Search

Classifications and concepts of insanity during the nineteenth century were constructed by numerous professional, quasi-professional and lay observers. Consequently, ideas of mental ill health and its causes were varied. This article explores how 'insanity' in children was observed, explained and evolved following 1845. It focuses on medico-cultural exchanges between families and doctors to plot shifts in how child mental health was understood. Numerous causes of insanity were given at admission including terrifying dogs, out of control lunatics and even visits to the zoo shocking expectant mothers so severely that they produced mentally-imperfect children. Such narratives were superseded by a dialogue that still included the family and their ideas, but also served the professional and intellectual agenda of medical men in consolidating their expertise over the insane. The article examines varied ideas of insanity, highlights the importance of the family in influencing medical understanding and introduces the experience of asylums for children. [ABSTRACT FROM AUTHOR]

Parents with a mental illness, especially single mothers, who are caring for their children are particularly vulnerable to social isolation, stress, financial hardship, and lack of resources. Prevention and strengths-based interventions are needed for mothers with serious mental illness and their children. Current mental health interventions tend to focus on the individual without respect to family context and do not address parenting needs or support for both the parent and child. The literature indicates mothers with a mental illness and their children should be considered a high-risk group in need of more intensive and more frequent mental health supports. One alternative for more frequent mental health support is through the peer support specialist model. Although the peer support specialist model is a nationally recognized evidence-based practice, research is limited on identifying the program and service needs of parents with mental illness from a peer support specialist perspective. This study implemented an exploratory investigation to identify life stressors and specialized programs and service needs for parents with mental illness from a peer support specialist perspective. Results of this study identified support groups for parents with mental illness and for youth/young adults with a parent with a mental illness as the highest level of need. Results also found a need for peer support specialists to be paired with individuals based on mutual characteristics of parental status and identification of having a parent with a mental illness. [ABSTRACT FROM AUTHOR]

The central thesis of this paper is that treatment of neglected children can better take place in a caring relationship than in psychotherapy or analysis. In order to create the basis for this idea, Part 1 introduces a milieu therapy for neglected children, developed by the author. In Part 2 of the article, it is proposed that treatment in a caring relationship is in line with the child's dependence on a caring person. It is also argued that the traditional distinction between problems in the child's environment and internal psychological difficulties seems imprecise. Instead, it is proposed that a problem has both an external and an internal aspect. This supports the idea that it may be possible to solve problems that are traditionally considered internal through environmental strategies, for example milieu therapy. The article is hypothesis-generating and builds upon clinical experience inspired by works of, among others, Erikson, Bowlby, Winnicott, and Fonagy and collaborators. Part 1 of the article is the first presentation in English of the main points of the author's books on milieu therapy. The ideas in Part 2 are published here for the first time. [ABSTRACT FROM PUBLISHER]

Background: Insecure attachment styles have received theoretical attention and some initial empirical support as mediators between childhood adverse experiences and psychotic phenomena; however, further specificity needs investigating. The present interview study aimed to examine (i) whether two forms of poor childhood care, namely parental antipathy and role reversal, were associated with subclinical positive and negative symptoms and schizophrenia-spectrum personality disorder (PD) traits, and (ii) whether such associations were mediated by specific insecure attachment styles. Method: A total of 214 nonclinical young adults were interviewed for subclinical symptoms (Comprehensive Assessment of At-Risk Mental States), schizophrenia-spectrum PDs (Structured Clinical Interview for DSM-IV Axis II Disorders), poor childhood care (Childhood Experience of Care and Abuse Interview), and attachment style (Attachment Style Interview). Participants also completed the Beck Depression Inventory-II and all the analyses were conducted partialling out the effects of depressive symptoms. Results: Both parental antipathy and role reversal were associated with subclinical positive symptoms and with paranoid and schizotypal PD traits. Role reversal was also associated with subclinical negative symptoms. Angry-dismissive attachment mediated associations between antipathy and subclinical positive symptoms and both angry-dismissive and enmeshed attachment mediated associations of antipathy with paranoid and schizotypal PD traits. Enmeshed attachment mediated associations of role reversal with paranoid and schizotypal PD traits. Conclusions: Attachment theory can inform lifespan models of how adverse developmental environments may increase the risk for psychosis. Insecure attachment provides a promising mechanism for understanding the development of schizophrenia-spectrum phenomenology and may offer a useful target for prophylactic intervention. [ABSTRACT FROM AUTHOR]

