Wrapping community-based mental health services around children with a severe behavioral disorder: An evaluation of project wraparound

During the past two decades there has been a significant increase in community-based mental health and educational services for children and youth with serious emotional and behavioral problems and their families. However, in the vast majority of programs there are no reliable longitudinal data on the adjustment of the children that are served. Project Wraparound was a community-based individualized treatment program which served children and youth with severely maladjusted behavior and their families by providing intensive home and school-based services. The purpose of this paper is to provide a longitudinal analysis of client and family adjustment data. Data on client adjustment within the home and characteristics of the home environment were obtained at intervals of 3 months, 6 months, and 1 year. Data on client adjustment in school was obtained at four points over a period of 2 years. The results from 19 cases indicate that substantial change occurred on measures of the home environment and client adjustment in the home with no significant change in adjustment in the school. Implications of the findings are discussed.     

Family-centered intensive case management: A step toward understanding individualized care

New York State's initial attempt at individualizing services occurred within the context of an experiment. We randomly assigned children 5–12 years old who were referred for out-of-home placement in treatment foster care to either treatment foster care, Family-Based Treatment (n=15), or to Family-Centered Intensive Case Management (FCICM) (n=27). FCICM used teams of case managers and parent advocates to provide in-home services. Flexible service dollars, respite care, and behavior management skills training were available to assist teams in individualizing care. Preliminary outcomes indicate that children in FCICM are doing as well or better than children assigned to FBT in their functioning and symptom reduction. Parents of children in FCICM have made gains, although not at a statistically significant level, in behavior management skills and family strengths that allow them to provide care for their children at home.     

Psychologists' role in family-centered approach to practice, training, and research with young children

Family-centered, community-based, coordinated care for children with special needs is presented as the best practice model for providing services to children and families. Psychologists must learn to play an active role in this frame-work that both integrates psychology with other health and education disciplines and uses the broad spectrum of psychological knowledge about families, development, community organization, and intervention strategies. Key principles of family-centered child psychology affect practice research and training. The psychologist becomes part of a team created to support families as the primary care-givers of their children. Training programs must reorganize the types of experiences both in the classroom and the field to train new psychologists within this model. As mandates for family-centered care affect policies at the state and federal levels, research will remain a critical factor in understanding the effects of these policy shifts on child and family functioning and the delivery of services.     

A Conceptual Toolkit for Intensive Early Behavioral Intervention Teachers

Intensive early behavioral intervention (IEBI) for children with autism requires effective team work involving professional therapists, parents, teachers and others. It is important for all team members to employ a common conceptual and procedural vocabulary so that communication among them is clear, unambiguous, and effective. This article outlines the rationale of a small and practical vocabulary or conceptual toolkit that we have found useful in working with teachers and families in designing, implementing, and analyzing the details of behavioral programs to help autistic children learn to speak and understand language. Special attention is given to a heuristic device called the language matrix. Illustrative data describing the course of generative language acquisition by a child with autism taught according to the language matrix approach are included.     

Military children and families: strengths and challenges during peace and war

Throughout history, military children and families have shown great capacity for adaptation and resilience. However, in recent years, unprecedented lengthy and multiple combat deployments of service members have posed multiple challenges for U.S. military children and families. Despite needs to better understand the impact of deployment on military children and families and to provide proper support for them, rigorous research is lacking. Programs exist that are intended to help, but their effectiveness is largely unknown. They need to be better coordinated and delivered at the level of individuals, families, and communities. Research and programs need to take a comprehensive approach that is strengths based and problem focused. Programs for military children and families often focus on the prevention or reduction of problems. It is just as important to recognize their assets and to promote them. This article reviews existing research on military children and families, with attention to their strengths as well as their challenges. Issues in need of further research are identified, especially research into programs that assist military children and families. Military children and families deserve greater attention from psychology.     

A review of teen-tot programs: comprehensive clinical care for young parents and their children

Comprehensive clinical programs for teenage mothers and their children, also known as teen-tot programs, have been a promising intervention to improve outcomes of teenage childbearing and parenting. However, much remains unknown regarding the efficacy of such programs. We reviewed four published evaluations of programs that provided medical care, counseling, contraception, guidance for parenting, and assistance with staying in school. The evaluations reported moderate success in preventing repeat pregnancies, helping teen mothers continue their education, and improving teen and infant health over 6 to 18 months. However, the evaluations had limitations that may have reduced or accentuated observed effectiveness. Teen-tot programs will continue to face the challenges of sustaining adequate long-term interventions and evaluations, and reducing the high attrition rate among program participants. It is concluded that increased support and funding for teen-tot programs and more complete evaluations are warranted.     

