The development and evaluation of a natural helpers' training program to increase the engagement of urban,Latina/o families in parent-child interaction therapy

Latina/o immigrant children are at increased risk for developing conduct disorders, and are simultaneously less likely to access services. Natural helpers are uniquely positioned to promote effective parent training programs to address service disparities in these communities. This study describes one effort to train natural helpers to increase engagement in parent-child interaction therapy (PCIT), an evidence-based parent training program. An academic-community partnership prompted the development and evaluation of this natural helpers training program. Five natural helpers were trained to recruit Latina/o families into PCIT, address barriers to treatment, and support parents' skill development. Over the course of training, natural helpers increased their knowledge of PCIT and their ability to use and model treatment targeted parenting skills. Additional consultation was necessary to improve the natural helpers' abilities to conduct behavioral observations of parent skill use and provide feedback on these skills. Natural helpers expressed overall satisfaction with PCIT and the training program. Suggestions for incorporating natural helpers into PCIT services are discussed based on the strengths and challenges identified from the evaluation of this training program.     

Incorporating natural helpers to address service disparities for young children with conduct problems

In response to the high levels of unmet need among historically underserved young children with conduct problems, this paper outlines some of the key issues involved in incorporating natural helpers into the delivery of parenting interventions for the treatment of conduct problems among historically underserved children. Strategies for the selection and training of natural helpers are discussed along with challenges that might be encountered in these processes. Directions for future research are also highlighted. With appropriate selection and training procedures in place, natural helpers may increase the accessibility of services for children and families and foster the reduction of service disparities.     

Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Many foster parents are ill prepared to meet the behavioral needs of children placed in their homes. Research suggests they lack training in evidence-based behavioral interventions and feel unsupported by child welfare professionals. Given the complex needs of foster children and increased rates of placement disruption for foster children with behavior problems, implementation of effective interventions is essential. However, little is known about foster parents' receptivity to these types of interventions. In this qualitative study, we examine urban foster parents' perceptions of the specific elements of parent management training (PMT), an evidence-based treatment for disruptive behaviors that teaches parents to improve desired behaviors and decrease oppositional behaviors by rewarding positive behaviors (positive reinforcement) and responding to negative behaviors with mild, consistent punishments such as timeout or a privilege removal. We present data from four focus groups (N = 38). While the questions focused on parent's perceptions of PMT, responses often related to parent interactions with agency staff. Four strong themes emerged from the data. First, foster parents discussed a need for more support and training in how to address children's behaviors, but also had concerns that some PMT discipline techniques would be ineffective based on their past experiences with foster children. Second, they described how staff communication skills and allegations of child abuse could affect parents' motivation to continue fostering. Third, they expressed a need for more detailed information about children's histories and visits with biological families as the lack of information contributed to difficulty in meeting foster children's needs. They suggested that joint training of foster parents and staff in the intervention could improve their ability to work together to support the child's positive behaviors. Finally, parents reported little involvement in child mental health services and doubted the effectiveness of the mental health services their foster children received.     

Risk factors for attrition from an evidence-based parenting program: Findings from the Netherlands

Parent management training programs for the treatment of childhood conduct problems are increasingly being transported from their country of origin to international settings. Family interactions, however, may be influenced by different cultural expectations and children's mental health problems may be addressed within different systems. Demonstrating reductions in symptoms within the new population is insufficient to support the wide-scale transport of a treatment model. Implementation outcomes such as the rates of treatment retention and factors related to treatment attrition must also be considered. We explored predictors of attrition in families from the Netherlands referred to the evidence-based parenting program Parent–Child Interaction Therapy (PCIT). Participants included 40 children with conduct problems (2–7 years; 68% boys) and their caregivers. Attrition (40%) was somewhat lower than findings with similar community samples in the US. Significant predictors of attrition were child age and maternal levels of internalizing symptoms. Low parental demandingness and high child compliance before start of treatment were related to early attrition within twelve treatment sessions. Meeting the needs of families at risk for attrition is an important goal for parent management training programs within and outside the US if families in need of services are to benefit from them.     

