Foster and Adoptive Parent Perspectives on Needs and Services: a Mixed Methods Study

Caring for children with complex needs severely stresses foster and adoptive parents, but few studies have examined their perspectives on needs and services. To examine parental views, the authors analyzed four focus groups (n = 27 participants) and one state-wide survey (n = 512 respondents, 42% of 1206 contacted) of foster and adoptive parents in one state. Results highlighted inadequate communication between providers and families, cultural and legal barriers, needs for parent training and preparation, the importance of several types of parent supports, and needs for specialized mental health treatment for the children. Surveyed parents identified children’s behavior problems as their top challenge, and over half rated the availability of mental health providers who treat attachment and family as insufficient. The findings suggest specific areas in which state leaders could enhance training and supports for child welfare staff and foster and adoptive parents and improve mental health services for children in foster and adoptive care.     

Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County.

OBJECTIVES. Few studies have estimated the extent of specific emotional, behavioral, and academic problems among sheltered homeless children. The objectives of this study were to describe such problems, identify those children with the problems, and evaluate the relationship between child problems and use of physical and mental health services. METHODS. From February through May 1991, 169 school-age children and their parents living in 18 emergency homeless family shelters in Los Angeles County were interviewed. To evaluate the answers, interviewers used standardized measures of depression, behavioral problems, receptive vocabulary, and reading. RESULTS. The vast majority (78%) of homeless children suffered from either depression, a behavioral problem, or severe academic delay. Among children having a problem, only one third of the parents were aware of any problem, and few of those children (15%) had ever received mental health care or special education. CONCLUSIONS. Almost all school-age sheltered homeless children in Los Angeles County have symptoms of depression, a behavioral problem, or academic delay severe enough to merit a clinical evaluation, yet few receive specific care. Programs targeted at sheltered homeless school-age children are needed to close this gap.     

Children's mental health care: differences by race/ethnicity in urban/rural areas

This study examines racial/ethnic disparities in children's mental health and the receipt of mental health services, and whether those disparities differ between urban and rural areas. We find no significant difference between racial/ethnic groups in the prevalence of child mental health problems in either urban or rural areas. However, there are disparities in the use of mental health services. Hispanic children and Black children in urban areas receive less mental health care than their White counterparts, and the disparity persists for Hispanic children in rural areas, even after controlling for other relevant factors. Initiatives to improve access to mental health care for racial/ethnic minorities should recognize these disparities, and address the lack of culturally appropriate services in both urban and rural areas. In addition, outreach should raise awareness among parents, teachers, and other community members concerning the need for mental health services for minority children.     

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.     

The impact of children's emotional and behavioural difficulties on their lives and their use of mental health services

This paper examines the relationship between the impact of children's emotional and behavioural difficulties and the use of mental health services, using 3 years of nationally representative data from the National Health Interview Survey. Data for the years 2001, 2003 and 2004 were combined ( n  = 29 265) to identify a sample of 1423 children aged 4–17 years with emotional/behavioural difficulties. Multivariable logistic regression analysis was used.
About 5% of U.S. children had emotional or behavioural difficulties. Children whose difficulty was a burden on their family were almost twice as likely to have contact with a mental health professional. Younger children (aged 4–7 years), Hispanic children and non-Hispanic black children with emotional or behavioural difficulties were less likely to use mental health services. These findings indicate that children's emotional and behavioural difficulties influence their lives and those of their families, leading parents to seek help. Racial disparities in mental health service use exist when controlling for the severity and the burden of these difficulties.     

The Impact of Parental Migration on the Mental Health of Children Left Behind

This study aims to examine the impact of parental international migration on the mental health of children left behind. Data for this paper were taken from the “Child Health and Migrant Parents in South-East Asia, Thailand, 2008” project. A total of 1,030 children (519 from emigrant parents and 511 from non-migrant parents) were covered. Data were collected from the caregivers of children using the Strength and Difficulties Questionnaire. Multivariate analyses were performed to determine the association between parental migration and the mental health status of children left behind. Several factors were significantly associated with children’s mental health. Our study did not find any association between current parental migration status and mental health status of the children left behind. The study found, however, that mother’s earlier migration history had a significant, independent association with mental health problems of the children left behind. Therefore, effective strategies to prevent such mental health problems among children are warranted.     

Unmet Need and Problems Accessing Specialty Medical and Related Services Among Children with Special Health Care Needs

OBJECTIVES: To extend what is known about parent reports of their child's need for specialty medical and related services, unmet need, and specific types of access problems among children with special health care needs (CSHCN). METHODS: Using data from a 1998-1999 20-state survey of families of CSHCN, we examined differences in parent report of need for services by child characteristics, investigated parent report of unmet need and access problems by service area and number of services needed, and estimated the likelihood of four access problems and unmet need by child, family, and health insurance characteristics. RESULTS: Overall, the sample children had numerous service needs, although the prevalence of need varied by service type and child characteristics. Reports of unmet need were greater for older children and for children with multiple service needs, unstable health care needs or a behavioral health condition, parents who were in poor health or had more than a high school education, and families whose insurance coverage was inconsistent or lacked a secondary plan. Reports of access problems were greatest for mental health and home health services. The two most prevalent access problems were finding a skilled provider and getting enough visits. CONCLUSIONS: The results underscore the importance of finding new ways to link children with behavioral health problems to mental health services, implementing coordinated care and the other core dimensions of the medical home concept, increasing the number of specialty pediatricians and home health providers, and expanding coverage for a wider range of mental health services.     

