Establishing a mental health service for young children in out-of-home care: The Gumnut Clinic for 0 to 5 year olds in Western Sydney

Objective

Children aged 0 to 5 years in out-of-home care represent a vulnerable population at high risk of social, emotional and developmental problems, yet there are few services specifically addressing their psychological needs. This paper is the first of two concerning the establishment of The Gumnut Clinic, a specialist mental health assessment clinic in Western Sydney for this population. The current paper provides the rationale for the development of the clinic and detail of the referral and assessment processes.

Method

The paper describes the establishment of The Gumnut Clinic at Redbank House in Sydney, Australia, the approach to assessment of these young children and their carers, and the challenges encountered.

Conclusions

Young children are overrepresented in child protection and out-of-home care services. Their social, emotional and developmental needs are under-recognized. Development of a specialist mental health service is a step towards improving health outcomes for these children.     

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.     

Externalizing problems in young foster children: Prevalence rates,predictors and service use

Objective

Examining the prevalence of externalizing problems, their predictors and mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Method

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children's externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in linear regression.

Results

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

Conclusions

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children's externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.     

Risk factors and services for child maltreatment among infants and young children

Objectives

Child maltreatment (CM) causes injury in large numbers of U.S. children. This study uses a large, multi-state dataset of child protective services reports for infants and young children under five years of age to examine risk factors and the effects of services in confirmed maltreatment investigations and recurrence over five years.

Methods

The Child Files of the National Child Abuse and Neglect Data System (NCANDS) for 2003-2007 were used to study confirmed CM reports to child protective services (CPS) using regression models and survival analysis among a cohort of children first reported during 2003.

Results

There were 1.2 million confirmed maltreatment reports to state child protective services agencies in 22 states during 2003-2007 in NCANDS, including 177,568 infants and young children under five years. 19.3% had a second confirmed CM report within 5 years. White race, inadequate housing and receiving public assistance were associated with significantly increased risk of CM recurrence. Infants and young children received more services and had less recurrence than did older children.

Conclusions

Infants and young children have different risk factors and receive different services than do older children in the CPS system. We need additional research to further assess and better target services for the special needs of infants, young children and their families if we are to protect them and reduce future child maltreatment.     

Perceptions of Long-Term Community Adaptation of Delinquent Young Adults Who Graduated from Children’s Residential Mental Health Treatment

Purpose

This article presents results from one part of a longitudinal study into the post-discharge community adaptation of youth involved in residential mental health treatment. The focus is on young adults interviewed in Phase 3 of the research who have been identified as experiencing delinquent behaviour in their communities which brings them into contact with the law. This research is unique as young adult graduates of residential treatment were interviewed and they describe in detail how they are currently functioning in their lives.

Method

Qualitative interviews were completed with a convenience sample of 59 young adults between 18 and 25 years of age who had accessed children’s residential mental health treatment up to 10 years prior to data collection.

Results

The results demonstrate that delinquent behaviour post-discharge from residential treatment is a real concern and, for a sub-set of young adults, relates to negative outcomes in multiple domains of living, such as substance abuse, personal well-being, education and employment, and social networks and relationships.

Conclusions

The results indicate there is a need to improve long term community adaptation for this group, and that improving community living outcomes is much more a function of ongoing support and caring than short-term treatment and cure.

     

Risk factors for involvement in cyber bullying: Victims, bullies and bully-victims

Objectives

The purpose of the current study was to examine the frequency of cyber bullying among youth by distinguishing among the three categories of involvement in cyber bullying: victims, bullies, and bully-victims, to compare these to a fourth category of students who are not involved in the three categories of cyber bullying and to explore the factors that contribute to involvement in cyber bullying.

Method

This study utilized a large and diverse sample of 2186 middle and high school students, who completed self report questionnaires during class time. We performed a Multinomial Logistic Regression to examine the relationship between the cyber bullying categories and our independent variables (gender, age, technology use, parental involvement and safety).

