Parental Cooperation with Social Services and Termination of Parental Rights in Israeli Court Cases of Child Maltreatment

Parental cooperation with social services in child maltreatment cases is fundamental to all forms of family intervention. If rehabilitation efforts fail and the child cannot be safely reunified with his parents, the state is authorized to initiate termination of parental rights (TPR) proceedings. Given the scant literature on parental cooperation and TPR, the present study examined associations between parental cooperation and TPR in Israeli court cases of child maltreatment. Comparisons between uncooperative (n = 106) and cooperative parents (n = 155) revealed that uncooperative parents were more than three times more likely to have their parental rights terminated than cooperative parents, controlling for child and parent characteristics. Parents who did not cooperate with social services had high levels of mental health problems, substance abuse, criminal records, and poverty and their children had more mental health concerns and suffered more from neglect. We discuss the important implications resulting from these findings, which include: the need to view the engagement of parents in the child welfare process as a specific goal in itself and develop research-based models specifically targeting multiple-problem families at high risk of TPR; the need for professionals to build a good working alliance with parents in order to strengthen their participation; the need to take into account different background conditions and stressors related to the parents in order to facilitate greater cooperation; and the need to assess the potential mental health needs of children involved in cases of maltreatment with low parental cooperation.     

Child custody evaluations: Fair and unfair professional practices

Mental health professionals are frequently called upon to conduct psychological evaluations of the adult parties and minor children in contested child custody actions. Whether Court-appointed or as an agreed examiner, the professional's essential role is that of expert consultant to the court. He or she can only assist the trier of fact by conducting an evaluation that is fair, impartial and objective, that protects the personal and legal rights of all parties, and that is consistent with professional and ethical standards. Ethical principles require the mental health professional to accept the burden of responsibility for protecting and preserving the clients' rights and welfare throughout the evaluation period, from the initial referral to the rendering of recommendations.     

Very Young Child Well-being in Military Families: A Snapshot

Since the September 11th attacks on the U.S., more than 2 million children have experienced parental deployment during their early years, with potentially lasting impact. When a parent is deployed, a number of factors may affect the well-being of the service member and his/her family. One parental factor—posttraumatic stress disorder or distress—might be particularly powerful in its effect on young children and the family system. We analyzed baseline data from an intervention development project which focused on supporting military families with very young children during post-deployment. The purpose of this research is to understand the relationships between parental mental health status, parenting stress, couple functioning, and young child well-being. The effects of mental health status of home-front and service member parents and the role of couple functioning on parent–child interactions and behavioral problems of young children were examined in a sample of military families during the post-deployment period. Findings suggest that service member posttraumatic stress symptoms are associated with higher parental report of child behavior problems. Higher quality of the couple relationship appears to lessen the impact of parental posttraumatic stress but is not related to parent perceptions of child behavior concerns. Implications for future research with military families are discussed.     

The Relation Between Parental Mental Illness and Adolescent Mental Health: The Role of Family Factors

Children of parents with a mental illness are often found to be at high risk of developing psychological problems themselves. Little is known about the role of family factors in the relation between parental and adolescent mental health. The current study focused on parent–child interaction and family environment. This cross-sectional questionnaire study included 124 families with a mentally ill parent and 127 families without a mentally ill parent who at the time of the study had children aged 11–16 years old. Parents completed questionnaires about their mental health, parent–child interaction (i.e., parental monitoring and parental support), and family environment (i.e., cohesion, expressiveness, and conflict). Adolescents reported their internalizing and externalizing problems. Path analyses were used to examine the direct associations between parental mental illness and adolescent problems as well as the indirect relations via parent–child interaction and family environment. The results showed that interaction between parents with a mental illness and their child was significantly worse compared to parents without a mental illness. The family environment of parents with mental illness was also more negative. Mentally ill parents monitored their adolescents less, which in turn related to more externalizing problems of the adolescents. No factors mediated the relation between parental mental health and adolescent internalizing problems. Moreover, no direct effects of parental support, family cohesion, and family expressiveness with externalizing problems were found. These findings imply that parental monitoring should get a specific focus of attention in existing interventions designed to prevent adolescents with a mentally ill parent from developing problems.     

