Do State Mental Health Plans Address the New Freedom Commission’s Goals for Children’s Mental Health?

The latest initiative to address mental health needs of the nation, including those of children and youth, is the President’s New Freedom Commission on Mental Health (NFC). The NFC formulated a benchmark of six goals and related recommendations toward which the U.S. should strive, including the recommendation that each state develop a comprehensive mental health plan. It is not clear, however, whether the states’ developed plans address the goals established by the NFC and to what degree. This project provides a summary of 50 state mental health plans regarding children and youth in the U.S. by examining components that address each of the six NFC goals and is a test of federal leadership on a state issue. Results indicate that state mental health plans addressed the NFC goals to differing degrees with specific attention to children and youth mental health services. Overall, the NFC goal of eliminating disparities in mental health services was addressed most completely, while the NFC goal of understanding that mental health and physical health are associated was addressed least often. The information provided by this analysis represents a first step in gaining a comprehensive picture about public policies for the mental health of children, adolescents, and their families.     

Ethnic Differences in Children’s Entry into Public Mental Health Care via Emergency Mental Health Services

For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care.     

Identifying the Common Elements of Treatment Engagement Interventions in Children’s Mental Health Services

Difficulty engaging families in mental health treatment is seen as an underlying reason for the disparity between child mental health need and service use. Interpretation of the literature on how best to engage families is complicated by a diversity of operational definitions of engagement outcomes and related interventions. Thus, we sought to review studies of engagement interventions using a structured methodology allowing for an aggregate summary of the most common practices associated with effective engagement interventions. We identified 344 articles through a combination of database search methods and recommendations from engagement research experts; 38 articles describing 40 studies met our inclusion criteria. Following coding methods described by Chorpita and Daleiden (J Consul Clin Psychol 77(3):566–579, 2009, doi:10.1037/a0014565), we identified 22 engagement practice elements from 89 study groups that examined or implemented family engagement strategies. Most frequently identified engagement practice elements included assessment, accessibility promotion, psychoeducation about services, homework assignment, and appointment reminders. Assessment and accessibility promotion were two practice elements present in at least 50 % of treatment groups that outperformed a control group in a randomized controlled trial. With the exception of appointment reminders, these frequently identified engagement practice elements had a high likelihood of being associated with winning treatments when they were used. This approach offers a novel way of summarizing the engagement literature and provides the foundation for enhancing clinical decision-making around treatment engagement.     

Parental Migration and Rural Left-Behind Children’s Mental Health in China: A Meta-Analysis Based on Mental Health Test

Parental migration has been an important predictor of left-behind children’s developmental outcomes. Based on the ecological model of rural left-behind children’s development, we systematically reviewed studies related to rural left-behind children’s mental health in China and investigated left-behind children’s mental health and its influencing factors. Thirty-two studies involving 28,629 participants met the inclusion criteria were included in our meta-analysis to compare mental health of left-behind children and non-left-behind children. Twenty-two studies involving 8,634 participants were included in gender difference meta-analysis. The results indicated that left-behind children report more mental health problems than non-left-behind children, left-behind girls were confronted with higher level of mental health problems than left-behind boys, left-behind children in primary school and junior high school reported more mental health problems than those in senior high school, and self-guardian children have more serious mental health problems than children guarded by grandparents, former generation, and single parent. Implications for future practice were analyzed from family, school, and government perspectives.     

The Effects of Parental Labor Migration on Children’s Mental Health in Rural China

Applied Research in Quality of Life - Utilizing data from the China Education Panel Survey, we investigated the effects of parental migration and its duration on children’s mental health in...     

Participatory Research in Systems of Care for Children’s Mental Health

The children’s system of care initiative in the United States requires the participation of caregivers of children with emotional or behavioral problems in conducting research and evaluation. This entails a restructuring of traditional power dynamics among families served by the community mental health system and other system stakeholders, including researchers. However, evidence indicates that system of care research may not currently embrace the different types of knowledge possessed by caregivers and may be frustrated by traditional power hierarchies, resulting in research findings that are not useful for the community. In this paper I examine a framework for power and knowledge and examine how, when viewed through this framework, participatory research in the system of care initiative thus far may be less than authentic. I conclude with improvements suggested by the framework that are expected to shift power to caregivers and result in more useful, actionable research findings for the community.     

The Impact of Parent Empowerment in Children’s Mental Health Services on Parenting Stress

Emotional and behavioral (EB) problems in children are associated with increased perceptions of strain in parenting. Among children receiving services, parenting stress has been linked to initiating services for their children, and may strain the relationship between parent and child. In contrast, parental engagement and empowerment in services is an important quality indicator for positive treatment outcomes. However, no known studies have examined the association between parent empowerment in their child’s services and their perceptions of stress related to parenting a child with significant mental health needs. Further, no studies have explored whether empowerment moderates the relationship between the child’s symptoms and parental perceptions of stress. The current study examined the impact of child EB problems and parent empowerment on parenting stress. Among a sample of 525 parents of children receiving school-based services for disruptive behavior disorders, child EB problems significantly predicted parenting stress. Parent empowerment also correlated with lower parenting stress, as hypothesized. Although parent empowerment was not found to moderate the relationship between child symptomatology and parenting stress, the relationship between parent empowerment and parenting stress differed based on child gender and age. Parent empowerment was associated with lower parenting stress more for parents of females and younger children than for parents of males and older children.     

Parental Participation in Religious Services and Parent and Child Well-Being: Findings from the National Survey of America’s Families

Using data from the 1999 and 2002 National Survey of America’s Families, a large-scale nationally representative sample, this study finds that parental religious attendance is positively associated with parent self-rated health, parent mental well-being, positive parenting attitudes, child health, and child school engagement. Although the strength of these associations varies to some extent according to socio-demographic factors, the interactive patterns are not consistently predictable. Moreover, parental health and well-being and positive attitudes toward parenting appear to be important pathways linking parental religious attendance to child well-being. These findings suggest that opportunities for participation in local religious services offered by faith-based organizations may be fruitful avenues through which the government and society can help American families enhance parent and child well-being.     

African Immigrant Parents’ Perspectives on the Factors Influencing Their Children’s Mental Health

Journal of Child and Family Studies - African immigrant children experience some of the poorest mental health outcomes in Canada, yet limited research has systematically mental health determinants...     

Parental Health and Children’s Functioning in Immigrant Families: Family Roles and Perceived Treatment at School

Although parents’ health condition is generally thought to be related to their involvement in their children’s functioning, the possible dynamics behind the scenes in school contexts with immigrant children has received little attention. This study examined the association between parents’ health condition and their children’s academic and behavioral functioning, as well as the mediation effects of parents’ school engagement and children’s perceived treatment at school among 607 immigrant families with 10- to 12-year-old children. Using structural equation modeling, the results indicated that parents’ poor health condition was associated with children’s increased behavioral problems. Parents’ school engagement fully mediated the association between parental health condition and children’s academic achievement and partially mediated the association between parental health condition and children’s behavior problems. Notably, higher levels of parents’ school engagement were associated with increased behavior problems, demonstrating a unique feature in these immigrant children’s developmental functioning. Higher levels of perceived harsh treatment by peers at school due to children’s immigrant identity were associated with these children’s greater risks of behavior problems. The results suggested what may lie behind the scenes in these children’s behavioral problems is that many of these children who act out and are brought to the school office for disciplinary issues may suffer from perceived discrimination and bad treatment by their peers. The findings provide important implications for researchers, healthcare practitioners, and educators seeking to understand this subpopulation and to design and implement family support and prevention programs for young adolescents from immigrant backgrounds.     

African American Children’s Racial Discrimination Experiences and Mental Health

Journal of Child and Family Studies - The current study examined how African American children’s experiences of perceived personal racial discrimination and perceived vicarious racial...     

The Impact of Latino Caregiver Acculturation on Treatment Engagement in Children’s Community Mental Health Services

Ongoing treatment engagement is low in children’s community mental health. Although concerns are more pronounced for racial/ethnic minorities, findings have been mixed when comparing racial/ethnic minorities with Non-Hispanic Whites. Within-group variability, such as level of acculturation, may be a more proximal predictor of treatment engagement. The current study aimed to examine the effect of Latino caregivers’ acculturation on ongoing treatment engagement indicators, specifically session attendance, premature treatment termination, and treatment satisfaction. Participants were families of youth, ages 5–15, with a Latino primary caregiver (N = 93) receiving treatment for anxiety/trauma, depression, or disruptive behavior problems in community-based mental health agencies. Caregivers were classified into low and high acculturation groups using latent class analysis based on demographic indicators, such as nativity status and primary language spoken. Groups significantly differed in terms of caregivers’ nativity status, age at immigration, primary language spoken, language of study assessment completion, and language spoken in the home. Families of low acculturation caregivers no showed to significantly fewer planned treatment sessions than families of highly acculturated caregivers. Treatment satisfaction did not differ between groups. Low acculturation families also had lower odds of prematurely withdrawing from treatment. Results of this study highlight the importance of considering family characteristics such as acculturation when engaging families in treatment.     

Psychological Androgyny and Children’s Mental Health: A New Look with New Measures

We evaluated Bem’s (1981, 1993) thesis that psychological androgyny—perceiving the self to possess characteristics of both genders—is associated with healthy adjustment and minimal gender-polarizing cognition. Prior studies testing Bem’s ideas have yielded ambiguous results, mainly because self-perceptions of gender-typed attributes have been inferred narrowly from self-perceptions of expressive and instrumental personality traits. We administered measures of gender identity (self-perceived similarity to a gender) that more clearly capture self-perceptions of attributes typical of a gender, and we examined conjoint influences of same-gender typicality and other-gender typicality on children’s self-esteem, internalizing problems, felt pressure for gender differentiation, and sexist ideology. Two studies were conducted with ethnically/racially diverse samples of preadolescent children in the southeastern United States. In Study 1 (N?=?305, M _age?=?10.8 years), androgynous children (i.e., children who saw themselves as similar to both genders) reported high self-esteem, evidenced few internalizing problems, and reported feeling little pressure for gender differentiation. In Study 2 (N?=?236, M _age?=?11.3 years), androgynous boys reported few sexist beliefs. Children with other patterns of gender identity (e.g., high same-gender typicality coupled with low other-gender typicality) sometimes showed similar correlates, but each other pattern of gender identity was associated with poor adjustment or strong gender-differentiating cognition on at least one dependent variable whereas androgyny never was. Results support Bem’s thesis that persons who perceive themselves as possessing characteristics of both genders enjoy mental health advantages over those who perceive themselves as possessing characteristics of only one.     

Future Directions for Advancing Issues in Children’s Mental Health: A Delphic Poll

The current study utilized a Delphic poll to identify significant problems regarding children and families in which psychologists can assist. The Delphic poll methodology combines both qualitative and quantitative methodologies to obtain information and predictions about the future from a panel of knowledgeable experts. Thirty-one professionals participated in the first round of the survey, and 26 participants (83.9 % of the round 1 participants) chose to complete the second-round survey. Several themes emerged consistently across questions as important issues to be addressed in the future of childhood mental health. For example, participants frequently identified access, advocacy, research and research dissemination, prevention/early intervention, and integration of services as important issues. Implications and recommendations are drawn for organizations and individual psychologists as advocates for improving children’s mental health in the United States.     

Evaluation of a Train-The-Trainers Model for Family Peer Advocates in Children’s Mental Health

Standardized training and credentialing is increasingly important to states and healthcare systems. Workforce shortages in children's mental health can be addressed through training and credentialing of professional peer parents (called family peer advocates or FPAs), who deliver a range of services to caregivers. A theory-based training program for FPAs targeting skills and knowledge about childhood mental health services (Parent Empowerment Program, or PEP) was developed through a partnership among a statewide family-run organization, state policy leaders, and academic researchers. Prior studies by this team using highly-experienced family peer advocates (who were also co-developers of the training program) as trainers found improvements in knowledge about mental health services and self-efficacy. In 2010, to meet demands and scale the model, a training of trainers (TOT) model was developed to build a cohort of locally-trained FPAs to deliver PEP training. A pre/post design was used to evaluate the impact of TOT model on knowledge and self-efficacy among 318 FPAs across the state. Participants showed significant pre-post (6 month) changes in knowledge about mental health services and self-efficacy. There were no significant associations between any FPA demographic characteristics and their knowledge or self-efficacy scores. A theory-based training model for professional peer parents working in the children's mental health system can be taught to local FPAs, and it improves knowledge about the mental health system and self-efficacy. Studies that evaluate the effectiveness of different training modalities are critical to ensure that high-quality trainings are maintained.     

Mothers’ Mental Health Treatment Associated with Greater Adolescent Mental Health Service Use for Depression

Despite concerns surrounding depression in adolescence and the existence of effective treatments, adolescent depression often goes untreated. In 2014, only 41.2% of adolescents experiencing a major depressive episode (MDE) received mental health treatment. Parents play a key role in adolescents’ treatment utilization. We examined whether among mothers with any mental illness, mothers’ utilization of mental health treatment was associated with greater likelihood of their adolescent children who experienced an MDE receiving mental health treatment. Using nationally representative data from the National Survey on Drug Use and Health (2008–2014), we performed logistic regression analysis to model the odds of adolescents (aged 12 to 17 years) with a past year MDE receiving any mental health treatment in the past year as a function of their mothers’ mental health treatment utilization in the past year, adjusting for control variables. The rate of adolescent treatment utilization was 66% when mothers had utilized treatment, as compared to 45% when mothers did not utilize treatment (p?<?0.001). The odds of an adolescent with an MDE receiving mental health treatment were two times greater when the mother received mental health treatment as compared to adolescents whose mothers did not receive any mental health treatment (OR?=?2.09, 95% CI [1.04, 4.17]). There was no effect of adolescent gender (OR?=?1.15, 95% CI [0.40, 3.28]) or interaction between gender and mothers’ treatment (OR?=?0.95, 95% CI [0.26, 3.46]). Barriers to adolescent mental health treatment may be lower when mothers receive mental health treatment.     

Predictors of Dutch and Finnish Children’s Satisfaction with Schooling

Considerable research has shown that there are clear links among satisfaction with schooling, overall life satisfaction, and physical and psychological well-being. In this investigation, we expand on that line of research by identifying the predictors of overall satisfaction with schooling of 331 Dutch and Finnish pupils aged 6–13. Similar to previous research, student age, student gender, and teacher likeability were strong predictors of students’ overall satisfaction with schooling. New findings from this investigation were that teacher gender and class size were significant predictors of overall satisfaction with schooling.     

Multiproblem Families Referred to Youth Mental Health: What's in a Name?

The purpose of this study was threefold, namely (1) to differentiate between multiproblem families and control families on characteristics and processes within the family based on a theoretical framework, (2) to identify multiproblem families by establishing cut‐off scores on various questionnaires, and (3) to categorize multiproblem families into subtypes by cluster analyses. Various questionnaires were administered to multiproblem families (n = 85) and control families (n = 150). Results showed that what we propose to refer to as multiproblem families present a broad range of problems on seven domains: (1) child factors, (2) parental factors, (3) childrearing problems (inadequate or inconsistent parenting), (4) family functioning problems, (5) contextual problems, (6) social network problems, and (7) mental health care problems. Further, reliable cut‐off scores were established for various questionnaires. Finally, three types of families were found: (1) community‐problem families, (2) multiproblem families, and (3) child‐focused mild‐problem families. This paper looks to advance an evidence‐based definition and assessment of “multiproblem families” suggesting the possible value of defining and assessing multiproblem families in relation to these seven dimensions. Moreover, the classification of multiproblem families stresses the importance of providing tailored treatments.