Engaging families as experts: collaborative family program development

This article presents the collaborative family program development (CFPD) model, a collaborative research-based approach to creating community-based programs for families. In this approach, families are viewed as experts on the nature of their challenges and on what they desire in a program. This approach is particularly useful in developing programs for families who have experienced social oppression and who may have been reluctant to participate in programs created for them by professionals without their consultation. In contrast, when professionals adopt the stance of respectful learners, families respond by actively engaging in the program development research and in the program created from it. This article describes the nature and complexities of a collaborative program development stance, the unique contribution to community-based program development offered by a family systems focus, and the 10 steps in the CFPD approach. These 10 steps guide movement from initiating the project and forming collaborative professional partnerships to engaging cultural consultants; conducting in-depth research to understand the problems, resources, contexts, and recommendations from the perspective of families who will receive the program and from the perspective of front-line professionals working with these families; transforming research findings into program contents and formats; and implementing, evaluating, revising, and replicating the program. The approach is illustrated by a program called Fresh Start for Families, developed and replicated for families in New York City who are homeless and attempting to move from welfare to work.     

What Abandoned Children Construe as Stressful Experiences: Implications for Psychoanalytic Relational Theory and Child Psychotherapy

As part of psychological evaluations to determine whether interventions were needed, 106 abandoned children (aged 5 to 19 years) residing in SOS-Kinderdorf International Children's Villages in Spain were individually administered a structured interview to learn what each child construed as upsetting. Before admission, each child had been exposed to one of three traumatic, interpersonal experiences: excessive neglect; physical abuse; and parents who were prostitutes, abusing drugs, or both. In an unexpected finding, the events these children discussed most often as having upset them did not focus on abandonment or on traumatic conditions they had endured. Rather, converging with reports of public school children residing with their families in the United States, the events they discussed concerned harm to loved ones (e.g., accident, illness, hospitalization). In addition, children who had been visiting relatives while residing in a Children's Village differed from those who had not visited relatives in what they experienced as traumatic. The results are examined in terms of implications for psychoanalytic-relational theory and for planning treatment programs for children who have been abandoned or are living in institutions.     

Culturally competent outcome evaluation in systems of care for children's mental health

Conclusions The area of culturally competent outcome evaluation and cross-cultural mental health research in general needs to be greatly developed given the culturally diverse nation we live in and the different needs of culturally diverse children and their families. Such evaluation is crucial in supporting the need for and effectiveness of culturally competent programs and special programs with a focus on particular cultural populations. The imperatives for cost effectiveness and clinical effectiveness which have been promoted by the transition to managed systems of care may actually promote the development of higher levels of cultural competence in community-based systems of care. Culturally competent care may well be the most cost-effective and clinically effective care.     

Psychoanalytically Based Treatment for Traumatized Children and Families

A psychoanalytic orientation provides an important perspective for developing community-based prevention and intervention programs for traumatized children and their families. In New Orleans, the Violence Intervention Program for Children and Families is designed to reduce the risk of exposure to violence, mental health problems following exposure, interference with normal developmental progression, academic performance, family functioning, onset of behavioral and conduct disturbances, later psychopathology, and subsequent violence. The program includes an unusual focus on work with police officers as first responders to increase their sensitivity and responsiveness to traumatized children. A psychoanalytic perspective helps a therapist or interventionist understand a person's strengths and weaknesses, frustrations, and conflicts as well as those within a chaotic environment and social situation. The psychoanalytic approach allows for more effective therapeutic approaches as well as more flexible problem-solving strategies.     

Children's Perception of Parental Empathy as a Precursor of Children's Empathy in Middle and Late Childhood

The present study investigated the relationship between children's self-concepts and evaluations of parent figures. The subjects were elementary school children (352 males and 280 females; Grades 5 through 10) who came from intact families, divorced families, or families in which one or both parents had died. Significant relationships were obtained between children's self-concept ratings and their evaluations of their natural father and mother for both intact and divorced families. This relationship was not significant, however, for families in which a parent had died. Furthermore, children's self-ratings were not significantly correlated with their evaluations of stepparents.     

A longitudinal study of the impact of parental divorce on adolescents' evaluations of self and parents

Children's evaluations of their parents and themselves were obtained over a three-year period. In the interim, as well as prior to the study, some of these children experienced parental divorce and/or unhappy intact families. This report will compare these children's evaluations of themselves and their parents to the evaluations of children who had experienced an intact familial configuration. Notably, two sets of troubled children emerged from this study--an acutely troubled group and a chronically troubled group. These findings are discussed.     

Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada

The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi‐component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team‐based practice, and facilitating case‐based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system—practitioners, teams, and communities—while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.     

Relationships Between Evaluations of Self and Parents by Children from Intact and Divorced Families

In the present study 639 fifth through eighth grade boys and girls from a total of 14 school districts across the State of Kansas voluntarily filled out evaluative surveys for each of the following target groups: “yourself,” “mother,” “father,” and when applicable, “stepfather.” In accordance with Lifshitz's model and the findings reported by Parish and Copeland, children from intact families were found to have self-concepts that were significantly correlated with how they evaluated their mothers and fathers. In addition, children from divorced families were found to have self-concepts that were significantly correlated with their ratings of their mothers and stepfathers, but not with their fathers. However, of those children from divorced families, those whose parents had been divorced for less than two years had self-concepts that were strongly correlated with their evaluations of their mothers and also significantly correlated with their evaluations of both their natural fathers and their stepfathers.     

