Working on the interface: identifying professional responses to families with mental health and child-care needs

The gaps between mental health and child-care services constitute a recognised barrier to providing effective services to families where parents have mental health problems. Recent guidance exhorts professionals to coordinate and collaborate more consistently in this area of work. The present study aimed to identify the barriers to inter-professional collaboration through a survey of 500 health and social care professionals. The views of 11 mothers with severe mental health problems whose children had been subject to a child protection case conference were also interrogated through two sets of interviews. The study found that communication problems were identified more frequently between child care workers and adult psychiatrists than between other groups. Communication between general practitioners and child-care workers was also more likely to be described as problematic. While there was some support amongst practitioners for child-care workers to assume a coordinating or lead role in such cases, this support was not overwhelming, and reflected professional interests and alliances. The mothers themselves valued support from professionals whom they felt were 'there for them' and whom they could trust. There was evidence from the responses of child-care social workers that they lacked the capacity to fill this role in relation to parents and their statutory child-care responsibilities may make it particularly difficult for them to do so. The authors recommend that a dyad of workers from the child-care and community mental health services should share the coordinating key worker role in such cases.     

Stresses on grandparents and other relatives caring for children affected by HIV/AIDS

This study investigated the needs of relative caregivers of children in the child welfare system whose parents had HIV. Families of children supported by the state child welfare agency were invited to participate in the study; 17 families reported that HIV affected them and 11 families did not identify HIV as an issue. The findings indicate that complex emotional and behavioral issues stressed the HIV-affected kin caregivers; these issues included the children's behavioral problems, HIV-related concerns, adolescent issues, emotional difficulties, and sexual abuse, HIV-affected caregivers had more concern about their health and multiple roles. Nonaffected caregivers were less likely to report severe parenting stress and more likely to report financial stress. HIV-affected caregivers require attention and intervention by social workers, child welfare workers, and case managers.     

Interorganisational cooperation and its effects on community rehabilitation for people with severe mental disorders in Beijing,China: A case study

A national comprehensive management pilot project for mental health has been implemented in China to provide integrated care for people with severe mental disorders through strengthened cooperation among government organisations and between government and other relevant social organisations. The promotion of community rehabilitation has been included as a key part of this pilot program. The present study took the AD district of Beijing as a case study to examine interorganisational cooperation and its effects on community rehabilitation in a real-world setting. Interviews were conducted with 14 frontline workers, including 7 mental health workers from community health centres and 3 staff and 4 social workers working in rehabilitation centres. Five officials from relevant health and social welfare departments and a social work organisation were also interviewed. Experiences in Beijing revealed that interorganisational cooperation helped to build a multiagency workforce furnished with basic mental health knowledge at the community level, which rendered it possible for frontline workers to provide fundamental follow-up services, pilot the case management model of service provision and increase the provision of psychosocial rehabilitation services within the poorly resourced context of Chinese mental healthcare. Moreover, the engagement of social organisations provided bottom-up pressure to innovate through the active bringing forward of new ideas concerning cooperation and service delivery. However, differences in professional authority and commitment were observed. Health department officials and health professionals seemed to exercise a dominant role as compared to social welfare department officials and social workers. Future policy making should motivate social welfare department officials to improve social care for people with severe mental disorders. Social workers require training to improve their knowledge of mental health matters, and social organisations need greater latitude to strengthen their influence over the development of community rehabilitation services for people with severe mental disorders.     

Experiences of social work intervention among mothers with perinatal mental health needs

Perinatal mental health difficulties are prevalent among women, and the vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. This study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi‐structured interviews were carried out with 18 women with 6‐ to 9‐month‐old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children's social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother's own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers’ mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of ‘turning points’ where initially negative interactions stabilised and child protection concerns lessened. Women's accounts highlighted the importance of feeling ‘known’ by social workers who understood and respected them. The findings also suggested there may be value in improving collaboration between social workers and mental health professionals to create more space for representation of women's needs as well as those of their babies.     

Psychosocial outcomes for adult children of parents with severe mental illnesses: demographic and clinical history predictors

Children of parents with mental illness are at risk of psychiatric and behavioral problems. Few studies have investigated the psychosocial outcomes of these children in adulthood or the parental psychiatric history variables that predict resilience. From a sample of 379 mothers with serious mental illnesses, 157 women who had at least one adult child between the ages of 18 and 30 were interviewed. Mothers reported that about 80 percent of these adult children were working, in school, or in training. However, about one-third had not completed high school, and 54 percent were judged to have a major problem in psychological, drug or alcohol, or legal domains. Although nearly 40 percent were parents of minor children, only about 12 percent were in a committed relationship. Mothers' bipolar diagnosis was a significant predictor for number of adult child problems.The results indicate a need for more attention to the parenting status of adults with mental illnesses and to their parenting concerns and needs.     

