A Randomized Effectiveness Trial of Brief Parent Training in Primary Care Settings

Brief Parent Training (BPT) is a short-term intervention (3?C5 sessions) delivered by regular staff in municipal child and family services. BPT is based on social interaction learning theory and Parent Management Training, the Oregon model (PMTO) and promotes parenting skills in families with children who either are at an early stage of problem behavior development or have developed conduct problems. This study examined the effectiveness of BPT compared to regular services in primary care settings at post assessment. Participants were 216 children (3?C12?years) and their parents who were randomly assigned to BPT or the comparison group. Data were collected from parents and teachers. Significant intervention effects emerged for caregiver assessments of parenting practices, child conduct problems, and social competence. The results suggested that BPT had beneficial effects for families, although the generalization of the effects to school was limited.     

Coping and resilience of children of a mentally ill parent

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.     

Perceived parental burden and service use for child and adolescent psychiatric disorders.

OBJECTIVES: Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family care-takers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. METHODS: A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. RESULTS: Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. CONCLUSIONS: Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use.     

Mental health risks of parents of children with developmental disabilities: A nationally representative study in the United States

BackgroundCaring for a child with a developmental disability may affect parents’ mental health. There are few longitudinal or nationally representative studies, none on new mental health problems. Studies have few young children, and few adult children.Objective/hypothesesWe hypothesized that parents of children with developmental disability would be more likely to develop mental health problems than other parents.MethodsWe used the Panel Study of Income Dynamics (PSID, 1997–2017) and its Child Development Supplements, defining developmental disability by diagnoses such as autism spectrum disorder or intellectual disability, and requiring additional evidence of lasting impairment. We linked children’s and parents’ data spanning 20 years, including 44,264 mental health measurements for 4024 parents of 7030 children. Discrete-time hazard analysis controlled for child and parent characteristics.ResultsAbout 9.4% of children had developmental disability. Parents of children with developmental disability were more likely to develop mental health problems than other parents. The odds of developing anxiety or depression were higher when an adult child with developmental disability lived independently, nearly 3 times higher for mothers (OR 2.89, CI 2.33–3.59) and more than twice as large for fathers (OR 2.35, CI 1.70–3.26). Compared to fathers whose children did not have developmental disability and challenging behaviors, the odds of psychological distress were over 7 times larger (odds ratio, OR 7.18, 95% confidence interval, CI, 5.37–9.61) for those whose children had developmental disability and challenging behaviors.ConclusionsParents of children with developmental disability may benefit from increased emotional support, respite, and interventions addressing challenging behaviors.     

The mental health of children in homeless families and their contact with health, education and social services

Previous research indicates that children in homeless families have a high risk of physical and mental illness. This study reports the initial stage of a longitudinal research programme to measure the prevalence of psychiatric disorders among parents and children in homeless families. A sample of parents in 113 homeless families were interviewed within 2 weeks of admission to seven homeless centres in the City of Birmingham, and compared with a sample of 29 low-income families who were not homeless. Both sets of interviews used the Child Behaviour Checklist (CBCL), the Communication Domain of the Vineland Adaptive Behaviour Scales (VABS), the General Health Questionnaire (GHQ), the Interview Schedule for Social Interaction (ISSI), and height and weight percentiles. A sub-sample of children was also interviewed. The results indicate that 85% of families became homeless because of domestic or neighbourhood violence, that in 54% of families in homelessness coincided with the separation of the partners, and that 49% of mothers had current psychiatric morbidity. Children in homeless families had delayed communication and higher mean scores for mental health problems than the comparison sample. Homeless children were also more likely to have had histories of abuse, and less likely to have attended school or nursery school since becoming homeless. Homeless families had high rates of contact with primary healthcare and social services, but few had been in contact with specialist child and adolescent mental health services. These results indicate a need for a co-ordinated action by housing, social services, education, health services, and the police to prevent families from becoming homeless by protecting victims of domestic and neighbourhood violence from further violence and intimidation. Hence the need to rapidly re-house into permanent accommodation those who do become homeless, to maintain education for their children, and to ensure that such families have access to effective social support and healthcare.     

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.     

