In-home treatment of abusive families: Cost and placement at one year.

Evaluated a child-abuse prevention project designed to keep abused children safely at home. In-home prevention services were provided to 59 children in 26 families referred by county child protective services as an alternative to out-of-home placement. Therapists, carrying a caseload of 2 families each, provided intensive treatment in the families' homes for 4–6 wks. A comparison group of 24 child protective service referred families, with 49 children, received usual county services. A 1-yr follow-up evaluated the 2 groups on cost, on whether or not the children stayed at home, and on psychological measures of family functioning. Results indicate that the goals of reducing out-of-home placement and lowering placement costs were being met. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infant care decisions and attachment security: The Canadian Transition to Child Care Study.

To examine the family and child factors associated with child care decisions, 189 infants (aged 2–30 mo) were visited in their homes 3 wks before starting full-time out-of-home care and were followed for 6 mo (or its equivalent for parent-care families). Employed mothers who preferred to stay home were more depressed, and their children were more likely to experience unstable care than those who were working and wanted to work. Early entry was related to higher household income, less maternal depression and use of family home care as opposed to centre care. Age of entry, and type, stability, or quality of care were not related to attachment security but children with less sensitive mothers using extensive out-of-home care were least secure. Difficult temperament infants were more likely to experience insecure mother-infant relationships, but extensive use of out-of-home care buffered this effect. Findings provide strong support for the hypothesis that psychological and social characteristics play a significant role in child care decisions, in the stability of care, and in developmental outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When children cannot remain home: foster family care and kinship care

Despite the best efforts of child welfare agencies, community agencies, and individuals, some children are not safe in their homes and must be placed in substitute care settings by child welfare authorities. Increasingly, as this article points out, child welfare agencies are placing children in the homes of their relatives rather than in traditional foster family homes (31% of all children in out-of-home care in the early 1990s were living with kin). This article discusses how such factors as the availability of foster homes, the demand for foster care, attitudes toward the extended families of troubled parents, and policies regarding payment for the costs of care have contributed to the rapid growth in kinship foster care. It discusses differences in the personal characteristics of kin and traditional foster parents and in the supports provided to the caregivers by child welfare agencies. Research findings suggest that kinship homes can promote the child welfare goals of protecting children and supporting families, but they are less likely to facilitate the prompt achievement of legal permanence for children. To forge a coherent policy toward kinship caregivers, officials must balance the natural strengths of informal, private exchanges among family members with the power of government agencies to provide both resources and oversight.     

The costs of child protection in the context of welfare reform

The financing structure of any large public service system both reveals the priorities held by policymakers and drives the delivery of services. Of the $11.2 billion in public funds for child welfare services, somewhat less than half is federal. As this article explains, federal funds for child welfare overwhelmingly go to support out-of-home care (foster care and adoption services), and these costs have risen sharply in recent years. In contrast, federal funding for child protection investigations, prevention programs, and treatment services is more limited, and expenditures have not risen apace with reports of maltreatment. The article compares the high cost of foster care with the lower per capita cost of cash assistance to poor families and the per-case costs of child protection investigations and service provision. Pointing out that the great majority of families served by the child welfare system are poor, the author argues that child welfare and cash assistance should be seen and analyzed as interrelated programs serving poor families. The article examines the varied ways in which the changes in cash assistance programs introduced by the 1996 federal welfare reform law may increase the need for child welfare services and drive up the costs of child protection.     

Probability of particle and salbutamol deposition in the respiratory tract: comparison between MDI and Autohaler

QOL for children with chronic neurological diseases (CND) depends mainly on the supporting system of children's development and respite measurements of their families. For supporting children's development with CND and for alleviating the burden on the family members, various staffs are needed such as pediatricians, nurses, psychologists, OT, PT, home helpers, etc. Especially children with CND are living at home needs in-home services supplied by these supporting staffs. An in-home care service center is desirable to be established in their living area. According to the maternal and child health law and child welfare law, several measures have been adopted, but these services are not available for children with CND and their family, without registration as handicapped children. All these children should be treated because they have the same problems as physically or mentally handicapped children. The capability of the medical and social service supply has been influenced by recent decrease of the birth rate and improvement of the level in the maternal and child health. The number of facilities, such as pediatric clinics or nursing homes for physically handicapped children, is decreasing because of poor profit. These trends will be continued if appropriate measurements are not introduced. The final estimation of need and supply must be made at the local community level.     

Facilitating the care of terminally Ill children

Life-threatening illness is fortunately rare in children. Some children, however, will need palliative care for symptom control; psychological support may be needed by the child and the child's family; and families may require help with decisions about life-prolonging treatment. Providing consistent high-quality care for a relatively uncommon problem is difficult. Adult palliative care services, liaison with pediatricians can help provide this care.     

