Reliability of self-reported service use: Test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA)

This paper reports on the reliability of children's responses on the Child and Adolescent Services Assessment (CASA) — a self-report instrument for use with 8– to 18-year-olds that gathers information about services used to address mental health problems. Findings were based on interviews completed by 77 children at a one week test-retest interval. Results showed that reports of lifetime service use were as reliable as were reports of service use in the preceding three months. Children reported restrictive and intrusive services more reliably than services that were provided in their natural environment. Reliability appeared to be associated more strongly with characteristics of the type of service than with characteristics of the child. Children also could report reliably on some details about their encounters with service providers (e.g., length of stay, number of visits, and onset of service use).     

Parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China

The objective of this study was to examine the relationship between parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China. In this study, cross-sectional data were collected from 755 AIDS orphans (296 double orphans and 459 single orphans), 466 vulnerable children living with HIV-infected parents, and 404 comparison children in China. The trusting relationship with current caregivers was measured with a 15-item scale (Cronbach's α?=?0.84) modified from the Trusting Relationship Questionnaire developed by Mustillo et al. in 2005 (Quality of relationships between youth and community service providers: Reliability and validity of the trusting relationship questionnaire. Journal of Child and Family Studies, 14, 577-590). The psychosocial measures include rule compliance/acting out, anxiety/withdrawal, peer social skills, school interest, depressive symptoms, loneliness, self-esteem, future expectation, hopefulness about future, and perceived control over the future. Group mean comparisons using analysis of variance suggested a significant association (p?相似文献   

Behavioral and Emotional Rating Scale: Two Studies of Convergent Validity

As the field of mental health services shifts its focus to early intervention, the need to develop valid and reliable measures of young children's behavioral functioning is clear. Traditional assessment instruments have focused on deficits, problems, and pathologies to the exclusion of strengths and competencies. However, assessing child strengths provides parents, direct service providers, and educators with a more holistic view of the child's functioning and an understanding of skills from which individualized treatment and education plans may be written. The Behavioral and Emotional Rating Scale (BERS; Epstein & Sharma, 1998) is a strength-based instrument designed to identify children's behavioral and emotional strengths. The psychometrics of the BERS has been demonstrated through several studies; however, the focus has mainly been on older age students. We sought to assess the convergent validity of the BERS with kindergarten children. The results of these two studies provide further support of the psychometric characteristics of the BERS and indicate its appropriateness with young children.     

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.     

Correlates of household smoking bans in low-income families of children with and without asthma

Exposure to secondhand smoke (SHS) harms all children's health, especially children with asthma. Yet, children with asthma are as likely to live with smokers as healthy children. Household smoking bans are being advocated to reduce children's harm from SHS. To measure the effect of household smoking bans on child SHS exposure and to examine correlates of strict smoking bans in a low-income, diverse sample, 91 children with asthma were matched to 91 healthy children. All had at least one smoker living in their homes. Nicotine dosimeters, child cotinine assays, and maternal reports quantified child SHS exposures. Maternal reports of household smoking rules, behaviors, and beliefs, and other family characteristics were also gathered. The presence of a strict household smoking ban vastly reduced children's SHS exposures and was associated with fewer cigarettes smoked by the mother and by other family members, the belief that SHS was a personal health risk, having children with asthma, and living in a single-family home. Many children are exposed to high levels of SHS at home. Strict household smoking bans greatly decrease, but do not eliminate children's SHS exposure. Even in disadvantaged families, mutable factors were associated with strict smoking bans. Increased dissemination and use of established public health strategies are needed to reduce children's SHS exposures.     

Psychological Distress in Orphan,Vulnerable Children and Non-Vulnerable Children in High Prevalence HIV/AIDS Communities

The degree of psychological distress and access social support is investigated in children (n = 741) living in nine high prevalence HIV/AIDS communities. They comprised (i) vulnerable, maternally-orphaned (n = 319); (ii) vulnerable and not orphaned (n = 276); and (iii) typically developing (n = 146). The following psychometric tests were administered: The Trauma Symptom Checklist for Children (Townsend, 2002); the Reynolds Depression Scale for Children (Reynolds, 1989); and the Social Support Scale (Beale Spencer, Cole, Jones & Phillips Swanson, 1997). Primary caregivers completed the Conners' Parent Rating Scale (Conners, Parker, Sitarenios, & Epstein, 1998) and an Adversity Index (Killian, 2004a) to establish the vulnerability status of each child. The data were analysed to distinguish the groups from each other regarding profiles of distress. The findings suggest that vulnerable children, be they orphaned or not, manifest similar degrees of emotional distress and perceived themselves as unable to access social support. Interventions should address the needs of both orphans and other vulnerable children, without prioritising the needs of orphans over other vulnerable children.     

Links between social network closure and child well-being: the organizing role of friendship context

Third grade children (N = 404) and their mothers completed questionnaires and participated in interviews designed to identify children's friendships across multiple contexts, determine levels of social network closure for these friendships, and assess child well-being. Cluster analyses revealed distinct patterns in the contexts in which children's friendships were maintained. Closure was highest for children whose friendship clusters heavily represented relatives as friends and lowest when friends were from schools and the broader community. Intermediate levels of closure were observed for the clusters of neighborhood friends and friends from church and school. Both friendship cluster and, to some extent, ethnicity moderated associations between closure and indicators of well-being.     