芜湖市初中生心理健康状况调查分析

[目的]了解芜湖市初中生的心理健康状况,为心理健康教育提供科学依据。[方法]使用《中学生心理健康量表》对芜湖市575名初中生进行调查。[结果](1)35.7%的初中生存在轻度心理问题,5.3%的初中生存在中度心理问题,心理健康水平各因子得分排在前三位的是学习压力,自我强迫,情绪不稳;(2)在抑郁、焦虑、自我强迫因子上存在显著差异,女生得分高于男生;(3)不同年级的初中生在心理健康水平上差异无统计学意义;(4)在焦虑因子上,留守初中生得分显著高于非留守初中生,在另外9个因子上,两类学生差异无统计学意义。[结论]芜湖市初中生的心理健康水平不容乐观,应该加强学校心理健康教育工作,尤其要关注女生和留守初中生。     

Parental discipline behaviours and beliefs about their child: associations with child internalizing and mediation relationships

Introduction   Internalizing disorders of childhood are a common and disabling problem, with sufferers at increased risk of subsequent psychiatric morbidity. Several studies have found associations between parenting styles and children's internalizing, although few have considered the role of parental discipline. Parental discipline style may exert an effect on children's internalizing symptoms. Anxiety and depression are reliably found to run in families and parental anxiety has been shown to effect parenting behaviour. This study set out to examine the links between parental anxiety, parental discipline style and child internalizing symptoms.
Method   Eighty-eight parents of children aged 4–10 years were recruited through primary schools. All parents completed questionnaires including measures relating to: adult anxiety (State-Trait Anxiety Inventory – Trait version, Penn State Worry Questionnaire), parental depression (Beck Depression Inventory – Fastscreen), parental discipline (The Parenting Scale), parenting-related attributions (Parenting Attitudes, Beliefs and Cognitions Scale) and child psychological morbidity (Child Behaviour Checklist 4–18 version).
Results   Significant correlations were found between both parental anxiety and child internalizing symptoms with ineffective discipline and negative beliefs about parenting. Particularly strong correlations were found between parental anxiety and child internalizing symptoms with harsh discipline. Parents of anxious/withdrawn children were more likely to hold negative beliefs about their child. The link between parental anxiety and child internalizing symptoms was mediated by harsh discipline. The link between parental anxiety and harsh discipline was mediated by parental beliefs about the child.
Conclusion   Discipline style may be an important factor in the relationship between parent anxiety and child internalizing symptoms.     

儿童抑郁症状与家庭因素的关系

目的:了解儿童抑郁症状及其与家庭因素的关系,为预防控制儿童抑郁症的发生,促进儿童心理健康提供依据。方法:采用分层整群抽样的方法抽取洛阳市某小学、某中学800余名8～16岁中、小学生,采用流调中心用儿童抑郁自评量表及自拟的一般情况问卷调查。结果:获有效问卷755份。调查对象的抑郁检出率为34.57%。父母经常或偶尔吵架、与父母关系紧张或抵触、父母的教养方式以拒绝或放任、过分干涉或保护、惩罚严厉为主、母亲脾气暴烈、急躁、对母亲的唠叨很厌烦者的抑郁检出率较高。结论:儿童抑郁症状发生率较高,与家庭环境因素(包括父母间关系、子女与父母关系、父母教养方式、母亲心理行为)有关。建议家长应改善教养方式、父母关系等家庭环境因素以避免儿童青少年抑郁症的发生。     

Effects of an urban high school-based child care center on self-selected adolescent parents and their children

This study examined the effects of an urban high school-based child care center on parenting teens and their children enrolled during 1995-1998. Retrospective record review of 52 low-income, urban adolescent parents enrolled at the Celotto Child Care Center (CCCC) during the period of study was conducted from the CCCC and the high school records. Mean age of the student parents was 17 years (s.d. = 1.3) and mean grade level was 11.2 (s.d. = 1). Most parents were female (98%) and African American (62%). Children enrolled at CCCC had a mean age of 10 months (s.d. = 10.8). Students using the services of CCCC showed improvement in overall grade point averages, and 100% were educationally successful as defined by promotion to the next grade or graduating from high school. None of the students experienced a repeat childbirth during the period of CCCC enrollment. Ninety percent of children were up-to-date with pediatric health visits and immunizations. These results lend strong support to the importance of extending child care and social support services to teen parents, and for the implementation of high school-based child care centers as alternative sites for these critically important services.     

"Uncharted waters": the experience of parents of young people with mental health problems

In this article, the author discusses the experiences of parents of young people with mental health problems and their relations with health care professionals. She conducted qualitative interviews with 25 parents whose teenage child had a diagnosed psychiatric condition. She argues that the experiences of parent-carers can best be understood in the context of the particular relationships involved. The author contextualizes the meanings parents give to care received in wider understandings of parenting and the parental caregiving role. She argues that the parents were deskilled by the condition and by the medical profession. At the same time, parents engaged in a range of actions through which they were reskilled and their parental caregiving role was reestablished.     