Barriers and facilitators to delivering effective mental health practice strategies for youth and families served by the child welfare system

While the gap between need for and access to mental health services is well documented among children of color in foster care, little is known about why they are sustained. To illuminate barriers of service delivery, thirty-six caseworkers participated in one of five focus group meetings in a large urban Mid-Atlantic City. Ground Theory Methods revealed that there are barriers and facilitators at the macro, meso, and micro practice orientations. At the macro-level, development of effective practice strategies and proximity to effective services are likely to influence dissemination of effective practices. Secondly, at the meso-level, job support is needed to facilitate awareness, but for case managers to feel supported, they need effective training and opportunities to facilitate interagency collaboration. Finally, at the micro-level, cultural competence largely impacts implementation of effective practices. However, increased awareness around the social ills of stigma and the salience of “insider work” are needed to increase cultural competence. A “downstream” effect in which there are numerous barriers identified at the macro level has a direct negative impact on organizational capacity and readiness to deliver and engage youth and families in mental health services served by the child welfare system. Findings underscore the need for child welfare agencies to build supports at the macro, meso, and micro practice levels to ameliorate mental health service disparities.     

Foster parents exposed to political violence: The role of social support in addressing emotional and functional difficulties

BackgroundBeing a foster parent is stressful. It becomes even more stressful when foster parents face major threats to their own families and to the foster children in their care, such as during war situations. This study focuses on foster parents' reactions to the war with Gaza in southern Israel that took place in 2014. The first goal of this study was to describe posttraumatic symptoms (PTS) and problems in functioning among foster parents following their exposure to the war. The second goal was to identify background and social support predictors of PTS and functioning problems among these parents. The third goal was to examine the role of formal and informal support received by the parents as a moderator of the association between exposure to war events and PTS and problems in functioning.MethodsParticipants were 354 Israeli foster parents who were exposed to the war. Participants completed structured instruments of exposure to war events, PTS, functioning, and social support.ResultsExposure to war events was associated with PTS and related functioning problems. Education and religiosity were correlated with PTS and problems in functioning. Contrary to our hypothesis, more formal social support was associated with more PTS. Social support did not moderate the association between exposure to war events and PTS.DiscussionThe unexpected positive correlation between support and PTS was interpreted as either reflecting the fact that foster care agencies targeted foster parents who were most in need, or as a reflection of the inadequacy of the support they received. The findings indicate that foster parents need support during times of major stressful events such as natural disasters and wars, so that they will be able to help the children in their care. Specialized professional training for foster care workers needs to be implemented. Future longitudinal and mix-methods studies are suggested to help address the limitations of the present study.     

An mHealth Approach to Extend a Brief Intervention for Adolescent Alcohol Use and Suicidal Behavior: Qualitative Analyses of Adolescent and Parent Feedback

Abstract

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the posthospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.     

Computer-mediated parenting education: Digital family service provision

Computer-mediated family service provision holds the promise of equal efficacy, lower cost, and higher accessibility than traditional parent education groups that require parents to travel to a service venue, thereby alleviating often-cited pragmatic barriers to participation in parenting programs. Hence, examinations of which populations are attracted to particular service modalities are a necessary step in building a reliable evidence base. The scant computer-mediated parent education literature indicates that online parenting programs are beneficial to indicated or secondary prevention programs seeking to bolster specific parent, child, or dyadic outcomes; it is reasonable to ask, then, if this service provision mechanism would be equally effective for all parents, outside of targeted intervention designs. The current paper describes the provision of computer-mediated parenting services to a large sample of parents (N = 192, 89.6% female, average age 40 years; 27% racial/ethnic minority) with no shared prevention indicator through an employer-based program. Our research questions on service provision and utilization include: Who is served by primary prevention programs like this? Do participants report satisfaction with computer-mediated services commensurate with traditional face-to face services? In addition to significant differences in perceived social support by gender, marital status, and number of children younger than 18 living in the home, results from three measures of parenting attitudes and behaviors (e.g., discipline style, sense of competence, and locus of control), indicate that this sample has some confidence in their general abilities as parents, but struggle to feel an internal sense of control over their children's behavior, with the greatest number of parents tending towards overreactive discipline. Associations between these indicate a consistent pattern such that dysfunctional parenting practices tend to co-occur, and parents who do employ dysfunctional strategies feel less competent as parents. Participants report high satisfaction with these services, at equal or better rates than reported in the parent education literature. This work provides evidence that computer-mediated parenting services can attract and exceed expectations of participants with clinical and subclinical but moderate parenting needs, indicating that this service delivery mode has the potential to reach a wide number of individuals ideally situated for prevention services.     

