youth reported to the child welfare system (CWS) do not receive mental health services, despite need. While children of color are less likely to receive services than Caucasians, the mechanisms through which disparities are sustained remain largely unknown. Data come from two nationally representative cohorts of youth who were referred to the CWS in 1999 and 2009. Results showed that while need for mental health services decreased, significant differences in the number of children who received services was not detected between cohorts. African American youth were less likely to receive services compared to their Caucasian counterparts, even after controlling for age, gender, type of maltreatment, and placement instability. However, after taking into account urbanicity, poverty, and the organizational-social context, the disparity between African American and Caucasian youth dissipated. Service disparities between Latino and Caucasian youth were not detected. The odds of service receipt were lower among youth nested within stressful organizational climates and urban (versus rural) counties, and the organizational-social context did not moderate the relationship between race and service receipt. Findings underscore the need to develop and implement strategies to increase access to services in urban counties and to promote an organizational climate conducive to reducing racial disparities.     

Posttraumatic Stress and Depression in the Nonoffending Caregivers of Sexually Abused Children: Associations With Parenting Practices

Caregiver mental health is a known correlate of parenting practices, and recent research indicated that parental depression following childhood sexual abuse disclosure is associated with concurrent parenting difficulties. The present study extended this line of research by investigating posttraumatic stress symptoms and depression in a sample of caregivers (N = 96) of children who experienced sexual abuse recruited from a child advocacy center as well as parenting practices reported by both caregivers and their children (mean age = 10.79 years, SD = 3.29; 79% female). Twenty-four percent of caregivers met criteria for presumptive clinical depression, clinically significant posttraumatic stress, or both. Results indicated elevated caregiver-reported inconsistent parenting in the context of clinically significant distress across symptom groups; children reported particularly elevated inconsistent parenting for caregivers with posttraumatic stress only. Caregiver depression was associated with low self-reported positive parenting and caregiver involvement in addition to self-reported inconsistencies. Directions for future research are offered to further elucidate the relationships between caregiver mental health and parenting practices following childhood sexual abuse.     

Referrals, language proficiency, and enrolment for children's mental health services

Alberta Health Services maintains a database of children, adolescents and adults referred to the child and adolescent mental health and psychiatry intake service. In this study, we sought to systematically assess the impact, if any, of English language proficiency on enrolment of children for mental health services. Specifically, we assessed the extent to which children referred for mental health services were enrolled. In doing so, we categorized our sample (12,143) as English Proficient (EP), or Less English Proficient (LEP). Overall, we found that LEP children were significantly less likely to be enrolled compared to EP children. This disparity in enrolment was only present when other variables were not taken into account. English Proficiency is an important factor for some subgroups.     

The state and my happiness: Youth mental health,citizenship education and discursive contestations in contemporary Indonesia

Complementing studies on youth mental health that were mainly depoliticised, this article offers a discursive examination of youth mental health in an Indonesian educational context. We argue that subject positions enabled by the discourse of mental health were at odds with dominant constructions of an ideal Indonesian citizen. Drawing upon qualitative data from 22 teachers and 20 students in a junior high school in Indonesia and analyses of educational policies and textbooks, we identified three discourses underpinning the ideal(ised) constructions of young Indonesian citizen, namely, neoliberalism, (masculine) patriotism and (religious) moralism and discussed how these inhibited youth mental health.     

Building Community Capacity to Help Persons with Mental Illness

Abstract

In a time of crisis, persons with mental illness who encounter the police are often sent to jail or are involuntarily committed for psychiatric evaluation when mental health services are not readily available. To better serve these persons and the community, law enforcement and mental health professionals in one Iowa county joined together to ensure these individuals received the assessment and treatment needed. The results of a mixed methods program evaluation are detailed and suggest that the process to develop the program was as critical as the conduct of the program itself. Implications for program development are discussed.     

How different are their experiences and outcomes? Comparing aged out and other child welfare involved youth

This paper adds to the growing body of research examining the experiences of youth aging out of the child welfare system. Through a comparison of youth aging out with two other groups of child welfare-involved youth—those whose families received child welfare services but were never placed out of home and those who were in out-of-home placement but did not age out—it presents a profile of their care careers and other system involvement (e.g., mental health, justice system). Analyses indicate that young people aging out of care have experienced significant amounts of time in out-of-home placement, a great deal of placement instability, and high levels of other system involvement. In general, their involvement is more extensive than that of the two comparison groups. However, the justice system involvement of youth who experienced out-of-home placement but did not age out is just as high as that of youth who have aged out. This finding highlights the importance of devoting resources not only to youth aging out of care but also to similarly-aged young people with prior child welfare involvement.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.     

Multidisciplinary Team Perspectives on Older Adult Hoarding and Mental Illness

This qualitative study examined multidisciplinary team members' perspectives of their involvement in older adult hoarding cases. Fifteen informants, as representatives of four hoarding teams, described cases in which teams did or did not work well together. Specifically, informants described their (a) team characteristics, (b) awareness of hoarding as a mental health illness, (c) barriers to providing mental health services for older adults who hoard, and (d) components of successful teamwork within the team and with the older adult as hoarder. Implications include research to better guide interventions, team training to develop common perspectives, and policy development that supports mental health representation on teams and in-home mental health treatment.     

The new mentality: Youth–adult partnerships in community mental health promotion

Youth–adult partnerships (Y-APs) engage young people in meaningful community activity and in the institutions and decisions that affect their lives. The current study is an examination of the process of The New Mentality, a multi-site pilot program intended to mobilize Y-APs to raise community awareness of child and youth mental health, reduce the stigma surrounding mental illness, and advocate for a mental health service system that is more responsive to the needs of children and youth. Data were gathered through individual interviews, focus groups, observations, and questionnaires with youth and adult stakeholders at various levels of the project. A number of themes emerged from the data. These included the critical nature of relationships youth experienced, the cultural differences and advocacy opportunities presented in the child and youth mental health system, the program's level of structure, and individual learning and knowledge sharing.