Family Support in Children’s Mental Health: A Review and Synthesis

A comprehensive review of structured family support programs in children’s mental health was conducted in collaboration with leadership from key national family organizations. The goals were to identify typologies of family support services for which evaluation data existed and identify research gaps. Over 200 programs were examined; 50 met criteria for inclusion. Programs were categorized by whether they were delivered by peer family members, clinicians, or teams. Five salient components of family support were identified: (a) informational, (b) instructional, (c) emotional, (d) instrumental, and (e) advocacy. Clinician-led programs were heavily represented (n = 33, 66%), followed by family-led (n = 11, 22%), and team-delivered (n = 6, 12%) programs. Key differences between programs delivered by clinicians or by peer family members were found in the degree of emphasis, research methodology, and outcomes. However, the content of the components was similar across all three program types. There are both important differences in emphasis across typologies of family support provided by clinicians, family members, or teams as well as important similarities in content. Family-delivered support may be an important adjunct to existing services for parents, although the research base remains thin. A research agenda to promote more rigorous evaluations of these services especially those delivered by peer family members is critical.     

Do State Mental Health Plans Address the New Freedom Commission’s Goals for Children’s Mental Health?

The latest initiative to address mental health needs of the nation, including those of children and youth, is the President’s New Freedom Commission on Mental Health (NFC). The NFC formulated a benchmark of six goals and related recommendations toward which the U.S. should strive, including the recommendation that each state develop a comprehensive mental health plan. It is not clear, however, whether the states’ developed plans address the goals established by the NFC and to what degree. This project provides a summary of 50 state mental health plans regarding children and youth in the U.S. by examining components that address each of the six NFC goals and is a test of federal leadership on a state issue. Results indicate that state mental health plans addressed the NFC goals to differing degrees with specific attention to children and youth mental health services. Overall, the NFC goal of eliminating disparities in mental health services was addressed most completely, while the NFC goal of understanding that mental health and physical health are associated was addressed least often. The information provided by this analysis represents a first step in gaining a comprehensive picture about public policies for the mental health of children, adolescents, and their families.     

Parental Migration and Rural Left-Behind Children’s Mental Health in China: A Meta-Analysis Based on Mental Health Test

Parental migration has been an important predictor of left-behind children’s developmental outcomes. Based on the ecological model of rural left-behind children’s development, we systematically reviewed studies related to rural left-behind children’s mental health in China and investigated left-behind children’s mental health and its influencing factors. Thirty-two studies involving 28,629 participants met the inclusion criteria were included in our meta-analysis to compare mental health of left-behind children and non-left-behind children. Twenty-two studies involving 8,634 participants were included in gender difference meta-analysis. The results indicated that left-behind children report more mental health problems than non-left-behind children, left-behind girls were confronted with higher level of mental health problems than left-behind boys, left-behind children in primary school and junior high school reported more mental health problems than those in senior high school, and self-guardian children have more serious mental health problems than children guarded by grandparents, former generation, and single parent. Implications for future practice were analyzed from family, school, and government perspectives.     

African American Children’s Racial Discrimination Experiences and Mental Health

Journal of Child and Family Studies - The current study examined how African American children’s experiences of perceived personal racial discrimination and perceived vicarious racial...     

Future Directions for Advancing Issues in Children’s Mental Health: A Delphic Poll

The current study utilized a Delphic poll to identify significant problems regarding children and families in which psychologists can assist. The Delphic poll methodology combines both qualitative and quantitative methodologies to obtain information and predictions about the future from a panel of knowledgeable experts. Thirty-one professionals participated in the first round of the survey, and 26 participants (83.9 % of the round 1 participants) chose to complete the second-round survey. Several themes emerged consistently across questions as important issues to be addressed in the future of childhood mental health. For example, participants frequently identified access, advocacy, research and research dissemination, prevention/early intervention, and integration of services as important issues. Implications and recommendations are drawn for organizations and individual psychologists as advocates for improving children’s mental health in the United States.     

