Barbara J. Friesen

Measuring Empowerment in Families Whose Children Have Emotional Disabilities: A Brief Questionnaire

This paper describes the development and empirical examination of a brief questionnaire for assessing empowerment in families whose children have emotional disabilities. The questionnaire is based on a two-dimensional conceptual framework of empowerment derived from the literature. One dimension reflects empowerment with respect to the family, service system, and larger community and political environment; the other dimension reflects the expression of empowerment as attitudes, knowledge, and behaviors. The paper outlines the questionnaires conceptual basis, describes its development, and presents analyses of reliability and validity based on 440 responses of family members. Applications of the instrument in both research and service delivery are discussed. Family empowerment is increasingly seen as a central goal of efforts to improve services for families whose children have disabilities. The emergence of this concept reflects recent developments in the consumer, practice, and research communities. Among these developments are the growth of the consumer movement with its emphasis on self-help and self-reliance (Moxley, Raider, & Cohen, 1989), the widespread application ofpractice models that focus on family strengths rather than deficits (Cochran, 1987; Dunst, Trivette, & Deal, 1988; Poertner & Ronnau, 1992), the explicit incorporation of empowerment values within public policies and programs (Gallagher, Trohanis, & Clifford, 1989; Stroul & Friedman, 1988), and the increasing recognition that services can be delivered in ways that either promote or inhibit self-efficacy (Bandura, 1977, 1982; Dunst & Paget, 1991; Dunst & Trivette, 1987). The concept of family empowerment has also benefited from the synergistic effect that comes from many different disciplines focusing on one idea at the same time. Virtually all the helping professions that serve families of children with disabilities have adopted this concept to some degree, and thus it is beginning to emerge as a common value across disciplines. REHABILITATION PSYCHOLOGY Vol. 37, No.4, 1992

Family-centered services: Implications for mental health administration and research

Efforts to move the system of care for children with serious emotional disorders toward community-based alternatives has prompted a growing recognition of the need for supportive services for families. This article examines the shifts in policy and administrative practice that are needed in order to move toward a family-centered system of care. Proactive administrative support is particularly important in this system shift. Four important barriers to a family-centered system of care are examined: (1) efforts have tended to focus on the child as the unit of services, rather than on the family; (2) efforts have tended to focus primarily on mental health services, rather than considering the full range of services needed by the child and family; (3) efforts have tended to emphasize formal services, often ignoring the support provided by informal networks; and (4) the resources and expertise of parents and other family members have not been used. New roles for parents—which involve working with administrators and providers as partners—are described, and implications for mental health administrators and researchers are discussed.

Participatory Action Research as a Model for Conducting Family Research

We discuss a participatory action research (PAR) approach to conducting family research. We conceptualize participatory action research as a collaborative process among researchers and stakeholders throughout the entire research sequence. Based on our five years of implementing PAR, we describe potential PAR advantages and challenges that need to be documented in future research. We propose a model of PAR implementation levels including the options of family members as research leaders and researchers as ongoing advisors, researchers and family members as coresearchers, and researchers as leaders, and family members as ongoing advisors. Finally, we discuss key implementation issues (i.e., defining stakeholders to include in the PAR process, maximizing benefits and minimizing drawbacks of diverse expertise, and addressing logistical considerations) with suggestions for effectively addressing them.

Children's Stigmatization of Childhood Depression and ADHD: Magnitude and Demographic Variation in a National Sample

OBJECTIVE To estimate the magnitude of stigmatizing attitudes toward peers with depression or attention-deficit/hyperactivity disorder (ADHD) in a national sample of children ages 8 to 18 and to examine variation in level of stigma by school location, region of the United States, grade level, race/ethnicity, or sex. METHOD Surveys were administered to 1,318 children and adolescents. Respondents were randomly assigned to depression, ADHD, or asthma conditions and were presented with a vignette about a peer with one of the conditions. Participants responded to items assessing positive and negative attributions, social distance, and family attitudes. Mean differences were tested for statistical significance and effect sizes were computed. RESULTS Respondents were more likely to make negative attributions about peers with ADHD and depression versus asthma, particularly regarding the likelihood of antisocial behavior and violence (Cohen d range 0.78-1.35, large effect sizes). Moderate effect sizes were found for preferences for social distance from peers with ADHD(d = 0.37) and depression (d = 0.45). Effects were found for perceptions of negative family attitudes toward both mental health conditions, with depression (d = 0.78) seen as even more stigmatized than ADHD (d = 0.47). The level of stigmatization was relatively constant across demographic variables, with the exception of greater stigmatization evident in Asian/Pacific Islander youths. CONCLUSIONS Across most items, both depression and ADHD were more stigmatized than asthma, with depression more stigmatized than ADHD. The perception of likelihood of violence and antisocial behavior was particularly high for both ADHD and depression, greatly exceeding the real-world association for depression.

