Impact of Caregiver Factors on Youth Service Utilization of Trauma-Focused Cognitive Behavioral Therapy in a Community Setting

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an increasingly available evidence-based therapy that targets the mental health symptoms of youth who have experienced trauma. Limited research has examined how to engage and retain families in TF-CBT services in community settings. Using a mixed-methods approach, the goal of this exploratory study was to identify caregiver factors that impact youth enrollment and completion of community-delivered TF-CBT. The study included 41 caretakers of youth referred to therapy at a local child advocacy center following a forensic assessment substantiating youth trauma exposure. Caregiver factors examined include caregiver demographics, trauma exposure, and mental health symptomology. Results from multivariate logistic regressions indicate that caregivers reporting more children residing in the household were significantly more likely to enroll youth in therapy (OR 2.27; 95 % CI 1.02, 5.03). Qualitative analyses further explicate that parents with personal trauma or therapy experiences expressed positive opinions regarding therapy services for youth, and were more likely to enroll in or complete services. Findings suggest that caregivers with personal traumatic experience and related symptomatology view therapy as important and are more committed to their child receiving therapy. Future research on service utilization is warranted and should explore offering parental psychoeducation or engagement strategies discussing therapy benefits to parents who have not experienced trauma and related mental health symptomatology.     

Training parents as behavior therapists: A review

The following paper presents theoretical, empirical, and ethical rationales for the training of parents as behavior therapists for their own children. Thirty-four studies, ranging from single case studies to reports on large-scale, multi-family training programs, are critically reviewed, with primary emphasis on the nature and extent of parental involvement and responsibility, and on the level of methodological sophistication. Related papers are cited when appropriate. Further research and areas needing theoretical clarification are suggested, in relation to the future and expansion of this type of therapeutic intervention. In addition the implications of such an approach for both a “systems” model of child therapy and a prevention-oriented model of mental health services are discussed.     

Therapist Focus on Parent Involvement in Community-Based Youth Psychotherapy

Parent involvement in the treatment of childhood disruptive behavior problems is a critical component of effective care. Yet little is known about the amount of time therapists are involving parents in treatment and factors that predict therapists' efforts to involve parents in routine care. The purpose of this study is to examine therapists' within-session involvement of parents in community-based outpatient mental health treatment. The data are from a larger longitudinal observational study of psychotherapy for children ages 4-13 with disruptive behavior problems and include videotaped psychotherapy sessions coded for the therapeutic strategies delivered as well as measures of child, parent/family, and therapist characteristics at baseline. Parent involvement is defined as the proportion of time in the session that therapists direct treatment strategies towards parents. Results indicated that therapists directed treatment strategies towards parents an average of 44% of the time within a session. Multilevel modeling was used to examine client-level (child, parent, and family functioning) and provider-level (therapist experience and background) predictors of parent involvement. Therapists involved parents more when the child had higher levels of behavior problems, when the parent reported higher levels of internalized caregiver strain, and when the therapist was more experienced. The results highlight potential areas to target in efforts to increase parent involvement, including training less experienced therapists to increase their focus on directing strategies towards parents.     

Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics

Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD offers initial support for such efforts to improve care. Specifically, quantitative data from a recent pilot study indicate that CMH therapists with limited ASD experience can deliver an EBP intervention with fidelity and perceive it as useful to their practice. Further, client attendance is high and children demonstrate improvement on standardized measures. To further understand the feasibility and impact of training CMH therapists to deliver EBPs, this mixed-methods study examined parent perspectives of the process and impact of outpatient psychotherapy for 13 parents of children ages 5–13 with ASD whose therapists were trained to deliver the EBP intervention. Results complement and expand previously reported quantitative data on psychotherapy process indicating that parents are highly involved in treatment for their children, perceive a strong therapeutic alliance with their children’s therapist, and highlight that treatment was different once therapists began delivering the intervention. Results also indicate themes related to parents’ perceptions of positive child and parent outcomes that provide important details on the specific gains that were observed during treatment. Study findings underscore the importance of parent perspectives in understanding the process and impact of implementing EBPs in CMH settings for families of children with ASD.     

Variations and Extensions of Filial Therapy

Various procedures for training parents to be play therapists for their own young children are described. In their play encounters with the child, not only is each of the parents learning ways of being with the child that are indicative of empathy and caring, but they are also learning that the way each acts toward the child in the playroom (and in the home) is reflective of their own conflicts as persons and as spouses.     

Factors That Predict Premature Termination Among Mexican-American Children in Outpatient Psychotherapy

The role of demographic variables, acculturation, and therapy attitudes and expectations in predicting treatment dropout for Mexican-American families who presented for mental health treatment for a young child at a community mental health center was examined. Univariate analyses indicated that less educated parents who felt that they should be able to overcome their child's mental health problems on their own, and who felt that emotional and behavioral problems should be handled by increasing discipline were more likely to terminate prematurely. In addition, parents who perceived more barriers to treatment and expected their child to recover quickly were more likely to drop out of treatment after attending just one session. Measures of household income, acculturation, therapist–client ethnic match, perceptions of stigma, and expectations of therapist directiveness were not related to treatment dropout. When multivariate analyses were examined, parental education, perceived barriers to treatment, and belief in increased discipline remained significant predictors of treatment dropout, and client–therapist ethnic match became a significant predictor of dropout. Results are discussed in terms of implications for culturally-sensitive interventions.     

