Wrap-around services: an analysis of community-based mental health services for children

TOPIC

Wrap-around services-individualized, community-based mental health services for children in their homes and schools-for children with severe emotional and behavioral disorders.

PURPOSE

To conduct an analysis of the social policy antecedents that culminated in wrap-around services in one state and consider the development of one state's implementation and relevant value issues.

SOURCES

Policy and historical literature; the first author's experience as a director of a large wrap-around program.

CONCLUSIONS

While the advent of wrap-around services and the expansion of Medicaid represent significant steps forward in the treatment of children with mental health problems, outcome studies of these services are sorely needed.

Group-based parent training for preventing mental health disorders in children

Conduct problems in preschool children are a significant mental health problem associated with later psychosocial and psychiatric disorders, pointing to the need for effective community-based preventive interventions with families of young children at risk. Group-based parent training has been described as one such intervention. This paper presents the nature of conduct problems in young children, the role of day care and preschools in gaining access to young children at risk, the theory and research underlying group-based parent training as one type of effective prevention strategy, and characteristics of effective parent training programs. Examples from the authors' experiences implementing parent training in day care centers in Chicago are presented.

Child maltreatment and the early onset of problem behaviors: can a program of nurse home visitation break the link?

This study investigated the relationship between child maltreatment and the early onset of problem behaviors in the Elmira Nurse Home Visitation Program. Participants were predominantly low-income and unmarried mothers and their first-born children who were randomized either to receive over 2 years of home-visitation services by nurses or to be placed in a comparison group. Data were drawn from a follow-up study that took place when the children were 15 years of age. Results demonstrated that, in the comparison group. child maltreatment was associated with significant increases in the number of early onset problem behaviors reported by the youth. For the youth in the nurse-visited group there was no relationship between maltreatment and early onset problem behaviors. We suggest that this finding was due to the effects of the intervention in reducing the number as well as the developmental timing of the maltreatment incidents. Results suggest that prenatal and infancy home visiting by nurses can moderate the risk of child maltreatment as a predictor of conduct problems and antisocial behavior among children and youth born into at-risk families.

Benefits of a course in behavioural analysis for health visitors

Twenty-four health visitors participated in a 12-week course in behavioural intervention methods for work with children with behavioural difficulties. Each health visitor identified a family with child behavioural problems and worked with this family while attending the weekly training sessions. The course was run in 1998/99 and in 2000/01 for 12 health visitors. The 1998/99 trainees established a control group by identifying a second family experiencing similar difficulties. These families received the standard service for the same duration as the course. After the course, all health visitors demonstrated a significant increase in knowledge of behavioural techniques. Significant improvements were seen in measures of child behaviour and maternal mental health for both groups of intervention families, compared with non-significant improvements in the control families. The course's success in giving health visitors the skills and practice to develop effective behavioural strategies in work with child behavioural problems is also discussed.

[How can child development disorders be recognized in early childhood?]

In the last 10 years beside the well known developmental criterias like turning from back to prone, crawling, standing up, free walking, speaking of the first words and the position-reactions, the exact observation of the spontaneous movements, of handling-planing and the speech development could be detected as more important factors for the examination of development. Certain parameters of explanation of developmental disorders are to differenciate from uncertain and only probably one. Of special interest are the frequent problems like excessive crying, feeding- and sleeping disorders.

Effectiveness of a home intervention for perceived child behavioral problems and parenting stress in children with in utero drug exposure

OBJECTIVE

To determine if a home-based nurse intervention (INT), focusing on parenting education/skills and caregiver emotional support, reduces child behavioral problems and parenting stress in caregivers of in utero drug-exposed children.

DESIGN

Randomized clinical trial of a home-based INT.

SETTINGS

Two urban hospital newborn nurseries; homes of infants (the term infant is used interchangeably in this study with the term child to denote those from birth to the age of 36 months); and a research clinic in Baltimore, Md.

PARTICIPANTS

In utero drug-exposed children and their caregivers (N = 100) were examined when the child was between the ages of 2 and 3 years. Two groups were studied: standard care (SC) (n = 51) and INT (n = 49).

INTERVENTION

A home nurse INT consisting of 16 home visits from birth to the age of 18 months to provide caregivers with emotional support and parenting education and to provide health monitoring for the infant.

MAIN OUTCOME MEASURES

Scores on the Child Behavior Checklist and the Parenting Stress Index.