Economic evaluations are increasingly used in decision-making. Accurate measurement of service use is critical to economic evaluation. This qualitative study, based on expert interviews, aims to identify best approaches to service use measurement for child mental health conditions, and to identify problems in current methods. Results suggest considerable agreement on strengths (e.g., availability of accurate instruments to measure service use) and weaknesses, (e.g., lack of unit prices for services outside the health sector) or alternative approaches to service use measurement. Experts also identified some unresolved problems, for example the lack of uniform definitions for some mental health services. [ABSTRACT FROM AUTHOR]

Children with developmental delays (DD) are at heightened risk for developing clinically significant behavioral and emotional difficulties as compared to children with typical development (TD). However, nearly all studies comparing psychopathology in youth with DD employ TD control groups of the same chronological age (CA). It is unclear, then, whether the heightened symptomology found in age-matched children with DD is beyond what would be expected given their developmental level. The present study assessed rates of behavior problems and mental disorder in 35 children with DD at age 9 years. These were compared with rates from 35 children with TD matched for CA at age 9 and also earlier rates for these same children at age 6, when matched for mental age (MA). Children with DD had significantly more behavior problems in 7 of the 17 scales of the CBCL when compared to TD children matched for CA, and 6 of 17 scales when compared to the MA-matched group. Rates of meeting DSM-IV criteria for a psychiatric disorder were significantly higher in the DD group than both the CA- and MA-matched TD groups for three and four, respectively, of the seven diagnoses examined. Descriptively, the mean ratings for all variables assessed were higher for the DD group than both TD comparison groups, with the exception of the Anxious/Depressed scale of the CBCL. These findings validate the heightened risk for clinically significant behavior problems and mental disorders in youth with DD above and beyond their developmental functioning. [ABSTRACT FROM AUTHOR]

The article discusses the problems that are associated with situations where a single agency has the sole discretion to file petitions for children in need of services in Indiana, and it mentions the Indiana Department of Child Services and the proper care and treatment of children with mental health and behavioral illnesses and disorders in the state. Services for vulnerable children are examined, along with Indiana's child welfare system and state legislative proposals to help children.

Purpose – The aim of this paper is to assess information needs and information seeking behaviour of parents and caregivers of children with mental illness at the Kilimanjaro Christian Medical Centre (KCMC) in Tanzania. The study mainly assessed the information needs of parents and caregivers of children with mental illness, their preferable sources of health information, and their constraints on information seeking. Design/methodology/approach – This study used a case study research design, where 168 structured questionnaires were distributed to parents and caregivers of children with mental illness at the Neurological Pediatrics Outpatient Clinic of KCMC. The rate of response was 89.3 per cent. Findings – The study found that health information needs of parents and caregivers were mainly associated with health care (for example, nutrition, treatment) and health education. Parents and caregivers of children with mental illness used the internet as the main source of information about their children's health, which was followed by printed books and television. Health information seeking behaviour appeared similar across gender categories, but there were differences on the use of print and electronic information sources according to age and level of education. The main factors that hindered access to health information included low level of education, lack of funds and health information illiteracy. Practical implications – The paper provides useful suggestions that would facilitate information seeking and use among parents and caregivers of children with mental illness in Tanzania and other countries with similar conditions. Originality/value – Previous studies on the topic are scanty and, therefore, the paper provides important insights into the information needs and information seeking behaviour of parents and caregivers of children with mental illness in a developing country setting. [ABSTRACT FROM AUTHOR]

In this article, changing treatment ideologies and policies in child psychiatric outpatient services in Sweden from 1945 to 1985 are examined. The aim is to discuss the role played by psychoanalytic and psychodynamic thinking in this process of change. When mental health services for children were introduced in the mid-1940s, psychoanalytic thinking was intertwined with the social democratic vision of the Swedish welfare state in which children symbolized the future. In practice, however, treatment ideology was initially less influenced by psychoanalytic thinking. From the early 1960s, child psychiatric services expanded and the number of units increased. By then, the political vision had disappeared, but a treatment ideology began to evolve based on psychodynamic theories, which became dominant in the 1970s. [ABSTRACT FROM PUBLISHER]