Connecting Low-Income Families to Mental Health Services: The Role of the Family Associate

The family associate is a parent without professional mental health training who acts as a system guide to low-income families whose children have been referred to mental health services through the Early and Periodic Screening, Diagnosis and Treatment program. The family associate provides emotional support, information about mental health services and community resources, and directs assistance, such as help with transportation and child care. Based on the belief that parent-to-parent support can be a powerful tool in overcoming the barriers to accessing services, the family associate role has been successfully implemented in three counties in Oregon. The family associate role and its implementation, characteristics of the families who participated, and the implications for introducing this role into traditional mental health service systems are described.

Linking Low-Income Families to Children's Mental Health Services: An Outcome Study.

An intervention designed to address barriers that interfere with access to childrens mental health services for low-income families was implemented in three Oregon counties; four other counties were included as a comparison condition. The intervention involved the use of paraprofessionals called Family Associates who provided families with information, emotional support, and tangible assistance to reduce barriers to services. Families in the intervention group (n = 96) were significantly more likely to initiate childrens mental health services than were those in the comparison group (n = 143); however, the groups did not differ in their rates of appointment attendance or discontinuing services prematurely. A modest but significant difference between the groups was found for family and service system empowerment, with the intervention families reporting higher levels of empowerment at post-test. The barriers to childrens mental health services experienced by the intervention families and the barriers for which Family Associate services were provided are described.

Support groups for parents of children with emotional disorders: a comparison of members and non-members.

This study involving more than 800 parents whose children have emotional disorders focuses on comparisons between parents who are members of support groups and those who are not. While no difference was found between members and non-members on most demographic variables, members reported needing and using more information and services and found each more difficult to locate than nonmembers. Thirty-one percent of all respondents identified involvement with other parents as the most helpful activity in coping with their childs problems.

Challenges in Conducting Family-Centered Mental Health Services Research

In this article, the authors provide an analysis of the challenges facing researchers as they respond to the ideas that guide family-centered services and incorporate these themes into research focused on improving services for children with emotional, behavioral, or mental disorders and their families. The concept of “family-centered services” has emerged only recently as a generally well understood set of practice principles. Traditional approaches to conducting mental health research have not yet responded to the fundamental changes in thinking about service delivery evoked by a family-centered service system. The authors examine the fit between traditional mental health research and family-centered services and provide an introduction to the articles in this special issue.

Promoting Family Empowerment Through Multiple Roles

SUMMARY A guiding principle in the system of care philosophy for meeting the needs of children with serious emotional problems and their families is that the families “should be full participants in all aspects of the planning and delivery of services” (Stroul & Friedman, 1996, p. 9). Family members, both individually and as representatives of family organizations, are participating in systems of care in a number of vital roles. Friesen and Stephens (1998) delineated six of these roles, and summarized related practice and research. In this paper we expand and continue their discussion of multiple roles, adding a seventh with elaboration of the role of family members as educators and trainers, separating that from the role of service provider. The following roles are reviewed: family members as context; targets for change and recipients of service; partners in the treatment process; service providers; educators and trainers of professionals, students, and other family members; advocates and policymakers; and evaluators and researchers. Recognition of these expanded family roles may help service providers be better prepared to work collaboratively with families and family organizations, and to become aware of the accomplishments that may be achieved through such collaboration.

Preserving Family Bonds: Examining Parent Perspectives in the Light of Practice Standards for Out‐of‐Home Treatment

Family participation is a core system of care value that is supported by previous research in medical, child welfare, and mental health settings. However, many parents with children receiving out-of-home mental health treatment experience restrictions on contact. This cross-sectional study examines the experiences of families (N = 102) regarding parent-child contact in relation to examples of national accreditation standards. Results of the national survey found that most respondents (79.4%) reported restrictions on contact, including limits based on behavioral contingencies (65.7%) and point and level systems (52.5%).