残疾儿童心理健康内涵及结构初探

心理健康是儿童生活和健康成长的保障,相较于普通儿童,在某些方面具有障碍或缺陷的残疾儿童更容易出现情绪和行为问题,其心理健康状况堪忧,迫切需要得到更多的关注和有效的干预.本文基于心理健康的概念和标准,结合残疾儿童的身心发展特点,厘清了残疾儿童心理健康的内涵,其实质是努力达成残疾儿童与外界环境的适度平衡和内心的和谐,即良好的社会适应.在此基础上,从社会适应心理机能的活动领域和特质内容两个维度入手,初步构建出残疾儿童心理健康的五领域(自我意识、人际交往、学习适应、生活适应、社会支持)与三内容(认知、情绪情感、意志行为)相交叉的二维结构模型,为进一步开展残疾儿童心理健康教育的实践工作奠定理论基础.     

Parenting with a Disability and Child Mental Health: A Propensity Score Analysis

Little research has examined the impact of having a parent with a disability on child mental health. This study used data from 7,116 families of children who participated in the 2006 National Health Interview Survey and propensity score matching (PSM) to investigate this question. Prior to PSM, differences in Child Mental Health Brief scores were significant with a moderate effect size. After PSM, differences in Child Mental Health Brief scores were still significant, but the effect size was small. Results indicate that much of the mental health risk for children of parents with disabilities is connected to related issues.     

‘It's afforded us a huge flexibility’: the impact of ‘Disabled Children's Access to Childcare Pilots’ on families with a disabled child in England

For many parents of disabled children, finding affordable and suitable childcare that meets their needs is very challenging. Research in the UK has shown that parents with disabled children experience barriers not just with cost, but also accessibility, the attitudes of childcare providers and in getting good information about sources of childcare. The Disabled Children's Access to Childcare (DCATCH) pilots was an initiative designed to improve access to childcare for disabled children in England. As part of an evaluation of DCATCH, qualitative interviews were carried out with 38 members of 22 families who had received support from the initiative. All of the families reported positive outcomes and highlighted: a beneficial impact on the parents' capacity to work; enjoyable experiences for the disabled child; increased confidence and independence for both parents and children; and the creation of time for parents to pursue other activities. The results of the DCATCH initiative support other research which argues that whilst cost is a significant factor around childcare choices for families with a disabled child, having confidence in the childcare provider's ability to meet specific needs (including complex health care needs) and providing positive experiences for the disabled child are also key, determining factors.     

What Can We Say Regarding Shared Parenting Arrangements for Swedish Children?

ABSTRACT

Joint physical custody (JPC) refers to children living alternatively and about equally with both parents after a parental separation or divorce. The practice has been debated in relation to child well-being because of the frequent moves imposed on children and the potential stress from living in 2 homes. This study describes the background to the high frequency of Swedish children in JPC and the results from research on Swedish children’s well-being in this living arrangement. Children in JPC report better well-being and mental health than children who live mostly or only with 1 parent. No Swedish studies have found children’s health to be worse in JPC than in sole parental care from child age of 3 years and beyond. The existing literature cannot, however, inform us about the mechanisms behind the findings. The risks of selection effects into living arrangements are plausible. For this purpose, longitudinal studies are warranted.     

The cost of caregiving: wage loss among caregivers of elderly and disabled adults and children with special needs

Sixty-one percent of the adults caring for elderly and disabled family members and 53% of parents of children with special needs are employed. Yet studies examining the experience of employed caregivers of children with special needs and elderly or disabled adult family members have not examined the impact on earnings or the workplace policies that might help reduce the conflicts between work and caregiving. This study begins to fill this gap using data from a nationally representative US survey of American adults. We find that employees who live with a child with a health problem are 48% more likely to have lost wages. Each adult with health issues that an employee is responsible for raises the chances of wage loss by 29%. At the same time, access to paid leave for family health needs reduces the likelihood of wage loss by 30%, and having a supportive supervisor reduces the odds of experiencing wage loss by 37%. Implications for employers and US policy-makers are discussed.     

Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

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

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

Subjective Economic Status in Adolescence: Determinants and Associations with Mental Health in the Norwegian Youth@Hordaland Study

We aimed to identify factors associated with perceived economic well-being (PEWB), and examine its association with symptoms of depression and attention-deficit/hyperactivity disorder. In the Norwegian youth@hordaland study, 9166 16–19-year-olds provided information on perceived economic well-being and relevant covariates. Information about families’ income-to-needs was obtained from tax return forms. Adolescents in households with a low income-to-needs ratio, with non-working parents, and in single-parent households were more likely to report poor PEWB. Adolescents with poor PEWB reported more symptoms of depression and ADHD, also after adjusting for covariates, including income-to-needs. There was a significant indirect effect of income-to-needs on mental health problems though PEWB. The current study demonstrates the role of PEWB as a contributor in the pathway from social inequalities to disparities in mental health.     

Disadvantage and Discrimination Compounded: the experience of Pakistani and Bangladeshi parents of disabled children in the UK

This paper discusses a qualitative and quantitative study of the circumstances of 20 Pakistani and Bangladeshi families with one or more severely disabled children living in Birmingham, England. Parents and other adult carers were interviewed using a combination of structured questionnaires and a semi-structured interview schedule focusing on the families' material circumstances, their use of formal services, informal care arrangements, and aspects of the parents' social and psychological well-being. The study suggests that previous national surveys of disabled families may have under-estimated the extent of material disadvantage, while it confirms that health and social care professionals should not assume that Pakistani and Bangladeshi parents have recourse to high levels of extended family support. The combination of disadvantaged circumstances and difficulties in securing access to appropriate services, which are found for the majority of families with a disabled child, was particularly acute for these ethnic minority families, suggesting the additional dimension of institutional racism.     

Remaining home: Well-being outcomes and co-occurring parental substance use following a maltreatment investigation in middle childhood

PurposeThe purpose of the study is to understand differences in child well-being related to parental substance use among children ages 6–12 who were investigated for maltreatment but not removed from their homes. Children with a substance-using parent in the home are compared to those without a substance-using parent in the home.MethodsLongitudinal data from waves 1 and 3 of the second National Study of Child and Adolescent Well-Being (NSCAW II) are used. NSCAW II is a national sample of families with children and youth aged birth to 17.5 investigated by child protective services (CPS). A subset of the data (analyzed with domain analysis methods) is used for this study (n = 575). Eight well-being outcomes from four domains (cognitive development, physical health, psychological/behavioral development and social/emotional competence) are analyzed.FindingsWe hypothesized that (among children investigated for maltreatment and not removed from home) children whose parents used substances would exhibit lower mean levels of well-being at thirty-six months follow-up compared to those whose parents did not use. Unexpectedly, we found no significant differences in well-being levels between children with parents in the home using substances and those without.ConclusionsChildren with substance-using parents may be able to remain at home over an extended period after investigation, while maintaining well-being levels similar to children at home with parents not using substances. If an effective safety plan can be put in place, this option may provide a path to maintaining safety, permanency and well-being for such children without placement in out-of-home care.     

A survey of disabled children and young people’s views about their quality of life

This study aimed to explore disabled children and young people’s perspectives about their quality of life, in terms of physical, mental and social well-being. Ninety-one disabled children, recruited through voluntary organisations in Scotland, completed KIDSCREEN-27, a validated measure of health-related quality of life for children. Findings were compared with those from a European study of predominantly non-disabled children. The children gave largely positive reports about school, family relationships and their physical health. However, one in three reported often feeling ‘sad’ and many were excluded from social activities with their peers. Expectations of achieving academic qualifications, and moving into further or higher education, were generally low. The children’s perceived quality of life was lower than their European counterparts, less so in relation to school but particularly for friendships and peer support. The findings are discussed in the light of the social relational understanding of disability. Policy and practice implications are identified.     

