Can't have one without the other: Mental health providers and community parents reducing barriers to services for families in urban poverty

University–community partnerships are widely recognized as critical to the success of community research and advocacy work but difficult to form and sustain. This article will describe a unique facet of that partnership, namely the collaboration between mental health clinicians and community consultants, a partnership that our data suggest was a cornerstone of our school‐based mental health service program called PALS, an ecological model designed to engage African American families living in urban poor communities in mental health services. The service model was designed to promote children's learning and positive behavior through supporting teachers and encouraging parental involvement in school. In PALS, parent representatives from the community and clinicians from the university worked together in school‐based teams to support children, families, and teachers. This article will discuss the evolution of our clinician–consultant partnership and several lessons that emerged regarding the incorporation of community members into the world of academia, research, and mental health service delivery. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 435–446, 2007.     

Mental health aspects of emergency medical services for children: summary of a consensus conference.

OBJECTIVE: To address the mental health needs of children involved in emergency medical services (EMS). METHODS: A multidisciplinary consensus conference convened to identify mental health needs of children and their families related to pediatric medical emergencies, to examine the impact of psychological aspects of emergencies on recovery and satisfaction with care, and to delineate research questions related to mental health aspects of medical emergencies involving children. RESULTS: The consensus group found that psychological and behavioral factors affect physical as well as emotional recovery after medical emergencies. Children's reactions are critically affected by age and developmental level, characteristics of the emergency medical event, and parent reactions. As frontline health care providers, EMS staff members are in a pivotal position to recognize and effectively manage the mental health needs of patients and their families. CONCLUSIONS: Ecological changes in emergency departments, such as linkages to mental health follow-up services, training of EMS providers and mental health professionals, and focused research that provides an empirical basis for practice, are necessary components for improving current standards of health care.     

Serving the homeless mentally ill: Mental health linkage

A substantial amount of research on homeless mentally ill individuals within the last 5 years has clarified their numbers, characteristics, and service needs. Research is lacking, however, on effective service models. A Mental Health Linkage model is presented, derived from practice principles in the literature, including outreach, community integration of mental health services, and meeting clients on their terms. The model is described and data on client characteristics and service operations are presented from three demonstration sites. Significant differences in client characteristics were found, indicating the heterogeneity of this population across different community contexts. When evaluated against practice principles and the program's intent, research results suggest the model's success in serving the target group by providing them with linkage and housing. Barriers identified through the demonstration projects' experiences are substantial, however, and warn of the challenges that services to homeless mentally ill individuals face within mental health agencies and within their communities.     

Federal Efforts to Improve Mental Health Services for Children: Breaking the Cycle of Failure

This article describes the recently implemented Child and Adolescent Service System Program (CASSP). This program, administered by the National Institute of Mental Health, is the latest federal effort to address the provision of mental health services to children and adolescents through grants to states to improve service systems at the state and local level. The article traces the history of federal initiatives for children's mental health services, a history marked by a series of failures. Drawing from the lessons of the past failures as well as the successful effort to create CASSP, implications for the survival of CASSP and future federal initiatives are presented.     

Practical Guidelines for Educating Policymakers: The Family Impact Seminar as an Approach to Advancing the Interests of Children and Families in the Policy Arena

Psychologists are well positioned to contribute to policymaking on issues affecting the well-being of children, youth, and families. A good deal of psychological research is relevant to policy issues such as child mental health services, child care, adoption and foster care, and children's media. In this article we offer an alternative to direct policy advocacy as a means for psychologists' involvement in the policy arena. Policy education, a nonpartisan and nonadversarial approach to working with policymakers, is described and differentiated from child advocacy. We then present an example of 1 approach to policy education, the Family Impact Seminar. The article closes with a discussion of lessons we have learned regarding effectively communicating research to policymakers.     

Bringing Parenting Interventions Back to the Future: How Randomized Microtrials May Benefit Parenting Intervention Efficacy

A novel approach is needed to promote the efficacy of parenting interventions designed to improve children's mental health. The proposed approach bridges developmental and intervention science to test which intervention elements contribute to parenting intervention program efficacy. The approach encourages the field to move “back to the future” using stringent, focused experimental techniques to test discrete parenting techniques (e.g., praise, time‐out) on their merit. We argue that these randomized microtrials are needed to (a) distinguish between the less and more efficacious elements of parenting interventions, (b) illuminate for whom and under what conditions elements are efficacious, and (c) explore the potential for empirically supported tailoring of interventions to meet families’ specific needs.     

Responding to the mental health needs of Latino children and families through school-based services

This article highlights the value and utility of school-based mental health services in addressing the unmet mental health needs of Latino children and families in the United States. To better understand our nation's rapidly growing Latino population, such critical factors as demographic characteristics, cultural values, and family structure are examined. Special attention is devoted to the daunting challenges and resultant trauma experienced by many of these children and families who have recently immigrated to this country from war-torn home-lands in Central America. The mental health status of Latino children is addressed, along with various service delivery issues and psychotherapeutic modalities to facilitate their personal adjustment and social adaptation in a culturally sensitive manner. The article concludes with the presentation of an innovative school-based mental health program that offers a range of services of demonstrated effectiveness in aiding Latino children and their families. Specific strategies for replicating the program model in other culturally diverse settings are also discussed.     