The National Child Traumatic Stress Network: Collaborating to improve the standard of care.

Mental health practitioners are often called upon to provide services to children, adolescents, and families in the aftermath of traumatic experiences such as child neglect, sexual or physical abuse, family/domestic violence, sexual assault, interpersonal violence, school and community violence, serious accidental injury, catastrophic medical illness, traumatic bereavement, or mass casualty events, including natural and man-made disasters. The National Child Traumatic Stress Network (NCTSN) was established in 2001 to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States. This article describes the development of the NCTSN, its structure, programs, and many of the products and resources--including online lectures, training programs and videos, and searchable databases of child trauma resources--available through the NCTSN Web site (www.nctsn.org) to assist professionals in providing state-of-the-art assessment, treatment, and services to these children and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In-home family-focused reunification: an experimental study

Intensive, in-home family-based services were employed in reunifying families separated by the placement of a child in out-of-home care. After a 90-day service period, 93% of the 57 families randomly assigned to receive the intensive treatment were reunited-compared to 28% of the 53 families in a control group who received routine out-of-home care services. Follow-up data were collected six and 12 months after the end of treatment. Estimates of outcomes suggest that the experimental treatment had a substantial impact on families and that treatment effects endured for upwards of 12 months following cessation of direct intervention services.     

Helping military families through the deployment process: Strategies to support parenting.

Recent studies have highlighted the impact of deployment on military families and children and the corresponding need for interventions to support them. Historically, however, little emphasis has been placed on family-based interventions in general, and parenting interventions in particular, with returning service members. This article provides an overview of research on the associations between combat deployment, parental adjustment of service members and spouses, parenting impairments, and children's adjustment problems. We provide a social interaction learning framework for research and practice to support parenting among military families affected by a parent's deployment. We then describe the Parent Management Training-Oregon model (PMTO), a family of interventions that improves parenting practices and child adjustment in highly stressed families, and briefly present work on an adaptation of PMTO for use with military families (After Deployment: Adaptive Parenting Tools, or ADAPT). The article concludes with PMTO-based recommendations for clinicians providing parenting support to military families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treatment trends during a thirteen-year period in a student pediatric dentistry clinic

As the number of children receiving care in out-of-home settings increases in the United States, the risk of injury in such settings has become the subject of intense research. OBJECTIVES: This study examined the relative safety of out-of-home care compared with care in a child's own home. METHODS: This community based prospective cohort study of 656 families in three adjacent counties in the Piedmont region of North Carolina characterizes the patterns and rates of injuries among children less than 5 years of age in three child care settings, home care (HC), center based care (CBC), and other out-of-home care (OOHC). Information about minor and severe injuries was obtained from parents using monthly telephone interviews over a one year period. Statistical modeling designed to handle unbalanced data with correlated observations was used as the primary tool for analysis. RESULTS: Rate of minor injuries was highest in CBC, followed by HC, and then OOHC. However, these differences for OOHC may have been due to reporting biases and errors in rate estimates. There were no significant differences in severe injury rates among the three settings. CONCLUSIONS: The risk of serious injury among children under 5 in CBC is not different from that of children in HC or OOHC despite the fact that the risk of minor injury is higher.     

Trajectories of emotional well-being in mothers of adolescents and adults with autism.

Raising an adolescent or adult child with a developmental disability confers exceptional caregiving challenges on parents. We examined trajectories of 2 indicators of emotional well-being (depressive symptoms and anxiety) in a sample of primarily Caucasian mothers (N = 379; M age = 51.22 years at Time 1) of adolescent and adult children with an autism spectrum disorder (ASD; M age = 21.91 years at Time 1, 73.2% male). We also investigated within-person associations of child context time-varying covariates (autism symptoms, behavior problems, residential status) and maternal context time-varying covariates (social support network size and stressful family events) with the trajectories of emotional well-being. Data were collected on 5 occasions across a 10-year period. Average patterns of stable (depressive symptoms) and improved (anxiety) emotional well-being were evident, and well-being trajectories were sensitive to fluctuations in both child and maternal context variables. On occasions when behavior problems were higher, depressive symptoms and anxiety were higher. On occasions after which the grown child moved out of the family home, anxiety was lower. Anxiety was higher on occasions when social support networks were smaller and when more stressful life events were experienced. These results have implications for midlife and aging families of children with an ASD and those who provide services to these families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Children's mental health problems and services: Current federal efforts and policy implications.

