The family empowerment program: an interdisciplinary approach to working with multi-stressed urban families

The family empowerment program (FEP) is a multi-systemic family therapy program that partners multi-stressed families with an interdisciplinary resource team while remaining attached to a "traditional" mental health clinic. The rationale for this model is that far too often, families presenting at community mental health centers struggle with multiple psychosocial forces, for example problems with housing, domestic violence, child care, entitlements, racism, substance abuse, and foster care, as well as chronic medical and psychiatric illnesses, that exacerbate symptoms and impact traditional service delivery and access to effective treatment. Thus, families often experience fragmented care and are involved with multiple systems with contradictory and competing agendas. As a result, services frequently fail to harness the family's inherent strengths. The FEP partners the family with a unified team that includes representatives from Entitlements Services, Family Support and Parent Advocacy, and Clinical Staff from the agency's Outpatient Mental Health Clinic practicing from a strength-based family therapy perspective. The goal of the FEP is to support the family in achieving their goals. This is accomplished through co-construction of a service plan that addresses the family's needs in an efficient and coherent manner-emphasizing family strengths and competencies and supporting family self-sufficiency.     

The heart of the matter 2: integration of ecosystemic family therapy practices with systems of care mental health services for children and families

Many children in this country do not receive the mental health care they need. At the same time, a nationwide movement known as systems of care is providing innovative services for families and children. This article links the ideas inherent in systems of care with ecosystemic family therapy principles and practices. Based on a study of nine innovative systems of care pilot projects in Massachusetts, it describes how these innovative programs, and others like them, have been most successful in increasing access to services and providing for coordinated services. They have been less successful in accomplishing positive clinical and functional outcomes. Change in these systems is often described in terms of how services are provided. Not enough attention is given to the conversations that take place between families and case coordinators and how these conversations lead to long-term change. This article contends that the ways in which services are delivered in these systems of care fit well with ecosystemic family therapy principles and practices. We, as family therapists, have an opportunity to link these two sets of ideas, which share common assumptions and values and increase the likelihood of positive clinical outcomes for children and families.     

Serving the mental health needs of families with children under three: A comprehensive program

This paper describes a pregnancy and infant/parent program that was developed to provide comprehensive mental health services to families with children under 3 years of age. Because either the infant or parent can be the identified patient, we are able to treat families who define their problems in a variety of ways. The program has four basic premises: (1) the mental health of all family members should be addressed, (2) treatment of family members should be provided with minimum fragmentation of services, (3) the treatment plan must be individualized for each family, and (4) modes of therapy must be changed as the needs of the family change over time. This paper presents the rationale and techniques necessary for integrated services to families with children under 3 years of age. Two cases are presented: one with the infant as the identified patient, and one with the mother as the identified patient.     

Gaps and Barriers in Services for Children in State Mental Health Plans

Significant gaps exist in children’s mental healthcare, and barriers prevent access to existing services. Current federal initiatives call for state governmental agencies to recognize and resolve deficits in their systems of care. Previous work has acknowledged some of the problems in meeting the mental health needs of children within a system of care. This current project sought to discriminate between gaps (e.g., non-existent services) and barriers (e.g., problems that prevent access to existing services) within state mental health care plans. Because acknowledging barriers and gaps in mental health services is a step towards systems improvement, the present project describes how state governments recognize the limits of their children’s mental health care systems. We analyzed state mental health plans submitted to the federal government in applications for block grant funds. Results illustrate that a varied number of gaps and barriers are acknowledged in state plans. Overall, 90% of state plans discussed barriers and 84% of state plans discussed service gaps. The gap most frequently recognized was lack of providers (74%), while lack of funding (52%) was the most common barrier. This project points to some recognition of system limits in the states and reflects potential efforts to create policies for system improvement for children and families.     

Integrating Narrative Family Therapy in an Outdoor Behavioral Healthcare Program: A Case Study

Adolescent mental health is a significant societal concern in the United States. Diagnosable mental health disorders have been reported at rates of 10–20 % among children and adolescents and this does not include adolescents experiencing personal and interpersonal distress not meeting diagnostic criteria. Adolescents who do not respond to traditional mental health services are often placed in residential treatment centers or other out-of-home treatment programs. Outdoor Behavioral Healthcare (OBH) is growing as a viable treatment option for adolescents who struggle with emotional, behavioral or substance related problems; however, questions have been raised about how to integrate the family into an OBH treatment setting. This article describes a case study illustrating how techniques from Narrative Family Therapy can be used to accomplish this integration, and offers a view of using Narrative Family Therapy to further involve families in the treatment and post-treatment process in an OBH program.     

