Mobile crisis services for children and families: Advancing a community-based model in Connecticut

The purpose of this paper is to describe a best practice model of care for children's mobile crisis services in Connecticut: Emergency Mobile Psychiatric Services (EMPS). EMPS responds to homes, schools, emergency departments and other community locations to provide children and their families with mobile crisis stabilization, assessment and brief intervention, and referral and linkage to ongoing care. The system is comprised of a statewide network of contracted providers, a statewide Call Center to manage and triage incoming referrals, and a Performance Improvement Center to provide data analysis, reporting, quality improvement, and standardized training. Data collected since 2009 demonstrate high service utilization, consistently high mobility rates, and rapid response times as well as statistically significant improvements in child outcomes. The paper discusses the role of mobile crisis services within a comprehensive continuum of behavioral health care for children and families.     

Pediatricians could help SUD workforce by using SBIRT

Most studies on the use of screening, brief intervention and referral to treatment (SBIRT), a primary care model for screening and prevention of substance use, in adolescents have looked only at outcomes related to substance use. But SBIRT can also affect use of medical services, as well as comorbidities. Researchers found that SBIRT does reduce psychiatry visits, mental health diagnoses and chronic conditions at one and three years following the intervention. Ultimately, providing SBIRT in primary care may reduce utilization in other areas of health care later on, researchers write in the May issue of Pediatrics.     

Moving Toward Collaboration

Summary

Traditionally, organizations serving children and families have focused service delivery by available funding stream criteria. Federal funding streams supported fragmented services by tightly channeling monies to specific programs for specific needs. The intensity of providing and improving the delivery of services has overshadowed building connectedness across organizations and systems. Service has been the major goal and intense effort has gone into maximizing opportunities and measuring effects through service frequency. Over the past several years, new funding incentives have provided the opportunity for new collaboratives. This article describes an innovative collaboration between the Idaho Department of Health and Welfare (IDHW) and Eastern Washington University (EWU) and the unique directions and support that a university/agency partnership can provide for both organizations. Key features of this collaboration include shifts in funding and staffing strategies that contributed to more flexible services and increased levels of collaboration between IDHW, EWU and other community and state organizations and institutions. This article describes how funding can be viewed as a tool to increase the level of collaboration between systems, thus potentially leading to a breakdown of the traditional service delivery system. Finally, this article describes how an agency/higher education partnership played a key role in documenting the success of a school based program in meeting the emergency assistance needs of children and families, and how program evaluation, like funding requirements, can provide a supportive role in building collaborative relationships.     

Community drug abuse prevention in a Hmong village in Thailand

The goal of this project was to implement a model of drug abuse prevention, drawing on health care, psychosocial and legal principles, in a selected village community in Thailand. Primary, secondary, and tertiary prevention strategies were used within a nursing conceptual framework that included the interactions among the person, drugs, and environment. An initial community survey revealed 112 addicted individuals and identified many atrisk groups, such as children of addicted parents, adolescents, and women. Primary health care and dental health services were provided in the community, as well as drug abuse education and activities for school children and at-risk groups. Treatment camps were also established in the community on two occasions to provide detoxification and rehabilitation services for addicted individuals. At the end of the 3-year program, there were no new addicted individuals, and the number of addicted individuals decreased from 112 to 50 (after first treatment) and 26 (after second treatment). In addition, the villagers were more aware of problems related to using opium and heroin and of modern, approved drugs to treat illnesses. The prevention strategies were beneficial for the community members, as well as the addicted individuals and theirfamilies.     

Family-Based HIV Preventive Intervention

Summary

Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youth's exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smith, & Henry, 2003). This often translates into three concrete programmatic features: (1) Contextual relevance; (2) Developmental-groundedness; and (3) Systemic Delivery. Because families are considered to be urban youth's best hope to grow up and survive multiple dangers in urban neighborhoods (Pequegnat& Szapocznik, 2000), centering prevention within families may ensure that youth receive ongoing support, education, and messages that can increase their capacity to negotiate peer situations involving sex. This paper will present preliminary data from an HIV/AIDS prevention program that is contextually relevant, developmentally grounded and systematically-delivered. The collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP) is aimed at decreasing HIV/AIDS risk exposure among a sample of African American youth living in a poverty-stricken, inner-city community in Chicago. This study describes results from this family-based HIV preventive intervention and involves 88 African American pre-adolescents and their primary caregivers. We present results for the intervention group at baseline and post intervention. We compare post test results to a community comparison group of youth. Suggestions for future research are provided.     

Differential response in child protection: How much is too much?