Social skills training and parent education programs for aggressive preschoolers and their parents in South Korea

The purpose of this study was to develop and evaluate social skills training and parent education programs for aggressive young children and their parents in South Korea. Participants consisted of intervention group I, which included six children and their mothers in the social skills training and parent education programs; intervention group II, which included seven children and their mothers in the social skills training; and control group, which consisted of six children and their mothers. Pre-test-post-test control group design was used. Participants in both intervention groups reported a significant decrease in aggression and on improvement in pro-social behavior, emotional regulation, and social skills, while the control group reported an increase in aggressive behavior. Mothers in the intervention group I also reported an increase in warmth/acceptance. The findings indicate that both programs are highly effective in reducing aggressive behavior among young children and in fostering positive parenting behaviors.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Social gradients and participant characteristics in child behavior problem interventions

A social gradient has been found in both children's behavior problems and among the users of services that treat such problems. If low-resource families are simultaneously at higher risk of having a child with behavior problems and less inclined to use services to address such problems, healthcare inequality and social inequity could be exacerbated. I focus on social gradients in participant characteristics in two evidence-based parent training interventions that target children who display behavior problems: Parent Management Training—Oregon Model (PMTO) and Brief Parent Training. This study extends the literature on social gradients in participant characteristics by focusing on family social and economic resources independently and in an additive cumulative risk index. I investigated potential social gradients overall in a pooled sample and in separate analyses relating social gradients to more intensive treatment. The results revealed inverse social gradients among the intervention participants compared with the Norwegian general population of families with children; intervention participants had fewer social and economic resources. The inverse social gradient was partially replicated through analyses that focused on treatment intensity. Families with fewer resources were more likely to receive high-intensity treatment; however, these associations disappeared for families with > 3 cumulative risks. These results indicate that these PMTO interventions do not exacerbate social inequality by serving a high-resource population.     

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.     

The effect of caregiver's burden on change in frail older persons' use of formal helpers

We used a national longitudinal probability sample of frail older persons and their caregivers to examine three questions: 1) What are the probabilities of transition to use of formal helpers over a two-year period? 2) What is the role of predisposing, enabling, older person's need, and caregiver's need variables in changes in the use of formal helpers? 3) Do determinants of change in the use of formal helpers vary by level of caregiver's burden? Results show a slight trend to increased use in formal help over time. Personal burden, but not interpersonal burden, had a lagged effect on increased use of formal services. Use of formal helpers was greater in situations combining high levels of older person's need, high levels of caregiver's personal burden, and insufficient support from the informal network.     

Help seeking among addicted and nonaddicted women of low socioeconomic status

Concern with the provision of health and welfare services to underserved or inappropriately served groups has led to numerous studies of patterns of service utilization. This article focuses on the help-seeking patterns of heroin-addicted and nonaddicted women of lower socioeconomic status. The results suggest addicts generally experience more problems than nonaddicts; those with few problems are less likely to use formal support systems; and black respondents, both addicts and nonaddicts, are less likely to use formal support systems. The evidence indicates that while addicts tend to use natural support systems less frequently than nonaddicts, addiction per se does not explain help seeking when race and number of problems are taken into account. The heavy reliance of both addicts and nonaddicts on informal helpers supports the value of professional efforts designed to facilitate or enhance these networks.     