Parents’ Reports of Children’s Internalizing Symptoms: Associations with Parents’ Mental Health Symptoms and Substance Use Disorder

This brief report examined the unique associations between parents’ ratings of child internalizing symptoms and their own depression and anxiety in families with parental substance use disorder (SUD). Further, we examined whether parental SUD (father only, mother only, both parents) was related to discrepancy in mothers’ and fathers’ reports of children’s internalizing symptoms. Participants were 97 triads (fathers, mothers) in which one or both parents met criteria for SUD. Polynomial regression analyses were conducted to examine whether father-mother reports of child internalizing symptoms had unique associations with parents’ own symptoms of depression and anxiety while controlling for child gender, child age, and SUD diagnoses. Controlling for fathers’ symptoms and other covariates, mothers experiencing more depression and anxiety symptoms reported more symptoms of child internalizing symptoms than did fathers. Mothers’ and fathers’ SUD was associated with higher anxiety symptoms among mothers after controlling for other variables. A second set of polynomial regressions examined whether father-mother reports of child internalizing symptoms had unique associations with parents’ SUD diagnoses while controlling for child gender and child age. After controlling for mothers’ symptoms and other covariates, parents’ reports of children’s internalizing symptoms were not significantly associated with either parent’s SUD or parental SUD interactions (i.e., both parents have SUD diagnoses). Taken together, mothers’ ratings of children’s internalizing symptoms may be accounted for, in part, by her reports of depression and anxiety symptoms.     

Household Chaos and Caregivers’ and Young Children’s Mental Health during the COVID-19 Pandemic: A Mediation Model

Journal of Child and Family Studies - Based on 764 households with young children in Wuhan, China, where the COVID-19 pandemic started, this study investigated how household chaos during the...     

Delivering Diagnoses: Parents as Translators and Withholders of Children’s Mental Health Diagnoses

There is a lack of research on how mental health diagnoses are delivered and explained to children and the effectiveness of these strategies. This qualitative study examines how emerging adults recall the delivery of mental health diagnoses in childhood and how they suggest these diagnoses should be delivered to children. Semi-structured interviews were conducted with 42 emerging adults (aged 18–22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depressive disorders, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Findings reveal that parents, rather than mental health professionals, often inform children of their diagnoses. The data suggest that parents often act as translators of diagnostic information, acting as liaisons between mental health professionals and their children. The paper explores ways in which parents and mental health professionals withhold diagnoses from children, and how this affects children’s experiences. Drawing on their own experiences, participants offer suggestions regarding the best ways to deliver diagnoses to children. Findings suggest that adults should share mental health diagnoses openly with children. Implications for social workers and other allied health professionals who support families when children are diagnosed are discussed.     

Promoting Optimal Parenting and Children’s Mental Health: A Preliminary Evaluation of the How-to Parenting Program

Parenting quality is widely accepted as a primary predictor of children’s mental health. The present study examined the effectiveness of a parenting program in fostering optimal parenting and child mental health. The selected program was How to talk so kids will listen & listen so kids will talk (How-to Parenting Program). This program was selected because its content corresponds closely to what the parenting style literature suggests is optimal parenting (i.e., includes structure, affiliation and autonomy support). Eleven groups of six to twelve parents were conducted in 7 local grade schools. The program, offered by two trained leaders, consisted of eight weekly sessions and taught a total of 30 skills. A total of 82 parents completed questionnaires both prior to and after the program. Participants’ children between eight and 12 years old (N = 44) completed questionnaires at school, at both assessment points. Repeated measures ANOVAs using parent reports indicated that structure, affiliation and autonomy support were increased after the program, compared to baseline. The level of child internalizing and externalizing problems also decreased significantly. Importantly, children reports confirmed that parental autonomy support increased from pre to post-test and child-reported well-being improved as well. The preliminary evidence from this pre-test versus post-test repeated measures design suggests that the How-to Parenting Program is effective in improving parenting style and in promoting children’s mental health and that future evaluation research examining the potential of this program is warranted.     

Capturing the Child’s Perspective: A Review of Self-Report Measures used with Children

Recent policy extends the patient-professional collaboration in making health care decisions to children. As a result, the development of self-reporting measures allowing children to express their concerns is growing. A literature review identified 33 self-report measures for children among a range of disciplines. While these tools allow children to be part of the rehabilitation process, the information obtained does not seem to capture what matters to children. This is particularly true for children with mental illness whose views are often ignored. More research is needed on clinical approaches that access the unique experiences of children with mental illness.     

Ethnic Differences in Children’s Entry into Public Mental Health Care via Emergency Mental Health Services

For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care.     