Short Break and Respite Services for Disabled Children in England: Comparing Children's and Parents' Perspectives of Their Impact on Children

Researchers, health and social care workers often seek to understand the perspectives of children; but gathering views directly from children can present difficulties. Parents are often asked to provide accounts of children's feelings or opinions on the assumption that their proxy reports are accurate and unproblematic. This qualitative thematic analysis of open‐question responses from 352 parents and 73 disabled children examines their accounts of the impact of short break services on disabled children. Participants' perspectives differed; children tended to describe immediate outcomes such as enjoying activities and participation; parents acknowledged these, but focused on longer term developmental outcomes for children.     

The effect of social anxiety,generalized anxiety,depression and substance abuse on child support payment compliance among non-custodial parents

Millions of children live with custodial parents (CPs) who have child support court orders for the non-custodial parent (NCP) to provide payments to the CP for care of the children. Unfortunately, less than half of CPs receives full child support. A key issue influencing the failure to pay child support is NCP unemployment. Despite a clear association between unemployment and several mental disorders, the nature and prevalence of mental disorders has not been investigated in the NCP population. The purpose of this study was to explore the association between mental health and substance use problems among non-custodial parents and their payment of child support. The study also investigated whether unemployment mediated the relationship between these variables.Surveys that included validated screening instruments to assess for generalized anxiety, social anxiety, depression, and substance use disorders were administered to a convenience sample of 633 NCPs. Survey respondents were matched with state support payment information.The results indicated that depression, generalized anxiety, social anxiety and substance use problems were present at a much higher rate than 12-month rates of these conditions found in the general population. This study also confirmed the strong association between child support payments and employment. Employment mediated the relationship between mental health problems and child support payments. The findings suggest that non-compliant NCPs, particularly those who are also unemployed, may experience clinically significant mental health conditions that contribute to unemployment and potentially, payment non-compliance. Future studies could explore if providing mental health assessment and employment-focused treatment for mental health-related barriers to employment may increase employment and child support compliance for NCPs, thereby improving children's economic stability and well-being.     

Supporting families: Outcomes of placement in voluntary out-of-home care for children and young people with disabilities and their families

Parents caring for children and young people with disabilities typically have extensive additional demands on their time and resources. This added pressure can significantly impact well-being and mental health. In extreme circumstances, parents may seek an out-of-home placement for their child. Previous research has looked into factors that influence decisions for families to place their child into out-of-home care but little is known about outcomes for these young people and their families. The Supporting Families study aimed to explore the impact of a voluntary out-of-home placement on young people with disabilities, and consequences for their families. Fourteen parents/carers, twenty six case managers, six accommodation services' managers, and four young people with disabilities participated in face-to-face and telephone interviews and focus groups. Participants reported a range of outcomes for young people in care. Positive outcomes included increased levels of respect for themselves and others, an improvement in independent living skills, and reductions in challenging behaviours. Negative outcomes centred on their experiences of grief, loss and rejection, as well as behavioural problems. Positive and negative outcomes were also found for families. For many parents/carers there was a reduction in perceived stress and caring load, as well as improved mental health and wellbeing for them and the child's siblings. However, parents/carers often experienced ongoing feelings of guilt, grief and loss. The study adds to knowledge about outcomes of being in voluntary out-of-home care for this small but vulnerable group of young people in care and their families.     

The psychosocial benefits of work for people with severe and enduring mental health problems

Perceptions of the value of work for people with severe and enduring mental health problems have changed frequently over the last two decades. With the new social inclusion agenda manifest in the Disability Discrimination Act and in the NHS modernization agenda, work is once again in vogue. There is a need for a way of evaluating work which draws on its potential contribution to psychological well-being as well as its provision of a valued social role and which is less susceptible to fluctuations in health and social policy. Jahoda's work on the psychosocial functions of work provides such a framework and this study sets out to explore its utility among workers who are severely disabled by mental health problems. Twelve of the psychosocial functions of work were rated by 50 people attending two sheltered work placements according to how important they were perceived to be and the extent to which the functions were fulfilled through their attendance. Satisfaction of the psychosocial functions through work was compared with their satisfaction through other aspects of the respondents’ lives. All functions were perceived as important, but self-confidence/self-esteem was rated as more important than most of the others. Structure to the day, self-confidence and social contact were better satisfied through work than were decision making, practising old skills and having goals to aim for. In general, the results showed that the functions were fulfilled better by work than by other aspects of the respondents’ lives. The study supports the notion that work is of value in the rehabilitation of people with severe and enduring mental health problems and offers a possible framework for the further exploration of this theme, both within mental health services and the community at large.     