Admission and Discharge Criteria for Children's Mental Health Services: A Review of the issues and Options

This paper examines issues involved in the establishing of admission and discharge criteria for children's mental health programs. Four basic approaches to the establishment of such criteria was discussed. The conclusion of the analysis was that the present state of knowledge does not permit very accurate identification of the type of program that will best meet the needs of particular individuals. Instead, it was recommended that the emphasis in the children's mental health field be on the development of a full range of programs with children basically being given an opportunity first in the less restrictive, more community-based, and family-focused programs. Such an approach helps protect the rights of children and families and is consistent with a growing body o f findings that suggest children can benefit from less restrictive programs than those in which they have often been placed.     

Harnessing innovative technologies to advance children's mental health: Behavioral parent training as an example

Disruptive behaviors of childhood are among the most common reasons for referral of children to mental health professionals. Behavioral parent training (BPT) is the most efficacious intervention for these problem behaviors, yet BPT is substantially underutilized beyond university research and clinic settings. With the aim of addressing this research-to-practice gap, this article highlights the considerable, but largely unrealized, potential for technology to overcome the two most pressing challenges hindering the diffusion of BPT: (1). The dearth of BPT training and supervision opportunities for therapists who work with families of children with disruptive behaviors; and (2). The failure to engage and retain families in BPT services when services are available. To this end, this review presents a theoretical framework to guide technological innovations in BPT and highlights examples of how technology is currently being harnessed to overcome these challenges. This review also discusses recommendations for using technology as a delivery vehicle to further advance the field of BPT and the potential implications of technological innovations in BPT for other areas of children's mental health are discussed.     

SUPPORTING POSITIVE PARENTING IN COMMUNITY HEALTH CENTERS: THE ACT RAISING SAFE KIDS PROGRAM

The present study involves an evaluation of the effect of the American Psychological Association's ACT Raising Safe Kids (RSK) program on parenting outcomes for families served by Community Health Centers. The ACT‐RSK program is a primary family violence and child physical abuse prevention program for parents of young children. Parents were trained in effective parenting including nonviolent discipline, child development, anger management, social problem‐solving skills, effects of violent media on children, and methods to protect children from exposure to violence. Results indicate improved nurturing and positive parenting behaviors and lower rates of psychologically and physically aggressive behavior toward children. These improvements occurred independent of children's age and prior levels of aggression. Use of this model within healthcare settings has the potential to more effectively address parents’ needs for parenting guidance while reducing the likelihood of child maltreatment.     

Improving Foster Parent Engagement: Using Qualitative Methods to Guide Tailoring of Evidence-Based Engagement Strategies

This qualitative study examined applicability and need for tailoring of an evidence-based engagement intervention, combined with Trauma-Focused Cognitive Behavioral Therapy, for foster parents. Qualitative methods were used, including individual interviews with participating foster parents (N = 7), review of interview findings with an independent group of foster parents (N = 5), and review of the combined foster parent findings by child welfare caseworkers (N = 5), an important stakeholder group. The engagement intervention, with its primary focus on perceptual barriers (e.g., past experiences with mental health), was relevant for the foster care population. However, the study identified areas for tailoring to better recognize and address the unique needs and situation of foster parents as substitute caregivers. Perceptually focused engagement interventions may have broad applicability to a range of populations, including foster parents, with the potential for improving caregiver participation in children's mental health services.     

Mental Health Needs of Older Adults and Primary Care: Opportunity for Interdisciplinary Geriatric Team Practice

The convergence of a number of disparate factors has led to opportunities to help address the mental health needs of older adults in primary care (PC) or "integrated care" settings. Older adults are disproportionately high users of health care resources, and cost projections for coming decades have catastrophic implications. Elders shun mental health services, instead turning to their personal physicians when troubled. The PC system is clogged with patients without medical problems or whose medical conditions are exacerbated by psychosocial factors (estimated at 60% to 70%), resulting in overutilization of services and high costs. However, PC physicians detect and adequately treat or refer only 40% to 50% of patients with mental health problems. Early experience with brief and/or structured interventions in PC settings is promising and suggests opportunities for multidisciplinary team geriatric practice.     

HEAD START ENROLLMENT AND CHILDREN'S MENTAL HEALTH TREATMENT

This secondary data analysis from a Head Start program examines the association between children's entry age and enrollment duration and the likelihood of mental health treatment. Study questions are as follows: (a) Do baseline characteristics differ among three groups of Head Start children? (children who enrolled at 3 years of age and stayed for 1 year [group 1], enrolled at 4 years of age and stayed for 1 year [group 2], and enrolled at 3 years of age and stayed for 2 years [group 3]); (b) Does the likelihood of children's mental health treatment differ among the groups?; and (c) Are baseline characteristics associated with the likelihood of mental health treatment? Except ethnicity and family size, other baseline characteristics did not differ across the three groups. Groups 1 and 3 received more mental health treatment than group 2. Different percentages of mental health treatment were found, depending on children's gender, ethnicity, family income, special needs, and bilingual status.     