Background: An instrument was developed in Canada to assess impairments related to oral functioning of individuals with four years of age or older with Down syndrome (DS). The present study attempted to carry out the cross-cultural adaptation and validation of the instrument for the Brazilian Portuguese language and to test its reliability and validity. Findings: After translation and cross-cultural adaptation, the instrument was tested on caregivers of people with DS. Clinical examination for malocclusion was carried out in people with DS by two calibrated examiners. Inter and Intra examiner agreement was assessed by Intraclass Correlation Coefficient (ICC) and ranged from 0.92 to 0.97 respectively. Total of 157 people with DS and their caregivers were able to compose the sample. They were selected from eight institutions for people with DS in five cities of southeastern Brazil. The mean age of people with DS was 20.7 [±13.1] and for caregivers was 53.1 [±13.7]. The mean instrument score was 18.6 [±9.0]. Internal reliability ranged from 0.49 to 0.80 and external reliability ranged from 0.78 to 0.88. Construct validity was verified by significant correlations identified between malocclusion and the total instrument; and caregivers' educational level and the instrument (p<0.05). Discriminant validity was proved as the instrument presented different mean comparing people with DS and non-DS (p<0.05). Conclusions: Initial validity tests indicated that the instrument related to the oral health for people with DS may be a valid instrument to this segment of the population in Brazil. [ABSTRACT FROM AUTHOR]

In contrast to the artificially determined limitations imposed by managed behavioral health networks, thorough treatment planning with very disturbed children and adolescents entails sustained assessment and recognizing that symptoms are multidimensional expressions of diverse, interacting developmental pathways. Meaningful psychotherapy with psychotic children and adolescents has to be guided by the individual patient's idiosyncratic characteristics and vulnerabilities across domains of functioning. Comprehensive treatment for youth with psychotic features requires flexibility about the need for long-term psychotherapy, openness to the value of integrating psychoanalytic formulations and cognitive behavioral strategies, and an appreciation of the primacy of the psychotherapeutic relationship. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this research was to examine the factors associated with various levels of engagement with mental health services in a large sample of mothers at high risk of maltreating their children. Methods: Data were collected by LONGSCAN (the Consortium for Longitudinal Studies of Child Abuse and Neglect) for 909 mothers of six-year-old children. These women reported on recent use of mental health services, with four levels of engagement: no use of services (76%), consideration of services (8%), use of and dissatisfaction with services (4%), and use of and satisfaction with services (11%). Logistic regression analyses were conducted to predict level of engagement in services. Results: Predictors of considering services included being formerly married, previous receipt of services, physical victimization, psychological intimate partner victimization, and depressive symptoms. Predictors of satisfaction with services were social support and lack of sexual victimization. Conclusions: It is important to take a broad approach to assessing mental health needs, including not only current functioning, but social networks, prior experiences with services, and trauma exposure. Further research is needed on the process of engagement in mental health services, including examination of the factors associated with satisfaction with these services. [ABSTRACT FROM AUTHOR]

The article presents a case study examination into the efficacy of preventative intervention for mentally ill parents in order to assist in the treatment and minimization of negative impacts on the mental health of their children. 13 clinical trials involving over 1,490 children are reviewed and analyzed. Methodologies used and results found are listed. Concluding statements affirming the efficacy of the interventions are also included.

This qualitative study explores person-centered practitioners' perceptions of what is helpful in their work with clients who experience psychotic processes and the impact that they believe this practice has on their clients. In-depth interviews with 20 British person-centered practitioners focused on how they worked with clients who experienced psychotic process, what they perceived as helpful, and how they believed these practices helped their clients. Analyses used a grounded theory approach. In addition to standard person-centered therapy, practices with this client group often incorporated Pre-Therapy and other elements acquired through advanced training. Emerging themes in perceived useful practice included "getting beyond labels and illness" and "working with particular care and attention." Results suggest the importance of specific therapeutic conditions, especially unconditional positive regard. The perceived therapeutic change most often described was increased social adjustment. Some clients were also perceived by therapists as showing lessened risk of harm to self or others and improvement in self-awareness, mood, resilience and other areas. [ABSTRACT FROM AUTHOR]

In this article we discuss the necessity of fully informing patients and their families of what constitutes physical interventions and their attendant risks under the established principles and obligations of informed consent. After a brief review of the elements of informed consent and the nature of the duty to advise patients and their families of treatment risks, we argue that physical interventions are an unvalidated treatment for aggressive and violent behavior and should be used only as a safety intervention. We focus our discussion on the informed consent issues for school aged children, adolescents, and emancipated minors and contend that if restraints are used they must pose less risk than the behavior they are trying to alleviate. We also opine that if restraints are misused by mental health or child welfare treatment settings, then their misuse may be considered a subject of a patient maltreatment, abuse, criminal or civil action. A central thesis of the article is that informed consent must be seen as an integral and dynamic process of treatment. We recommend strategies that gain parental permission and child assent, that view informed consent as a dynamic and individualized process that aids and supports the therapeutic relationship, and that stress the importance of simplicity and clarity. [ABSTRACT FROM AUTHOR]