Service Coordination and Children’s Functioning in a School-Based Intensive Mental Health Program

Coordination of mental health services in children with serious emotional disturbance (SED) has shown a preliminary relationship to positive outcomes in children. Yet, research in this area is sparse. Therefore, the relation between service coordination activities and adaptive functioning was examined for 51 children SED who were treated in the school-based Intensive Mental Health Program for elementary school students (IMHP; average treatment length was 12?months; mean age 9.37 at intake). Systematic review of detailed case records identified 16,669 episodes of service coordination that could be coded reliably for frequency, quality, and purpose (planning, linking, monitoring) of the service coordination component. Adaptive functioning was measured by Child and Adolescent Functional Assessment Scale (CAFAS) ratings and daily points earned on the behavior management system of the IMHP at intake, 6, 12?months, and discharge. Findings indicated that the frequency, quality, and purpose of the service coordination component varied from case to case and by time in treatment. Although service coordination activities overall decreased as treatment progressed, concentrated high quality service coordination (measured by frequency, quality, and component of service coordination) consistently predicted improved functioning on both CAFAS ratings and daily points earned. Results have both practice and policy implications for training interagency teams and clinicians on when and how to optimally coordinate services.     

Mothers’ Mental State Talk and Preschool Children’s Social-Behavioral Functioning: A Multidimensional Account

This study aimed to investigate the multidimensional nature of maternal mental state talk with respect to children’s social-behavioral functioning in a low-income urban preschool sample. Maternal speech data were collected as mothers narrated a wordless picture book depicting a diverse set of mental states to their children (n = 130, 2–4 year olds). Dimensions of maternal mental state talk (i.e., type, direction, causality) were examined with the Coding System for Mental State Talk in Narratives. Approximately half of the sample consisted of higher-risk children who were identified as in need of clinical services by on-site clinicians. Results indicated that mothers’ diversity and causality of mental state talk, their acknowledgement of characters’ negative emotions, and talk about children’s cognitions and their own mental states were associated with children’s socially adaptive behaviors. On the other hand, mothers’ tendency to focus on children’s perceptions during the story-telling task (e.g., “see that?,” “look!”) was linked with lower social competence and internalizing problems. Mothers in the clinical sample used a significantly lower proportion of emotion words compared to mothers in the nonclinical sample. Results suggest that a picture book reading task might provide a cost-effective method for assessing and possibly modifying maternal mental state talk.     

Assessing Parental Satisfaction with Children’s Mental Health Services with the Youth Services Survey for Families

We assessed parent satisfaction with childrens mental health services with a new instrument: The Youth Services Survey for Families (YSSF). The Dillman method was used to administer the survey to a random sample of 1,500 parents of Medicaid youth from Kentuckys 14 community mental health centers (CMHCs). The response rate was 37% (n = 534 parents). A factor analysis of YSSF identified five parent-perceived factors: (a) Appropriateness, (b) Outcome, (c) Participation in Treatment, (d) Access, and (e) Cultural Sensitivity. About 70% of parents reported a high level of endorsement with the Appropriateness factor, but only 47% reported high levels of endorsement with the Outcome factor. Results were interpreted as providing support for the reliability of the YSSF in evaluating childrens mental health services in CMHCs.     

Participatory Research in Systems of Care for Children’s Mental Health

The children’s system of care initiative in the United States requires the participation of caregivers of children with emotional or behavioral problems in conducting research and evaluation. This entails a restructuring of traditional power dynamics among families served by the community mental health system and other system stakeholders, including researchers. However, evidence indicates that system of care research may not currently embrace the different types of knowledge possessed by caregivers and may be frustrated by traditional power hierarchies, resulting in research findings that are not useful for the community. In this paper I examine a framework for power and knowledge and examine how, when viewed through this framework, participatory research in the system of care initiative thus far may be less than authentic. I conclude with improvements suggested by the framework that are expected to shift power to caregivers and result in more useful, actionable research findings for the community.     

Perceived Parental Warmth, and Children’s Psychological Adjustment, and Personality Dispositions: A Meta-analysis

The purpose of this meta-analysis is to address three questions drawn from one of the basic postulates of parental acceptance–rejection theory: (1) To what extent are children’s perceptions of parental warmth related to their psychological adjustment? (2) To what extent are children’s perceptions of parental warmth related to their personality dispositions? (3) Do relations found in these questions vary by the gender of parents? The meta-analysis was based on 30 studies from 16 countries in five continents involving 12,087 children (52 % boys and 48 % girls). All studies included in the meta-analysis, used child versions of the Parental Acceptance–Rejection Questionnaire for Mothers and for Fathers (Child PARQ: Mothers and Fathers), as well as the child version of the Personality Assessment Questionnaire (Child PAQ). Results showed that perceived parental warmth correlated significantly with psychological adjustment and personality dispositions—including hostility and aggression, independence, positive self-esteem, positive self-adequacy, emotional responsiveness, emotional stability, and positive worldview of children across ethnicities, cultures, gender, and geographical boundaries.