Systems of Care as Asset-Building Communities: Implementing Strengths-Based Planning and Positive Youth Development

Using a strength-based approach is one of the hallmarks of the system of care (SOC) initiative, and is consistent with the foundations of community psychology. However, while strengths-based planning is recommended and child and family teams often list child and family strengths, the care plans often do not incorporate the strengths in strategies and interventions. The research base regarding strength implementation and effectiveness is summarized, and needed research is outlined. Steps are offered for promoting the use of strengths in SOCS. Implementing programs from the field of positive youth development is advocated as a way that the educational and criminal justice systems could be more actively engaged in implementing strength-based strategies in SOCs. Promoting SOCs to focus more attentively to asset-building (at the child, family, and community level) is compatible with a public health model that addresses mental health concerns in the context of a full range of supports and services so that all children might experience good mental health and realize their potential.     

Family therapists as front line mental health providers in war-affected regions: using reflecting teams, scaling questions, and family members in a hospital in Central Africa

This paper will illustrate the utilization of systemic family therapy services inside a hospital in a war-affected region of the Central African Republic. Through an international non-governmental organization (NGO), the author, a family therapist, provided counselling supervision and services to hospital staff and patients in an area of open conflict in the northern region of the country. In circumstances of chronic insecurity fuelled by both government and rebel forces, families displaced in this region are vulnerable to numerous health conditions and social problems. Family therapy techniques and ideas were used to work with individuals, couples and families presenting with health and social problems resulting from HIV-TB, infections, chronic malnutrition, acute poisoning and beliefs about sorcery. Case examples illustrate the systems consultation model used with the mental health team in order to expand and promote the sustainability of patient mental healthcare in this underserved region.     

Comparing Maltreating and Foster Families in Italy

Maltreating and foster families belong to different research areas and have rarely been considered together. This exploratory study compared maltreating and foster families to demonstrate an integrated approach that overcomes the dichotomic view that often separates problematic families from those who have resources. This study had 81 participants: 48 maltreating parents and 33 foster parents and the children who were in foster care. We examined family functioning (FES), adult attachment styles (ASQ) and foster children’s strengths and difficulties (SDQ) in maltreating and foster families to examine the differences and similarities between families. Both types of families had significant differences on the FES and ASQ scales. Maltreating families had a stronger orientation to succeed and a family profile that was more orientated towards independence. Maltreating parents had higher scores on the scale that measured discomfort with closeness than foster families. However, both family types had a high level of confidence. Many foster children had SDQ scores that were in the borderline and problem categories. These components may promote a theoretical view of an integrated model for family and children’s problems that promotes children’s welfare and supports maltreating parents. Practitioners can build on parent’s strengths or protective factors and provide services to address less developed areas.     

WHEN INFANTS GROW UP IN MULTIPERSON RELATIONSHIP SYSTEMS

Despite prompts from the field of family therapy since its inception, contemporary infant mental health theory and practice remain firmly rooted in and guided by dyadic-based models. Over the past 10 years, a groundswell of new empirical studies of triadic and family group dynamics during infancy have substantiated that which family theory has contended for decades: looking beyond mother-infant or father-infant dyads reveals a myriad of critically important socialization influences and dynamics that are missed altogether when relying on informant reports or dyad-based interactions. Such family-level dynamics emerge within months after infants are born, show coherence through time, and influence the social and emotional adjustment of children as early as the toddler and preschool years. This report summarizes key findings from the past decade of empirical family studies, highlights several areas in need of further conceptual development and empirical study by those who work with infants and their families, and outlines important implications of this body of work for all practicing infant mental health professionals.     

The Strengths and Limitations of Case Record Reviews in Examining Family Preservation Outcome Formulation and Treatment Planning

Much debate has centered on what are reasonable outcomes of the short-term intensive family preservation services (IFPS). However, little attention has been given to how therapists actually formulate outcomes in their practices. The files of 98 families who used IFPS were reviewed to determine how therapists formulated outcomes and whether formulated outcomes varied by service sector (child welfare or mental health) and child age. It was found that formulated outcomes in mental health were more likely than those in child welfare to have a child focus and an interpersonal locus. Variation in outcome formulation in child welfare by child age was found, with outcomes of younger children more likely to be parent-focused than were outcomes of older children. The issues pointed out by these findings are discussed. Since case records are a potential data source for researchers, the paper concludes with a discussion of the strengths and limitations of case record reviews for research purposes.     