Universal parental support for parents of adolescents: Who wants municipality‐based parental support and in what form?

Parenting a child through adolescence can be a challenge for many parents; adolescents go through notable developmental, physical, and psychological changes that affect the relationships around them. Most parents find parental support during these years important. These young people's relationships with their parents are important to their mental health, but although parental support is universally available to parents of younger children, it is still scarce for parents of adolescents. The aim of this study was to explore what factors are associated with interest in universal parental support through telephone interviews and questionnaires with 223 parents of 13‐ to 17‐year‐olds. Parents’ interest in parental support was linked to their own anxious mood, their lower perceived parental capacity, their perception of the child as having psychiatric problems, the parents’ perception of their adolescents’ openness about things and their perception of the adolescent's overall difficulties in daily life due to psychiatric symptoms. The results show that lighter forms of support such as lectures or seminars were more appealing to parents with higher social status. Offering community‐based individual counseling and leader‐led parent training groups therefore has the potential to reach parents with difficulties more equally, while offering support only through lectures and seminars could increase the inequality between parents in different social situations.     

‘Someone to talk to who'll listen’: addressing the psychosocial needs of children and families

The paper presents the Lewisham Community Child and Family Service (LCCFS), a community‐based intervention providing psychosocial help for children, young people, parents and families. The service is focused on early intervention, prevention and promotion in the improvement of local health. It works under a service framework based on inter‐agency collaboration, and a counselling model based on community and interpersonal partnerships, grounded in personal construct theory (Kelly, 1955). The policy demands and local need for accessible and acceptable mental health are discussed, and quantitative and qualitative findings of the needs assessment preceding the establishment of the LCCFS are presented, supporting the need for community mental health provision. The feasibility for the LCCFS to reconcile and meet the policy demands and the needs of parents with respect to child psychosocial help and services are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

The Client Cultural Competence Inventory: An Instrument for Assessing Cultural Competence in Behavioral Managed Care Organizations

The rapid growth in Behavioral Managed Care Organizations has led to increasing concern about the future availability of culturally competent mental health services for ethnic minorities. Prior efforts to assess cultural competence of mental health services have focused exclusively on agency providers and individual mental health professionals rather than on clients' perceptions of care. We introduce the Client Cultural Competence Inventory, which has several advantages over other cultural competence measures including its (a) lower susceptibility to social desirability bias, (b) ability to assess attitudes concerning a broader range of therapists, providers and plans, and (c) focus on clients rather than the psychiatric community as the central force in determining cultural competence. Preliminary psychometric analyses of the inventory are presented from data gathered in a group of parents with children who are severely emotionally disturbed.     

Finding focus in a difficult landscape: Therapists’ experiences with challenging video guidance processes for parent–infant dyads

Marte Meo video guidance uses filmed interaction of the actual parent–infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent–infant dyads may illuminate important aspects of the method itself as well as the therapists’ role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent–infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent–infant dyads where child protective issues arise, where caregivers’ insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists’ role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.     

Ethical Considerations for Assessing Parent Mental Health during Child Assessment Services

Parents play an integral role in the mental health service provision of children and adolescents, and they can have significant effects on the outcomes of youth. A growing body of research has linked parents’ own mental health status to numerous outcomes for their children, and recent guidelines have emerged recommending the assessment of parent psychopathology when treating child patients. However, these recommendations present a range of ethical considerations. Mental health professionals must determine if the assessment of a parent is empirically supported and that an assessment procedure appropriate for parents can be feasibly implemented. They must also respect the autonomy and confidentiality of parents while ensuring that assessment findings can be translated to meaningful benefits for child patients. This article details and discusses each of these concerns within the context of the relevant principles and standards of the 2016 American Psychological Association’s Code of Ethics. Further, it provides guidelines, relevant clinical examples, and an applied model for mental health professionals to consider the ethical implications of assessing parent mental health when serving child patients.     

Relationships,Environment, and the Brain: How Emerging Research is Changing What We Know about the Impact of Families on Human Development

Recent research is providing family therapists with new information about the complex interaction between an individual's biological makeup and his/her social and physical environment. Family and social relationships, particularly during sensitive periods early in life, can affect a child's biological foundation. Additionally, stress during the early years can have a lasting effect on an individual's physical and mental health and contribute to the onset of severe mental illness. Community programs have been developed to intervene early with families who have an at‐risk child to prevent or minimize the onset of mental illness including providing partnerships with at‐risk mothers of infants to shape attachment relationships. Programs are also developing individual and family interventions to prevent the onset of psychosis. Practicing family therapists can incorporate emerging neuroscience and early intervention research and leverage the growing base of community programs to enhance the effectiveness and sustainability of mental health outcomes for clients. Additionally, family therapy education programs should broaden student training to incorporate the growing body of information about how family relationships affect individual mental health development.     