Results

Over 30% of the students in this study identified as involved in cyber bullying, as victims or perpetrators, and one in four of the students (25.7%) reported having been involved in cyber bullying as both bully and victim during the previous three months. Students who were involved in cyber bullying were more likely than others to report perpetration of violence toward peers, to use computers for more hours a day, and to give their password to friends. Other risk factors, such as gender, age and safety, were found to be specific only for one category of cyber bullying.

Conclusion

The findings revealed that students are highly involved in cyber bullying. Several unique characteristics emerged regarding the frequency and risk factors of students' involvement in cyber bullying. In traditional bullying the category of bully-victims represents the smallest and most vulnerable group of children, whereas in the current study the bully-victims category emerged as common. In addition, females were more likely than males to be bully-victims, in contrast to research on traditional bullying, in which more males than females are typically involved as bully-victims. In addition, several risk factors were common among the three groups of children, including the amount of hours per day students use the computer, and giving passwords to a friend. These results point to the need for further examination and to focus on the risk factors for students' cyber bullying involvement in each of the three categories.     

Reflections on citizen-state child welfare partnerships: Listening to citizen review panel volunteers and agency liaisons

Objective

Previous research pertaining to the citizen review panel (CRP) initiative indicates that discrepancies exist between panel member and state agency liaison perceptions of CRP effectiveness in fulfilling the CAPTA CRP mandate. This study explores the impressions of both CRP members and liaisons involving barriers to effective CRP-state child welfare partnerships and recommendations to improve the relationship, provided through narrative survey responses from CRP liaisons from 30 states and D.C. and panel members from 32 states and D.C. Thematic categories which emerged from analyses of these responses are discussed, and a conceptual model and substantive-level theory of the CRP-child protective services (CPS) relationship developed from the results are presented.

Results

The complex nature of CRP-CPS relationships emerged as the central theme among CRP members' and liaisons' responses. Liaisons and CRP members identified a need for CRP members to become more educated globally on child welfare despite the relatively high level of education and experience of much of the sample. Difficulties encountered by panel members in the effort to partner surfaced in themes of mistrust and skepticism about the worth of citizen participation in child protection. Negative agency attitudes, lack of role clarity, and lack of commitment to authentic partnership were cited as negative influences upon the relationship by both liaisons and CRP members. The most important preferred outcome of the partnership was that citizen volunteers would become more knowledgeable partners who could meaningfully contribute to child welfare efforts. A second desired outcome important to CRP members was to form a shared vision with CPS.

Conclusions

Findings imply that when key components of mutual respect, legitimacy, CPS knowledge, shared vision, authenticity, citizen engagement, honest communication, and a serious, deliberative process are in any way impeded, the partnership is vulnerable to breakdown, and intended outcomes may be compromised.

Implications

Important relational difficulties that have formed barriers between volunteers and CPS agencies have been identified, and results suggest specific issues to target for improvement. These findings can prompt a more informed discourse about the challenges and opportunities presented when attempting to engage citizens in child welfare practice and policy-making, and can lead to new research paths. Suggestions for such efforts are offered.     

Examining the relationship between psychotropic medication use and testing positive for Chlamydia and Gonorrhea among detained adolescents

Objective

We examined whether psychotropic medication (PTM) use was related to testing positive for Chlamydia and Gonorrhea among detained adolescents.

Methods

A convenience sample of 550 detained adolescents ages 14-18 years were recruited from eight youth detention centers in Georgia. Using A-CASI technology, data was collected on demographic factors, use of PTM, and sexual risk behaviors. Chlamydia and Gonorrhea diagnoses were assessed by laboratory testing.

Results

Thirteen percent (13.1%) of adolescents not using PTMs tested positive for STIs compared to only 4.9% of those reporting PTM use. PTM users had a 62% smaller odds ratio for testing positive for Chlamydia or Gonorrhea.

Conclusion

Findings suggest that use of psychotropic medication, if deemed useful by detained youth, may be a protective factor against engaging in behaviors which may culminate in contracting some STDs. The practice implications are discussed within the context of these findings.     