Family Influences on Treatment Refusal in School-linked Mental Health Services

This study analyzed family influences on treatment refusal in school-linked mental health services (SLMHS). Specifically, it assessed whether levels of family cohesion, conflict, and organization were related to whether a family refused to initiate recommended treatment. Children (N = 133) referred for emotional and behavioral problems and their families participated. Results indicated that (1) family environment factors explained a significant amount of variance in treatment refusal after controlling for demographic factors, (2) families of children with predominantly internalizing symptoms were at greater risk for refusing treatment than families of children with predominantly externalizing symptoms, and (3) lower level of family cohesion was an individual risk factor for refusing treatment. Incorporating an evaluation of family environment within SLMHS assessments may aid in the identification of areas wherein intervention may be beneficial in preventing treatment refusal.     

An audit of a school-based counselling provision for emotional and behavioural difficulties in primary school children

The presence and prevalence of mental health problems in young children ad well as therapeutic interventions is less well understood than the same problems in adults, Long-term consequences of childhood mental health problems have been noted, yet provision of services at the age appropriate level is ofter limited. This sudy presents a case note audit of 540 children attending an innovative programme for counselling and therapy in school-based centres based in 8 inner London Primary schools. This represented 22.4% of all children attending the schools, with an overage age at referral of 8.1 Years. 53.8% of boys compared to 46.2% girls ew referred emanating from varied backgrounds. The majority of the children spoke English at home (86%) and the only significant differences according to home language related to concern over social interactions. Comparisons between children cared for by both parents(48%) and those cardd for by a single parent (37.3%) showed the latter group to have higher distress and concerns affection school work, home situation, stress for significant life events and lowered coping. Atendance and defaulting rates were good, with no significant differences among those who attended regularly. Many of the conderns surrounded self-esteem and social/family factors. The level of distress was significantly lowered after counselling (t = 17.5 p_.001) 51.45 of the children experienced significant life events which preceded their referral, 30.9% triggered the referral and 45.6% during the course of counselling. Distress caused by life events was generally high with coping levels moving down after multiple exposure. The data is discussed in the light of future provision of care for children.     

The Trajectory of Counseling in China: Past,Present, and Future Trends

This article surveys the past, present, and future trends of counseling in China. Historically, mental health problems were addressed within the family. Currently, psychotherapy from trained practitioners is available on a limited basis, at least in urban settings. The challenge of mental health in China is tremendous, and the efforts to meet that challenge are encouraging. The authors recommend that in the future, prevention and intervention services be offered that are ecosystemic, strengths‐based, and culturally appropriate.     

“I'm a police officer not a social worker or mental health nurse”: Online discourses of exclusion and resistance regarding mental health‐related police work

Despite estimates suggesting that around 15% of UK police incidents involve people with a mental health concern, officers receive very little mental health training. The police have faced high‐profile criticisms over their handling of mental health‐related incidents, whereas the underfunding and fragmentation of UK mental health services has led to concerns that police officers are being forced to undertake a primary role in mental health care. At a time of austerity and widespread cuts to public services, it is important to explore how particular groups work to justify the parameters of their professional duties. This article therefore explores the discourses surrounding mental health problems on an online police discussion forum, highlighting two distinct ways in which mental health‐related work is represented as being incompatible with policing. First, mental health problems are delegitimised and conflated with “scrounging,” positioning individuals as undeserving of police time; second, mental health problems are reified and associated with violence and extreme behaviour, justifying the use of force by police officers and deflecting responsibility onto mental health services. Findings are consistent with previous research suggesting that mental health work is not perceived to be a valid part of the police role.     

Help-seeking for mental health problems of children: preferences and attitudes in the United Arab Emirates

Parental attitudes, religious beliefs, and other sociocultural factors have all been recognized to influence help-seeking patterns in relation to child psychiatric morbidity. But few systematic studies have addressed this issue in the Arab region. In this study, we investigated the help-seeking preferences for mental health problems in a community sample. 325 parents contacted as part of a community-based study of child psychiatric disorders were surveyed using a semistructured interview schedule. Only 38% of those surveyed indicated they would seek help from mental health specialists in the event of psychiatric problems developing in a family member, including their children. Main reasons given for nonconsultation were reluctance to acknowledge that a member of their family has a mental illness, stigma attached to attending mental health services, and the skepticism about the usefulness of mental health services. Willingness to utilize psychiatric services was associated with better parental education, occupation, and socioeconomic status. Our results suggest that sociocultural factors and parental perceptions may have a major effect on whether children with psychiatric disturbance receive professional help.     

