Experiences of social work intervention among mothers with perinatal mental health needs

Perinatal mental health difficulties are prevalent among women, and the vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. This study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi‐structured interviews were carried out with 18 women with 6‐ to 9‐month‐old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children's social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother's own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers’ mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of ‘turning points’ where initially negative interactions stabilised and child protection concerns lessened. Women's accounts highlighted the importance of feeling ‘known’ by social workers who understood and respected them. The findings also suggested there may be value in improving collaboration between social workers and mental health professionals to create more space for representation of women's needs as well as those of their babies.     

Working on the interface: identifying professional responses to families with mental health and child-care needs

The gaps between mental health and child-care services constitute a recognised barrier to providing effective services to families where parents have mental health problems. Recent guidance exhorts professionals to coordinate and collaborate more consistently in this area of work. The present study aimed to identify the barriers to inter-professional collaboration through a survey of 500 health and social care professionals. The views of 11 mothers with severe mental health problems whose children had been subject to a child protection case conference were also interrogated through two sets of interviews. The study found that communication problems were identified more frequently between child care workers and adult psychiatrists than between other groups. Communication between general practitioners and child-care workers was also more likely to be described as problematic. While there was some support amongst practitioners for child-care workers to assume a coordinating or lead role in such cases, this support was not overwhelming, and reflected professional interests and alliances. The mothers themselves valued support from professionals whom they felt were 'there for them' and whom they could trust. There was evidence from the responses of child-care social workers that they lacked the capacity to fill this role in relation to parents and their statutory child-care responsibilities may make it particularly difficult for them to do so. The authors recommend that a dyad of workers from the child-care and community mental health services should share the coordinating key worker role in such cases.     

Getting the complete picture: combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas

Background Childhood mental health problems are prevalent in Australian children (14–20%). Social exclusion is a risk factor for mental health problems, whereas being socially included can have protective effects. This study aims to identify the barriers to social inclusion for children aged 9–12 years living in low socio‐economic status (SES) areas, using both child‐report and parent‐report interviews. Methods Australian‐born English‐speaking parents and children aged 9–12 years were sampled from a low SES area to participate in semi‐structured interviews. Parents and children were asked questions around three prominent themes of social exclusion; exclusion from school, social activities and social networks. Results Many children experienced social exclusion at school, from social activities or within social networks. Overall, nine key barriers to social inclusion were identified through parent and child interviews, such as inability to attend school camps and participate in school activities, bullying and being left out, time and transport constraints, financial constraints and safety and traffic concerns. Parents and children often identified different barriers. Discussion There are several barriers to social inclusion for children living in low SES communities, many of which can be used to facilitate mental health promotion programmes. Given that parents and children may report different barriers, it is important to seek both perspectives. Conclusion This study strengthens the evidence base for the investments and action required to bring about the conditions for social inclusion for children living in low SES communities.     

Meeting Children's Mental and Physical Health Needs in Child Welfare: The Importance of Caregivers

Caregivers in the child welfare system are an important element in ensuring that mental and pediatric health services for their children are utilized appropriately. The high prevalence of mental and physical health problems of children in the child welfare system along with the inadequate utilization of health services make the role of caregivers essential for improving health outcomes. This article explores the barriers to meeting the health needs of this vulnerable population of children and how different types of caregivers (unrelated foster, kinship foster, and birth parents) utilize mental and pediatric health services. Child welfare caseworkers need to increase their communication with caregivers, assess adherence to health care recommendations, and help alleviate barriers to care.     

Discrepancy between expected and actual child support payments: predicting the health and health-related quality of life of children living in low-income, single-parent families

Objective Although the amount and frequency of child support payments received by single parents are often erratic and fluctuate, no study to date has quantitatively explored how the discrepancy between expected and actual payments relates to child health. This study aims to examine whether the discrepancy between expected and actual child support payments predicts a range of child health outcomes, including global health, health‐related quality of life, involvement in activities and parental psychological distress. Methods This study used results from the Longitudinal Study of Australian Children, which included a sample of parents of children aged 4–5 years (n = 4983). The questionnaire was completed by the parent who spent the most time with the child and knew the child best. From the 4983 families, 332 low‐income single parents reliant on welfare with a formal or informal child support order in place were identified. Results After controlling for income, the discrepancy between expected and actual child support predicted school functioning, conduct problems, total mental health problems and involvement in activities. Discrepancy between expected and actual child support payments did not predict the remaining health‐related quality of life domains, mental health domains, global child health or parental psychosocial distress. Conclusion This was the first study to examine how the discrepancy between expected and actual child support payments relates to child health, providing important data on the effectiveness of the child support system for children's well‐being. These findings highlight the potential impact of the discrepancy on school functioning, conduct problems, total mental health problems and involvement in activities.     