Examining Psychotherapy Processes in a Services Research Context

Interdisciplinary research efforts integrating services and interventions research methodologies are needed to improve the "real-world" clinical utility and impact of youth mental health research. "Hybrid" services and interventions research efforts can capitalize on the methodologic strengths of each research tradition in order to more rigorously examine and affect therapy processes in usual care youth mental health service settings. The goals of this article are to (a) identify the need for hybrid practice research on youth mental health care; (b) present a "case example" of a hybrid study, where child and family therapy processes are being examined in a usual care, practice-based context by a team of services researchers; (c) address the potential advantages and challenges of hybrid research; and (d) suggest promising areas for future hybrid research in youth mental health care.     

Commentary: Organizational Culture and Practice Epistemologies

Hemmelgarn, Glisson, and James (2006) provide an excellent review of the impact of organizational culture and climate for the implementation of evidence-based practice (EBP) models within social and mental health services systems. As their article makes clear, the implementation process should address the organizational context, and effectiveness and services research should consider organizational factors in outcome and EBP transport research. This commentary extends discussion of one aspect of organizational culture—the extent to which organizations are driven by an empirical scientific epistemology—and how this may contribute to establishing a context for EBP design, selection, implementation, and sustained evolution in field settings.     

Woman-to-woman support: lessons from an Australian case story

The purpose of this article is to demonstrate the use of storytelling to generate critical thinking about women's mental and emotional health care. The case story at the heart of the storytelling process describes a real, conflict situation in a remote, Australian women's health center. The themes generated lead to critical analysis of the concepts of care, independence, self-responsibility, ideology and woman-space, as they pertain to services designed to promote women's mental and emotional well-being. The conflict in the story arose between a lay worker providing woman-to-woman support and a professional counselor. Woman-to-woman support is a strategy developed in the women's health movement. It refers to the provision of time and space in women's health centers for women to work on their own needs with the support of women's health workers. Based on feminist principles, the aim is to empower women with knowledge, resources and skills. Woman-to-woman support builds on the care that women have traditionally provided for each other and is particularly useful for women living in regions where only limited, professional counseling services may be available.     

Mentalization in children exposed to parental methamphetamine abuse: relations to children's mental health and behavioral outcomes

This study examined the mentalization capabilities of children exposed to parental methamphetamine abuse in relation to symptom underreporting, mental health, and behavioral outcomes. Twenty-six school-aged children in foster care participated in this study. Mentalization was assessed using the My Family Stories Interview (MFSI), a semi-structured interview in which children recalled family stories about a happy, sad or scary and fun time. An established scale of the Trauma Symptom Checklist for Children (TSCC), a self-report measure, provided information on children's symptom underreporting. The Child Behavior Checklist (CBCL), completed by the children's foster caregivers, assessed children's mental health and behavioral outcomes. Children with higher mentalization were significantly less prone to underreport symptoms. These children had fewer mental health problems and were rated by their foster caregivers as more socially competent. The findings underscore that mentalization could be an important protective factor for children who have experienced parental substance abuse.     

Integrating Interventions and Services Research: Progress and Prospects

Although interventions and services research paradigms have distinct historical roots and methodologic traditions, both aim to improve mental health services for adults and youth. This article introduces a series of articles that represent examples of innovative and integrative (i.e., integration of services and interventions research) research efforts. This work involves an integration of the interventions and services research paradigms to address the difficult questions related to improving mental health services in diverse settings. Each of the four articles takes a distinctly different path in bringing together the interventions and services research traditions, with foci ranging from (a) using psychotherapy measurement tools to assess the content of usual care practice in collaboration with providers, (b) adapting randomized clinical trial design to fit nonmental healthcare settings while addressing relevant outcomes, (c) understanding and incorporating patient preferences into treatment research, and (d) identifying organization-level variables relevant to interventions development and implementation. In the introductory article, we provide a brief précis concerning the interventions and services research traditions, highlight how each of the four articles illustrates an innovative integration of interventions and services research, and discuss additional future directions beyond the work introduced in this series.     

Clinical Considerations When Treating Adults Who Are Parents

When providing mental health services to adults, we are often treating individuals who, among their other roles, are also parents. The goal of this article was to provide practitioners with the state of the science about both the impact of parental psychopathology on children and the role that children's well‐being has in parental psychopathology. We discuss the benefits of integrated care for adult clients who are parents, as well as the barriers to providing integrated care for both parents and children in psychotherapy, and provide recommendations for practice. With this information, practitioners will gain greater awareness of their opportunities to treat adults in their parenting roles as well as to contribute to prevention of mental disorders in children.