Mental Health Concerns of Older Adults Living in Long-Term Care Facilities: An Area of Expansion for MFTs

As baby boomers reach retirement age, the number of older adults living in long-term care will inevitably increase. Living in long-term care often brings psychological, relational, and emotional challenges for older adults, their families, and professional care-providers. Despite these trends and associated challenges, there appears to be an underrepresentation of attention addressing the mental health care of older adults and their families in marriage and family therapy (MFT) literature. Emphasis needs to be turned to assessing the quality and effectiveness of mental health resources for older adults in residential facilities, and to filling the gap where needed services are unavailable. The current review summarizes research addressing residential care for older adults, detailing a) mental health challenges faced by residents, families, and professional care-providers, b) effective mental health treatment options, and c) how MFTs are uniquely suited to working in long-term care settings.     

Systems analysis and school psychology

Traditionally the activities of professionals supplying mental health services to schools have been guided by a medical model which stressed intrapsychic dysfunction. This model is contrasted with an ecological orientation utilizing a systems approach for preventing or alleviating problems. The case history method is used to demonstrate how school psychologists actually perform within this model and to illustrate some of the general characteristics of the ecological approach; it also demonstrates how teacher consultation, family therapy, and student role-playing are organized into a meaningful and unified strategy directed at helping a child in trouble.     

“I didn’t understand their system,and I didn’t know what to do”: Migrant Parents’ Experiences of Mandated Therapy for Their Children

In this phenomenological study, we explored the experiences of migrant parents whose children received mandated therapy in Southern California. Migrants are people who move to a host country either voluntarily as immigrants or involuntarily as refugees. Mandated therapy means that the school or court system required that their children receive services from a mental health provider. Parents often participated by having to take parenting classes and join in some sessions with their children; however, the children were the identified clients. We conducted eight, in-depth interviews with migrant parents. We employed Giorgi and Giorgi’s (Qualitative research in psychology: expanding perspectives in methodology and design. American Psychological Association, Washington, 2003; Qualitative psychology: a practical guide to research methods. Sage, London, 2008) phenomenological psychological research approach to analyze data. Analysis revealed four constituents, which are overarching themes related to the essential structure of the shared phenomenon: (a) migrant parents encountered discrimination and devaluation; (b) migrant parents experienced increased exposure to US culture and the mental health system, which accelerated acculturation; (c) the degree of cultural sensitivity exhibited by providers both positively and negatively influenced participants’ attitudes and perceptions toward mental health services; and (d) migrant parents used their mandated therapy experiences as opportunities to examine their family relationships and to learn new skills and concepts.     

Connections between Family Centered Care and Medical Homes of Children with Neurodevelopmental Disabilities: Experiences of Diverse Families

Cultural issues tied to race/ethnicity are important aspects in delivering medical home services to children with neurodevelopmental disabilities and their families. To better understand family satisfaction with family centered care (FCC) in medical homes of children with disabilities, this study investigated whether family race/ethnicity, in addition to parent and child characteristics, significantly influenced family perceptions of FCC in three areas: family-provider partnership, care setting practices and policies, and community coordination and follow-up. Based on the life course theory for optimizing children's developmental trajectories, examining connections between family race/ethnicity and satisfaction with health care allows for identification of strengths and weaknesses in medical home services delivery, and offers opportunities for family support and improvement in outcomes for children with disabilities. This study developed an original empirical survey using a structured questionnaire developed by Family Voices, a national advocacy organization dedicated to promoting the well-being of children with disabilities and their families. The study collected data for 122 families in a large urban area in the northeastern United States. Multivariate analyses revealed that family race/ethnicity significantly contributed to the prediction of parental satisfaction with medical homes of children with disabilities, and to families' perceptions of FCC in care setting practices and policies, and community coordination and followup, but not to family provider partnership. Non-White families reported significantly lower satisfaction. Discussion emphasizes that health care providers need to become more vigilant in providing culturally sensitive care. To enhance FCC practices and policies, the study advances a checklist of ten essential areas that promote culturally sensitive interactions between families of children with disabilities and their medical and non-medical health care providers.