Objective: This study examined parents and clinicians' use in treatment sessions of routinely collected information on child functioning for children receiving ambulatory mental health treatment. Methods: Information was obtained from 1,215 Child Outcomes Surveys completed at ten provider organizations. The Child Outcomes Survey is a collaboratively developed brief strength-based measure of child functioning and therapeutic relationship. This study examined parent-clinician discussion of information obtained in the survey from the previous session. Chi square tests were used to examine the association between sóciodemographic and clinical covariates and parent-clinician discussion of information. Results: In the measure that assessed the extent to which parents discussed the information about their child's functioning in the prior session with their clinician, 61% of parents reported high levels of discussion, 25% of parents reported moderate levels of discussion, and 14% reported low levels of discussion. Parents of boys, Latino children, and children of "other" races were significantly more likely to report high levels of discussion than other parents. Levels of discussion about the results of the previous Child Outcomes Survey were positively and significantly associated with successful child functioning and therapeutic relationship with clinicians. Conclusions: The findings of high rates of use of outcomes data routinely gathered with a very brief measure are encouraging given prior reports of challenges in using such information in treatment sessions. The successful treatment of children and families requires an ongoing and effective partnership between parents and clinicians, and the results suggest how important routine conversations about the progress of children in treatment can be. Further research is needed to understand the impact of gathering and using such data on the process and outcomes of mental health treatment for children and families. [ABSTRACT FROM AUTHOR]

Research findings on family psychoeducation as evidence-based treatment for serious mental illnesses and benefits for families of peer-led family education groups are presented. Because major psychiatric disorders frequently are long term with episodic crises, caregivers have ongoing needs for support to enhance time-limited interventions. This article describes a continuous psychoeducational family support group that gives prolonged assistance and also helps problem families who reject family therapy. Three case examples are given of such families and the contributions of the group in effecting change. It is suggested that mental health systems incorporate psychoeducational support groups for family caregivers in standard practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The uptake of new antipsychotic medications among children has not been studied adequately. Although ziprasidone received Food and Drug Administration approval for the treatment of psychotic disorders among children in June 2009, it first became available for off-label use by children in 2001 and presented an excellent case study for off-label market entry. The objective of this study was to determine the pattern of initiation and switching for off-label use of ziprasidone among Michigan children who were insured by Medicaid in the first year that ziprasidone was available. METHODS: We conducted a retrospective study by using Michigan Medicaid data for patients who were aged <21 years and had 2 years of continuous enrollment and at least 1 prescription for ziprasidone in the first year the medication was available. The main outcome mea- sures were proportion of children prescribed ziprasidone as their first antipsychotic, with evidence of treatment resistance, and by a psychiatrist. RESULTS: In the first year, 292 individuals who met criteria were prescribed ziprasidone. Approximately 53% had a diagnosis of psychosis. Explosive personality disorder and oppositional defiant disorder were the next most common diagnoses. For 33% of individuals, this was the first antipsychotic medication. Only 12% of individuals showed evidence of treatment resistance to other antipsychotic medications before switching to ziprasidone. CONCLUSIONS: During the period when ziprasidone had no approved pediatric usages, a small percentage of patients who were prescribed ziprasidone showed evidence of treatment resistance, the primary expected indication. Some prescribing for ziprasidone in the first year in this population could be considered inappropriate considering what was known about the safety and efficacy of ziprasidone in children and adolescents atthetime. "Fail first" and prior authorization policies may be appropriate in the first year a medication is available so as to protect children from potential serious harm. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess trends in treatment intensity in outpatient child and adolescent mental health services (CAMHS) in Norway from 1998 to 2006. During this period, Norway experienced substantial growth in available CAMHS resources. In 2002 hospital ownership was recentralized and health enterprises were established. Methods: A nonexperimental, interrupted time-series design was used to estimate trends adjusted for patient case mix and CAMHS size. From a panel of 37 CAMHS units, two subsamples were extracted. These patients (N=94,173) were aged 0-17 years and had participated in at least one treatment session with a therapist (direct consultation) during the year of observation. Direct and indirect consultations (appointments with co-operating services) were separately analyzed with multilevel regression analyses. Results: Patient-level factors were the main sources of variation in number of consultations. CAMHS unit size was positively associated with direct consultations in both subsamples. A trend of increased direct consultations was observed in one subsample. Comparing the period 2002-2006 with 1998-2001 revealed a positive shift in treatment intensity for both consultation types in both subsamples. Trends and shifts differed between patient groups according to the main reason for referral and gender. Conclusions: The main health policy objective during the study period was increased access to mental health treatment. Both access and treatment intensity increased. The study was inconclusive about whether incentives related to CAMHS performance measurement caused treatment intensity to increase, specifically after the 2002 hospital ownership reform. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study is to generate a theory of meaning of care-giving for parents of mentally ill children in Taiwan. Background. Studies indicate that the meaning of care-giving plays an important role in the psychological adjustment of care-givers to care-giving. With a positive meaning of care-giving, care-givers can accept their roles and adapt to them more readily. Design. The research employs the qualitative method of grounded theory, the inquiry is based on symbolic interactionism. Methods. Twenty parental care-givers of children with schizophrenia were recruited at a private hospital in central Taiwan. Semi-structured interviews were conducted. A comparative method was used to analyse the text and field notes. Results. Responsibility (zeren) emerges as the core category or concept. Responsibility expresses broadly the behavioural principles that are culturally prescribed and centred on familial ethics and values. Related concepts and principles that influence caregiver actions and affections include a return of karma, challenges from local gods and fate. By maintaining their culturally prescribed interpretations of care-giving, parents hope to give care indefinitely without complaints. Conclusions. The findings clearly suggest that the meaning of care-giving is determined through a process of internal debate that is shaped by culturally specific concepts. The paper attempts to explain some of these culturally specific determinants and explanations of care-giving behaviour. Relevance to clinical practice. The theory contributes knowledge about the meaning of care-giving for parents of mentally ill children in Taiwan. It should be useful reference for mental health professionals, who provide counselling services to ethnically Taiwanese care-givers. [ABSTRACT FROM AUTHOR]