Recurring maltreatment can have devastating, lifelong consequences for children who are victims of abuse and neglect. The primary mission of child protection services (CPS) agencies is to prevent the recurrence of child maltreatment by offering families services designed to prevent future maltreatment. In order for these services to be effective, however, families must actually engage in them. This study focuses on how differential response programs impact families' successful engagement in services as indicated by long-term child safety outcomes.Differential response refers to a dual track system that allows public CPS agencies to respond to accepted reports of child abuse or neglect with either a traditional investigative response (TR) or an alternative response (AR). The AR is designed to be a less authoritative and less adversarial approach to families presenting a low- to moderate-risk of maltreatment. The AR involves collaboration with the family in a comprehensive assessment of the family's needs, risks and strengths and a referral to services on a voluntary basis. States implementing DR systems statewide vary greatly in the percentage of accepted reports that are assigned to the AR track. The goal of this study is to determine what rate of AR utilization is most effective in reducing subsequent reports of abuse and neglect for cases assigned to the AR.This study compares child safety outcomes for children assigned to the AR and those assigned to the TR within each of the fourteen states which implemented DR statewide between 2000–2012. The analysis uses Cox proportional hazards regression. Data for this observational study are drawn from the 2000–2012 data in the National Child Abuse and Neglect Data System (NCANDS) child files. Child safety is measured by re-reporting of the child to CPS.The theoretical model underpinning the study is McCurdy and Daro's (2001) Integrated Theory of Participant Involvement (ITPI) which outlines a conceptual model of parental engagement in services. This study hypothesizes that AR utilization rates affect the risk level of cases assigned to the AR. The ITPI model offers a possible explanation as to why higher risk cases may not be as responsive to the AR approach which depends upon the family's voluntary participation in services.The key finding of this study is that, in states assigning > 33% of reports to the AR, children on the AR track are being re-reported at equal or higher rates than those on the TR track. Only in those states utilizing the AR track for < 33% of the cases are AR cases being consistently re-reported at lower rates than those on the TR track. This article explores ways to improve the accuracy of track assignment decisions to prevent the assignment of higher risk families to the alternative response.     

Violence, coping, and mental health in a community sample of adolescents

The current study examined the coping strategies, exposure to violence and psychological trauma symptoms of violent adolescents compared to less violent and nonviolent adolescents in a community sample. An anonymous self-report questionnaire was administered to students in six public high schools (grades 9-12). The 10% most violent adolescents were identified and compared to their less violent and nonviolent peers. A total of 3724 students represented 68% of adolescents in all targeted schools. Ages ranged from 14 to 19 years; 52% were female; and 35% were African-American, 34% Caucasian and 23% Hispanic. Analyses revealed that violent adolescents compared to their less violent and nonviolent peers employed more maladaptive coping strategies, were exposed to higher levels of violence and reported higher clinical levels of psychological trauma symptoms. Maladaptive coping was also significantly associated with psychological trauma symptoms and violent behavior, even after controlling for the influence of demographic factors. The findings support the importance of appropriate identification, assessment and referral services for adolescents in nonclinical settings, and the role that coping strategies play in contributing to adolescent mental health and well-being.     

Are services to prevent foster care effective?

The prevention of foster care became an important issue for child welfare services during the 1970s. Two main types of prevention models have emerged: crisis intervention programs intended to prevent imminent placement and intensive service programs designed to avert those crisis situations that precipitate placement. A critical analysis of several project evaluations leads to the conclusion that neither model has been markedly successful. Low nominal project placement rates seem attributable to inability to predict placements and to client selection biases. From a strictly financial perspective, preventive services have been considerably more expensive than regular services, including temporary family foster care. Data from a new demonstration project in New Jersey illustrate various problems in providing and evaluating preventive services to families referred to protective service agencies. Implications of the findings for prevention programs and policies are discussed, and a new direction focused on truly early intervention with children and families is proposed.     

Open Days for NESB Communities: Primary Prevention for Sexual Abuse

The realisation that cultural contexts were impeding access to services for many disadvantaged families and hindering the disclosure of child sexual abuse prompted two agencies to organise collaborative primary prevention strategies. Family groups were convened from the local Cambodian, Vietnamese, Latin American and Arabic‐speaking communities. Focus groups were attended by one or more members of each family. Participants contributed to the formation of a collective understanding that could then be adapted and passed on to other families in their communities. It was observed that once individual families entered this process, isolation diminished and steps towards exploration of the issues could be taken. This paper outlines a process through which family therapists can use primary prevention strategies to reach NESB groups.     

Finding Our Way

Abstract

In the fall of 1992, a community needs assessment on the problem of family violence was completed in the Aboriginal community of Conne River, Newfoundland, Canada. This article reports both the process and findings of the study which was guided by two important principles. First, community participation was a critical component of all aspects of the assessment and, second, the assessment was based on multiple sources of data.