A comparative study of adolescent risk assessment instruments: predictive and incremental validity

Promising new adolescent risk assessment tools are being incorporated into clinical practice but currently possess limited evidence of predictive validity regarding their individual and/or combined use in risk assessments. The current study compares three structured adolescent risk instruments, Youth Level of Service/Case Management Inventory (YLS/CMI), Structured Assessment of Violence Risk in Youth (SAVRY), and Psychopathy Checklist: Youth Version (PCL:YV), for both predictive and incremental validity with respect to general and violent recidivism. Receiver operating characteristic and hierarchical logistic regression analyses revealed that the risk tools predicted general and violent recidivism to varying degrees of accuracy, but the SAVRY offered the most in incremental validity. Clinical implications and future directions for youth risk assessment are discussed.     

Race, Culture, and Ethnicity: Implications for a Community Intervention

We present an overview of research on African American families and emphasize in this discussion limitations of approaches used in the past to study African American families. We also discuss and identify challenges for designing and implementing community, family-based programs targeting competence-promoting behaviors in African American families. In addition, we attempt to accomplish the following objectives: (1) identify themes in studies of African American families, including bias in prior research; (2) discuss ways in which prior approaches and conceptual models guiding studies of African Americans have created challenges for the development and implementation of community-based intervention and research programs; and (3) present the Parents Matter! Program as an example of a community-based prevention effort that attempted to overcome many of the challenges created by prior research efforts.     

A Review of Parenting Programs in Developing Countries: Opportunities and Challenges for Preventing Emotional and Behavioral Difficulties in Children

Many children in developing countries are at risk of emotional and behavioral difficulties, which are likely to be elevated due to the effects of poverty. Parenting programs have shown to be effective preventative strategies in high-income countries, but to date the research on their effectiveness in lower-income countries is limited. International organizations such as the World Health Organization have called for the implementation of programs to prevent behavioral difficulties through the development of stable relationships between children and their parents. The aim of the present paper was to review the literature on parenting programs in developing countries in order to identify challenges, opportunities and directions for further research. First, reports of international organizations were reviewed in order to gain a preliminary overview of the field. In a second stage, a non-systematic review was carried out. Databases were searched in order to identify empirical evaluations of parenting programs in low-income countries. Finally, a systematic review was carried out to specifically identify evaluations of programs targeting emotional or behavioral outcomes. Only one study had a strong methodology among those designed to prevent emotional and behavioral outcomes. Opportunities for further program development and research are identified.     

Satisfaction with Components of the Therapeutic Model: Perspectives of Consumers and Professionals

We provide information about consumer and provider perceptions using a mixed-model pilot study within the Intensive Mental Health Project (IMHP), a school-based treatment service for children with SED and their families. Caregiver, youth, and provider questionnaires developed for this project elicited quantitative and qualitative information on treatment satisfaction, therapeutic alliance, and active involvement in treatment. Caregivers and children overall had positive perceptions of the services they received through IMHP. Providers reported very good working relationships with most children and families. Consumers also provided constructive comments about how to improve services. Our results add support to the importance of therapeutic alliance and collaboration, which are guiding principles of the IMHP.     

The Interplay Between Housing Stability and Child Separation: Implications for Practice and Policy

Greater understanding of how residential stability affects child separation and reunification among homeless families can guide both child welfare and homeless policy and practice. This article draws upon two longitudinal studies examining services and housing for homeless families and their relationship to family and housing stability. Both studies were conducted in the same state at roughly the same time with similar instruments. The first study, examining families’ experiences and outcomes following entry into the homeless service system in three counties in Washington State, found that at 18 months following shelter entry, families that are intact with their children were significantly more likely to be housed in their own housing (46%) than families that were separated from one or more of their children (31%). The second study, a quasiexperimental evaluation of a supportive housing program for homeless families with multiple housing barriers, found that the rates of reunification for Child Protective Services (CPS)‐involved families receiving supportive housing was comparable to that for families entering public housing without services, but significantly higher than the rate of reunification for families entering shelter. Taken together, the findings from both studies contribute to the evidence underscoring the importance of housing assistance to homeless families involved in the child welfare system.     

Innovation in HIV prevention: organizational and intervention characteristics affecting program adoption

A multiple case study design was used to explore the organizational characteristics of community-based organizations that provide HIV prevention programs and the criteria these organizations employ when judging the merits of externally-developed HIV prevention programs. In-depth interviews were conducted with organizational representatives of 38 randomly-selected HIV prevention providers throughout Illinois. Results indicated that there were three main types of adopting organizations: adopters of entire programs, adopters of program components and practices, and adopters of common ideas. These three types of organizations were distinguished by their level of organizational commitment to HIV prevention, organizational resources, and level of organizational maturity. Narrative data from the interviews are used to describe the dimensions that underlie the organizations' program adoption criteria. The criteria of merit used by these organizations to evaluate prevention programs provide partial empirical support for existing theories of technology transfer. Implications for designing and disseminating HIV prevention programs are discussed.