Evaluation eines präventiven Beratungskonzeptes für Kinder körperlich kranker Eltern

Children of parents suffering from a serious disease (e.g. cancer, multiple sclerosis, Aids) are at increased risk for mental health problems. Empirically based interventions for these children are missing. At the University Medical Centre Hamburg-Eppendorf, a preventive short-term counselling service has been existing since July 2000. Results from a 6-month evaluation (n=50) are presented. The evaluation encompasses a retrospective interrogation in a multiperspective und multidimensional approach. Most families experienced the intervention as helpful and supportive in coping with the multiple stressors of the situation. Out of a previously defined list of 12 intervention goals, enhancing anticipatory grief in children, their active coping behaviour as well as parents’ sense of their own parenting competence were identified as the most important foci of the counselling interventions, as reported by parents, children and therapists.     

Reflections on Family Therapy in Australia

Family therapy in Australia has been influenced by ideas mostly from North America and Europe. However Australian family therapists have also made their own significant contributions to theory and practice. The vastness of the continent combined with a relatively small population has presented challenges with respect to the formation of a national association and for many years, the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy Board acted as de facto national voice for the discipline. The Australian Association of Family Therapy was formed as recently as 2011. It has a total of over 1,000 members and is the sole organisation representing family therapy and family therapists in Australia. Clinical membership is achieved via successful completion of a 2-year sequence of study in family therapy followed by 50 hours of supervision (or its equivalent). Family Therapy training is mostly delivered in the four most populated states in Australia at both University level and through private organisations registered to provide training at government approved levels. La Trobe University (through the Bouverie Centre), Swinburne University (through the Williams Road Family Therapy Centre) and the University of New South Wales currently provide training leading to specialist qualification in family therapy. A number of other private institutions also provide recognised family therapy training. To date, family therapists and couple therapists in Australia have not in the main shared common platforms such as conferences, training and professional journals. Narrative therapy has also remained somewhat detached from “mainstream” family therapy. Family therapy qualifications are often valued by prospective employers even when duty statements are focused on the more traditional skills of professionals such as psychologists or social workers. Researching family therapy outcomes remains challenging. But although there is increasing practiced-based evidence of the efficacy of family therapy, Australian family therapists as a group are yet to concentrate their efforts on convincing funding bodies of its usefulness. At the same time, via the teaching and promotion of family sensitive practices, systemic ideas are being increasingly incorporated within areas of mental health, disability, alcohol and drug dependency, and within a range of health and welfare areas that impact not just on the individuals but on those close to them.     

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.     

Impact of play therapy on parent-child relationship stress at a mental health training setting

This study investigated the impact of Child-Centred Play Therapy (CCPT)/Non-Directive Play Therapy on parent-child relationship stress using archival data from 202 child clients divided into clinical behavioural groups over 3-74 sessions in a mental health training setting. Results demonstrated significant differences between pre and post testing on the Parenting Stress Index. CCPT appeared to be especially effective with children identified with clinical externalising behavioural problems, combined externalising and internalising behavioural problems, and children who were not categorised with clinical problem behaviours but whose parents sought counselling services for them. There were also significant differences determined by length of therapy. Results are discussed concerning implications for clinical practice and further research.     

The Development,Pilot, and Process Evaluation of a Parent Mental Health Literacy Intervention Through Community Sports Clubs

The mental health literacy of parents may be critical in facilitating positive child and adolescent mental health outcomes. The purpose of this study was to develop, pilot, and evaluate a targeted parent mental health literacy intervention through community sports clubs. Sixty six parents (M_age?=?44.86?±?5.2 years) participated in either a brief mental health literacy intervention workshop delivered through community sporting clubs (n?=?42) or a community-matched control group (n?=?24). Participants’ mental health literacy was assessed at baseline, post-intervention and at 1 month follow-up. A mixed methods process evaluation was conducted with intervention participants to determine the acceptability and feasibility of the intervention. Participants in the experimental group showed greater increases in depression literacy, anxiety literacy, knowledge of help seeking options and confidence to assist an adolescent experiencing a mental health disorder, compared to those in the control group. Post-intervention changes in the experimental group were maintained at 1 month follow-up. A mixed methods process evaluation revealed that parents found the intervention content engaging, relevant to their needs, and practically useful in terms of actively supporting adolescent mental health. Findings provide evidence that a brief, targeted intervention through community sports clubs might be a particularly useful method of improving parental mental health literacy and facilitating positive youth mental health outcomes.     

Clinical commentary by David Trevatt,Clinical Manager of ‘Hear and Now’ Adolescent Counselling Service,Redbridge and Manager of Open Door's Parenting Teenagers Project,Haringey

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.     

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.     

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.