‘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.     

儿童心理咨询与治疗的生态模型

儿童心理咨询与治疗的生态模型强调将个体置身于家庭、学校和社会等环境中,这种治疗方法改变了传统的以个体为主的治疗模式。该模型围绕心理咨询与治疗中各阶段的评估、干预和激励三个方面来具体实施,本文总结了它的实施过程和特点,以及其典型应用家庭调查模型,最后,本文阐述了该模型的发展方向及启示。     

Using the Double ABCX Model to Integrate Services for Families of Children with ASD

This conceptual paper reviews the need for a family-focused service delivery model within the autism spectrum disorder (ASD) field and suggests that the Double ABCX Model of Stress and Adaptation is a way to address this need. Within the ASD field, there is an absence of service delivery models that are able to address the needs of the family as a unit, rather than the individual child with ASD. This gap is striking given the reciprocal relationship between parent and child outcomes within the ASD field. To support our argument that the Double ABCX model could be used to integrate parent and child-focused interventions within the ASD field, this paper starts by reviewing the mental health outcomes often associated with having a child with ASD. We next provide a historical overview of the Double ABCX model and review a body of ASD intervention literature within the context of the Double ABCX model framework. Doing so shows that a number of child and parent focused interventions within the ASD field can be fit within the Double ABCX framework. However, a handful of methodological and sampling limitations prevent the Double ABCX model from being fully supported as a model that could be applied in a variety of settings. Taken together, this review highlights that the Double ABCX model is a promising strategy to integrate child and parent-focused interventions within the ASD field, but highlights that specific areas of future research are needed in order to build continued support for this argument.     

Use of Services Prior to and Following Intensive Family Preservation Services

A goal of short-term intensive family preservation services (IFPS) is to facilitate access to other services. However, service use following IFPS has rarely been studied. I describe the types of aftercare services that IFPS therapists recommended and use of these services in the two months following IFPS termination. Since families were using services that were not on the recommended aftercare plans, use of these services is also described. Primary caregivers of families who received family preservation through either child welfare or mental health were interviewed at two months after family preservation for the purpose of ascertaining service use. Different types of services were recommended and used based on whether families received IFPS through child welfare or mental health. However, there were also differences in the presenting problems and demographics between families in child welfare and mental health. Future research should include an independent assessment of need in order to determine the relationship between need and the types of services recommended and used. Even though families used services prior to IFPS, the findings indicated that IFPS facilitated use of new services. More research is needed on the process of how therapists decide what services to recommend and what they do to help families access services. It is also important to examine whether use of less restrictive services helps prevent out-of-home placements and the relationship between informal support and use of formal services.     

Children with SED and Their Families in an Urban Public Mental Health System: Characteristics, Needs, and Expectations

We present information with implications for the design of comprehensive systems of care for children with severe emotional disturbance and their families. Combining quantitative data derived from children and caregivers on multiple standardized assessments and qualitative data based on the caregivers' personal comments, we provide a detailed account of child clinical status, service needs, involvement in normative childhood activities, aspects of family coping and functioning, and expectations of mental health services. Research participants were from a random sampling of children, 9 to 11 years of age, receiving an above average number of services from a large urban public mental health system. Results from this comprehensive needs assessment demonstrate the serious nature of the children's disabilities, illuminate the corresponding challenges for families, and provide direction for enhancing the system of care. The caregivers rated recreation and after school programs as their first priority. Since traditional mental health services are fairly well articulated and evolved, we concentrate on using information about child functioning and family context to inform the development of recreation and after school programs that can accommodate children with extremely challenging behaviors.     

The Effectiveness of Cultural Adjustment and Trauma Services (CATS): Generating Practice-Based Evidence on a Comprehensive, School-Based Mental Health Intervention for Immigrant Youth

A collaborative study of Cultural Adjustment and Trauma Services (CATS), a comprehensive, school-based mental health program for traumatized immigrant children and adolescents, was conducted to generate practice-based evidence on the service delivery model across two school districts. Program effectiveness was assessed by testing whether client functioning and PTSD symptoms improved as a result of 7 separate service elements. An array of clinical services including CBT, supportive therapy, and coordinating services were provided to all students, and an evidence-based intervention for trauma, TF-CBT, was implemented with a subset of students. Greater quantities of CBT and supportive therapy increased functioning, while greater quantities of coordinating services decreased symptoms of PTSD. TF-CBT services were associated with both improved functioning and PTSD symptoms, although TF-CBT was implemented with fidelity to the overall comprehensive service model rather than the structured intervention model. Results suggest the comprehensive school-based model was effective, though different service components affected different student outcomes. Implications of these findings for immigrant mental health interventions and implementing structured evidence-based practices into community mental health programs are discussed. Suggestions are made for future research on existing mental health practices with immigrants.     

School psychology: a public health perspective : I. Prevention, populations, and systems change

Concerns regarding American schools and mental health services for children abound, including inadequate educational achievement, school violence, over-referral to special education and disproportionate placement of minorities into special education, under-utilization of mental health services for children, and a poorly coordinated system of child mental health services. All of the above concerns share two common attributes: (a) they are statements regarding populations, rather than specific individuals; and (b) they are best addressed by changing system-wide elements of psychological service delivery. We argue that, although conceptualizing school psychology as primarily an indirect service specialty (e.g., J. Sch. Psychol. 28 (1990) 203) has advanced our thinking about effective service delivery, conceptualizing school psychological services from a public health perspective will provide an even broader framework that can increase both the efficacy and efficiency of school psychologists' work.     

A Community‐Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low‐income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.     