RESULTS

Significantly more drug-exposed children in the SC group earned t scores indicative of significant emotional or behavioral problems than did children in the INT group on the Child Behavior Checklist Total (16 [31%] vs 7 [14%]; P =.04), Externalizing (19 [37%] vs 8 [16%]; P =.02), and Internalizing (14 [27%] vs. 6 [12%]; P =.05) scales and on the anxiety-depression subscale (16 [31%] vs. 5 [10%]; P =.009). There was a trend (P =.06) in more caregivers of children in the SC group reporting higher parenting distress than caregivers of children in the INT group.

CONCLUSIONS

In utero drug-exposed children receiving a home-based nurse INT had significantly fewer behavioral problems than did in utero drug-exposed children receiving SC (P =.04). Furthermore, those caregivers receiving the home-based INT reported a trend toward lower total parenting distress compared with caregivers of children who received SC with no home visits.

Severity of violence against women correlates with behavioral problems in their children

In order to examine the type and severity of violence against women by intimate partners and the associated behavioral problems of their children, 83 abused women were interviewed when they presented to the criminal justice system for protective orders or to file assault charges. Two questionnaires were administered: (a) the 46-item Severity of Violence Against Women Scale (SVAWS) measured threats of abuse and actual physical violence, and (b) the 118-item Child Behavior Checklist (CBCL) measured child behavior problems for children between the ages of 4 and 18.

Intimate partner violence. Mothers' perspectives of effects on their children

PURPOSE

Intimate partner violence not only affects adults but also the children living within that "war zone." The present study expands our understanding about how children are affected when they observe violence in their own homes, as reported by their mothers.

STUDY DESIGN

This descriptive study was conducted to describe mothers' perspectives of the impact of the violence on their children. A consecutive sample of 72 mothers attempting to file assault charges were interviewed in a private room by a registered nurse and were asked to describe the effect of witnessing intimate partner violence on their child's behavior. Each response was written verbatim by the interviewer.

RESULTS

A majority (72%) of the mothers reported negative behaviors in their children that they believed were as a result of witnessing their mother's violent experiences. The most common negative traits were distress-indicating behaviors such as sleep disturbances, clinging, and fretful behaviors followed by problems with the abuser, problems in school, and problems with mother.

CLINICAL IMPLICATIONS

Because intimate partner violence affects children, health care providers should become familiar with behaviors indicative of this problem. To promote the well being and development of children, recommendations for assessment and intervention for women experiencing intimate partner violence are discussed.

Violent video games affecting our children

Exposure to media violence is associated with increased aggression and its sequelae. Unfortunately, the majority of entertainment video games contain violence. Moreover, children of both genders prefer games with violent content. As there is no compulsory legislative standards to limit the type and amount of violence in video games, concerned adults must assume an oversight role.

An action research inquiry into a health visitor parenting programme for parents of pre-school children with behaviour problems

An action research inquiry into a health visitor parenting programme for parents of pre-school children with behaviour problems Parent education programmes have recently been given a high profile in this country, such provision deemed necessary because of the commonality of children's behaviour problems and because of their potentially far-reaching effects on the child, the family and society. This action research study, undertaken in Scotland, aims to explore a health visitor parenting programme for parents of pre-school children with behaviour problems. Within this study, children with behaviour problems were identified as those whose parents perceived them to have such problems, the children eliciting a wide range of behaviours and to varying degrees. Critical social science is the chosen methodology, since it allows exploration of how people comprehend their social reality. Group interactions were recorded on audio-tape and themes associated with the methodology of enlightenment, empowerment and emancipation were identified. The results of the study demonstrate how a liberating, collaborative approach to parental education can empower mothers, by increasing understanding and raising self-esteem.

Detecting and addressing developmental and behavioral problems in primary care

Pediatric primary care clinicians usually offer a range of in-office services designed to detect and address developmental and behavioral problems. Research suggests that selecting among these services is difficult because fewer than 30% of children with disabilities are detected by their health care providers. Undetected children fail to receive early intervention, which has substantive benefits in improving high school graduation and employment rates, and reducing teen pregnancy and criminal activities. Fortunately, many recently published tools help detect the majority of children with problems. Measures relying on information from parents are flexible, brief, and accurate. One of the briefest tools. Parents' Evaluation of Developmental Status (PEDS), also offers an evidenced-based approach that helps clinicians decide when to refer, screen, advise, or reassure families or observe children more carefully over time.