The mental health of looked after children: matching response to need

Previous research has established high rates of mental health need in looked after children. The study described in this paper aimed to explore in more depth the mental health problems of looked after children and to examine the service response to those needs in two English local authorities. The study utilised a purposive sample of 80 looked after children which was biased towards those with high needs but which reflected the characteristics of looked after children in the two areas with regard to age, gender and type of placement. Key data on children and young people were collected from social services' case files and a set of indicators of mental health need was designed by the research team in order to distinguish different types and levels of mental health problems. High levels of mental health need in the study group were associated with placement disruption. Educational difficulties were also apparent in the group with the highest levels of mental health need. Longer-term input from child and adolescent mental health services (CAMHS) professionals did not appear to be targeted on the group with the highest level of mental health needs. The researchers conclude that longer-term CAMHS interventions could be usefully focused on looked after children who have experienced high levels of placement disruption. As the professional group most likely to be providing substantial intervention to looked after children and their carers, social workers require relevant training in identifying and responding to mental health needs. CAMHS professionals could develop and strengthen their consultative roles with front-line carers, social workers and schools.     

Applying the recovery approach to the interface between mental health and child protection services

There is a range of theoretical approaches which may inform the interface between child protection and adult mental health services. These theoretical perspectives tend to be focused on either child protection or mental health with no agreed integrating framework. The interface continues to be identified, in research, case management reviews and inquiry reports, as complex and problematic. This article proposes that more positive, integrated approaches to service user engagement, risk assessment and management may lead to better outcomes in working with families experiencing parental mental health problems and child protection concerns. It is proposed that the recovery approach, increasingly used in mental health services, can inform the processes of engagement, assessment and intervention at the mental health and child protection interface. The article provides a critical overview of the recovery approach and compares it with approaches typifying interventions in child protection work to date. Relevant research and inquiries are also examined as a context for how to more effectively respond to cases where there are issues around parental mental health problems and child protection. The article concludes with case material to illustrate the potential application of the recovery approach to the interface between mental health and child protection services.     

Family day care educators: an exploration of their understanding and experiences promoting children's social and emotional wellbeing

This study aimed to explore family day care (FDC) educators' knowledge of child social and emotional wellbeing and mental health problems, the strategies used to promote children's wellbeing, and barriers and opportunities for promoting children's social and emotional wellbeing. Thirteen FDC educators participated in individual semi-structured interviews. FDC educators were more comfortable defining children's social and emotional wellbeing than they were in identifying causes and early signs of mental health problems. Strategies used to promote children's mental health were largely informal and dependent on educator skills and capacities rather than a systematic scheme-wide approach. Common barriers to mental health promotion were limited financial resources, a need for more training and hesitance raising child mental health issues with parents. There is a need to build FDC educators' knowledge of child social and emotional wellbeing and for tailored mental health promotion strategies in FDC.     

Social Workers in Pediatric Primary Care: Communication,Gender, and Scope of Practice

While many child mental health issues manifest themselves in primary care, few pediatricians have received mental health training, and their communication with social workers may be limited due to unfamiliarity with mental health professions. The purpose of this study was to use ethnographic interviews to investigate factors affecting communication satisfaction between social workers and pediatricians. The study found that scope of practice issues were a communication barrier. This barrier is significant because health reform may lead social workers and pediatricians to collaborate more frequently in the future.     

Parental Incarceration as a Risk Factor for Children in Homeless Families

The current study aimed to describe the prevalence of children of incarcerated parents (COIP) in a sample of homeless/highly mobile children, examine the relationship between parental incarceration and other risk factors, and investigate the effect of parental incarceration on child academic and mental health outcomes. The authors compared COIP (n = 45) to children whose parents were never incarcerated (n = 93) within a sample of 138, 4‐ to 7‐year‐old ethnically diverse children residing in emergency homeless shelters. Children's caregivers provided information about children's history of parental incarceration and other family experiences. Children's teachers reported academic and mental health outcomes in the subsequent school year. Compared to children with no history of parental incarceration, COIP experienced more negative life events. Regression models revealed that a history of parental incarceration was a significant predictor of teacher‐reported internalizing problems. These results have implications for the identification and treatment of the highest risk homeless/highly mobile children.     