Parental Inconsistency: A Third Cross-Cultural Research on Parenting and Psychological Adjustment of Children

Inconsistency in parenting is a factor that may influence children’s mental health. A questionnaire, measuring three parental inconsistencies (temporal, situational, and father-mother inconsistency) was administered to adolescents in nine countries to assess its association with adolescents’ psychological disorders. The results show that parental inconsistency varies across cultures. Temporal inconsistency is not correlated with the other two inconsistencies. Temporal and father–mother inconsistencies, but not the situational inconsistency, were associated with adolescents’ psychological disorders. The associations between parental inconsistency and psychological disorders differed across cultures.     

Prevention Programs to Augment Family and Child Resilience Can Have Lasting Effects on Suicidal Risk

In this commentary, the effects of four family‐based preventive interventions designed to augment parent and child resilience, originally designed to prevent mental health and substance abuse, on suicide ideation and attempts are reviewed. Three of the preventive interventions showed a beneficial effect either on child suicide ideation or attempts, and one found a beneficial effect on parental suicidal ideation. The duration of effects in two of these studies was well longer than a decade. These studies suggest that interventions to augment family and child resiliency originally designed to prevent mental health and substance abuse disorders can also have beneficial, often long‐term, effects on suicidal ideation and behavior.     

Pediatrician Identification of Child Behavior Problems: The Roles of Parenting Factors and Cross-Practice Differences

While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The present study examined the potential role of parental characteristics (parental affect, parenting style, and parenting self-efficacy) in pediatrician identification of child behavior problems, and determined whether these relationships differed across practices. Parents of 831 children between 2 and 16 years completed questionnaires regarding demographic information, their child’s behavior, their affect, their parenting style, and their parenting self-efficacy. Pediatricians completed a brief questionnaire following visits in four community-based primary care practices in the Midwest. Logistic regressions controlling for child behavior and demographic predictors of pediatrician identification found that an authoritarian parenting style, in which parents yell or strongly negatively react to problem behavior, was negatively associated with likelihood of identification in the overall sample. However, the variables that were predictive of pediatrician identification differed depending on the specific practice. Parental characteristics can aid in understanding which children are likely to be identified by their pediatrician as having behavioral problems. The finding that practices differed on which variables were associated with pediatrician identification suggests the need to potentially individualize interventions to certain physicians and practices to improve identification of child behavior problems in primary care.     

Mental health professionals and child custody disputes: Are there alternatives to the adversarial process?

An increasing problem that can have serious consequences for children, adults and social institutions is child custody after divorce. The risks associated with the various courses of action in child custody cases are discussed. Alternatives to the adversarial process are presented. The position of the legal system is explained and the importance of the involvement of mental health professionals is emphasized. Also discussed are the possible roles mental health professionals can assume on behalf of the child in working with the family and the legal system.     

The Relationships Between Family Financial Stress,Mental Health Problems,Child Rearing Practice,and School Involvement Among Taiwanese Parents with School-Aged Children

This study examined the relationships between family financial stress, mental health problems, child rearing practice, and school involvement using a sample of 431 parents with children in grades 1–4 from one elementary school in a rural area of Taiwan. Financial stress was hypothesized to be associated with parental mental health problems, which in turn were expected to be linked to poorer child rearing practice and less parental involvement in school. Structural equation models were constructed and tested in a stepwise manner. Results showed that financial stress was significantly associated with higher mental health problems, poorer child rearing effort, and decreased parental school involvement while parents’ mental health problems were not significantly associated with their child rearing efforts or involvement in school. These findings suggest that the impact of family financial stress on Taiwanese parents’ child rearing practice is largely direct rather than mediated through their mental health problems.     

Relationships among parental reports of child, parent, and family functioning.

Most children with psychosocial problems do not present for treatment in mental health settings. They are managed by primary care physicians. Children with psychosocial problems often have parents and/or families with psychosocial distress. The present study measured associations between parental reports of child, parent, and family functioning in individuals in the general population. Participants were 226 parents of children, aged 2-16 years, who presented for routine primary care. Parents reported on the psychosocial functioning of themselves, their child, and their family. All correlations of measures were significant, ranging from .55 to .23. Similar to data from psychiatric samples, the psychological functioning of children, parents, and families were significantly correlated. Unlike in psychiatric settings, child mental health problems were not as closely related to parent or family distress as parent and family distress were related to each other and to child behavior problems.     

