A family support service for homeless children and parents: users' perspectives and characteristics

The objective of the present study was to establish the psychosocial characteristics and perspectives of 49 consecutive homeless families who received input from a new designated family support worker (FSW) post at a large statutory hostel for homeless parents and children. The FSW provided: assessment of social, educational and health needs; support and parent training; and liaison with and referral to specialist services. Measures included quantitative questionnaires (i.e. the Hospital Anxiety and Depression Scale, the Parenting Daily Hassles Scale, the Eyberg Child Behaviour Inventory, and the Health of the Nation Outcome Scales for Children and Adolescents), and a qualitative (semistructured) interview on service experiences and satisfaction. The psychosocial measures indicated high rates of parenting difficulties, mental health and related needs among children and their parents. Parenting difficulties were associated with child behaviour problems. Parents expressed satisfaction with the service whilst they were residents at the hostel, but they were often not clear about the objectives of agencies and interventions. Family support interventions have a key role in service provision for homeless and other vulnerable families by providing direct parenting interventions and ensuring that specialist agencies are appropriately involved. Family support worker involvement needs to continue when families are re-housed in the community.     

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec,Canada

User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio‐demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg–Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.     

The mental health of single homeless people in Northampton hostels

Much research evidence about homelessness and health relates to large population centres with correspondingly large homeless populations. Such results may not necessarily apply to small towns such as Northampton. A local need was identified for information relating to health and access to health care for homeless people.Seventy five single, homeless people temporarily residing at open access hostels in Northampton were interviewed.The interviews covered:

• recent accommodation histories

• recent physical health

• mental health

• access to health care

• current social contacts, life style and aspirations

The General Health Questionnaire (GHQ30) was administered to allow assessment of the levels of mental morbidity in the population studied.The results presented here relate to mental health issues. Current mental health problems were reported by 53% of thesample (40 people); of these only 40% (16 people) were receiving treatment. Three people had been admitted to a psychiatric hospital within the past year. Using standard scoring, the GHQ30 identified as cases 72% (44) of the 61 homeless people who completed the GHQ.It was concluded that levels of mental morbidity were higher in the homeless group than would be expected in the general population. This finding, mirrors those of studies in larger population centres.The main form of access to mental health services appeared to be via hospital admission. Any GP treatment offeredwas likely to be medication. There was no mention of Community Psychiatric Nurse involvement in treatment or care.The results may indicate a significant level of umnet need for mental health intervention amongst the local homeless population.     

Factors associated with violent victimisation among homeless adults in Sydney, Australia

Objective: To determine the prevalence and correlates of violent victimisation among homeless people in inner-Sydney.
Method: Cross-sectional design. Clients of a shelter for homeless, substance-using adults were interviewed about their drug use, mental health and violent victimisation in the previous 12 months. Logistic regression was used to identify factors associated with victimisation.
Results: Participants reported complex drug use histories and high levels of depression, post-traumatic stress disorder (PTSD) and schizophrenia or other psychotic disorders. Forty-eight per cent of participants reported past year victimisation. In univariate analyses, being female, schizophrenia/psychotic disorder, PTSD, depression and regular use of psychostimulants were associated with increased risk of victimisation. In multivariate analyses, regular use of psychostimulants (odds ratio [95% CI] 5.07 [1.53-16.84]), schizophrenia or other psychotic disorder (3.13 [1.24-7.9], and depression (2.65 [1.07-6.59]) were associated with increased risk of victimisation.
Conclusions and implications: This sample of homeless, substance-using adults experienced high levels of violence. People with poor mental health and regular psychostimulant users were at greater risk of victimisation. A longitudinal study to determine whether victimisation prolongs homelessness is warranted. Clinical staff working with homeless populations need to be aware of the likelihood of past and future victimisation and its effects on mental health. Homeless persons may benefit from learning to identify risk situations for victimisation and how to de-escalate potentially violent situations.     