Mental health problems among labour children in the Gaza Strip

Background There is increasing international concern over the rising number of children involved in labour, particularly in developing countries. Despite the multitude of related risk factors, and some evidence on their social needs, there has been limited research on these children's mental health. Methods The aim of this study was to establish the association between labour‐related variables and mental health problems among 780 children in labour (aged 9–18 years, mean 15.8) in the Gaza Strip. Measures included a demographic checklist, the Strengths and Difficulties Questionnaire, the Spence Children's Anxiety Scale and the Depression Self‐rating Scale for Children. Results Children came from large families (73.2% had eight or more siblings), mainly worked to increase family income, worked an average 6.8 h per day (range 1–16), and only 37.1% had regular rest. Ratings of mental health problems were predicted by different factors, i.e. total difficulties scores by poor friendship relationships and lack of health insurance; anxiety scores by selling in the streets, working to help family, low family income and lack of health insurance; and depression scores by parents' dissatisfaction with the job and longer working hours. Conclusions Mental health problems of children in labour are likely to be associated with socio economic determinants, as well as factors related to their under age employment. Policy, legislation and preventive programmes from statutory and voluntary agencies should adopt an integrated approach in meeting their mental health needs, by enhancing protective factors such as return to school.     

Coping and Resilience of Children of a Mentally Ill Parent

Abstract

This paper examines the needs and stress reactions of children of mentally ill parents, as well as coping and resilience. The study is based on the interviews of six 9-11 years old children and narratives of seventeen female grown up children of mentally ill parents. The younger and older children of the mentally ill parents had not been informed about their parent's illness. The illness of the parent aroused a variety of emotions in them. The children used both practical problem solving and emotional coping mechanisms. Informal social support was available to them but seldom from the public services. It is recommended that professionals in mental health and child welfare services clarify their roles when working with mentally ill parents. The best interest of the child and the parenting they need should be carefully assessed. Open care measures should be offered to families early enough to prevent serious child welfare and mental problems.     

Maternal social capital and child health in Vietnam

STUDY OBJECTIVE: To explore the association between maternal social capital and child physical and mental health in Vietnam. DESIGN: Cross sectional survey. Measures of maternal structural social capital comprised group membership, citizenship, and social support. Measures of cognitive social capital comprised trust, social harmony, sense of fairness, and belonging. Child health was measured by anthropometrics and mothers' reports of acute and chronic physical health problems and child mental health. PARTICIPANTS: 2907 mothers and their 1 year old or 8 year old children from five provinces in Vietnam. MAIN RESULTS: The study found low levels of group membership and citizenship and high levels of cognitive social capital and support, and generally higher levels of social capital among the mothers of 8 year old compared with 1 year old children. All but one association was in the hypothesised direction (that is, higher levels of social capital associated with reduced risk of child health problems). There were more statistically significant relations between maternal social capital and the health of 1 year olds compared with 8 year old children, and between measures of social support and cognitive social capital and child health, than with group membership and involvement in citizenship activities. CONCLUSION: This study is the first to explore the association between multiple dimensions of social capital and a range of different child health outcomes in the developing world. These results now need to be tested using longitudinal data.     

Adult disclosures of childhood sexual abuse and section 3 of the child care act 1991: past offences,current risk

In the Republic of Ireland Section 3(1) of the Child Care Act 1991 places an obligation and legal duty upon the State child protection services “to promote the welfare of children in its area who are not receiving adequate care and protection.” This article focuses on a specific element of this duty; the social worker’s responsibility to accept and assess retrospective reports of childhood sexual abuse. Retrospective disclosures of abuse are referrals made by adults of experiences they encountered as children. This article argues that current social work practice in this area lacks clarity and cohesion and while new policy and practice approaches are emerging ultimately there is a sense of confusion for both social workers and those adults affected by childhood abuse who come forward to disclose. This article presents an examination of the key judgement of Justice Barr in M.Q. v. Robert Gleeson and Ors [1998] 4 IR 85 and subsequent, related, precedents and how they relate to current Irish social work policy in this area. Adult disclosures of childhood abuse have the potential to bring alleged abusers to justice and thereby protect current and future children from harm. This article seeks to provide clarity, to social workers and those working with adults affected by abuse, regarding the Irish legal framework relating to adult disclosures of abuse as it stands. The article ultimately argues that further research and policy guidance is required.     

