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.     

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.     

The Impact of Parent Empowerment in Children’s Mental Health Services on Parenting Stress

Emotional and behavioral (EB) problems in children are associated with increased perceptions of strain in parenting. Among children receiving services, parenting stress has been linked to initiating services for their children, and may strain the relationship between parent and child. In contrast, parental engagement and empowerment in services is an important quality indicator for positive treatment outcomes. However, no known studies have examined the association between parent empowerment in their child’s services and their perceptions of stress related to parenting a child with significant mental health needs. Further, no studies have explored whether empowerment moderates the relationship between the child’s symptoms and parental perceptions of stress. The current study examined the impact of child EB problems and parent empowerment on parenting stress. Among a sample of 525 parents of children receiving school-based services for disruptive behavior disorders, child EB problems significantly predicted parenting stress. Parent empowerment also correlated with lower parenting stress, as hypothesized. Although parent empowerment was not found to moderate the relationship between child symptomatology and parenting stress, the relationship between parent empowerment and parenting stress differed based on child gender and age. Parent empowerment was associated with lower parenting stress more for parents of females and younger children than for parents of males and older children.     

A Lot of Warmth and a Bit of Control? How Parenting Mediates the Relationship Between Parental Personality and Their Children’s Mental Health Problems

Journal of Child and Family Studies - Research has identified parental personality and parenting behaviour as important contributors to healthy child development. However, indirect associations are...     

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.     

Psychological Androgyny and Children’s Mental Health: A New Look with New Measures

We evaluated Bem’s (1981, 1993) thesis that psychological androgyny—perceiving the self to possess characteristics of both genders—is associated with healthy adjustment and minimal gender-polarizing cognition. Prior studies testing Bem’s ideas have yielded ambiguous results, mainly because self-perceptions of gender-typed attributes have been inferred narrowly from self-perceptions of expressive and instrumental personality traits. We administered measures of gender identity (self-perceived similarity to a gender) that more clearly capture self-perceptions of attributes typical of a gender, and we examined conjoint influences of same-gender typicality and other-gender typicality on children’s self-esteem, internalizing problems, felt pressure for gender differentiation, and sexist ideology. Two studies were conducted with ethnically/racially diverse samples of preadolescent children in the southeastern United States. In Study 1 (N?=?305, M _age?=?10.8 years), androgynous children (i.e., children who saw themselves as similar to both genders) reported high self-esteem, evidenced few internalizing problems, and reported feeling little pressure for gender differentiation. In Study 2 (N?=?236, M _age?=?11.3 years), androgynous boys reported few sexist beliefs. Children with other patterns of gender identity (e.g., high same-gender typicality coupled with low other-gender typicality) sometimes showed similar correlates, but each other pattern of gender identity was associated with poor adjustment or strong gender-differentiating cognition on at least one dependent variable whereas androgyny never was. Results support Bem’s thesis that persons who perceive themselves as possessing characteristics of both genders enjoy mental health advantages over those who perceive themselves as possessing characteristics of only one.     

Children’s Evaluation and Categorization of Transgender Children

Despite extant evidence of negative peer treatment of transgender adolescents and adults, little is known about how young children perceive transgender peers, particularly those who have socially transitioned or are living in line with their gender rather than sex at birth. Whereas children have been shown to be averse to gender nonconformity in peers, because many transgender children appear and behave in ways consistent with their expressed gender (but not their sex at birth), it is unclear how children evaluate these identities. In 2 studies, we investigated 5- to 10-year-old children’s (N_total = 113) preferences for transgender versus gender-“typical” peers who either shared their gender identity or did not. We also examined whether children categorized transgender peers by their sex or expressed gender, as it might inform their evaluations. Children preferred cisgender peers over transgender peers; however, they also liked peers of their own gender rather than the other gender (e.g., female participants preferred girls over boys), demonstrating that the oft-documented own-gender bias plays an important role even when children are reasoning about transgender peers. Children did not reliably categorize transgender peers by sex or gender; yet those who categorized transgender peers by their sex showed greater dislike of transgender peers. The current studies are the first to investigate cisgender children’s attitudes toward transgender children and suggest that perceptions of gender categorization and conformity play a role in children’s evaluations of transgender peers.     

Evaluation of a Train-The-Trainers Model for Family Peer Advocates in Children’s Mental Health

Standardized training and credentialing is increasingly important to states and healthcare systems. Workforce shortages in children's mental health can be addressed through training and credentialing of professional peer parents (called family peer advocates or FPAs), who deliver a range of services to caregivers. A theory-based training program for FPAs targeting skills and knowledge about childhood mental health services (Parent Empowerment Program, or PEP) was developed through a partnership among a statewide family-run organization, state policy leaders, and academic researchers. Prior studies by this team using highly-experienced family peer advocates (who were also co-developers of the training program) as trainers found improvements in knowledge about mental health services and self-efficacy. In 2010, to meet demands and scale the model, a training of trainers (TOT) model was developed to build a cohort of locally-trained FPAs to deliver PEP training. A pre/post design was used to evaluate the impact of TOT model on knowledge and self-efficacy among 318 FPAs across the state. Participants showed significant pre-post (6 month) changes in knowledge about mental health services and self-efficacy. There were no significant associations between any FPA demographic characteristics and their knowledge or self-efficacy scores. A theory-based training model for professional peer parents working in the children's mental health system can be taught to local FPAs, and it improves knowledge about the mental health system and self-efficacy. Studies that evaluate the effectiveness of different training modalities are critical to ensure that high-quality trainings are maintained.     