The data were collected from face-to-face interviews with key informants (community experts) and consumers/potential consumers of services, focus groups with youth and women, and informal contact and discussion with interested members of the community, some of them professionals.

The findings indicate that the people of Conne River are knowledgeable about the types of family violence that occur in the community and the various sources of support and help. There was also a high level of interest in the topic and a genuine concern that some positive action would result from this assessment.

The assessment identified the need for more supports for women with families in crisis, not just crisis intervention during incidents of violence but a more holistic network of supports. These supports need to be community-based, operating within existing agencies. The study identified the need for a community-based committee to undertake the planning of emergency services for women and families in crisis and long-term planning for a support network and/or community centre for women.     

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.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

Family Services: A Proposed Model for Coordinating Spouse Abuse Services

ABSTRACT

This article presents a proposed model to organize spouse abuse services within communities. It proposes that family service agencies take the lead in organizing and implementing the model program. The community team would consist of representatives from agencies and disciplines that serve spouse abuse families. The community would benefit from the coordination of both the direct services to affected families and the prevention and education activities designed to eliminate spouse abuse.     

Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

ATTENDING TO THE CONTEXT OF FAMILY TREATMENT: PITFALLS AND PROSPECTS

This paper argues that family therapy is failing to attend to the contexts in which family mental health services are provided and, therefore, is losing touch with the realities of family services in communities. We present a model for describing the institutional contexts of family mental health treatment in North America, and explore how these contexts influence family treatment. The model proposes that family mental health care can be categorized into three levels, analogous to the levels of the health care delivery system: (a) primary, (b) secondary, and (c) tertiary care. These levels represent systematically different contexts for family treatment; each has unique advantages and limitations. Translating treatment methods across levels can be hazardous because of differences in contexts. We argue that delineating the contextual levels of family mental health care can encourage more fruitful and respectful collaboration among the diverse professional groups working with families.     

What Changes for Young Carers? A Qualitative Evaluation of the Impact of Dedicated Support Provision for Young Carers

In 2016, the Children’s Commissioner for England reported that the most frequent provision for young carers (YCs) comes from dedicated YC services. This study formed one part of a three-year evaluation of support for YCs and their families provided by the Hampshire YCs Alliance (HYCA), a county-wide collaboration of ten YC services in the UK. It set out to explore the following primary questions; (a) what are the most important changes that the YC services made to YCs and their families? (b) what is it about the services that creates those changes? Semi-structured interviews were carried out in 2017, with YCs aged 9–17 (n = 8), their parents (n = 5), HYCA staff (n = 6) and professionals from other stakeholder organisations (n = 5) and a thematic analysis was undertaken. Reflecting previous research that YCs and their families have a broad range of needs, findings also reveal how YC services support them through a diverse range of interventions. Support led to a diverse range of positive changes for YCs and their families. A number of service features that facilitate change for YCs, as well as ‘key dynamics’ important in facilitating change were identified. These findings have led to a conceptual framework of how YC services facilitate change for YCs and are important for understanding the impact these dedicated services can make to the lives of YCs and how they facilitate change. Together they have implications for the development and commissioning of interventions for YCs and families and how service providers promote their support provision.

     

Evaluation of the RAINN National Sexual Assault Online Hotline

ABSTRACT

This article describes the evaluation of rainn National Sexual Assault Online Hotline, a new model for delivery of rape and sexual assault crisis services through a secure, confidential chat-based online hotline. Outcome data from 623 visitors and 54 volunteers for the first 11 months of the program are presented. The results indicate that the model is viable and useful for approximately 80 percent of visitors, and volunteers are satisfied with the program. Recommendations for program development and further research are presented.     

The Community Context of Family Structure and Adolescent Drug Use

Using data from the National Educational Longitudinal Study (NELS), this article investigates a number of hypotheses used to explain the relationship between family structure and adolescent drug use. In particular, using linked community‐level data, an explicit examination of hypotheses drawn from a community‐context model is conducted. These hypotheses posit that the impact of family structure on adolescent behavior is, in part, explained by the different types of communities within which families reside and that community characteristics moderate the impact of family structure on drug use. The results of multilevel regression models fail to support these hypotheses; adolescents who reside in single‐parent or stepparent families are at heightened risk of drug use irrespective of community context. Moreover, adolescents who reside in single father families are at risk of both higher levels of use and increasing use over time. A significant community‐level effect involves jobless men: Adolescents are at increased risk of drug use if they reside in communities with a higher proportion of unemployed and out‐of‐workforce men.