Identification and measurement of maladaptive behaviors in preschool children: movement toward a preventive model of care

TOPIC

The early identification and intervention of maladaptive behaviors in preschool children as a precedent to the prevention of psychiatric disorders across the life span.

PURPOSE

To inform clinicians of maladaptive behaviors in the preschool population and the current diagnostic classifications used.

SOURCES

A developmental psychopathology perspective. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Diagnostic Classification: 0-3, and the Child Behavior Checklist/2-3 classification systems.

CONCLUSIONS

Initial evidence indicates that maladaptive behaviors in preschool children can be predictive of later psychopathology. Further research is needed to refine and test the classification systems presented in order to identify and intervene with at-risk preschool children.

Time-out: an overused and misused milieu intervention

TOPIC

The basic logic of the time-out, its conceptual underpinnings, its misuse in inpatient psychiatry, and suggestions for appropriate application.

PURPOSE

In the inpatient treatment setting, time-outs can become an automatic response to any behavioral infraction. When this happens, time-outs begin to lose their effectiveness because the intervention does not necessarily address the child's needs or the underlying mechanisms of the inappropriate behavior. They also can be misused when time-outs escalate into a lengthy stay in a seclusion room. The author examines the dynamic underlying the misuse and overuse of the time-out.

SOURCES

Personal observations and published literature.

CONCLUSIONS

The time-out is a useful tool, but only when employed with minded intent and understanding of how it is supposed to help the child.

Commitment to care: managed care and child incarceration

Downsizing and managed care in the 1990s followed the psychiatric hospital scandals and closures of the 1980s. Many families are now unable to provide care for their troubled children. Childhood emotional or behavioral disorders have rapidly spread beyond the confines of the home into a community that has adopted a "zero tolerance" for crime. Intolerance for childhood criminal behavior has resulted in an explosion of children's prisons where, in the name of rehabilitation, many are finally receiving psychological help. This article discusses the decreased treatment of childhood psychiatric disorders and the increased admissions to children's prison facilities.

Rethinking Behavior Disorders: Whose Attention Has a Deficit?

1. Children's behavior issues stem from multiple sources that must be assessed; nursing theory provides a framework to reassess children's behavior issues. 2. Not all behavior issues are problems, but some problems may be overlooked in blanket diagnosing. 3. Nurses can play a key role in designing and implementing interventions that promote a healthy child and a well-functioning family.

Case studies of children presenting with a history of ritualistic abuse

TOPIC

Ritualistic child abuse is an alarming and controversial problem. Child psychiatric nurses need to increase their awareness of the clinical picture associated with this specific form of abuse.

PURPOSE

This article reviews the literature to date on ritualistic child abuse and addresses the controversy surrounding the phenomena.

SOURCES

A small research project using historical data collection methods reviewed hospital records of children with a documented history of ritualistic abuse. Results are organized into clusters of linked interrelated characteristics.

CONCLUSION

The symptom characteristics of these children revealed medical/somatic symptoms, distortion of self-oncept and world view, and a variety of emotional disturbances. The findings of this study are presented with implications for nurses who care for clients with a history of ritualistic abuse.

Psychosocial assessment in the general pediatric population: a multiple-gated screening and identification procedure

This article describes a screening and assessment procedure to identify the need for psychologic and psychiatric services within the general pediatric population. This procedure is additionally designed to facilitate timely and focused treatment planning. It begins with a brief, user friendly instrument, the Pediatric Symptom Checklist (PSC), to routinely screen all pediatric patients. The procedure continues by asking parents of children who are identified as meeting cutoff criteria (on the PSC) or at-risk for psychosocial problems to complete a more sophisticated instrument, the Child Behavior Checklist. Using the PSC and the Child Behavior Checklist in this multiple-gated manner allows for screening and then identification of problem child behaviors, providing data necessary to complete an initial treatment plan. The procedure is proposed as an efficient means of routinely screening for, and then identifying, child psychosocial problems in general pediatric populations.

Helping children with challenging behaviour

Last year's reports from the Audit Commission and Mental Health Foundation (1, 2) have highlighted the extreme vulnerability of children with learning disabilities who also present severe challenging behaviour. The author outlines the findings of the latter report and emphasises the role nurses can play in protecting and caring for such children.