The Cuban immigration of 1980: a special mental health challenge

The 124,769 Cubans who entered the United States from Cuba in a boatlift in 1980 included a small minority of people who needed mental health care. Some had been taken involuntarily from psychiatric hospitals, mental retardation facilities, jails, and prisons. The National Institute of Mental Health, Public Health Service (PHS), was responsible for mental health screening, evaluation, and treatment of the Cuban Entrants. Bilingual psychiatrists and psychologists found that many Entrants given preliminary evaluations showed evidence of transient situational stress reactions, not psychiatric illnesses. Entrants who had not yet been sponsored were consolidated into one facility in October 1980, and about 100 of those with severe problems were transferred to an Immigration and Naturalization Service-PHS evaluation facility in Washington, DC. Between March 1, 1981, and March 1, 1982, a total of 3,035 Entrants were evaluated at both facilities. Among the 1,307 persons who presented symptoms, there was a primary diagnosis of personality disorders for 26 percent, schizophrenic disorders for 15 percent, adjustment disorders for 14.5 percent, mental retardation for 8.6 percent, chronic alcohol abuse for 8.6 percent, and major depression for 7.2 percent. Only 459 Cubans with symptoms were found to be in need of further psychiatric care. As of October 1984, many Entrants with psychiatric illnesses remained under inpatient or community-based halfway house psychiatric care as a direct Federal responsibility. A PHS program for further placement in community-based facilities is underway.     

Characteristics of sheltered homeless families.

To describe the characteristics of homeless families, we interviewed 80 homeless mothers and 151 children living in 14 family shelters in Massachusetts (two-thirds of the shelters in the state). Ninety-four per cent of the families were headed by women, 91 per cent were on AFDC (aid to families with dependent children), with twice as many as the state average having been on AFDC for at least two years; most had long histories of residential instability. Although 60 per cent had completed high school, only a third had worked for longer than one month. One-third of the mothers reported having been abused during their childhood, and two-thirds had experienced a major family disruption. At the time of the interview, almost two-thirds either lacked or had minimal supportive relationships and one-fourth of these named their child as the major support. Eighteen mothers were involved with the Department of Social Services because of probable child abuse or neglect. Seventy-one per cent of the mothers had personality disorders. In contrast to many adult homeless individuals, however, deinstitutionalized persons or those suffering from psychoses were not overrepresented. About 50 percent of the homeless children were found to have developmental lags, anxiety, depression, and learning difficulties, and about half required further psychiatric evaluation. Two-thirds described housing and social welfare agencies as not helpful. Given the many serious problems of the mothers and the difficulties already manifested by their children, comprehensive psychosocial and economic interventions must be made to interrupt a cycle of extreme instability and family breakdown.     

Using household survey data to inform policy decisions regarding the delivery of evidence-based parenting interventions

BACKGROUND: This study used household survey data on the prevalence of child, parent and family variables to establish potential targets for a population-level intervention to strengthen parenting skills in the community. The goals of the intervention include decreasing child conduct problems, increasing parental self-efficacy, use of positive parenting strategies, decreasing coercive parenting and increasing help-seeking, social support and participation in positive parenting programmes. METHODS: A total of 4010 parents with a child under the age of 12 years completed a statewide telephone survey on parenting. RESULTS: One in three parents reported that their child had a behavioural or emotional problem in the previous 6 months. Furthermore, 9% of children aged 2-12 years meet criteria for oppositional defiant disorder. Parents who reported their child's behaviour to be difficult were more likely to perceive parenting as a negative experience (i.e. demanding, stressful and depressing). Parents with greatest difficulties were mothers without partners and who had low levels of confidence in their parenting roles. About 20% of parents reported being stressed and 5% reported being depressed in the 2 weeks prior to the survey. Parents with personal adjustment problems had lower levels of parenting confidence and their child was more difficult to manage. Only one in four parents had participated in a parent education programme. CONCLUSIONS: Implications for the setting of population-level goals and targets for strengthening parenting skills are discussed.     