The number of children taking psychotropic medications has dramatically increased in recent years. These children typically take medication during school hours, thereby making the school setting an optimal venue in which evaluate the effectiveness of medications. Given their training in data-based decision making, intervention, and assessment, school psychologists should be involved in the evaluation of medication effectiveness in children at school. However, many school psychology programs do not offer formal training in psychopharmacology. This article describes the American Psychological Association and National Association of School Psychologists standards for psychopharmacology training. Additionally, the article details how school psychologists can use the behavioral consultation model, described by Kratochwill & Bergan (1990) to evaluate the effectiveness of medications. Legal and ethical considerations are also discussed. © 2009 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

In this article, we present a balanced view of the prescriptive authority debate in relation to five major issues and within the context of the practice of psychology in the schools: (a) appropriate training, (b) quality of care, (c) access to services, (d) continuity of care, and (e) professional identity. We also provide an analysis of the quality and relevance of each issue within the school practice context. Despite the increasing momentum of the prescriptive authority initiative at the state level, it seems unlikely that prescription privileges will be extended to psychologists working in school-based practice settings. Nevertheless, informed school psychologists have the opportunity to become involved in this issue at both the national and state levels. These efforts may take the form of supporting or opposing the initiative or of lobbying for extension of prescriptive authority into some school settings. At the individual level, informed school psychologists will have the opportunity to develop strong working relationships with prescribing psychologists in their communities and to exercise appropriate professional judgments when referring students or families for services in the community. © 2009 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Although psychotherapy for children and adolescents is efficacious when administered in university-based research settings, relatively little data support its effectiveness in the community. This study examined the outcomes of 35,429 youths (5–17 years of age) referred to public outpatient psychotherapy programs in Ohio. All youths showed statistical elevations in symptom severity and were assigned at least one DSM-IV diagnosis at intake. Parents, therapists, and adolescents completed the same norm-referenced symptom severity measure at intake and at 3 month intervals until termination. One year after intake, approximately 55% of youths showed statistically reliable symptom reduction whereas 8% showed reliable symptom exacerbation. Approximately one-third of the sample showed both reliable and clinically significant improvement. Outcomes varied significantly by informant, client age, and client gender. Results indicate that many youths improve during the course of therapy but most remain symptomatic 1 year after intake. [ABSTRACT FROM AUTHOR]

Aim: To assess the impact of socio-demographic and clinical variables on the oral hygiene and periodontal status in a sample of mentally disabled subjects. Materials and Methods: Study sample comprised of 171 mentally disabled subjects attending a special school in Udaipur, India. Oral hygiene status was assessed by Simplified Oral Hygiene Index (OHI-S) and periodontal status by Community Periodontal Index. Results: Stepwise linear regression analysis revealed that the best predictors in the descending order for oral hygiene index were disabled sibling, medical diagnosis, IQ level, education of mother and father. Having Down syndrome, less educated parents, poor economic status and a disabled sibling were the most important predictors for poor periodontal status. Conclusions: The present study highlighted that the oral hygiene and periodontal status of the present study population is poor and was influenced by medical diagnosis, IQ level, disabled sibling, parent's level of education and economic status. [ABSTRACT FROM AUTHOR]

The article focuses on the practice parameter on psychiatric assessment and management of physically ill children offered by American Academy of Child and Adolescent Psychiatry (AACAP). The AACAP parameter recommends a careful approach to prescribing psychotropic medications to physically ill children and adolescents. Moreover, it provides a higher level of care integration between general health and mental health professionals towards the treatment for this type of population.