Complex Families and Late‐Life Outcomes Among Elderly Persons: Disability,Institutionalization, and Longevity

The authors examined the effects of marital status and family structure on disability, institutionalization, and longevity for a nationally representative sample of elderly persons using Gompertz duration models applied to longitudinal data from 3 cohorts of the Health and Retirement Study (N = 11,481). They found that parents with only stepchildren have worse outcomes than parents with only biological children. Elderly mothers with only stepchildren become disabled and institutionalized sooner, and elderly men with only stepchildren have shorter longevity relative to their counterparts with only biological children. The effect of membership in a blended family differs by gender. Relative to those with only biological children, women in blended families have greater longevity and become disabled later, whereas men in blended families have reduced longevity. The findings indicate that changing marital patterns and increased complexity in family life have adverse effects on late‐life health outcomes.     

Parents of adults with developmental disabilities: Age and reasons for reluctance to use another caregiver

Parents of individuals with developmental disabilities differ in their expressed reluctance to use another caregiver depending on their age. Older parents, more than younger parents, reported a reluctance to use another caregiver because of financial reasons and the unavailability of qualified caregivers. The results suggest that elderly parents may be willing to leave their developmentally disabled child with someone else but they require financial assistance and education regarding program quality and availability.Jean L. Engelhardt is a Research Associate of the Family and Child Studies Center, Department of Home Economics and Consumer Sciences, at Miami University in Oxford, Ohio. Her current research is in the area of older parents of developmentally disabled children. Dr. Engelhardt received her Ph.D. in Psychology from Notre Dame.Dr. Lutzer is Assistant Professor of Educational Psychology and an Associate of the Family and Child Studies Center at Miami University in Oxford, Ohio. She is currently involved in research on the older parents of developmentally disabled children.Timothy H. Brubaker is Professor and Director of the Family and Child Studies Center, Department of Home Economics and Consumer Sciences, at Miami University in Oxford, Ohio. Dr. Brubaker holds a Ph.D. from Iowa State University and is currently conducting research on the older parents of developmentally disabled children.We express our gratitude to the Family Resource Services Program of the Butler County (Ohio) Board of Mental Retardation and Developmental Disabilities for their help, and to the Jacob G. Schmidlapp Trust of Cincinnati for financial support during the writing of this article.     

Predictors of Substance Use and Mental Health of Children of Divorce

Abstract

This short-term longitudinal study examined psycho-social influences on substance use and mental health among children of divorced parents. The sample consisted of ethnically diverse fifth and sixth grade students, and compared children of divorced parents (CODPs; N = 176), who were an average of four years post-divorce, with children of married parents (COMPs; N = 213) who had never divorced. CODPs reported more life stress, less problem-focused coping, and more substance-using friends and family members than COMPs. Further, these variables were significantly related to CODPs' greater reported substance use, aggressive behavior, and depression than COMPs cross-sectionally, and longitudinally, four months later. The results suggest the importance of including both substance use and mental health outcomes in preventive interventions for CODPs.     

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.     

Deaf Families’ Unique Experiences and Obstacles

ABSTRACT

This article focuses on deaf children of deaf parents who grew up using American Sign Language (ASL) in deaf culture. Deaf children of deaf parents described their unique experiences of struggling with obstacles, including quality of education, low expectations from professionals, unwanted sympathy, mental health therapists’ lack of cultural competency, and not being asked for valuable perspectives or advice. The advice from deaf children of deaf parents is included in the article. By bringing greater attention to this population, mental health, school, and other professionals can increase their awareness of deaf families’ unique needs in their work environment.