Family Advocacy, Support and Education in Children’s Mental Health: Results of a National Survey

In conjunction with the national survey of mental health service organizations (Schoenwald et al. this issue), a separate but complementary national survey was conducted of family advocacy, support and education organizations (FASEOs). Directors of FASEOs within the same localities as the mental health agencies responded to a survey and provided information in four areas: (1) structure and funding; (2) factors influencing advocacy decisions about children’s mental health; (3) types of services provided by FASEOs and factors perceived as related to improved outcomes; and (4) the types of working relationships between FASEOs and local mental health clinics. Findings from a total of 226 (82% response rate) portray a network of family advocacy, support and education organizations that are strategically poised to effect substantive change and characterized by significant fiscal instability. Results from this survey and implications for delivery of family-based services are provided. The Research Network on Youth Mental Health is a collaborative network funded by the John D. and Catherine T. MacArthur Foundation. Network Members at the time this work was performed included: John Weisz, Ph.D. (Network Director), Bruce Chorpita, Ph.D., Robert Gibbons, Ph.D., Charles Glisson, Ph.D., Evelyn Polk Green, M.A., Kimberly Hoagwood, Ph.D., Peter S. Jensen, M.D., Kelly Kelleher, M.D., John Landsverk, Ph.D., Stephen Mayberg, Ph.D., Jeanne Miranda, Ph.D., Lawrence Palinkas, Ph.D., Sonja Schoenwald, Ph.D.     

School-Based Screening: A Population-Based Approach to Inform and Monitor Children’s Mental Health Needs

School-based mental health professionals often conduct assessments and provide interventions on an individual basis to students with significant needs. However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.     

Pediatrician Perspectives on Children’s Access to Mental Health Services: Consequences and Potential Solutions

This paper examines pediatricians' perspectives regarding access to children's mental health care. In response to a question about factors that help or hinder coordination of care 190 respondents voluminously wrote about mental health access barriers. Responses were qualitatively analyzed to understand pediatricians' perspectives. Four thematic areas emerged: Insurance issues; availability of mental health specialty providers; state mental health systems; and pediatricians' attempts to improve access to mental health services. Pediatricians' responses included educating themselves, using telemedicine, and hiring co-located mental health specialists. Recommendations are made to address pediatricians' treatment of children with mental illnesses and their access to treatment resources.     

The Role of Parents,Parenting and the Family Environment in Children’s Post-Disaster Mental Health

There is widespread support for the hypothesis that, post-disaster, children’s mental health is impacted—at least in part—via the impact on parents, parenting, parent-child interactions, and the family environment. To some degree, the enthusiasm with which this hypothesis is held outstrips the evidence examining it. The current paper critically evaluates the empirical evidence for this hypothesis and concludes that although limited (both in terms of number of existing studies and methodological flaws), the extant literature indicates some parent-related variables, as well as some aspects of the family environment are likely to constitute risk or protective factors for children. Given that parenting is modifiable, it is proposed that the identified parent- and family-related factors represent important therapeutic targets, and a universal post-disaster parenting intervention (Disaster Recovery Triple P) is described.     

Use of the Family Resource Scale in Children’s Mental Health: Reliability and Validity among Economically Diverse Samples

The adequacy of a family’s resources has implications for child and family service processes and outcomes. The field needs tools to assess resources in a manner relevant to children’s services research. The purpose of this study was to examine the reliability and validity of the FRS among families caring for children who are receiving mental health services and to compare its measurement quality across samples that differ on economic variables. Exploratory and confirmatory factor analyses supported similar factor structures across samples, and internal consistency was equivalent. Findings from the regression analyses provided evidence of construct validity for the FRS. Overall, findings indicated that the FRS holds promise as a reliable and valid tool for assessing perceived adequacy of concrete resources among economically diverse families of children with emotional and behavioral disorders. However, the FRS could benefit from some refinements; those recommendations are discussed.     

Culturally Competent Systems of Care for Children’s Mental Health: Advances and Challenges

There has been a remarkable growth in cultural diversity in the United States over the past 20 years. The population of minority groups has increased at a much faster rate than the European-background population in America, and faster even among children and youth. At the same time, minority youth face increasing disparities in their mental health and in access to mental health services. These are related to the multiple challenges they already face in socioeconomic status, but are aggravated by the lack of culturally competent services that can address their specific mental health needs within the context of their culture, family, and community. This paper reviews the current knowledge about the mental health of culturally diverse youth in the United States, and provides guidance on approaches to address the disparities they face.     

Relationship Between Children’s Sleep and Mental Health in Mothers of Children with and Without Autism

The study employed 90 children with autism spectrum disorders (ASDs) who were matched to 90 typically developing children on age, gender, and ethnicity. Using structural equation modeling, maternal sleep and maternal stress mediated the relationship between children’s sleep and mothers’ mental health for mothers of children with and without ASDs. Mothers of children with ASDs reported more problems related to children’s sleep, their own sleep, greater stress, and poorer mental health; however, children’s sleep and maternal sleep were more closely related to maternal stress for mothers of typically developing children. Implications of these findings and future directions for research are discussed.     

Modeling the Decision of Mental Health Providers to Implement Evidence-Based Children’s Mental Health Services: A Discrete Choice Conjoint Experiment

Using an online, cross sectional discrete choice experiment, we modeled the influence of 14 implementation attributes on the intention of 563 providers to adopt hypothetical evidence-based children’s mental health practices (EBPs). Latent class analysis identified two segments. Segment 1 (12%) would complete 100% of initial training online, devote more time to training, make greater changes to their practices, and introduce only minor modifications to EBPs. Segment 2 (88%) preferred fewer changes, more modifications, less training, but more follow-up. Simulations suggest that enhanced supervisor support would increase the percentage of participants choosing the intensive training required to implement EBPs. The dissemination of EBPs needs to consider the views of segments of service providers with differing preferences regarding EBPs and implementation process design.