Epidemiological data indicate that nearly 20% of preschool aged children have significant behavioral problems. Parents typically consult their child’s primary care provider, who frequently refers to child psychologists for treatment regarding these difficulties. Psychologists skilled in providing effective services for young children are in short supply, limiting accessibility, and parents often are reluctant to follow up with a mental health specialist, suggesting low acceptability. The Behavior Consultation Clinic is a structured clinic for preschool children designed to address these issues of effectiveness, accessibility and acceptability. A retrospective review of 550 patients seen over a 5-year period found that half were seen for one therapy session. Review of the remaining patients found that slightly more than half showed improvement (32% successful discharge with improvement, 24% premature discharge with improvement) with a typical range of two to seven half-hour sessions, about a quarter did not improve, and the remaining patients were referred to a higher level of service. These data indicate that a structured, brief clinic that focuses on the needs of preschool children utilizing evidence-based approaches can be effective, acceptable, and accessible. The Behavior Consultation Clinic also serves as a training clinic for psychology interns and pediatric medical residents. [ABSTRACT FROM AUTHOR]

The article provides information on the use of physical restraints and seclusion in people with disabilities in the U.S. The author stated that physical restraint has been viewed as a form of therapeutic treatment and has been an accepted practice for dealing with violent patients in the mid- to late 1800s. He added that the use of human services restraint techniques are not simply a response to client behavior but an interplay among staff, setting and the characteristics of the individual. However, he emphasized that restraint will no longer be permitted since programmatic and planned restraint is not therapeutic or educational.

This article offers providers and family-centered systems of care helpful strategies for inviting effective working relationships with parents of young children with mental health concerns based on recommendations provided by parents. These recommendations resulted from a participatory action research project grounded in a narrative therapy approach to exploring three aspects of family-centered practices: (1) effective help-giving, (2) meaningful parent involvement, and (3) parent-to-parent support. Co-researchers--whether parent or professional--shared personal stories and reflections from the perspective of service seekers, and examined their experiences of power relations. This qualitative study demonstrates how cross-pollinating narrative therapy and participatory action research can contribute to knowledge about more equitable participative relationships between seekers of human services and providers and planners of these services. [ABSTRACT FROM AUTHOR]

Emergency departments are vital in tire management of pediatric patients with mental health emergencies. Pediatric mental health emergencies are air increasing part of emergency medical practice because emergency departments have become the safety net for a fragmented mental health infrastructure that is experiencing critical shortages in services in all sectors. Emergency departments must safely, humanely, and in a culturally and developmentally appropriate manner manage pediatric patients with undiagnosed and known mental illnesses, including those with mental retardation, autistic spectrum disorders, and attention-deficit/hyperactivity disorder and those experiencing a behavioral crisis. Emergency departments also manage patterns with suicidal ideally depression, escalating aggression, substance abuse, posttraumatic stress disorder, and maltreatment and those exposed to violence and unexpected deaths. Emergency departments must address not only the physical but also the mental health needs of patients during and after mass-casualty incidents and disasters. The American Academy of Pediatrics and tire American College of Emergency Physicians support advocacy for increased mental health resources, including improved pediatric mental health tools for the emergency department, increased mental health insurance coverage, and adequate reimbursement at all levels; acknowledgement of the importance of the child's medical home; and promotion of education and research for mental health emergencies. [ABSTRACT FROM AUTHOR]

Based upon the qualitative interviews of twenty mothers, this research details the stress and anxiety experienced by mothers who provide care for their socially devalued child as they struggle to maintain the positive social identity of ‘good mother’. Four themes are presented as findings. ‘First realization’ presents mothers' experiences including the sacrifices and losses she experiences before and after their child's diagnosis in four stages: ‘pre-crisis’, ‘crisis’, ‘diagnosis’, and ‘living with illness’. ‘Guilty Mother’ discusses mothers experience of guilt as a result of accusations of blame often placed on them and their efforts to distance herself from this blame. ’Stigma and Anti-Stigma Efforts’ looks at mothers' experience of stigma and the destigmatization campaigns to alleviate the stigma surrounding mental illness. ‘Mother's Involvement with the Mental Health Care System’ examines mothers' disenfranchisement from the mental health system and the consequences this has for social identity. [ABSTRACT FROM AUTHOR]