Family Functioning,Parental Psychological Distress and Child Behaviours: Evidence from the Victorian Child Health and Wellbeing Study

We examined, using data from the 2006 Victorian Child Health and Wellbeing Study (VCHWS), whether family functioning is associated with parental psychological distress and children's behavioural difficulties. The VCHWS was a statewide cross‐sectional telephone survey to 5,000 randomly selected primary caregivers of 0‐ to 12‐year‐old children between October 2005 and March 2006. Only parents or guardians of children aged 4–12 years (n = 3,370) were included in this study. After adjusting for sociodemographic variables and ethnicity, parents or guardians scoring higher on the family functioning scale (i.e., from poorly functioning households) were at greater risk of psychological distress and had children with lower levels of prosocial behaviour and higher levels of behavioural difficulties relative to those from healthily functioning households. Mental health prevention programmes addressing child mental and conduct problems should consider the family environment and target those families functioning poorly.     

Resilience and Family Psychosocial Processes Among Children of Parents with Serious Mental Disorders

Resilience involves successful adaptation despite adverse circumstances, and is operationalized in this study as a multidimensional construct which consists of both positive and negative indicators of adaptation. Previous research has emphasized the importance of parental psychopathology in predicting child adaptation among children of parents with serious mental disorders. In contrast, we hypothesized five family psychosocial processes as common sequelae to serious parental mental disorder that are central to child adaptation beyond that predicted by parental psychiatric status. These are diminished family financial resources, social network constriction, impaired performance of parenting tasks, increased familial stress, and disruption of the parent-child bond. We examined the relationship of these processes to child adaptation independently through hierarchical regression analyses after taking into account parental psychiatric symptoms and functioning as well as the child's age and gender. One hundred seventy-seven children of mothers with serious mental disorder, ages 2–17 years old, were assessed on measures of adaptation. Results indicated that family psychosocial processes are a more consistent and powerful predictor of child adaptation than parental psychopathology. Results also indicated that, for these children, adaptation is predicted most consistently by parenting performance, and to lesser extents, by the parent-child bond and familial stress. We discuss our results in terms of their implications for theory and intervention with children of parents with serious mental disorders and for the study of resilience.     

The Relationship Between Caregiver Capacity and Intensive Community Treatment for Children with a Mental Health Crisis

We studied 9,220 children referred to a comprehensive mental health crisis stabilization program to examine the impact of caregiver capacity on crisis worker decisions to refer children for intensive community-based treatment as opposed to inpatient psychiatric hospitalization. Due to the different role of caregivers in the child welfare system, analyses were stratified by state custody status. Among both groups, there was a significant inverse association between child mental health need and referral to intensive community-based treatment. For children not in state custody with low mental health need, there was no difference in the likelihood of referral to intensive community-based treatment across levels of caregiver capacity. However, for children not in state custody with medium and high mental health needs, those whose caregivers were deficient or severely deficient were significantly more likely to be referred for intensive community-based treatment than were those who had capable caregivers. Multivariate analyses demonstrated similar results after controlling for potential confounding variables and confirmed that caregiver capacity contributes significantly to the logistic model’s classification accuracy. Results suggest further investigation of the impact of caregiver capacity on mental health crisis worker referral decisions is needed.     

Behavior Problems at 5 Years of Age and Maternal Mental Health in Autism and Intellectual Disability

We examined child behavior problems and maternal mental health in a British population-representative sample of 5 year-old children with an autism spectrum disorder (ASD), controlling for the presence of an intellectual disability (ID). Behavior problems were significantly higher in children with ASD with/out ID compared to typically developing children, but compared to children with ID only hyperactivity was significantly higher in children with ASD/ID. After controlling for ID and maternal mental health, the presence of ASD significantly increased the odds for hyperactivity, conduct problems and emotional symptoms. Negative maternal outcomes (serious mental illness, psychological distress, and physical health limitations) were not consistently elevated in ASD. The findings highlight the early age at which behavior problems emerge in ASD, and suggest that at this age , there may not be a clear disadvantage for maternal mental health associated with having a child with ASD in the family, over and above that conferred by child behavior problems.     