The effect of experience of childhood abuse among university students on self-perception and submissive behavior

Objective

The aim of this study was to investigate the effect of experience of childhood abuse among university students on self-perception and submissive behavior.

Methods

The study group consisted of 646 students attending various departments of the Karadeniz Technical University Faculty of Education in Trabzon, Turkey. Participants were administered the Childhood Trauma Questionnaire, the Social Comparison Scale and the Submissive Acts Scale in a classroom setting.

Results

Analysis revealed a significant negative correlation between self-perception and all forms of abuse (physical abuse, sexual abuse, and emotional abuse and neglect), and a positive correlation between submissive behavior and all forms of abuse. The students' emotional abuse and neglect scores varied significantly according to gender, with males having higher emotional abuse and neglect scores than those of girls. Additionally, males had higher physical abuse scores than girls.

Conclusion

Childhood abuse emerged as a significant predictor of negative self-perception and submissive behavior. In addition, with the exception of sexual abuse, other forms of abuse vary according to gender. The experiences of childhood abuse may have a long-term impact on various features of character and behavior.     

Ethical and legal challenges of mandated child abuse reporters

Background

Mandated reporters inconsistently report child abuse cases. Ethical dilemmas and legal challenges to reporting arise creating barriers to assist abused children and their families.

Purpose

The purpose of this study was to describe professionals' ethical dilemmas and legal challenges to reporting child abuse.

Method

A qualitative study was conducted to explore the ethical and legal challenges of mandated reporters when reporting child abuse. Individual interviews between 60 and 100 min were conducted with a purposive sample of 18 mandated reporters including physicians, nurses, social workers, and teachers. Grounded theory methodology was used to develop categorical themes that reflected mandated reporters' experiences and challenges.

Result

Three themes emerged from the data: conflicts, time, and law as refuge. Professionals described challenges in balancing autonomy, beneficence, nonmaleficence, and justice. There was no best solution to do no harm. The associated stigma and pressure of cultural and secular norms of child abuse inhibit professionals' action based on legal and ethical requirements. The theme of time included limited time and an uncertain future. The law provides security and refuge for professionals to find a solution to the challenges of reporting child abuse.

Conclusion

The ethical and legal challenges of reporting child abuse create complex dilemmas for mandated reporters. Ethical principles are in constant opposition when negotiating rights of children and rights of parents. Supportive structures and education are needed to assist professionals in meeting their reporting obligation and solving their dilemmas.     

Integrating creative art into a community-based mental health program for Asian American transition age youth

This paper advocates for the use of creative art as an adjunct in the delivery of mental health care for Asian American transition age youth in the United States. A case study of a participant in a community-based mental health program called Project FOCUS in Orange County, California details how art was used to assist a young woman to identify and achieve her personal goals, mitigate her emotional and behavioral problems, and reach a sense of overall well-being. The findings in this paper lay the groundwork for future research into how art can be systematically incorporated into community-based mental health programs to facilitate service utilization. Further, this study demonstrates that Asian American transition age youth face mental health challenges typical of their cohorts, despite being putative members of a “model minority.” The use of creative art transcends cultural and language barriers, and empowers Asian American transition age youth to explore their identity and express their emotions, which ultimately promotes their mental well-being.     

Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

Access visits: Perceptions of child protection workers, foster parents and children who are Crown wards

Objective

To report findings from a study of the perceptions of foster parents, child protection workers and children regarding supervised access visits for children who are permanent wards (Crown wards).

Methods

Interviews were conducted with twenty-four Crown wards having regular supervised access visits. Eight focus groups were conducted with twenty-four foster parents, and twenty-six child protection workers. Interviews and focus groups explored perspectives regarding supervised access visits. Interviews and focus groups were transcribed, coded, and thematically analyzed. Negative case analysis, prolonged engagement, and triangulation contributed to the trustworthiness of the research.

Results

While this study is explorative, findings suggest considerable dissatisfaction regarding access visits among foster parents and workers, inadequate training for workers and foster parents, poor communication and consultation regarding access visits, and confusion regarding the roles of supervisors.