The author provides a response to “The Retarded, Society, and the Family: The Dilemma of Care,” in which Stanley Hauerwas attempts to establish a moral framework for parenting through observing the actions of parents with children having intellectual disabilities. Treloar's comments on the contemporary situation of caregivers emerge from her perspectives within nursing, disability studies, and perhaps most importantly, experience as the parent of a child (now a young adult) with physical disabilities. [ABSTRACT FROM PUBLISHER]

In this final chapter Hauerwas responds to the papers that have been presented within this volume. [ABSTRACT FROM PUBLISHER]

Hauerwas explores the nature of care. Exploring the notion of parenthood and the purpose of having children, he provides a theological framework which reframes our understanding of all children, including those whom we have chosen to label “mentally retarded.” [ABSTRACT FROM PUBLISHER]

This paper develops the theme of care which was begun in chapter 9. Here Hauerwas focuses on the importance of the family in the process of caring for people with developmental disabilities. He explores the motivation behind parenting and offers some piercing insights into why we have children and the ways in which our motivation for having children impacts upon the experience of having a child with a developmental disability. [ABSTRACT FROM PUBLISHER]

Looks into the development and improvement of pediatric rehabilitation. Concern on the extent of the development of the area to be recognized as a specialized field of rehabilitation medicine; Need to consider prognostic issues in childhood disabilities to improve counseling with parents; Lack of awareness and knowledge about pediatric rehabilitation.

Reports on the confirmation by the U.S. General Accounting Office of the extent to which parents turned to child welfare and juvenile justice systems in order to obtain treatment for emotionally disturbed children. Aspects supported by a related bill introduced by U.S. Senator Susan Collins (R-Maine) in October 2003; Reason behind failures in the placement of children in child welfare systems; Recommendations to psychiatrists.

At times children with mental retardation speak without pretense about their views of God. These statements may reveal the abuse and rejection which these children have experienced, and can be a reflection of destructive theologies being taught in the church. While these children do not understand abstract formulations of the faith, they often reveal its simple profundity and beauty with their insights. Their frankness and honesty, which can be entertaining, serves to teach us valuable lessons about the faith. [ABSTRACT FROM PUBLISHER]

Social workers have always provided services for children or youth with serious mental illness and their families. We have not, however, always included neuroscience findings as part of our treatment frameworks. Nor have we maximized the incorporation of biological theories into our daily practice. The social work role is often unclear when mental illness is framed as a brain disease rather than solely as a social-environmental problem. This article offers a treatment model and suggestions for working with children and youths who have neuropsychiatric disorders. Specific suggestions are offered for working with these children and their families, supporting biological and medication interventions, and functioning as a professional member of a multidisciplinary team. Social workers need accessible, easily applicable information that translates research into practice guidelines. These guidelines must form a coherent, flexible treatment model that meets the needs of children and their families. This article begins to meet this need by translating ecological theory and neurobiological concepts into a clinical framework. [ABSTRACT FROM AUTHOR]

Many communities have implemented systems of care in an effort to better coordinate and integrate mental health and other social services for children and youths, while simultaneously managing existing funding sources more effectively. Systems of care represent a fundamentally different way of delivering mental health services and accordingly require new approaches for both developing and sustaining collaboration. This article examines obstacles to collaboration and addresses key factors required to build and sustain collaboration. [ABSTRACT FROM AUTHOR]

Background The prevalence of minor children in families with a severely mentally ill member, these children's needs for support and the situation of the spouses were investigated as part of a multi-centre study of the quality of the mental health services in Sweden performed in 1986, 1991 and 1997. Methods The sample was drawn from relatives of compulsorily and voluntarily admitted inpatients to acute psychiatric wards. The instrument used was a semi-structured questionnaire, interviewing relatives about the burden of relatives, their needs for support and participation in care and items concerning the situation of the under-aged children in these families. Results The results over the years investigated showed the same proportion of patients admitted to hospital who were also parents to minor children and a decreasing proportion of patients who had the custody of their children. Female patients were more often a parent and also more often had the custody of the children. The majority of the children had needs for support caused by their parent's illness and these needs were met in half of the cases. The healthy spouses in families with minor children more often had to give up their own occupation and to a higher extent experienced own needs for care and support from psychiatric services compared to spouses without minor children. Conclusions The study supports that there is an urgent need for the psychiatric services to initiate parental issues in programmes for treatment and rehabilitation to ensure that the specific needs of minor children are met. [ABSTRACT FROM AUTHOR]

Describes and interprets the Korean American Families' caregiving experiences for their mentally ill grown children. Realization of children's illness; Caregivers' changed concept of mental illness; Poignant processes of care-giving; Korean value orientation reflecting Taoist acceptance of suffering as a way of life.