A pilot demonstration of comprehensive mental health services in inner-city public schools

BACKGROUND: National policy statements increasingly espouse the delivery of comprehensive mental health services in schools. In response to the limited evidence supporting this recommendation, the purpose of this study was to assess the need for, and feasibility, desirability, and outcomes of a full model of comprehensive mental health services in 2 public elementary schools in inner‐city neighborhoods. METHODS: The program, based upon a national model for comprehensive school mental health services, comprised universal and indicated preventive as well as clinical interventions designed to target needs identified in a baseline screening survey. The program was implemented over 1 school year by mental health professionals in collaboration with school teachers. Mental health outcomes comparing baseline to follow‐up data were assessed in multiple domains among students and teachers. RESULTS: After 1 year of intervention, students had significantly fewer mental health difficulties, less functional impairment, and improved behavior, and reported improved mental health knowledge, attitudes, beliefs, and behavioral intentions. Teachers reported significantly greater proficiency in managing mental health problems in their classrooms. School staff overwhelmingly endorsed satisfaction with the program. CONCLUSION: If the observed favorable findings from this pilot demonstration can be replicated in methodologically rigorous studies, additional support would be garnered for national policy recommendations about comprehensive school mental health services.     

Engagement with health and social care services: perceptions of homeless young people with mental health problems

The present qualitative study describes and discusses the perspectives and experiences of young homeless people with mental health problems in relation to their interactions with health and social care services. Working in partnership with Streetlink, a supported accommodation assistance programme in Adelaide, Australia, the authors interviewed 10 homeless young people, aged from 16 to 24 years of age, who had experienced mental health problems. In-depth interviews elicited accounts of the best and worst of the participants' experiences of health and social care services. Access to services was not identified as being a significant problem in comparison with the participants' concerns regarding the quality of the services encountered. The central findings stress the importance of a respectful and supportive climate in relation to the qualities of service provision that the young people identified as valuable for their continuing treatment or consultation.     

The contacts which families and children with learning disabilities have with health and social services

This study summarises all the documented service inputs which families who had a child classed as having learning disabilities, received from one community Health and Social Services Trust in Northern Ireland during the 12 month period April 1996 to March 1997.

Using data obtained from three computer-based recording systems used in Northern Ireland - Child Health Record (Module V); L-CID and Soscare - this paper documents the extent and type of service provision for this population. In all, eleven different health professionals were involved while social services offered a further five service inputs. However the services provided varied across different age groupings of children and severity of the disability. Similarities and differences are noted between the Trust's services and those reported in a national U.K. survey of parents with disabled children.

Four key issues are discussed in the light of the Children (N.I.) Order: the development of a common database for this population; the criteria used to determine which children receive a service and those who do not; the co-ordination of service inputs; and the failure of present computer systems to record the outcomes of service inputs.     

Work-related violence, lifestyle, and health among special education teachers working in Finnish basic education

BACKGROUND: Studies have reported higher levels of absenteeism due to illness among special education teachers compared to other teachers, but it is not known which factors might contribute to this difference. We examined whether health, health behaviors, and exposure to violence at work differed between special education and general education teachers in Finnish basic education. METHODS: Survey data from 5760 general and special education teachers were analyzed with multilevel logistic models adjusted for individual‐ and school‐level confounding factors. RESULTS: No difference was found between the health behaviors of general and special education teachers. The differences in physical and mental health between the two groups were also relatively small. With regard to work‐related violence, however, male special education teachers were 3 times more likely to be exposed to mental abuse, and 5 times more likely to be exposed to physical violence when compared to their male colleagues in general education. Although female special educators were also at an increased risk of mental abuse and physical violence compared to their female general teacher colleagues, their odds ratios for such an encounter were smaller (2‐ and 3‐fold, respectively) than those of male special education teachers. The school‐level variance of physical violence toward teachers was large, which indicates that while most schools have little physical violence toward teachers, schools do exist in which teachers' exposure to violence is common. CONCLUSIONS: These findings suggest that special education teachers may benefit from training for handling violent situations and interventions to prevent violence at schools.     

Children with epilepsy and their families: needs and services

Summary Social factors play a major role in determining the impact of epilepsy on families. This paper reviews the literature on the need's of families and their social networks, and services proposed for them. The predominantly negative picture presented in the 'expert' literature is compared with the more positive one presented in first-hand studies of families' views and in the literature on children with other disabilities. The implications of these differing perspectives for service provision are discussed.     