This article discusses the current federal role in the collection of information about the mental health problems of children and the provision of mental health services to children. It also describes the federal programs that help finance mental health services, support their coordination, and provide funding for research and training of mental health researchers and clinicians. Recent changes in federal policy are also described. This article, and the Office of Technology Assessment report on which it is based, conclude that although it is in some ways considerable, the federal role in providing mental health services to children is fragmented. This lack of cohesive policies toward children and across service programs may create difficulties for those who would move public policy toward the continuum of care that many observers conclude is needed to address children's mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promoting health in children with atopic dermatitis

Atopic dermatitis (AD), or eczema, can be a very challenging disease to manage. The etiology of the disease is not completely understood, and its incidence has risen in the past 10 years to more than 10% of the population. AD is characterized primarily by intense itching and the development of papules, scaly lesions, fissures, and crusting. The onset occurs primarily in childhood, and much of the disease management is conducted by the family. Patients and their families often experience multiple recurrences and exacerbations, repeated attempts at cures and treatments, lowered self-esteem of the child, impaired growth and development of the child, loss of sleep, discipline problems, and multiple clinic and emergency department visits for exacerbations. Management primarily consists of prevention (i.e., good daily skin care and management of environmental trigger factors such as infection, irritants, emotional stress, and allergens). These children and their families need education and the support of health care professionals. This article outlines specific techniques to help parents and children manage AD at home and minimize exacerbations.     

Respite care for families of children with disabilities

The number of children with chronic health problems and resultant disabilities is increasing. Most of the care received by these children is provided by family members, often at severe economic and psychologic cost. One service that has appeared in the past two decades to assist family caregivers is respite services. This article describes the needs for respite identified by family members, the types of respite services available, the benefits of respite care to families, and the essential roles nurses can assume in assuring this essential service is available to families.     

Delivering health and mental health care services to children in family foster care after welfare and health care reform

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.     

The power of Filial Relationship Enhancement therapy as an intervention in child abuse and neglect.

Identified variables that influence intervention in child abuse and neglect and proposes a constructive approach that can help these children and their families change. This is a difficult and complex societal problem, and it is difficult to tease out the specific elements that are responsible for the frequency of its occurrence. The family context is often recognized as having a significant influence. Filial Relationship Enhancement, using an improved family context to support gains, has a long history of research and practice to support its efficacy to intervene in difficulties that impede optimum functioning in children. Filial Relationship Enhancement helps parents learn to conduct weekly child-centered play therapy sessions with their own children at home. This article presents the basic assumptions and the rationale for considering the potential power of this approach. It also describes a program of intervention incorporated by a child protective unit of a county agency. Using informal measures, outcomes are described as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with child mental health service use in the community

OBJECTIVE: To determine the association of parent, family, and child factors with mental health services need and utilization. METHOD: Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. RESULTS: 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. CONCLUSION: Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.     

Improving parenting in families referred for child maltreatment: A randomized controlled trial examining effects of Project Support.

Project Support is an intervention designed to decrease coercive patterns of aggressive discipline and increase positive parenting. This research evaluates Project Support in a sample of families reported to Children's Protective Services (CPS) for allegations of physical abuse or neglect; 35 families with a child between 3- and 8-years-old participated. In all families, CPS allowed the children to remain in the family home while the family received services. Families were randomly assigned to receive either Project Support or services as usual, which were provided by CPS or CPS-contracted service providers. To evaluate intervention effects, a multimethod, multi-informant assessment strategy was used that included data from mothers' reports, direct observation of parents' behavior, and review of CPS records for re-referrals for child maltreatment. Families who received Project Support services showed greater decreases than families who received services as usual in the following areas: mothers' perceived inability to manage childrearing responsibilities, mothers' reports of harsh parenting, and observations of ineffective parenting practices. Only 5.9% of families in the Project Support condition had a subsequent referral to CPS for child maltreatment, compared with 27.7% of families in the comparison condition. The results suggest that Project Support may be a promising intervention for reducing child maltreatment among families in which it has occurred. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A competency-based parent training program for child abusers.

Evaluated an intervention program for child abusers using multiple outcome criteria and extended follow-up. 16 families were given the Parent–Child Interaction Form and the Eyberg Child Behavior Inventory and were assigned to either treatment or control groups. All families were supervised by protective services, and none had requested help voluntarily. A treatment program involving group parent training in the clinic and competency-based training and rehearsal in the home was provided. Findings indicate that training abusive Ss in child-management and self-control techniques resulted in improvements in parenting skills as measured by home observations, parental reports of child-behavior problems, and caseworker reports of family problems. A 1-yr follow-up indicated that no incidences of child abuse among treatment families had been reported to or suspected by caseworkers. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)