The purpose of this study was to establish the parental coping' factors associated with having a child in psychiatric inpatient care. The data were collected from 19 hospitals with child psychiatry units. At the time of data collection, all parents of children in psychiatric inpatient care in these hospitals were recruited. The method of data collection was a questionnaire (n = 79). The data were analysed with the Statistical Package for the Social Sciences (SPSS) for Windows statistical software. The connections between variables were studied with cross-tabulation, and the χ2 test was used to determine significance. Changes in internal and external family relationships and matters related to the upbringing of the child with mental problems statistically correlated significantly with parental coping (P < 0.001). Problem-oriented and emotionally-oriented coping strategies, skills and palliative strategies correlated significantly with parental coping (P < 0.001). Emotional support, support for the care and upbringing of the child in inpatient care, and love and acceptance also had statistically significant associations with parental coping (P < 0.001). [ABSTRACT FROM AUTHOR]

This study was based on vague but persistent problems of uncertain origin permeating treatment and care in Swedish residential institutions treating emotionally disturbed and socially disadvantaged children. The purpose was to generate a reliable, empirically grounded theory, sufficient to describe and explain these problems, which were first observed in supervisory sessions. The main methods used were grounded theory (Glaser & Strauss 1967; Strauss & Corbin 1990, 1998) and abduction (Peirce 1914/1990; Fann 1970; Josephson & Josephson 1996). During a three-year period, 17 respondents from three strategically chosen institutions were individually interviewed twice. The results suggest that artificial family institutions , enjoying family privileges , may develop out of family ideas . Under certain conditions, such institutions may be transformed into non-professional institutions that fail to carry out their official task, but that instead effect unconscious psychological tasks – tasks that are both hidden behind and obstruct the institution's official mission. The possibility of avoiding this development is dependent partly on the quality of the emotional content, called the need for reparation , within the institution, and partly on the methods used to control this need. This notion was tested in practice in a separate part of the study in which the method action-cum-research (Trankell 1973) was used. One of the studied institutions was then observed for two years during a process of planned change in organization, treatment routines and attitudes. After two years, the final resistance to the official task had disappeared, and the former non-professional institution now worked in a task-orientated manner. This result has broad implications for planning and support of care institutions, as the same phenomena might arguably occur in any care organization. [ABSTRACT FROM AUTHOR]

In this article we discuss the results of a controlled, longitudinal study of the short-term effectiveness of respite care services for families with children experiencing emotional and behavioral disturbance (EBD). Results indicated that 33 families caring for a child with EBD who received respite care experienced significantly better outcomes overall than did 28 families in a wait-list comparison group, including fewer incidents of out-of-home placement, greater optimism about caring for the child at home, reductions in some areas of caregiving stress, and lower incidence of negative behaviors expressed in the community. However, significant between-group differences were not found for several other variables, and regression analyses suggested that more intensive allocation of service hours was necessary to have a more pervasive impact. The results support the hypothesis that moderate amounts of respite services benefit families with children experiencing EBD but suggest that respite plus other individualized services and supports will be necessary to meet the substantial caregiving challenges faced by most of these families. [ABSTRACT FROM AUTHOR]

Presents a study on psychopharmacotherapy in children and adults with intellectual disability. The need for evidence-based practice in prescribing and monitoring drugs; Susceptibility to mental illness in those with intellectual disability; How psychiatric disorders in the context of genetic syndromes are overlooked; Decision-making in pharmacotherapy; Drug side effects; Positive trends, including the use of atypical antipsychotics, serotonin-specific reuptake inhibitors, and antiepileptic drugs.

Describes the market for residential and day programs that provide education and treatment services on site for children with severe emotional disturbance in the United States. Baseline of information from the education sector; Number of facilities; Differences in cost across ownership form.

Examines the role of statewide family advocacy networks (SFNs) in addressing children's mental health system of care and legislative issues in the United States. Developments and activities of SFNs; Diversity and types of organizational arrangements; Increase in outside financial resources; Extent to which ethnically and culturally diverse people are involved.