Focusing upon children and men in situations of domestic violence: an analysis of the gendered nature of British health visiting

Despite considerable feminist critiques of British health visiting work which have pointed to its gendered nature, this issue has received very little attention within the professional literature. The emphasis has been upon the 'health' focus, often highlighting the needs of marginalized groups. The recent professional interest in women experiencing domestic violence draws upon a long-standing feminist concern which has established the extent and nature of domestic violence, and the difficulties facing women in seeking help about their situation. The present paper reports some findings from a study of British health visiting practice in relation to women experiencing domestic violence. Drawing upon interview data from 24 health visitors, this paper focuses specifically upon health visitors' accounts of their practice in relation to both children and men when they were aware women were experiencing domestic violence. Their concerns, which include child welfare and personal safety illustrate some of the complexities facing practitioners when faced with domestic violence situations. The analysis also highlights the gendered practices inherent within health visiting work.     

Delivering healthcare services to children with cerebral palsy and their families: a narrative review

Children with cerebral palsy have complex healthcare needs and often require complex multidisciplinary care. It is important for clinicians to understand which approaches to healthcare service delivery for this population are supported in the literature and how these should be applied in clinical practice. This narrative review aims to identify and review the evidence for current approaches to healthcare service delivery for children with cerebral palsy. Databases were searched using key terms to identify relevant research articles and grey literature from December 2011 to September 2013. Search results were screened and sorted according to inclusion and exclusion criteria. Thirty‐two documents were included for evaluation and their content was analysed thematically. Three current approaches to healthcare service delivery for children with cerebral palsy identified in this narrative review were family‐centred care, the World Health Organisation's International Classification of Functioning, Disability and Health, and collaborative community‐based primary care. However, healthcare services for children with cerebral palsy and their families are inconsistently delivered according to these approaches and the identified guidelines or standards of care for children with cerebral palsy have limited incorporation of these approaches. Future research is required to investigate how these approaches to healthcare service delivery can be integrated into clinical practices to enable clinicians to improve services for this population.     

Disabled children and their families in Ukraine: health and mental health issues for families caring for their disabled child at home

In the Eastern European countries included in the communist system of the USSR, parents of disabled children were encouraged to commit their disabled child to institutional care. There were strict legal regulations excluding them from schools. Medical assessments were used for care decisions. Nevertheless many parents decided to care for their disabled child at home within the family. Ukraine became an independent country in 1991, when communism was replaced by liberal democracy within a free market system. Western solutions have been sought for many social problems existing, but 'hidden,' under the old regime. For more of the parents of disabled children, this has meant embracing ideas of caring for their disabled children in the community, and providing for their social, educational, and medical needs, which have previously been denied. The issue of disability is a serious one for Ukraine where the nuclear disaster at Chernobyl in 1986 caused extensive radiation poisoning. This almost certainly led to an increase in the number of disabled children being born and an increase in the incidence of various forms of cancer. This paper is based on a series of observation visits to some of the many self-help groups established by parents, usually mothers, for their disabled children. It draws attention to the emotional stress experienced both by parents and their disabled children in the process of attempting to come to terms with the disabling conditions, and the denial of the normal rights of childhood resulting from prejudice, poor resources, ignorance, and restrictive legislation. Attempts have been made to identify the possible role and tasks of professional social workers within this context. International comparisons show that many parents and their children do not benefit from the medical model of disability, and that serious consequences include the development of depressive illness among those who find that little help is available from public services.     

The impact of childhood abuse history, domestic violence and mental health symptoms on parenting behaviour among mothers in Japan

Background To assess the impact of childhood abuse history, domestic violence experiences and mental health symptoms on the parenting behaviour of mothers in Japan who have separated from violent husbands or partners. Methods A self‐administered questionnaire survey was conducted on a sample of mothers (n= 304) and their children (n= 498) residing in 83 mother–child homes in Japan. The survey assessed the mothers' childhood abuse history (physical, psychological and sexual abuse and neglect history), domestic violence experiences, current mental health symptoms (dissociative, depressive and traumatic symptoms) and parenting behaviours after moving into the homes to separate from a violent husband or partner. Results The mothers' childhood abuse history and experience of domestic violence were not associated with their not playing with their children. In contrast, the mothers' dissociative and depressive symptoms were significantly associated with not playing with their children. Although there was no association between the mothers' total childhood abuse history and not praising their children, their childhood physical abuse history was significantly associated with their not praising their children. The dissociative and depressive symptoms were also associated with no praise. Interestingly, the experience of domestic violence showed an inverse association with no praise. Conclusions Mental health symptoms, more specifically dissociative and depressive symptoms, are associated with a decrease in parenting quality. Mothers who were physically abused as children are less likely to praise their own children, independent of maternal mental health symptoms. In contrast, mothers who experienced domestic violence but subsequently separated from their violent husbands or partners are more likely to praise their children. The treatment of mental health symptoms, particularly dissociative and depressive symptoms, therapy for childhood abuse history and separation from violent husbands or partners might be effective ways to enhance the quality of parenting in Japan.     