Conclusions

The data suggest several possible explanations for children's distress associated with access visits including lack of communication among access supervisors, workers and foster parents; insufficient training for workers who supervise visits; and a lack of validation of the children's contradictory feelings towards their mothers.

Practice implications

Findings suggest the need for more consultation with and inclusion of foster parents in access visits. More training is required for workers supervising access visits including whether and how it is beneficial for children to express their feelings and address potentially difficult topics regarding their biological family members.     

Children adopted from China: Attachment security two years later

Background

This study continues the examination of the process of attachment formation of mothers and their adopted Chinese daughters two years postadoption.

Method

30 children adopted from China (mean age = 13.6 months at adoption) were assessed and followed two years following adoption. They were compared to 31 nonadopted Canadian girls of similar age and family background. In earlier reported longitudinal studies of the adopted children, maternal reports of attachment security were employed. In the current study the Strange Situation Procedure was used.

Results

Adopted children show signs of having a secure attachment with their mothers two years following adoption. There was some evidence that disorganized attachment characterized these children more so than for children in the comparison group.

Conclusions

The moderate degree of emotional deprivation experienced by Chinese adoptees does not hinder their ability to form a new attachment with adoptive mothers. Attachment appears open to change, even after a time when children should have already formed an attachment relationship and the change is maintained.     

Public attitudes toward child maltreatment in Israel: Implications for policy

Objective

The public view of the severity of social problems and their perceptions of how effectively they are being addressed have a major impact on public policies and resource allocation. The present study focuses on public attitudes toward child maltreatment. It examines perceptions of child maltreatment as a social problem, and attitudes toward prevention and treatment strategies in cases of child abuse and neglect.

Methods

A survey was conducted among a representative sample of 812 Israeli adults: 688 Jews, and 124 Arabs. Fifty additional Ultra-Orthodox Jews were added for comparisons among Jewish participants.

Results

The participants tend to view violence and alcohol consumption among youth as a more serious problem than parental maltreatment of children. Low-income participants tend to view child maltreatment as a more serious problem than did high-income participants. Jewish participants (except for ultra-Orthodox Jews) view child maltreatment as a significantly more serious problem than did Arabs and Ultra-Orthodox Jews. Most of the participants believe that parents who maltreat their children should be punished, but they should be taught how to refrain from maltreatment, and learn to change their behavior. Many participants believe that the courts do not sufficiently punish parents who maltreat their children. In their assessments of the quality of professional work, the highest evaluations are given to services provided by physicians and social workers, whereas the lowest evaluations are given to judges and police. Most of the participants (70%) believed that social workers play an important role in protecting children.

Conclusions

The survey findings have implications for enhancing public awareness of child maltreatment as well for policy making in the area of child abuse and neglect. The differences in the perceptions of participants based on their religious, cultural and economic background toward child maltreatment should be further studied and addressed in policy and interventions in this area.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Youth Substance Use in a Context of Family Homelessness

Objective

This study examines the relationship between family processes and youth substance use debuts among a sample of youth residing in urban family homeless shelters.

Method

Data regarding shelter experiences, youth and family characteristics, and the use of three substances (i.e., cigarettes, alcohol, and marijuana) were gathered from a sample of youth (11-14 years) and their respective parents residing in an urban family homeless shelter system. Multinomial logistic regression analysis was used to examine the influences on youth substance use.

Results

Of the 198 youth included in the statistical analysis, 72% (n = 143) reported no substance use debuts, while 18% (n = 35) indicated one and 10% (n = 20) indicated two to three substance use debuts. Within the final model, greater substance use debut was associated with being older (13-14 vs. 11-12; OR = 7.5; 95% CI = 1.8-30.9) and stressors exposure (OR = 4.8; 95% CI = 1.5-14.7). Furthermore, youth of adult caretakers that reported low levels of the three family processes considered were almost four and a half more likely (OR = 4.4; 95% CI = 1.2-16.5) to have made two to three substance use debuts.