Family characteristics as mediators of the influence of problem drinking and multiple risk status on child mental health

Structural equation modeling was used to test a theoretical model in which family cohesion and family reframing coping were hypothesized as mediators between family drinking problems, multiple risk factors, negative life events, and child mental health (conduct disorder, depression, anxiety) in two-parent families. Family cohesion mediated the relationships of family drinking problems and negative life events to child conduct disorder and depression. Negative life events mediated the relationships of family drinking problems and family multiple risk to child conduct disorder. Family reframing coping did not function as a mediator nor was it related to child mental health when other factors were considered simultaneously. Results indicate that increasing family cohesion and reducing sources of stress within the family (negative life events) represent promising areas for interventions for children with problem-drinking parents. Work on this study was funded in part by the National Institute for Mental Health Grant 2-P50-MH39246-06 to support a Preventive Intervention Research Center. The authors gratefully acknowledge contributions made by Rita Shell, Marcia Michaels, Joanne Gersten, George Knight, and Carolyn Berg.     

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.     

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10–13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families’ needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child’s therapist. Parents’ report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth’s treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research.     

Digital Mental Health Interventions for Child and Adolescent Anxiety

Anxiety disorders are the most common mental health conditions in children, with approximately 13% of kids struggling with excessive anxiety. The vast majority do not have access to effective treatments and there continues to be a disjunction between treatments that are empirically supported and those that are available in the community. Digital mental health interventions (DMHI) can increase efficiency, reach, and standardization as well as reduce costs of providing of mental health care. Here we review the extant research on DMHI, including web- or cloud-based programs, mobile applications (apps), virtual reality (VR), and digital assessment methods such as ecological momentary assessment (EMA) for the delivery and/or support of evidence-based care in child anxiety. Preliminary research is promising for these tools to improve access and efficiency of evidence-based practice. However, ethics and practice guidelines are needed and questions remain regarding what level and quality of therapeutic involvement is needed to maximize treatment completion and outcomes in youth and whether DMHIs are contraindicated for certain populations or whether they are similarly effective with those with comorbid conditions is unclear.     

Housing and Child Welfare: Emerging Evidence and Implications for Scaling up Services

Inadequate housing threatens family stability in communities across the United States. This study reviews emerging evidence on housing interventions in the context of scale‐up for the child welfare system. In child welfare, scale‐up refers to the extent to which fully implemented interventions sustainably alleviate family separations associated with housing instability. It incorporates multiple aspects beyond traditional measures of effectiveness including costs, potential reach, local capacities for implementation, and fit within broader social services. The framework further encompasses everyday circumstances faced by service providers, program administrators, and policymakers who allocate resources under conditions of scarcity and uncertainty. The review of current housing interventions reveals a number of systemic constraints for scale‐up in child welfare. Reliance on rental assistance programs limits capacity to address demand, while current practices that target the most vulnerable families may inadvertently diminish effectiveness of the intervention and increase overall demand. Alternative approaches that focus on homelessness prevention and early intervention must be tested in conjunction with community initiatives to increase accessibility of affordable housing. By examining system performance over time, the scalability framework provides an opportunity for more efficient coordination of housing services within and outside of the child welfare system.     

Service Delivery Issues and Program Evaluation in Pediatric Psychology

Presents a framework for categorizing pediatric psychology research into practice and service system outcomes and functioning. The questions of importance are (a) who is being served, (b) what services are provided, (c) how treatments are implemented, (d) how services are organized and staffed, (e) what are the outcomes of the services, (f) how do various consumers perceive services, (g) how services are reimbursed, and (h) what are alternatives and innovations? The framework of program evaluation is detailed for domains most germane to service delivery in pediatric/child health psychology. Such domains include diagnostic information on patients, types of intervention, behavioral/psychological outcome variables, costs of treatments, service system functioning, and perceptions of satisfaction from multiple sources. This framework may be useful in directing future research on the delivery of services in pediatric psychology settings, thereby adding to the value of the field.     

Taking Cognitive-Behavior Therapy to School: A School-Based Mental Health Approach

This paper offers an overview using cognitive-behavior therapy (CBT) within a school system. In addition to providing services to individual students, this article provides an overview of implementing CBT into a system of school-wide mental health services. Interventions are discussed at three levels—universal school-wide interventions, target interventions with at-risk students, and intensive interventions with students in need. Examples of specific programs or intervention are given for each level.     

Mental health services for African Americans: a cultural/racial perspective

African Americans have made consistent progress toward first-class citizenship since 1965. Nonetheless, mental health services for this population have been biased, incomplete, and deficient because similarities to European Americans have been emphasized whereas differences were largely ignored. This article addresses some differences, including cultural/racial identity and the cultural self, that affect assessment, psychiatric diagnoses, and psychotherapy or other interventions. An assessment-intervention model illustrates how cultural information can inform service delivery and improve services to African Americans. Cultural/racial perspectives on mental health in a multicultural society suggest innovations in the design of these services and access to them that can increase utilization by African Americans.     

Presidential Address: Team Science Across Disciplines: Advancing CBT Research and Practice on Hoarding

This presidential address focuses on the recent history of research and practice on hoarding disorder (HD) as a potential model for coordinating interdisciplinary teams of professionals within and outside mental health fields to advance scientific efforts to understand and resolve mental health problems. To identify, assess, and intervene with clients who have HD, psychologists, social workers, psychiatrists, and other service professionals are needed, including those in public health, housing, medicine, aging and protective services, fire, safety, and animal protection. Research findings and practice methods developed by many of my colleagues highlight the various skills of these diverse disciplines and fields. Of particular interest are multimethod assessments and CBT interventions that span individual, group, and family treatments, delivered in the office, at home and via the web by mental health and other professionals, as well as peers. Outcomes are positive, but there remains much work to do to improve understanding and intervention outcomes.