Stresses on grandparents and other relatives caring for children affected by HIV/AIDS

This study investigated the needs of relative caregivers of children in the child welfare system whose parents had HIV. Families of children supported by the state child welfare agency were invited to participate in the study; 17 families reported that HIV affected them and 11 families did not identify HIV as an issue. The findings indicate that complex emotional and behavioral issues stressed the HIV-affected kin caregivers; these issues included the children's behavioral problems, HIV-related concerns, adolescent issues, emotional difficulties, and sexual abuse, HIV-affected caregivers had more concern about their health and multiple roles. Nonaffected caregivers were less likely to report severe parenting stress and more likely to report financial stress. HIV-affected caregivers require attention and intervention by social workers, child welfare workers, and case managers.     

浅析社会工作介入在儿童福利机构脑瘫儿童康复治疗中的应用

脑瘫儿童康复治疗工作备受关注,脑瘫病症一旦在儿童身上出现,会对患儿自身及儿童福利机构带来沉重压力。儿童福利机构脑瘫儿童康复期间,社会工作及时介入,一定程度上为儿童福利机构提供支持,因为工作人员凭借专业知识及技能帮助脑瘫儿童早日康复,促进患儿身心健康发展。文章通过阐述儿童福利机构运用社会工作方法介入脑瘫儿童康复治疗的情况,分析具体工作中存在的问题,提出改进思路,从而提高脑瘫疾病治疗质量,提升孤残儿童幸福指数。     

Exploration of joint working practices on anti‐social behaviour between criminal justice,mental health and social care agencies: A qualitative study

Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti‐social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti‐social behaviour. We conducted a multi‐method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi‐structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti‐social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems.     

Children's Participation in Child-protection Processes as Experienced by Foster Children and Social Workers

Children in foster care often have no means of influencing matters that concern them, and can easily become outsiders in their own lives. The United Nations Convention on the Rights of the Child enshrines the rights of capable children to express their views freely in matters affecting them and to be heard in any judicial or administrative proceedings concerning them. The aim of this study is to analyse foster children's participation in child welfare processes in different time periods and contexts from the perspective of children and social workers. The data comprise semi-structured interviews of eight children and young people aged seven to 17 in family foster care, as well as interviews of four child welfare social workers. Ethical questions were taken carefully into account. The results suggest that participation in matters concerning them is very significant to children, although they do not always want be active participants (e.g. in meetings). The children hoped that social workers would take a genuine interest in them, listen to them and take their opinions and wishes into consideration. Children sought true and essential information about the reasons for placements and the plans for their future. They felt they were better heard and more able to influence their own affairs after being placed in a foster home than during earlier phases of services. The study identifies many obstacles in children's participation at different systemic levels. Children's loyalty to their parents may prevent them from expressing their opinions. According to social workers, the most serious obstacles in participatory work with children are related to a lack of human and time resources. Social workers need time, work practices, skills and practical wisdom through which children's personal experiences, opinions and wishes can be better heard. They also seek support in handling the emotional aspects of child-protection work and suggest some other measures to develop their work.     

Interprofessional Collaboration in Finnish Residential Child Care: Challenges in Incorporating and Sharing Expertise Between the Child Protection and Health Care Systems

Many children taken into care tend to be in need of psychiatric treatment as well as child protection services, and thus the professional expertise of both systems must be coordinated in their care. However, it is widely known across Europe that collaboration between child protection services and mental health services is not working well and the outcomes for looked-after children are poor. In spite of drastic need for knowledge, interprofessional collaboration between residential workers and mental health practitioners is poorly explored in international research. Most importantly, very little is known about shared expertise in multi-agency teams between these systems. Based on the analysis of interprofessional focus group interviews (eight interviews with 17 practitioners) in Finland, it is claimed that both sides have unrealistic expectations and perceptions of the other professional grouping and its facilities to help high-need children. The study also indicates that the collaboration assumes an equality of status and responsibilities between the professionals that does not always exist amongst residential child care practitioners and mental health professionals. The analysis suggests that the concept of residential child care work itself needs more empirical research to strengthen the interprofessional competencies and enhance child-centred integrated care.