System of Care Development in Children’s Mental Health: Lessons Learned from a Process Evaluation

Despite ongoing public calls for reform, the mental health needs of many children with psychological, emotional and behavioral disorders remain unmet. In response, providers continue to seek effective alternatives to institutional treatment by implementing comprehensive systems of care. The Children’s Enhancement Project (CEP) is a collaborative effort to provide holistic, community-based mental health services for children with an individualized, flexible, family-driven approach. We conducted a process evaluation of CEP’s early stage development and implementation utilizing both qualitative stakeholder interviews and quantitative survey components. The current article describes that evaluation and highlights the challenges and potential solutions encountered in developing a system of care. The lessons learned regarding system of care development, including the importance of a shared vision, establishing programmatic guidelines, achieving collaboration, and addressing sustainability concerns, are discussed.     

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.     

Description of a Fidelity Implementation System: An Example from a Community-Based Children’s Mental Health Program

Public policy initiatives to deliver evidence-based practices in community settings have increased the need to develop implementation feedback systems to assist program administrators adopting the practices as well as researchers who wish to continue the line of research. This paper contributes to the efforts to reduce the implementation gap in the children’s mental health services field by exploring the concept of fidelity and highlights its importance to the adoption of evidence-based practices. Fidelity, or the degree to which interventions are implemented as originally designed, is generally conceptualized as a system of five unique and interrelated components including adherence, dosage, participant responsiveness, quality of delivery, and program differentiation. Definitions and a critical analysis of each of the component’s strengths and weaknesses are offered while discussing the integrated nature of each component. An example of the development and use of the five components of fidelity within a community-based evidence-based program is described.     

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...     

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.     

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...     

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.     

Identifying the Common Elements of Treatment Engagement Interventions in Children’s Mental Health Services

Difficulty engaging families in mental health treatment is seen as an underlying reason for the disparity between child mental health need and service use. Interpretation of the literature on how best to engage families is complicated by a diversity of operational definitions of engagement outcomes and related interventions. Thus, we sought to review studies of engagement interventions using a structured methodology allowing for an aggregate summary of the most common practices associated with effective engagement interventions. We identified 344 articles through a combination of database search methods and recommendations from engagement research experts; 38 articles describing 40 studies met our inclusion criteria. Following coding methods described by Chorpita and Daleiden (J Consul Clin Psychol 77(3):566–579, 2009, doi:10.1037/a0014565), we identified 22 engagement practice elements from 89 study groups that examined or implemented family engagement strategies. Most frequently identified engagement practice elements included assessment, accessibility promotion, psychoeducation about services, homework assignment, and appointment reminders. Assessment and accessibility promotion were two practice elements present in at least 50 % of treatment groups that outperformed a control group in a randomized controlled trial. With the exception of appointment reminders, these frequently identified engagement practice elements had a high likelihood of being associated with winning treatments when they were used. This approach offers a novel way of summarizing the engagement literature and provides the foundation for enhancing clinical decision-making around treatment engagement.     

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.     

Severity of Children’s ADHD Symptoms and Parenting Stress: A Multiple Mediation Model of Self-Regulation

The goal of the current study was to determine the extent to which the perceived self-regulation deficits across behavioral, cognitive, and emotional domains seen in children with ADHD explain the association between the severity of ADHD symptoms and parenting stress. Participants for this study included 80 children (mean age = 10 years, 9 months) with a DSM-IV diagnosis of ADHD confirmed by a comprehensive clinical diagnostic assessment. Parents reported their own stress levels as well as the severity of their children’s ADHD symptoms, aggression, emotional lability, and executive functioning difficulties. Results indicated that the severity of children’s hyperactivity/impulsivity symptoms but not their inattention related to parenting stress. Multiple mediational analyses indicated that the association between hyperactivity/impulsivity and parenting stress was explained by children’s perceived comorbid aggression levels, emotional lability, and executive functioning difficulties. No significant differences in the strength of the mediators were found. The current study provides initial data showing that the perceived impairments in children’s self-regulation across emotional, cognitive, and behavioral domains are what parents report as stressful, not simply the severity of ADHD symptoms. Due to the cross-sectional nature of this study and shared variance from relying solely on parent report, it will be critical for future research to replicate our findings using longitudinal and multi-informant data such as teacher reports and standardized assessments.     

Pilot Evaluation of the ACT Raising Safe Kids Program on Children’s Bullying Behavior

Research documents that parents play a critical role in the development and maintenance of behavior problems in children. Few bullying prevention programs, however, target children in early childhood or include a parenting component in spite of experts recommending that parent training in behavior management be addressed. Based upon these recommendations, the present study examines the relationship among parent characteristics (hostility, depression, and overall parenting skills) and child bullying and the effects of the American Psychological Association’s ACT Raising Safe Kids program on reducing early childhood bullying. The ACT-RSK program is a primary family violence and child physical abuse prevention program for parents of young children. Fifty-two parents/caregivers, representing children ages 4–10, completed the Brief Symptom Inventory, the ACT Parents Raising Safe Kids Scale, and Early Childhood Bullying Questionnaire (derived from the Child Behavior Checklist and Strengths and Difficulties Questionnaire). Twenty-five of these parents/caregivers 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 through the ACT-RSK program. The remaining 27 parents/caregivers received treatment as usual. Results indicate decreased bullying in children whose parents completed the ACT-RSK program. Furthermore, of the parent characteristics assessed, parental hostility is the only significant parent predictor for child bullying. These findings suggest the efficacy of this brief intervention for preventing bullying.