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.     

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.     

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.     

Mental Health Problems in Norwegian School Children Placed Out-of-home: The Importance of Family Risk Factors

The main aim of this article is to explore the association between mental health problems in children placed out-of-home and family risk factors reported as reasons for placement. The sample consisted of 109 Norwegian children aged 6–12 years. Mental health problems were assessed by the Revised Rutter scales reported by the parents and the teachers shortly after placement. On the basis of the reported reasons for placement, three risk indexes were constructed: parental risk, interactional risk, and child neglect and abuse risk. The analyses showed that 70% or more of the placed children had symptoms of mental health problems, boys more often than girls. Parental risk and interactional risk each accounted for a significant part of the variance in the children's mental health, while child neglect and abuse did not. Our data, however, indicated that children placed out-of-home mainly due to parental risk had less mental health problems than other children, while children placed due to interactional risk or child neglect and abuse had more problems. The study indicates that family-related reasons for placement reported by the child welfare workers are important indicators for assessing mental health problems in children placed out-of-home.     

Applying the recovery approach to the interface between mental health and child protection services

There is a range of theoretical approaches which may inform the interface between child protection and adult mental health services. These theoretical perspectives tend to be focused on either child protection or mental health with no agreed integrating framework. The interface continues to be identified, in research, case management reviews and inquiry reports, as complex and problematic. This article proposes that more positive, integrated approaches to service user engagement, risk assessment and management may lead to better outcomes in working with families experiencing parental mental health problems and child protection concerns. It is proposed that the recovery approach, increasingly used in mental health services, can inform the processes of engagement, assessment and intervention at the mental health and child protection interface. The article provides a critical overview of the recovery approach and compares it with approaches typifying interventions in child protection work to date. Relevant research and inquiries are also examined as a context for how to more effectively respond to cases where there are issues around parental mental health problems and child protection. The article concludes with case material to illustrate the potential application of the recovery approach to the interface between mental health and child protection services.     

Infant mental health promotion and the discourse of risk

The field of infant mental health promotion has rapidly developed in academia, health policy and practice. Although there are roots in earlier childhood health and welfare movements, recent developments in infant mental health promotion are distinct and different. This article examines the development and practice of infant mental health promotion in South Australia. A regional, intersectoral forum with a focus on families and young children was used as a case study. In‐depth interviews with forum members were analysed using a governmentality lens. Participants identified a range of risks to the healthy development of the infant. The study suggests that the construction of risk acts as a technique of governing, providing the rationale for intervention for the child, the mother and the public's good. It places responsibility on parents to self‐govern. Although the influence of broader social contexts is acknowledged, the problematisation of mothering as risk shifts the focus to individual capacity, rather than encompassing the systems and social conditions that support healthy relationships. This research suggests that the representations of risk are a pervasive and potent influence that can act to undermine health promotion efforts that seek to empower and enable people to have more control over their own health.     

Beliefs about treatment of mental health problems among Cambodian American children and parents

Beliefs about treatment of mental health problems are a critical area for examination among immigrant and refugee populations. Data on treatment of child problems have been conspicuously absent from the literature. This study examines explanatory models of treatment among 40 second-generation Cambodian children aged 8-18 and their parents in the US. Comparisons of perceptions of intervention for an externalizing problem (gang-related behavior) and an internalizing problem (depression) are made in a group of children who have received mental health services, their parents, and a matched community sample. A significant interaction between respondent and group membership was present in the perception that these problems could be helped, and contrary to past findings among Asian Americans, both children and parents generally endorsed the use of mental health services. Data about actual experiences with mental health services are used to help explain the findings and suggest implications for treatment of Cambodian-American youth.     

Parenting a young person with mental health problems: temporal disruption and reconstruction

The article explores the experiences of parents living with a young person with mental health problems. Qualitative interviews were conducted with 25 parents (18 mothers and 7 fathers) whose child had a diagnosed psychiatric condition. It is argued that the parents engaged in a form of narrative reconstruction of their dual roles as parents and carers as they tried to make sense of the illness in their lives by reconstructing their past, present and future experiences. The concept 'responsibility' was threaded through the parents' narratives and is discussed in relation to three key dimensions - moral responsibility; causal responsibility; and responsibility for self. It is argued that the moral imperative to care for their child was the dominant theme in the parents' narratives but that this was challenged by their lack of knowledge of psychiatric conditions; their interactions with healthcare professionals; their relationships with their child; and their difficulties in coping with the extended parental responsibility that arose from their caring role.     