与子女关系对农村老人心理健康的影响

[目的]探讨子女数量、子女经济特征、代际关系等对老人心理健康的影响。[方法]对云南省15个州(市)60周岁及以上农村老人进行抽样调查,收回1983份有效问卷,覆盖云南省92个自然村。通过二分类Logistic回归分析影响老人心理健康的因素。[结果]农村老人心理健康评分为(93.95±23.084)分,其中得分为75分及以上有1541人(77.7%),75分以下有442人(22.3%)。单因素分析显示,与子女关系、子女经济状况、子女是否外出打工、子女对老人关心程度和子女探访频率对老人心理健康影响差异有统计学意义(P<0.05)。Logistic回归分析显示,子女数、与子女关系、子女是否在外打工、子女对老人的关心程度对老年人的心理健康有影响(P<0.05)。[结论]子女仍是农村老年父母心理慰藉的重要来源;代际关系中存在一定的矛盾心理;多子未必多福,女儿作用越来越重要;子女经济状况的影响呈现出复杂性。     

Cross‐ministerial collaboration related to paediatric rehabilitation for children with disabilities and their families in one Canadian province

The delivery of paediatric rehabilitation services is complex due to the involvement of different service sectors and diverse models of care. Parents of children with disabilities find it challenging to navigate successfully through complicated service delivery systems. Cross‐sectoral collaboration to improve continuity of care for children with disabilities and their families is viewed as ideal in public policies. The purpose of this research was to explore how ministerial cultures, processes and structures influence inter‐ministerial collaboration for the purpose of enhancing continuity of care for children with disabilities and their families in a Western Canadian province. Six key informants from three government Ministries that funded paediatric rehabilitation services participated in individual, semi‐structured interviews between January and May of 2007. Nineteen provincial public policy documents were reviewed. Hall’s framework guided the analysis of the key informant interviews and policy documents. Influences of organisational culture, processes and structures on cross‐ministerial collaboration were classified into the categories of ideas—values and beliefs that underlie policy development, interests—influence of various policy actors and institutions—structures and processes used to deliver public policy. Fundamental ideological and structural differences were apparent across the three ministries that affected the ease of inter‐ministerial collaboration towards ensuring continuity of care for children with disabilities. Variations in ideas (philosophy and values) and institutions (geography and service delivery structure, relationships with regional governance, mission and function, choice of policy instruments and financial processes) are presented and implications for service delivery are explored.     

Behavioural social work with encopretic children, their families and the school

Summary Social work intervention and the use of behaviour modification techniques is described in five cases of childhood encopresis, all boys. In two cases an operant model was adopted and the parents were asked to reinforce with praise and stars approximation to the goal (trying) as well as success (defaecation into the lavatory). The P.S.W. rewarded the children intermittently with praise and small gifts and supported and praised the mother for the efforts they were making. In the third case contingencies surrounding elimination were altered in order to bring about desensitization following an injury the child had suffered while sitting on the seat of the school lavatory. This had resulted in fearfulness over going to the toilet at school culminating in alternate soiling and constipation. In the remaining two cases self-monitoring was central to the treatment and training. The work was done within the context of a conventional casework relationship with the whole family which was warm and supportive in nature and directed towards problem solving in more than one area. Other members of the Child Guidance Team were involved with some of the children for the purpose of assessment, but the programmes were devised and carried out by the P.S.W. The author expresses the view that 'treatment through training' has shown better and quicker results than 'treating the underlying causes - not the symptom'. Several behavioural programmes currently in use are described and reasons given for the author's preference for the procedure adopted here.