Depressive Symptoms among Children with ODD: Contributions of Parent and Child Risk Factors in a Chinese Sample

Oppositional Defiant Disorder (ODD) is a developmental disorder characterized by serious and persistent social impairment, especially stressful interactions with parents. Although previous studies demonstrated associations between parent mental health and children’s ODD symptoms, less attention has been paid to integrating both parent and child risk factors. The purpose of the current study was to investigate the associations among parent emotion regulation, child emotion regulation, parental depression, and child depression in Chinese children with ODD. A total of 234 children with ODD ranging in age from 6 to 13 years, along with their fathers or mothers, completed questionnaires. Results indicated that: (1) Parent emotion regulation, parental depression and child emotion regulation were significantly correlated with children’s depressive symptoms. (2) Parent emotion regulation was related to children’s depression indirectly through parental depression and child emotion regulation. (3) Child emotion regulation fully mediated the relationship between parent emotion regulation and child depression, and also fully mediated the relationship between parental and child depression. These findings highlight the need to improve parent emotion regulation and pay attention to parental mental health, because both risk factors may exacerbate their children’s emotion regulation difficulties and further associate the high level of depressive symptoms among children with ODD.     

Introduction to Special Section on Cross-Cultural Research on Parenting and Psychological Adjustment of Children

Parental factors such as control, rejection, and inconsistency have been reported as associated with psychological maladjustment. The papers in this Special Section are based on a multi-national study examining the association between these parental factors and adolescents’ psychological disorders in nine western and eastern countries, differing in family connectedness. Questionnaires assessing these factors were administered to 2,884 male and female adolescents. In this paper we discuss the parental factors and describe the methodology. We hypothesize that parental factors, family connectedness, and the association between these factors and adolescents’ mental health differ across cultures. In the papers that follow, we present the results and discuss their implications.     

Child custody disputes: A review of legal and clinical resolution methods

This paper reviews existing practices from the mental health, marriage and family therapy, and legal professions which offer alternatives to traditional adversarial custody resolution methods. Based upon suggestions from legal and mental health professionals, the authors advocate allocating state resources for interprofessional family courts which would provide custody counseling, mediation, evaluation, and consultation as alternatives to adversarial methods.     

Current Treatment Strategies for Sexually Abused Children

SUMMARY

Given the disturbingly high prevalence of child sexual abuse, the expertise of medical and mental health professionals in treating child sexual abuse victims is essential. Relevant issues in treating these children include the mindfulness of developmental considerations, incorporation of a multi-modal therapeutic evaluation approach, clarification of treatment goals, appropriate use of and integration of various treatment modalities, and effective treatment termination. This article provides an introduction aid overview of treatment of sexually abused children of all ages, from preschoolers to adolescents, with special emphasis on the importance of developmentally linked evaluation and treatment strategies. Treatment is discussed in terms of goals, stages from evaluation to termination, and formats and modalities including individual psychotherapy, family psychotherapy, group psychotherapy and hypnotherapy, to provide a comprehensive overview of current treatment strategies for sexually abused children.     

Kids and Teens in Court (KTIC): A Model for Preparing Child Witnesses for Court

Each year, numerous children testify in the United States in either criminal, civil, or juvenile court cases. Typically, children who testify are alleged victims of sexual or physical abuse or neglect, witnesses to violent crime, or subjects in custodial hearings in civil court. As more maltreatment cases are prosecuted and child custody is contested, an increasing number of children are being called as witnesses in court. Many of these children have already been traumatized by the experiences that led to their need to testify, and participation in the court process can have additional negative effects. This article describes the development and recent formative evaluation of a court preparation program that provides psychoeducation and utilizes components of evidence-based trauma treatment approaches, such as relaxation and in vivo exposure, to support child witnesses and reduce the risk of retraumatization. Children and adolescents participating in the program attend group sessions conducted by mental health clinicians and complete a court-related anxiety measure before and after each session. Results from 175 participants are reported. Findings indicated significant decreases in court-related anxiety with large program effects. Challenges encountered by the program and future directions are discussed.     

Child abuse and neglect by parents with disabilities: A tale of two families

Two families, in which the children had been placed in foster care due to abuse and neglect by parents who had disabilities, were studied. In the first case, the mother was instructed in skills that our assessment suggested were important for her child's survival. The mother readily acquired and applied these skills, a fact reflected both in changes in her behavior and in changes in the child's well-being. In the second case, the parent's incremental resumption of child custody was made contingent upon completion of relevant parenting tasks. Initially, improvements in the completion of such tasks were evident, but over time and with the onset of militating factors, no further progress was made and all parental rights were terminated. The implications of these cases for behavior analysis and the effort to reunite and preserve families are discussed.