Characteristics of Adult Caretakers of Children and Youth Served by an Urban Child Welfare Agency

The child welfare system of the early 1990s was marked by the proliferation of home-based services. Research on the effectiveness of various home-based interventions indicates results have been equivocal. The need to make explicit the specific characteristics of the adults and children targeted for home-based services, particularly families from diverse cultural backgrounds, has been identified as a critically needed contribution to the literature. In this study, the characteristics and service utilization experiences of adults and families served in an urban, home-based, child welfare program was examined. The results are discussed in relation to findings on the characteristics and experiences of adults and families served in other settings. Implications for future research and service delivery are discussed.     

Child, Family and Case Characteristics: Links with Service Utilization in Physically Abused Children

We investigated the relationships between child, familial, and case characteristics and mental health and medical health care service utilization by physically abused children. Participants included 26 parents or caregivers of 37 Medicaid-eligible children who had substantiated cases of physical abuse. Children whose female caregivers reported a greater number of stressors were more likely to receive mental health care. Furthermore, children not living with the maltreating caregiver were more likely to receive medical health care services. Results are discussed in terms of factors that may account for these links, and the similarities of these findings with those of service utilization in general and clinical child samples.     

A project to strengthen linkages between genetic centers and child welfare services

Genetic centers are reaching out to underserved populations. One of the most vulnerable underserved populations is children receiving child welfare services. Delivering genetic services to this group is particularly problematic because of multiple barriers. The first step in overcoming barriers is developing linkages between the genetic and adoption service systems with the goal of increasing referrals of child welfare clients to genetic services. This paper presents a model of fostering linkages that was developed under the auspices of the Mid-Atlantic Regional Human Genetics Network with support from the Maternal and Child Health Bureau, Genetic Services Branch. Although the project was regional and funded, the model can be applied at the local level.     

Predictors of Treatment Engagement for Young Children Exposed to Violence

This study examined factors associated with treatment engagement and child outcomes in 1,365 children receiving community-based services for exposure to violence. Data were collected on children and families who completed an intake interview. Children were categorized into groups based on whether they attended any therapy sessions after the intake, terminated prematurely from therapy, or completed treatment. Results demonstrated that child emotional and behavioral problems at intake, general parent stress, and income did not differ by treatment engagement. Type of violence exposure, parent–child stress, and race differed by category of treatment engagement. Strategies from Safe From the Start service providers to increase treatment engagement are included in the discussion.     

Perceptions Among Child Welfare Staff when Modifying A Child Mental Health Intervention to be Implemented in Child Welfare Services

In order to increase access to child mental health evidence‐based interventions (EBIs) for vulnerable and hard‐to‐engage families involved in the child welfare (CW) system, innovative approaches coupled with input from service providers are needed. One potential solution involves utilizing task‐shifting strategies and implementation science theoretical frameworks to implement such EBIs in CW settings. This study examined perceptions among CW staff who were members of a collaborative advisory board involved in the implementation of the 4Rs and 2Ss Strengthening Families Program (4R2S) in CW placement prevention settings, utilizing task‐shifting strategies and the Practical, Robust, Implementation, and Sustainability Model. Advisory board members reported difficulties in engaging families, heavy workloads, and conflicting implementation initiatives. While 4R2S was perceived as generally aligned with their organization's mission, modifications to the intervention and to agency procedures were recommended to promote implementation success. Suggested modifications to the existing 4R2S training and supervision are discussed. Findings underscore the importance of understanding the experiences of CW service providers, which can inform future efforts to implement child mental health EBIs in CW services.     

Long Term Outcomes to Family Caregiver Empowerment

The Vanderbilt Caregiver Empowerment Project evaluated a training program designed to enhance empowerment of caregiver and their subsequent involvement in the mental health treatment of their children. The intervention utilized a multi-component parent training curriculum that was designed to enhance: (a) knowledge of the service system; (b) skills needed to interact with the mental health system; and (c) the caregiver' s mental health services self-efficacy designed to improve caregivers beliefs in their ability to collaborate with service providers. The resulting increased empowerment was hypothesized to increase caretaker involvement, which should affect service use and ultimately the mental health status of the child. A randomized design was used to test the effectiveness of this model with caregivers of children receiving mental health services. The results one-year after the training replicated the intermediate outcomes of the project conducted 3-months after the training. The initial training continued to significantly influence the parent's knowledge and mental health services self-efficacy. However, the intervention had no effect on caregiver involvement in treatment, service use or the mental health status of the children.     