Directions for developmental screening in child welfare based on the ages and stages questionnaires

Many young children investigated for maltreatment have developmental problems qualifying them for early intervention services, yet only a portion of these children receive such services. To address this gap, all children ages 0-3 with child welfare (CW) substantiated maltreatment in Pennsylvania are screened for developmental and socioemotional problems using the Ages and Stages Questionnaires (ASQ). This study views screening results for over 500 children to address whether children's substantiation status, living situation, and administering worker as CW or early intervention (EI) predicts screening rates. Bivariate and logistic regression analyses were used. Results showed that 22% of children scored in the problem-range of at least one developmental area and 18% scored in the problem-range of social-emotional concerns warranting EI referral. Results of bivariate analyses showed that children who spent time in the NICU were more likely to have developmental concerns. Socioemotional concerns were related to child race, foster care living situation, child as the subject of the referral, and physical neglect. Older children and children whose referral involved lacking basic needs showed both developmental and socioemotional concerns. There were no significant differences in screening results of children with substantiated versus unsubstantiated maltreatment. Children whose screening was conducted by EI were more than three times as likely to show developmental concerns compared with those screened by CW. Child welfare workers need more support when conducting developmental screening, and policies that limit screening to children with substantiated maltreatment or to children in out-of-home care should be reconsidered.     

Use of a Parent Management Training Intervention with Urban Foster Parents: A Pilot Study

The development of effective interventions for foster children with behavior problems is essential given the consequences of behavior problems for children's placement stability and permanency outcomes. This article presents findings from a pilot study of an intervention providing parent management training (PMT) and support to foster parents in groups and home visits. The intervention was an adaptation of the KEEP (Keeping Foster Parents Trained and Supported) group intervention, provided in a large urban child welfare agency serving predominantly African American foster parents. The study used an intent-to-treat design, with 25 foster parents of 31 children (ages 4-12) in specialized foster care assigned to either an intervention or treatment as usual control group. Longitudinal outcomes were analyzed using random effect regression models. Over time, children's behavior problems were significantly lower in the intervention group relative to the control group, and the effect of the intervention was partially mediated by parents' understanding of how to appropriately use the intervention parenting skills. These results provide support for the effectiveness of KEEP with urban foster children with significant behavior problems.     

Female victims of domestic violence: which victims do police refer to crisis intervention?

Factors associated with activation of a volunteer-based crisis intervention services program for victims of police-reported intimate partner violence (IPV) were examined to determine if those for whom services were activated were representative of the overall eligible population. The study population comprised 2,092 adult female victims of male-perpetrated police-reported IPV. Crisis intervention services were requested by responding patrol officers in 415 (19.8%) of these incidents. Activation of crisis intervention services was more likely for victims who were married to their abusive partner, pregnant, or of Latina or Asian race/ethnicity and among IPV incidents involving physical abuse, visible victim injuries, and arrest of the abusive partner. Additionally, one of the city's five police precincts was less likely than the remaining four to utilize these services. Activation of crisis intervention services was associated with factors related to need and feasibility of service delivery, but differential activation at the precinct level was also found to be influential.     

„Einfach mal zuhören.” — Alltägliche Helferinnen im System Hochschule

Women traditionally work in public health and welfare, often without public notice and recognition. “To be feminine” is accepted as a most important resource of support especially if it is given in voluntary, additional work and without pay. The dominance of women as “natural helpers” is featured in professional help too. Non-academics (e.g. secretaries) at universities are important and powerful groups of natural helpers. They have lots of contact with people in need (e.g. students), because they work in functions with intense social communications. The results of extensive research at the Technische Universität Dresden demonstrated for the first time which important role non-academic women play as natural helpers for students with mental and/or social problems. The research has examined the interaction between helpers and students, the dimensions of problems and conditions, forms, extent and subjective reflections on help giving.     

Raising Children Amid the Threat of Deportation: Perspectives from Undocumented Latina Mothers

Despite the large number of families with at least one undocumented parent, little research has investigated mothering amid the threat of immigration enforcement. We present results of a community-based participatory study with 7 Latina mothers who describe their experiences of parenting while navigating the possibility of deportation. Undocumented mothers found meaning in caring for their children. Yet due to restrictions related to immigration status, mothers were unable to support their children as they intended and feared their deportations would leave children without care, contributing to psychological duress. We provide recommendations for practitioners working with mixed-status families.     

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

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