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.     

School Problems and Teacher Responsibilities in Juvenile Rheumatoid Arthritis

Juvenile rheumatoid arthritis (JRA) may cause a variety of school problems. Twenty-four children with JRA, 24 of their parents, and 14 of their teachers completed questionnaires regarding the frequency of 40 potential school problems and the extent of the teacher's responsibility in helping children deal with 28 medical, academic, or social issues. Though respondents viewed school problems as occurring infrequently, parents and children more frequently than teachers noted that problems occurred (p less than .05). Children felt problems with self-concept and peer relationships occurred most frequently, while parents and teachers emphasized physical health and activity-related problems. Children's ratings regarding extent of teacher's responsibility were lower than those of parents' or teachers' ratings (p less than .05). While parents and teachers viewed the teacher as responsible for helping children deal with psychosocial issues, children felt that teachers should deal primarily with academic areas. Children viewed teachers as being responsible for withholding information about arthritis from their classmates, and did not want their teacher to encourage peer interaction. Results indicate major differences exist between perceptions of children with JRA, and their parents and teachers, regarding frequency of problems and extent of the teacher's responsibility. Since children may resist assistance from teachers in psychosocial areas, their views should be considered before planning interventions to resolve such problems.     

The mental health of looked after children: matching response to need

Previous research has established high rates of mental health need in looked after children. The study described in this paper aimed to explore in more depth the mental health problems of looked after children and to examine the service response to those needs in two English local authorities. The study utilised a purposive sample of 80 looked after children which was biased towards those with high needs but which reflected the characteristics of looked after children in the two areas with regard to age, gender and type of placement. Key data on children and young people were collected from social services' case files and a set of indicators of mental health need was designed by the research team in order to distinguish different types and levels of mental health problems. High levels of mental health need in the study group were associated with placement disruption. Educational difficulties were also apparent in the group with the highest levels of mental health need. Longer-term input from child and adolescent mental health services (CAMHS) professionals did not appear to be targeted on the group with the highest level of mental health needs. The researchers conclude that longer-term CAMHS interventions could be usefully focused on looked after children who have experienced high levels of placement disruption. As the professional group most likely to be providing substantial intervention to looked after children and their carers, social workers require relevant training in identifying and responding to mental health needs. CAMHS professionals could develop and strengthen their consultative roles with front-line carers, social workers and schools.     

Getting the complete picture: combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas

Background Childhood mental health problems are prevalent in Australian children (14–20%). Social exclusion is a risk factor for mental health problems, whereas being socially included can have protective effects. This study aims to identify the barriers to social inclusion for children aged 9–12 years living in low socio‐economic status (SES) areas, using both child‐report and parent‐report interviews. Methods Australian‐born English‐speaking parents and children aged 9–12 years were sampled from a low SES area to participate in semi‐structured interviews. Parents and children were asked questions around three prominent themes of social exclusion; exclusion from school, social activities and social networks. Results Many children experienced social exclusion at school, from social activities or within social networks. Overall, nine key barriers to social inclusion were identified through parent and child interviews, such as inability to attend school camps and participate in school activities, bullying and being left out, time and transport constraints, financial constraints and safety and traffic concerns. Parents and children often identified different barriers. Discussion There are several barriers to social inclusion for children living in low SES communities, many of which can be used to facilitate mental health promotion programmes. Given that parents and children may report different barriers, it is important to seek both perspectives. Conclusion This study strengthens the evidence base for the investments and action required to bring about the conditions for social inclusion for children living in low SES communities.     

重大突发公共卫生事件下学龄儿童心理健康研究进展

儿童是重大突发公共卫生事件中的脆弱易感人群,2020年新型冠状病毒肺炎疫情在世界范围内大规模流行,学龄儿童心理健康成为全世界关注的问题。研究通过对新冠肺炎疫情对一般儿童以及心理问题本身高发的特殊儿童群体心理健康问题的影响进行综述,重点阐述了新冠肺炎疫情期间不同国家和地区学龄儿童焦虑、抑郁和创伤后应激障碍问题的患病情况,考虑到个体间的易感性与社会资源可及性,研究进一步探究了影响学龄儿童心理健康的儿童、家庭及社会相关因素,最后从国家、学校-家庭-社区和个人层面对重大突发公共卫生事件中儿童心理健康服务体系建设提出了建议,为构筑一个安全、可靠的儿童心理健康防护网络需要社会各方的共同努力。     

Exploration of joint working practices on anti‐social behaviour between criminal justice,mental health and social care agencies: A qualitative study

Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti‐social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti‐social behaviour. We conducted a multi‐method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi‐structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti‐social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems.