Community-based Child Mental Health Services Research Articles

Parent mental health problems and motivation as predictors of their engagement in community-based child mental health services

Parent or caregiver engagement in child mental health treatment is an important element of treatment effectiveness, particularly for children with disruptive behavior problems. Parent or caregiver characteristics, such as their mental health and/or motivation to participate in treatment, may impact engagement and subsequent treatment outcomes. However, a lack of empirical research exists examining these potential links, particularly in community-based treatment settings. The current pilot study: 1) examines whether parent mental health problems and/or early parent motivation to participate in treatment predict three indicators of parent engagement in child treatment, controlling for the other predictor; and 2) examines and compares the differential influence of parent mental health and parent motivation on each parent engagement indicator. Participants in this study include 19 dyads from 18 therapists who were recruited from community mental health clinics. Results indicated a significant association between parent mental health and session attendance, and a marginally significant association between parent mental health and therapist-rated parent engagement. Parent mental health predicted outcomes above and beyond parent motivation. These findings preliminarily suggest that parent mental health problems early in child mental health treatment may be important to consider as an impactful target to promote parent treatment engagement, in addition to focusing on parent motivation to participate in treatment.

Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services.

Client engagement in services is a critical element of effective community-based child and family mental health service delivery. Caregiver engagement is particularly important, as caregivers often serve as gatekeepers to child mental health care and typically must consent for services, facilitate service attendance, and are often the target of intervention themselves. Unfortunately, caregiver engagement has been identified as a significant challenge in community-based child mental health services. To address this gap, the Parent And Caregiver Active Participation Toolkit (PACT), which includes therapist training and participation tools for caregivers and therapists, was developed. Stakeholders' perspectives regarding the delivery of interventions designed to improve the quality and effectiveness of community-based care are essential to understanding the implementation of such interventions in routine service settings. As such, this mixed methods study examined the perspectives of 12 therapists, 8 caregivers, and 6 program managers who participated in a community-based randomized pilot study of PACT. Therapists, caregivers, and program managers agreed that PACT was acceptable, appropriate, and feasible to use in community settings and that both changes in therapist practices and caregiver participation resulted from implementing PACT. Some variable perceptions in the utility of the therapist training components were identified, as well as barriers and facilitators of PACT implementation. Results expand the parent pilot study's findings as well as complement and expand the literature on training community providers in evidence-based practices. (PsycINFO Database Record

Using Observational Assessment to Help Identify Factors Associated with Parent Participation Engagement in Community-Based Child Mental Health Services.

Parent engagement in child mental health (MH) services has received growing attention due to its significance in intervention outcomes and evidence-based care. In particular, parent participation engagement (PPE) reflects active and responsive contributions in and between sessions. Yet, limited research has examined factors associated with PPE, particularly within community-based MH services where PPE is low and highly diverse families are often served. This study examined child, parent, and therapist factors associated with PPE in a sample of racially/ethnically diverse parent-child dyads receiving publicly-funded, community-based MH services. This prospective study included 18 parent-child dyads receiving community-based MH services from 17 therapists in five outpatient clinics for child disruptive behaviors. PPE was measured using in-session observational assessment of therapy recordings. Child factors that were examined included age, first time child MH service use, and intensity of child behavior problems. Parent factors included ethnicity, education, depression symptoms, and parent motivation to participate in therapy. Therapist factors included therapist training in parent-mediation interventions, attitudes towards organizational functioning, and attitudes towards parent participation strategies. Results from linear regression analyses indicated that first time child MH service use, intensity of child behavior problems, parent ethnicity and motivation to participate in therapy, as well as therapists' training and attitudes about their practice were each significantly associated with PPE. Results highlight specific child, parent, and therapist characteristics that may impact observed PPE in child MH therapy. These findings underscore the importance of considering the influence of family and provider factors on PPE in community-based child MH services.

The Parent Participation Engagement Measure (PPEM): Reliability and Validity in Child and Adolescent Community Mental Health Services.

Parent participation in community-based child mental health services is an important yet understudied process associated with treatment effectiveness. This paper describes the development and psychometrics of the Parent Participation Engagement Measure in a sample of 1374 parents and 563 youth receiving publicly-funded mental health services. Analyses indicated excellent internal consistency, and model fit indices/factor loadings supported a one-factor model. Convergent and discriminant validity were supported, although some coefficients were modest in magnitude. Psychometric results were consistent for Caucasian versus Hispanic, parent versus youth, and English versus Spanish-language respondents. The clinical and research utility of this measure are discussed.

Lithuania mental health country profile

As a part of international mental health policy, programmes and services project, the ‘country profile’ instrument was used for assessment of mental health policy and services in the Republic of Lithuania. Analysis of contextual factors revealed high levels of social pathology (including violence, suicide and other self-destructive behaviour) with stigmatizing approaches by the general population to mentally disturbed persons and other vulnerable groups. Analysis of existing data about resources invested in the mental health care system raises questions for policymakers about the effectiveness of this traditional way of investment. The largest proportion of physical and human capital is concentrated in psychiatric institutions, with large numbers of beds, psychiatrists and increasing funding for medications, while other components of care—such as housing, psychosocial and vocational rehabilitation, community-based child mental health services—are not being developed. Statistical accounts keep the tradition of presenting processes as outcomes, while modern assessment of outcomes of services, programmes and policies are lacking. The findings from this country profile may be very useful in the development of modern mental health policies in the countries of Eastern and Central Europe, which have been deprived for decades from the opportunity to introduce evidence-based mental health policies and services.

The development of a community child and family mental health service.

The Community Child and Family Service is a primary care and community-based child mental health service working in a socio-economically disadvantaged area of inner London. This paper outlines the strategic framework and value base from which the service has developed. The clinical projects set up by the service in general practice, community and education settings are described, as are the training and supervision programmes that have been undertaken. The framework for evaluating the clinical and economic outcomes of the projects is outlined. There has been a positive response from purchasers, providers and clients to the introduction of this Service. The relationship between community- and hospital-based child mental health services is discussed, as is the future direction of the Service.

A Description and Evaluation of a Community Child Mental Health Service

A community-based child mental health service was established for families of preschool children with emotional and behavioural problems in the children, psychosocial problems in the family or parenting difficulties. The intervention was home-based and conducted by health visitors and paediatric community medical officers trained in parent counselling, parenting issues and child behavioural management. The approach was based upon frameworks derived from counselling theory, with the intervention dependent upon the development of a trusting and respectful partnership with the parents. The aims were to promote and support the parents' own exploration of the identified problems, and to help them establish clear aims and effective problem management strategies. Ongoing supervision was provided by a clinical psychologist. The evidence indicated that the training course was acceptable to non-mental health professionals and effective in preparing them to work with psychosocial problems. The service was a feasible option for work at the community level; it was acceptable to both referrers and parents and beneficial for families living in a very deprived inner-city community.

The child advocacy concept: from a praiseworthy idea to practical demise.

S In the brief time since child advocacy has become a concept of national importance, there has been a meteonic rise in rhetoric and a less spectacular but more significant gain in the working understanding of the concept. However, in some cases the concept has been misapplied, undermining its usefulness and working against the interests of program development. It is necessary, therefore, to look at the programmatic effects of the exploitation of child advocacy. Child advocacy as a concept, a force, a political issue, a rhetorical weapon, and a funding ploy was and is easy to like. Its most simple translation is that someone on some group will do good on behalf of children. The critical question is, What happens in the doing? Unfortunately there has frequently proliferated a bureaucracy that serves to stifle efforts at service delivery, that drains off service funds for propaganda, that generates an antiprofessionalism, and that frequently tends to foster ill-informed controversy. The resultant obfuscation of the goal may be a reflection of society’s ambivalence toward children. In 1971, at a time when the mental health needs of children were being highlighted by the National Institute of Mental Health, the Massachusetts Mental Health Center prepared an elaborate proposal for comprehensive community-based child mental health services, incorporating community input. The MMHC catchment area is in Boston and serves a population of about 210,000 people ranging in socioeconomic class from utter poverty to great wealth. The area is urban with a diverse multiethnic, multisocial composition. It includes such institutions as Boston Children’s Hospital, Judge Baker Guidance Center, Beth Israel Hospital,