“Caught in the Same Webs”<Emphasis Type="Italic">—</Emphasis>Service Providers’ Insights on Gender-Based and Structural Violence Among Female Temporary Foreign Workers in Canada

Drawing on the experiences of service providers supporting live-in caregivers and migrant agricultural workers in two Canadian provinces (Ontario and Quebec), we explore how structural violence shapes the precarious conditions of female temporary foreign workers. Service providers emphasized how transnational social pressures on women to maintain employment, the captivity involved in women’s employment contracts, the limits on unionization, and women’s isolation and lack of privacy, act together to create an unbalanced relationship between the employer and female worker. In turn, this leads to precarious migration and work conditions that foster a vulnerability to violence and abuse while at the same time limiting access to and delivery of services and social support to female temporary foreign workers. Amid these restrictions, service providers focus on making a difference where they can through initiatives such as human rights education workshops, offering support, understanding Canadian regulation, and empowerment workshops. Greater Canadian national options for permanent residency status could provide a basis for adequate services to temporary foreign workers as part of their universal human rights. Temporary foreign workers contribute to Canadian society, making it encumbant upon the Canadian state to ensure the respect of their universal human rights.     

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.     

Lorenz Curves: A New Model for the Distribution of Psychiatric Services

The growth of child and adolescent psychiatric services based on the wraparound philosophy raises new questions for medical directors, investigators, and clinicians interested in improving quality of care and outcomes. Typically, quality improvement studies have focused on standardizing care and decreasing variation while community based services following a wraparound model are by definition individualized. To date, little information on how to evaluate such services in a managed care environment has been available. We present one option for evaluating the distribution of medical services and the extent to which providers individualize services for children with severe emotional disorders. Specifically, we (a) review the philosophy and goals of wraparound services, (b) introduce the Lorenz curve as a tool for determining the degree of inequality in service distribution at a given institution, and (c) present a case study on the use of Lorenz curves by a Medicaid Behavioral Health Organization in profiling behavioral providers.     

An ecological approach to child and family clinical and counseling psychology

The ecological model of child and family clinical and counseling psychology considers mental health service delivery within a health maintenance framework, approaching the complexity of children's behavior in a systematic and organized fashion using science-based intervention practices. The service delivery framework integrates assessment, intervention, and motivation at all phases of an intervention. Assessments enhance the participants' and professionals' appraisal, which in turn impact motivation to change. Interventions are sensitive to assessment-based targets and participant motivation. A menu of interventions range from assessment, feedback, and brief interventions to more extensive mental health services, potentially integrated with other community agencies and school settings. The ecological model suggests revisions in the conceptualization of child and adolescent psychopathology, training for mental health professionals, and strategies for the design and testing of interventions. In general, a reformulation of mental heath services for children and families within an ecological framework enhances the potential for integrating science and practice.     

Social Validity of a Training and Coaching Program for Parents of Children With Autism Spectrum Disorder on a Waiting List for Early Behavioral Intervention

Due to limited public resources, many children with autism spectrum disorder and their families must wait several months, if not years, to access early behavioral intervention (EBI) services. Service providers must thus develop alternative support models to assist families placed on waiting lists. The present study assessed the social validity of one such initiative, a training and coaching program for parents whose children had been put on a waiting list for EBI services. This program consisted of group training sessions on strategies to cope with their child’s disorder based on applied behavioral analysis and on one-hour, weekly follow-up meetings to support parents’ interventions with their child over the course of 12 months. Social validity was assessed through parental satisfaction with this program and their perception of its effects on themselves, the family, the child, and parental stress. The 94 participants were generally satisfied with the program overall, although they wished for more frequent and intensive interventions. They reported that the program had positive effects on their psychological well-being, their family’s quality of life, and their child’s behavior. However, parenting stress levels were found to have increased over the 12-month period. These results demonstrate that training and individually supporting parents can be beneficial for families of children with ASD who cannot have access to early behavioral intervention immediately upon receiving a diagnosis. Importantly, however, these lower-cost, parent-focused programs cannot be considered a substitute for more intensive and children-driven services.     

Help-Seeking Behaviors in Non-Offending Caregivers of Abused Children in the Philippines

The help-seeking process among non-offending caregivers (NOCs) of abused children particularly in the non-Western context has yet to be elucidated. The objective of the current study was to investigate what proportion of Filipino NOCs of abused children sought professional support services within 12 months following child abuse disclosure (T1) and at 12 months (T2) follow-up in the Philippines. Two further aims were to investigate NOCs’ preferred service providers and settings and to explore barriers to help-seeking. A comparison group of Filipino parents without an abused child were also recruited to compare preferences and potential barriers to help seeking for child and family problems. A total of 47 NOCs and 70 comparison parents/guardians completed questionnaires, which assessed help-seeking preferences and barriers as well as parental stress. The majority of NOCs reported seeking help, which was perceived to be helpful. Almost two thirds of NOCs indicated preference for in-person counseling relative to the comparison group of parents. The majority of NOCs preferred seeking help from social workers and psychologists. Almost one third of both parental samples reported being judged as an unfit parent as a key barrier to seeking help for family problems. The findings have implications for psychological and allied health service providers in facilitating the adjustment for families of recently abused children.     

Meaningful involvement of people living with HIV/AIDS in Uganda through linkages between network groups and health facilities: an evaluation study

While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a three-year project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience--ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations--can benefit from the lessons learned.