Conclusions

Family processes may be a particularly important intervention target toward reducing the rate of substance use among youth residing in urban family homeless shelters.     

Intersection of homelessness and mental health: A mixed methods study of young adults who accessed psychiatric emergency services

Young adults who experience homelessness have high rates of mental disorders, yet low rates of outpatient mental health service use. This mixed methods study examined the intersection of homelessness and mental health in a sample of 54 young adults (ages 18–25) who were hospitalized on a short-term, inpatient psychiatric unit. Nearly half (n = 26) reported being homeless in the prior year and more than a quarter were homeless at the time of admission (n = 15). Qualitative analyses identified key factors that contributed to both mental health problems and homelessness including disrupted support networks, fragile family relationships, foster care involvement, substance use and traumatic events. Homelessness was both a facilitator and a barrier to successfully accessing mental health services to manage mental health symptoms. Findings highlight the interconnection of homelessness and mental health and their common relationship with additional underlying risk factors. Providers across service settings need to recognize the overlap of client populations and provide integrated, trauma informed care to address housing instability, mental health, and substance use together.     

Factors impacting intention to leave in social workers and child care workers employed at voluntary agencies

Introduction

To ameliorate high turnover in child welfare, researchers have attempted to identify factors that lead to undesirable turnover. While this has been studied extensively, little attention has been paid to turnover based upon job roles. Like social workers in child welfare, the field of child care also experiences high turnover. Child care workers employed in child welfare settings are no exception. The current study seeks to understand differential factors that impact intent to leave for preventive and child care workers employed in child welfare agencies.

Materials and methods

Data for prevention workers (n = 538) were obtained from all preventive service programs under contract with the City. Data for child care workers (n = 222) were obtained from three voluntary agencies located elsewhere in the State. The instrument was a modified version of a survey developed to examine job satisfaction and potential turnover among public child welfare workers. Domains measured included job satisfaction, intention to leave, career commitment, and agency investment. Data were analyzed using bivariate analysis and Structural Equation Modeling (SEM).

Results

Child care workers had more positive perceptions of child welfare and planned to stay in child welfare longer. Despite this, prevention workers felt more invested in their work. Child care and prevention workers had different levels of satisfaction with their jobs although overall job satisfaction did not differ nor did their intention to leave. Tenure at the agency was predictive of career investment. Investment, perceptions of child welfare, satisfaction with nature of work, and contingent rewards were associated with career commitment. Commitment and satisfaction with supervision were the greatest predictors of intention to leave.

Discussion

There is a gap in literature addressing child care workers in child welfare, and future study of this group is needed. Child care workers are just as likely to intend to leave their jobs as prevention workers. For both groups, it appears that investment in their jobs increases commitment to the field which reduces intention to leave.     

Championing the interface between mental health and child protection: evaluation of a service initiative to improve joint working in northern Ireland

The importance of establishing effective inter‐agency working between adult mental health services and child care services in order to safeguard children has been repeatedly identified by research, policy, inquiries and inspection reports. This article reports on the evaluation of an initiative in one health and social care trust in Northern Ireland that aimed to facilitate joint working and so improve service provision and protection for children and families. The Champions Initiative involved identifying a Champion in each multidisciplinary community mental health team and in each family and child care team that would have responsibility for providing information, promoting joint working and identifying any obstacles to better cooperation. The evaluation of this Initiative assessed levels of experience, training, confidence, understanding and awareness in the Champions and their team members at baseline. The Champions and their Team Leaders were then followed up after six months to obtain their qualitative views of the impact of the initiative. The results include comparisons between mental health and child care staff, and crucially, views about whether the initiative has had any impact on working together. This study also generated recommendations for further service development in this complex and important area of practice. Copyright © 2010 John Wiley & Sons, Ltd.

‘Identifying a Champion in each multidisciplinary community mental health team and in each family and child care team’

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Volume 21 , Issue 3 May/June 2012

Pages 157-172