Moving from Principles to Practice: Recommended Policy Changes to Promote Family-Centered Care

This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by siblings of children with severe emotional disturbance and their caregivers. This discussion provides a springboard for policy recommendations to strengthen family support programming and enhance family-centered care, from modifying funding streams such that systems extend their reach beyond children with full-blown, diagnosable problems (those meeting standards of "medical necessity), to supporting prevention and early intervention initiatives that address families as targets for intervention. Recommendations include ensuring that communities with SOC funding address the needs of families; broadening Medicaid rules and definitions; expanding the range of reimbursable activities and services; and increasing funding for evaluating family-centered care models and family support programming.     

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.     

Ethnicity and the ethic of caring in african american families

Abstract

Several important demographic and economic factors have led to the shift in medical caregiving work from health care professionals to family members, primarily women. The growth in family caregiving has spawned numerous studies on how caring for the sick affects unpaid family caregivers. While caregiving work can be gratifying, most studies have focused on the negative effects, such as its adverse impact on the health and employment of caregivers. Only recently have we begun to expand this literature by examining the impact of ethnicity, specifically culture, on family caregiving. This study argues that African American families have retained specific cultural values and developed family systems which may lessen the negative impact of caregiving on families.     

共同养育研究及对儿童适应的影响

共同养育有别于个人养育, 在家庭系统中关注多个养育者共同抚养儿童的方式; 研究不同于婚姻关系、亲子关系的共同养育对儿童适应的独特贡献将有助于全面理解儿童在家庭生态系统中的成长过程。目前, 研究者们对共同养育的概念和内涵尚未有一致的界定, 共同养育的测量方法也未成体系。同时大量实证研究表明, 共同养育不仅直接影响儿童适应, 也通过亲子系统和婚姻关系系统间接影响儿童发展。未来的研究应结合中国社会文化背景下的特殊家庭类型如留守儿童家庭、离婚家庭、隔代养育家庭、服刑人员家庭的特点对共同养育的基本理论(如不同类型共同养育内部结构、评估体系等)问题以及对儿童适应影响的工作机制进行深入探讨。     

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

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

Becoming their mother: Knowledge,attitudes, and practices of orphanage personnel in Ukraine

Institutional caregiving can have adverse effects on children, yet little is known about the caregivers of institutionalized young children. We surveyed staff in three Ukrainian Baby Homes about their attitudes toward the nature of their work and the needs of the young children in their care. Seventy‐one caregivers completed anonymous, semistructured surveys. Popular reasons for working in Baby Homes included benefits and convenient work shifts, morality, and affection for children. Caregivers reported both favorable aspects of the work (enjoyment of children, professional satisfaction) and work difficulties (conflicts, lack of cooperation, little administrative support). In addition, they noted deficiencies in care: high caregiver–child ratio, frequent care disruptions, and lack of stimulation. Direct caregivers (in‐room “nannies,” educators, and nurses) and other providers (e.g., clinic nurses, physicians, therapists) differed in university‐degree attainment, professional motivation, enjoyment of children, professional satisfaction, and perceptions of self as substitute mother. A number of potential “windows for change” were identified, including recognition of deficiencies in institutional care and possibilities for improvement. Implications for interventions are discussed, including the need to consider lack of staff support, high emotional stress, internal conflicts, beliefs and attitudes about institutionalized children and their biological parents, and differences in staff educational achievement.     

Family therapy and social control with incestuous families

The family therapy and social control model describes first the relationship between unplanned change and developmental growth. With many families, the family therapist works to both provoke change and encourage growth. However, some out-of-control families present a level of danger to a family member that outside controls, such as child protective services, must be used. This model clarifies the complementary but independent roles of family therapy and social control in helping out-of-control families. Intervention with incestuous families is presented as illustrative of the model.My thanks to the staff of Child Protective Services, the Juvenile Court, Yuma Police Department, Yuma County Sheriff's Department, Adult Probation Department, and the staff and group members of Yuma County, Arizona Parents United for showing that shared concern about the well-being of children can make a real difference in working with families. My appreciation to William C. Nichols, EdD, Elora Cornille and Dale Brotherton for their helpful suggestions on a earlier version.     

Participation Patterns Among Mexican–American Parents Enrolled in a Universal Intervention and Their Association with Child Externalizing Outcomes

This study used growth mixture modeling to examine attendance trajectories among 292 Mexican–American primary female caregivers enrolled in a universal preventive intervention and the effects of health beliefs, participation intentions, cultural influences, and intervention group cohesion on trajectory group membership as well as trajectory group differences on a distal outcome, immediate posttest teacher report of child externalizing (T2). Results supported four trajectory groups—early terminators (ET), mid-program terminators (MPT), low-risk persistent attenders (LRPA), and high-risk persistent attenders (HRPA). Compared with LRPAs, caregivers classified as HRPAs had weaker familism values, less parenting efficacy, and higher externalizing children with lower GPAs. Caregivers in the two persistent attender groups reported strong group cohesion and providers rated these caregivers as having strong participation intentions. Children of caregivers in the LRPA group had the lowest T2 child externalizing. Children of caregivers in the MPT group had lower T2 externalizing than did those of the ET group, suggesting partial intervention dosage can benefit families. Despite high levels of attendance, children of caregivers in the HRPA had the highest T2 externalizing, suggesting this high-risk group needed either more intensive services or a longer period for parents to implement program skills to evidence change in child externalizing.     

Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.     

Caregiver perceptions of Parent Peer Support Services within the Wraparound Service Delivery Model

This qualitative study examined caregivers’ perceptions of Parent Peer Support (PPS) services, embedded in the Wraparound service delivery model for youth with severe emotional and behavioral disturbances (SEBD), to identify potential engagement facilitators and barriers. Wraparound is a holistic process involving multiple formal and informal providers to collectively implement an individualized, family-centered plan of care focused on maintaining youth with SEBD within the community. PPS are frequently referred to caregivers involved in Wraparound to provide additional support. Caregivers (n?=?35) previously involved in an evaluation of one state’s Wraparound model participated in a single 30–60-min interview. Interview questions examined caregivers’ expectations about PPS, reasons for accepting or refusing PPS, and caregivers’ perceived impact of PPS. Transcribed interviews were analyzed using strategies from grounded theory methodology. Perceived need, as well as desire for shared experiences, knowledge, and assistance in accessing resources, facilitated accepting the PPS service. Barriers included inaccurate expectations of PPS, time limitations on Wraparound services, escalating youth behavior requiring more restrictive placements, scheduling difficulties, perceived unresponsiveness, and caregivers feeling overwhelmed by the number of providers. Caregivers indicated that PPS provided several benefits for themselves, youth in the care, and their families. However, potential barriers to ongoing engagement included perceived intrusiveness, as well as misalignment between services offered and caregivers’ needs.     

Therapy with Families in China: Cultural Factors Influencing the Therapeutic Alliance and Therapy Goals

Rapid economic and social development in China is producing opportunities for a better standard of living for many families but also is associated with significant stress. Family therapy is one of the forms of mental health services that have become increasingly available. Western-derived models of family therapy are being used and adapted to meet the cultural traditions and needs of Chinese families. This article describes a variety of Chinese cultural factors that can influence the establishment of therapeutic alliances with family members (communication styles, collectivist values, family roles, and structure) and those that can shape family therapy interventions by addressing contextual factors affecting Chinese families (economic development, migration patterns, academic pressure, and changing gender roles for women). Suggestions are offered for using cultural sensitivity to address these factors tactfully to build strong therapeutic alliances and help families cope with significant life stresses.     