Comparing psychiatric symptoms among children of substance-abusing parents with different treatment histories

It appears that no studies to date have compared the psychiatric functioning of children of substance-abusing parents (COSs) across substance abuse treatment histories (e.g., inpatient, outpatient, and residential). Different treatment histories may reflect differences in the severity of drug use, degree of impairment, or drug of choice, which may result in different symptomatology among COSs. Moreover, this information may be important for family-based treatment and prevention planning. In this study, we examine psychiatric symptoms experienced by children whose parents have different addiction treatment histories. Eighty-one parents in treatment for a substance use disorder who had two–eight-year-old children completed an anonymous, computerized assessment. Respondents reported on their child’s symptomatology as well as their own treatment history and current substance use. Overall, children were remarkably similar in psychiatric functioning and demographic characteristics across parents’ treatment histories. However, children whose parents had only received medication management or detoxification had significantly higher somatization scores, more social withdrawal, and greater attention problems than children whose parents received outpatient treatment (but not inpatient/residential treatment). Children whose parents had been treated in an inpatient or residential setting had marginally higher attention problems than children whose parents received outpatient treatment (but not inpatient/residential treatment). Differences across treatment histories were reflected in the severity of psychiatric symptomatology in the young children of parents in treatment. However, given the modest size of these differences, prevention and intervention programs with COSs may not need to be tailored as a function of parental treatment history as recruitment from various treatment centers may provide a sample with similar characteristics and risk profiles.     

Parent views of the positive contributions of elementary and high school-aged children with autism spectrum disorders and Down syndrome

Background Much is known about the hardships associated with parenting a child with a disability, but few studies have examined the broader contributions of the child to family life or society. Methods The study involved qualitative analysis of interviews with 16 families of children with autism spectrum disorder or Down syndrome at critical transition periods (entry to elementary or high school), targeting their perceptions of benefits. Results Parents discussed a wide range of benefits beyond the personal level, including parental, family and societal benefits. Exploratory group comparisons indicated that parents of high school-aged children were more likely to mention family-level and societal benefits. Conclusions The findings suggest that raising a child with a disability can trigger role-related decisions that lead to a series of resiliency-related processes and cascading benefits. The findings inform practitioners about the nature of potential positive experiences that can be shared with families starting out on their journey, allowing parents to recognize the positive dimensions of raising a child with a disability in addition to the hardships.     

A qualitative study exploring the experiences and views of mothers, health visitors and family support centre workers on the challenges and difficulties of parenting

Successive policy documents have referred to the need to support parents as an approach to reducing social exclusion, behaviour problems among young people and crime rates. Much of the rhetoric focuses on professional intervention, and there is less attention paid to the views and experiences of parents themselves. The present study explores the experiences and views of mothers, health visitors and family support centre workers who work with parents on the challenges and difficulties of parenting children under the age of 6 years. It provides an appreciation of their views on effective parenting and how parents can be helped to feel more effective in the parenting role. Focus groups, which were exploratory and interactive in form, were conducted across three primary care trusts in Hertfordshire, UK. Three samples were purposively selected in order to examine the range and diversity of experiences and views about parenting, and included the parents of children up to the age of 6 years, health visitors and family support centre workers. The mothers were those waiting to attend a parenting programme, and included first-time mothers and those with more than one child. The health visitors and family support workers had a range of experience in working with parents and children, and included those who were facilitating parenting programmes and those who were not. A number of themes emerged surrounding the challenges and difficulties of parenting and effective parenting, including expectations of others, establishing routines, play, behavioural issues and discipline, empathy, and communication. Similar themes emerged from all groups; however, there were qualitative differences between parents and professionals in the way in which these issues were expressed. Key statements from the parent focus groups have been developed into self-efficacy statements, which will be used as input to the development of a tool to measure the effectiveness of parenting programmes.     

School Reintegration Following Psychiatric Hospitalization: An Ecological Perspective

Background

School reintegration following psychiatric hospitalization can be challenging for children, their families, and school personnel. While school reintegration of children with physical illness has received considerable professional attention, our knowledge about the needs of children returning to school after psychiatric hospitalization is still limited.

Objective

This paper delineates an ecological perspective on school reintegration of children after hospitalization for mental health reasons. This perspective takes into account the multiple social systems in which children are embedded and focuses on both individual and environmental factors that may contribute to a child’s well-being or, conversely, trigger emotional and behavioral difficulties.

Methods

This is a theoretical paper based on the systematic review of empirical literature related to psychiatric hospitalization of children, post discharge adjustment, school reintegration following hospitalization, mental health stigma in children, and cross-agency collaboration.

Results

Several ecological factors that may affect school reintegration after psychiatric hospitalization were identified, including: (1) child/youth experiences with and perceptions of having a mental health condition, being hospitalized, and subsequent school reentry; (2) parental experiences and perceptions of child/youth psychiatric condition and hospitalization; (3) attitudes and reactions from members of the child/youth school ecology including teachers and peers; and (4) inter-disciplinary collaboration. The paper proposes ecologically informed guidelines to facilitate successful school reintegration and discusses the roles of the school-based mental health professionals in this process.

Conclusions

While complex and challenging, a successful reintegration may be the key step in reducing inpatient recidivism rates and improving a child’s future academic and behavioral success.