Jean Adnopoz

Resilience and Family Psychosocial Processes Among Children of Parents with Serious Mental Disorders

Resilience involves successful adaptation despite adverse circumstances, and is operationalized in this study as a multidimensional construct which consists of both positive and negative indicators of adaptation. Previous research has emphasized the importance of parental psychopathology in predicting child adaptation among children of parents with serious mental disorders. In contrast, we hypothesized five family psychosocial processes as common sequelae to serious parental mental disorder that are central to child adaptation beyond that predicted by parental psychiatric status. These are diminished family financial resources, social network constriction, impaired performance of parenting tasks, increased familial stress, and disruption of the parent-child bond. We examined the relationship of these processes to child adaptation independently through hierarchical regression analyses after taking into account parental psychiatric symptoms and functioning as well as the childs age and gender. One hundred seventy-seven children of mothers with serious mental disorder, ages 2–17 years old, were assessed on measures of adaptation. Results indicated that family psychosocial processes are a more consistent and powerful predictor of child adaptation than parental psychopathology. Results also indicated that, for these children, adaptation is predicted most consistently by parenting performance, and to lesser extents, by the parent-child bond and familial stress. We discuss our results in terms of their implications for theory and intervention with children of parents with serious mental disorders and for the study of resilience.

Intensive, integrated, in-home psychiatric services. The catalyst to enhancing outpatient intervention.

The authors introduce the Yale Intensive In-Home Child and Adolescent Psychiatric Service, a model of home-based care for children with severe psychiatric disturbances. This model synthesizes the principles and method of the wrap-around paradigm and in-patient child psychiatric practice within the reality of the managed care system. A clinical team, under the direct supervision of a child psychiatrist, works directly within the family to understand and address the multilevel transactions that have affected the childs ability to function in various domains and resulted in recommendations for intensive intervention, including psychiatric hospitalization. This article suggests that if the psychiatrist is to provide the highest level of care, cognizance of and involvement in the childs ecology are as essential for the child and adolescent psychiatrist as other aspects of the childs world and life. In the days of ever shortening patient lengths of stay, this model of care offers promise for both clinical and fiscal effectiveness.

Treatment recommendation, implementation, and follow-up in child abuse

Seventy cases of child abuse identified at an urban general medical hospital were studied to find variables which predict treatment recommendations and follow-up care. Response to only the most vivid cases often overlooks the need to assess other abuse. Continued clinical research and improved follow-up documentation are recommended.

Changes in mental health outcomes with the intensive in-home child and adolescent psychiatric service: a multi-informant, latent consensus approach

This study investigates the Intensive In‐home Child and Adolescent Psychiatric Service (IICAPS), a large‐scale home‐based intervention that collaboratively engages the family, school, and various other service providers (e.g. health practitioners or judicial systems) to prevent the hospitalization, institutionalization or out‐of‐home placement of children and adolescents with serious emotional disturbance. Multi‐informant data (youth, parents and clinician) on the level of youth problem severity and functioning was gathered from 7169 youth and their families served by the IICAPS network, pre‐ and post‐intervention. A newly developed “Multi‐informant Latent Consensus” (MILC) approach was employed to measure mental health “baseline levels” and change, within a Structural Equation Modeling framework. The MILC approach demonstrated promise integrating information from multiple informants involved in the therapeutic process to yield a more accurate and systemic view of a childs level of functioning and problem severity than each report taken individually. Results indicated that the IICAPS family and community based intervention model led to a reduction of problem severity and improved functioning in children and adolescents with severe emotional disturbance. Copyright

IICAPS: A Treatment Model for Delinquent Youths with Co-occurring Mental Health Disorders

More than 1.7 million youth are presently on the delinquency caseloads of the juvenile courts in the USA (Harms 2003). Youth who enter the juvenile justice system have been found to present with a range of problematic behaviors that require mental health intervention if they are to be ameliorated (Wasserman et al. 2004). Prevalence research suggests that the rate of mental health disorders among youth in the juvenile justice system is close to 70%, exceeding the 10–20% estimated rate for youths in the general population (Espelage et al. 2003; National Center for Mental Health and Juvenile Justice 2005). One large-scale study of 1,829 male and female juvenile detainees in Cook County, Illinois found that excluding conduct disorder, nearly 60% of male and 66% of female detainees met criteria for psychiatric disorders and had diagnostic-specific levels of impairment for one or more disorders. (Teplin et al. 2002)