The Context of Caretaking in Rural Areas: Family Factors Influencing the Level of Functioning of Seriously Mentally Ill Patients Living at Home

After the deinstitutionalization of psychiatric hospitals, many families became primary caregivers for seriously mentally ill individuals. Mental health services became further reduced with the advent of managed care and reductions in health and mental health care. The dearth of community-care options often results in psychiatric patients being quickly stabilized in hospital units and discharged to live with their families. The lack of community resources is particularly acute in rural areas. Given these realities the current study sought to determine if family caretaking variables are related to patient outcomes. Family factors including the perception of burden, expressed emotion (EE), and primary caregivers’ social support were tested in a model of caretaking that examines the relationship between these factors and patients’ symptom expression and social and occupational functioning. The sample includes 49 predominantly African American families living in a rural area and with a chronically ill family member who had been previously diagnosed with a psychotic disorder. Primary caregivers and patients were interviewed using adapted measures of burden, EE, and social support. Patients were administered a revised version of the Brief Psychiatric Rating Scale. Results suggest less perceived burden, increased caregiver support and, to a lesser extent, EE explain approximately one-fifth of the variance in patient functioning. These results support previous research demonstrating the importance of family factors for seriously mentally ill patient outcomes. Results are discussed in terms of implications for assisting families in the current era of diminished resources.     

Parent-School and Community Partnerships in Children's Mental Health: Networking Challenges, Dilemmas, and Solutions

Inter-agency collaboration, service coordination, and the creation of successful partnerships among parents, teachers, and human services professionals continues to be a challenge for the development of responsive community-based systems of care for at-risk youth and their families. We explore how one inner-city neighborhood struggles to create successful community partnerships through traditional networking strategies. Our findings identify networking strategies that appear to work and those that do not. Recommendations for improving communication are provided.     

Systems of Care: New Partnerships for Community Psychology

For almost two decades, the federal government has supported the development of integrated models of mental health service delivery for children and families, known as systems of care (SOCs), that strive to be child-centered, family-focused, community-based, and culturally competent. These efforts align well with the values and principles (e.g., empowerment, collaboration, strengths emphasis, focus on macro-level social/system change) central to community psychology (CP; Kloos et al. in Community psychology, Cengage Learning, Belmont, 2012). Despite the convergence of many core values, CPs have historically been underrepresented in key roles in SOC initiatives. However, this has changed in recent years, with increasing examples of community psychology skills and principles applied to the development, implementation, and evaluation of SOCs. Because successful and sustainable implementation of SOCs requires community and system-level change, and SOCs are increasingly being urged to adopt a stronger "public health" orientation (Miles et al. in A public health approach to children's mental health: a conceptual framework, Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children's Mental Health, Washington, DC, 2010), there is great potential for CPs to play important roles in SOCs. This paper discusses opportunities and roles for CPs in SOCs in applied research and evaluation, community practice, and training.     

Competence, Risk, and Resilience in Military Families: Conceptual Commentary

This commentary highlights conceptual themes in the opening section of this special issue on military families in relation to a new synthesis of developmental systems theory that emerged from developmental, ecological, and family systems theory, as well as developmental psychopathology and risk/resilience frameworks. Articles in this special issue draw on these concepts to characterize and guide the burgeoning research on military families. This perspective emphasizes that multiple dynamic systems interact across levels to shape individual development, as well as the function of families and military units. Developmental timing is important for understanding how challenges of military life may impact individuals and families. Cascade effects are noted, where stress experienced by one family or service member can influence the function of other individuals or larger systems. Capacity for resilience is distributed across systems, including families and cultures, as well as resources or supports provided by military organizations to foster adaptive responses or recovery. These systems include schools and educational programs that play key roles in fostering and supporting resilience for children. Overall, developmental system concepts have considerable utility for guiding research with military families, particularly in regard to promoting resilience. Moreover, lessons learned from military families and programs may have much broader implications for many other nonmilitary children, families, and organizations that share similar goals and challenges.     

Changing the School Culture Toward Integrated Services

Summary

In this article, contemporary school culture is examined, as it relates to delivery of health and mental health services to children and families. Proposed changes are put forth that can help move from services as currently organized to integrated services as discussed herein.