Mental health professionals’ views of the parents of patients with psychotic disorders: a participant observation study

As a consequence of the deinstitutionalisation of mental health services, family members have become an important part of the care system. However, little is known about mental health professionals’ perceptions of these family members. The aim of this study was to explore professionals’ views of one particular group, the parents of patients with psychotic disorders. Because sensitive issues such as professionals’ perceptions of parents can be difficult to capture via interviews or self‐report instruments, we conducted participant observation of 20 multi‐professional team meetings. The observations were carried out during 2011 at a psychiatric care unit specialised in working with patients with psychosis. Approximately 10 inpatients and outpatients were discussed in each team meeting. All conversations about the patients’ parents were documented with field notes that were later analysed using inductive thematic analysis. Through the analysis, a complex and multi‐faceted image emerged of parents as seen by mental health professionals. Some parents were described as a helpful resource, but others were thought to hinder treatment. Conflicts between staff members and parents were commonly due to their differing views on the treatment, particularly the medical treatment, of the patient. Other parents were described as causing the patient emotional pain and some parents were perceived as neglectful or abusive. These findings highlight the crucial role mental health professionals play in identifying families’ particular needs and capacities to provide interventions that effectively address each specific situation. Professionals should also recognise families with adverse experiences and help parents fulfil their potential to become resources for their children with psychosis.     

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.     

孤独症儿童家长的应对方式与心理健康的相关性研究

目的探讨孤独症儿童父母的应对方式与心理健康的关系,为孤独症儿童的康复治疗营造更有利的家庭环境。方法使用90项症状清单、应对方式问卷对72例孤独症儿童的父母和64例健康儿童父母进行对照研究。结果研究组"解决问题"的应对方式少于对照组,幻想、退避的应对方式多于对照组,差异有统计学意义。多因素回归分析的结果显示应对方式对SCL-90的总分及各因子均有影响。结论孤独症儿童父母易出现心理健康问题,他们的应对方式会增加出现强迫状态、人际关系敏感、恐怖等精神症状的危险。     

Quality standards for child and adolescent mental health in primary care

ABSTRACT: BACKGROUND: Child and adolescent mental health problems are common in primary healthcare settings. However, few parents of children with mental health problems express concerns about these problems during consultations. Based on parental views, we aimed to create quality of care measures for child and adolescent mental health in primary care and develop consensus about the importance of these quality standards within primary care. METHODS: Quality Standards were developed using an iterative approach involving four phases: 1) 34 parents with concerns about their child's emotional health or behaviour were recruited from a range of community settings including primary care practices to participate in focus group discussions, followed by validation groups or interviews. 2) Preliminary Quality Standards were generated that fully represented the parents' experiences and were refined following feedback from an expert parent nominal group. 3) 55 experts, including parents and representatives from voluntary organisations, across five panels participated in a modified two-stage Delphi study to develop consensus on the importance of the Quality Standards. The panels comprised general practitioners, other community-based professionals, child and adolescent psychiatrists, other child and adolescent mental health professionals and public health and policy specialists. 4) The final set of Quality Standards was piloted with 52 parents in primary care. RESULTS: In the Delphi process, all five panels agreed that 10 of 31 Quality Standards were important. Although four panels rated 25-27 statements as important, the general practitioner panel rated 12 as important. The final 10 Quality Standards reflected healthcare domains involving access, confidentiality for young people, practitioner knowledge, communication, continuity of care, and referral to other services. Parents in primary care agreed that all 10 statements were important. CONCLUSIONS: It is feasible to develop a set of Quality Standards to assess mental healthcare provision for children and adolescents seen within primary healthcare services. Primary care practitioners should be aware of parental perspectives about quality of care as these may influence helpseeking behaviours.     

Prevention of Secondary Conditions in Fetal Alcohol Spectrum Disorders: Identification of Systems-Level Barriers

Fetal alcohol spectrum disorders (FASD) impact 2–5 % of the US population and are associated with life-long cognitive and behavioral impairments. Individuals with FASD have high rates of secondary conditions, including mental health problems, school disruptions, and trouble with the law. This study focuses on systems-level barriers that contribute to secondary conditions and interfere with prevention and treatment. Using a phenomenological methodology, semi-structured interviews and focus groups were conducted with parents of children with FASD and service providers. Data were analyzed using a framework approach. Participants emphasized the pervasive lack of knowledge of FASD throughout multiple systems. This lack of knowledge contributes to multi-system barriers including delayed diagnosis, unavailability of services, and difficulty qualifying for, implementing, and maintaining services. FASD is a major public health problem. Broad system changes using a public health approach are needed to increase awareness and understanding of FASD, improve access to diagnostic and therapeutic services, and create responsive institutional policies to prevent secondary conditions. These changes are essential to improve outcomes for individuals with FASD and their families and facilitate dissemination of empirically supported interventions.     

SOCIAL WORK IN A PEDIATRIC PRIMARY HEALTH CARE TEAM IN A GROUP PRACTICE PROGRAM

The inclusion of a psychiatric social worker as a member of a pediatric team in a prepaid group practice extends the range of pediatric mental health services to children. This paper discusses the collaboration of the social worker with the pediatricians and allied health personnel on the team in dealing with the emotional problems of referred children and their parents. Case examples are included. All cases seen by the social worker during a 6-month period are reviewed. With available psychiatric backup a wide range of emotional problems are identified, and effective mental health care is provided.     

Social work in a pediatric primary health care team in a group practice program.

The inclusion of a psychiatric social worker as a member of a pediatric team in a prepaid group practice extends the range of pediatric mental health services to children. This paper discusses the collaboration of the social worker with the pediatricians and allied health personnel on the team in dealing with the emotional problems of referred children and their parents. Case examples are included. All cases seen by the social worker during a 6-month period are reviewed. With available psychiatric backup a wide range of emotional problems are identified, and effective mental health care is provided.     

Understanding the mental health needs of children under five in one inner city authority

There is increasing awareness of mental health problems among young children, and early years settings are encouraged to take a wider family support role in order to prevent mental health difficulties. Local population studies are needed to inform delivery of universal through to targeted services. In the current study, parents and teachers of 2% of early years children in one inner city local authority were contacted. A one-stage survey was undertaken using the Early Years Behaviour Checklist (EYBC) and questions ascertaining services required. Questionnaires were distributed in appropriate languages to parents and teachers of 364 children. About 362 teacher questionnaires and 177 parent questionnaires were returned. Detailed analysis of the teacher questionnaires demonstrated that 11% (40) of the children scored in the abnormal range on the EYBC for possible behaviour problems. Just under half of parents returned questionnaires, and 11.9% (21) of the children were scored in the abnormal range for possible behaviour problems. This study indicates that the mental health needs of children under 5 in this inner city sample were broadly in keeping with the national figures. Implications for service delivery are discussed.     

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.     

Beliefs about and responses to childhood ear infections: a study of parents in eastern North Carolina

Middle ear infection, also known as otitis media (OM), is a major public health problem among American children. Although clinical and epidemiological aspects of OM have been intensely studied, cultural factors that may be contributing to the problem of OM have received less attention. This article presents findings from an ethnographic study exploring beliefs about OM and responses to the illness among parents from eastern North Carolina. In-depth interviews were conducted with a convenience sample of nine mothers in order to learn more about parents' explanatory models of OM, the source of their beliefs, and how they respond to the illness. A survey instrument based on their statements was then constructed and administered to a convenience sample of 79 parents. The survey consisted of belief statements about OM, as well as questions pertaining to sources of beliefs, the home management of the disease, and the effects of the illness on families. A cultural consensus analysis of responses to belief statements indicates that parents shared a common model of OM. Beliefs about risks, symptoms, and causes of OM were similar to the current biomedical model of the illness, but their divergent beliefs about the diagnosis, prognosis and treatment of OM could lead to unnecessary use of health care services. Clinicians, family, and friends were reported to be important sources of information about OM. Parents also reported using similar home management strategies and care seeking behaviors to minimize the impact of the illness on their children and families. While these findings need to be replicated in studies with larger, more representative samples, this study suggest that ethnographic approaches may provide new insights into the cultural dimension of the problem of OM.     

学龄前注意缺陷多动障碍儿童症状与父母心理健康状况的相关研究

目的 了解学龄前注意缺陷多动障碍(ADHD)儿童父母的一般心理健康状况,探讨其与儿童ADHD症状的相关性。 方法 2015年5月-2017年1月选取符合精神障碍诊断与统计手册(第5版)(DSM-5)诊断标准的学龄前ADHD儿童119例,以及附近普通幼儿园正常对照儿童115例,年龄范围均为4岁0月~5岁11月。研究采用SNAP-Ⅳ评定量表对两组儿童的症状进行评估,采用12项一般健康问卷(GHQ-12)、患者健康问卷抑郁症状群量表(PHQ-9)、广泛性焦虑量表(GAD-7)对两组父母的一般心理健康水平和焦虑、抑郁情绪进行评定,并对两组结果进行比较及相关性分析。 结果 1)研究组儿童SNAP-Ⅳ各因子得分及总分均显著高于对照组儿童(P<0.001)。 2)研究组儿童父母的 PHQ-9和GAD-7得分高于对照组(P<0.05),且心理健康水平筛查阳性率和焦虑、抑郁症状发生率均高于对照组(P<0.05)。 3)学龄前ADHD儿童SNAP-Ⅳ各因子得分及总分与父母的GHQ-12、PHQ-9、GAD-7得分呈低至中度正相关(r=0.22~0.35,P<0.01)。 结论 学龄前ADHD儿童父母的焦虑、抑郁水平较高,父母的心理健康状况与儿童ADHD的症状存在一定的相关性,应重视对学龄前ADHD儿童父母进行心理辅导和治疗。