Stuart Cumella

Psychosocial functioning of homeless children

OBJECTIVE To investigate the psychosocial characteristics of homeless children and their parents. METHOD Homeless families were assessed within 2 weeks of admission to seven hostels and were compared with a group of housed families matched for socioeconomic status. Measures included a semistructured interview, the General Health Questionnaire (GHQ), the interview Schedule for Social Interaction, the Child Behavior Checklist (CBCL), the Communication domain of the Vineland Adaptive Behavior Scales, and height and weight percentiles. The sample consisted of 113 homeless families (249 children aged 2 through 16 years) and 29 comparison families (83 children). RESULTS Homeless families primarily consisted of single mothers and an average of two children, who had become homeless because of domestic violence (56%) or violence from neighbors (29%). Homeless mothers reported high rates of previous abuse (45%) and current psychiatric morbidity (49% caseness on the GHQ) and poor social support networks compared with housed controls. Homeless children were more likely to have histories of abuse, living in care, and being on the at-risk child protection register and less likely to have attended school or a preschool/day-care center since admission to the hostel. They also had delayed communication and higher CBCL scores. Maternal GHQ scores best predicted CBCL caseness. CONCLUSIONS Homeless mothers and children have high rates of psychosocial morbidity, which are related to multiple risk factors and chronic adversities. Their complex needs should be best met by specialized and coordinated health, social, and educational services.

Mental Health Problems and Social Supports Among Homeless Mothers and Children Victims of Domestic and Community Violence

BACKGROUND Children and mothers who have suffered domestic or neighbourhood violence constitute a high risk group, although it has not been clear whether their mental health needs are specifically related to the type of violence. This paper reports on the prevalence of mental health problems in homeless parents and children who have experienced domestic and neighbourhood violence and their access to social support networks. METHODS Three groups of families who had become homeless were compared: those experiencing domestic violence (48 with 75 children), victims of neighbourhood violence (14 with 29 children), and those who became homeless for other reasons (31 with 54 children). Mothers completed a service use semi-structured interview, the Strengths and Difficulties Questionnaire, the General Health Questionnaire, the Family Support Scales, and the SF-36 Health Status Questionnaire. RESULTS Levels of psychiatric morbidity were high in the group experiencing domestic violence (35.7% in children and 21.9% in mothers) and higher still in those who were victims of neighbourhood violence (52.2% in children and 50% in mothers). Levels of social support were found to be an important factor, particularly in relation to professional support and support from other family members, as they predicted both child and maternal psychopathology. CONCLUSIONS Mental health interventions for victims of domestic and neighbourhood violence should be integrated with community programmes of social reintegration. Mental health professionals should work in close collaboration with Housing Departments, Social Services, Education and the Police.

Evaluation of a mental health outreach service for homeless families

Aims: To describe the characteristics of homeless children and families seen by the mental health outreach service (MHOS), to evaluate the impact of this service on the short term psychosocial functioning of children and parents, and to establish perceptions of, and satisfaction with, the service. Methods: Twenty seven children from 23 families who were in receipt of the MHOS and 27 children from 23 families residing in other hostels where no such service was available were studied. The MHOS was delivered by a clinical nurse specialist with expertise in child mental health, who offered the following interventions: assessment and brief treatment of mental health disorders in children; liaison with agencies; and training of homeless centre staff. Results: Children in the experimental group had a significantly higher decrease in Strengths and Difficulties Questionnaire (SDQ) total scores. Having received the intervention was the strongest predictor of improvement in SDQ total scores. There was no significant impact on parental mental health (General Health Questionnaire) scores. Homeless families and staff expressed high satisfaction with the MHOS. Conclusion: This MHOS for homeless families is an innovative intervention which meets the complex and multiple needs of a vulnerable population unable to access mainstream mental health services. The primary objective of the service was to improve child mental health problems; however, the service developed in a responsive way by meeting social and practical needs of families in addition to its clinical role.

The mental health of children in homeless families and their contact with health, education and social services

Previous research indicates that children in homeless families have a high risk of physical and mental illness. This study reports the initial stage of a longitudinal research programme to measure the prevalence of psychiatric disorders among parents and children in homeless families. A sample of parents in 113 homeless families were interviewed within 2 weeks of admission to seven homeless centres in the City of Birmingham, and compared with a sample of 29 low-income families who were not homeless. Both sets of interviews used the Child Behaviour Checklist (CBCL), the Communication Domain of the Vineland Adaptive Behaviour Scales (VABS), the General Health Questionnaire (GHQ), the Interview Schedule for Social Interaction (ISSI), and height and weight percentiles. A sub-sample of children was also interviewed. The results indicate that 85% of families became homeless because of domestic or neighbourhood violence, that in 54% of families in homelessness coincided with the separation of the partners, and that 49% of mothers had current psychiatric morbidity. Children in homeless families had delayed communication and higher mean scores for mental health problems than the comparison sample. Homeless children were also more likely to have had histories of abuse, and less likely to have attended school or nursery school since becoming homeless. Homeless families had high rates of contact with primary healthcare and social services, but few had been in contact with specialist child and adolescent mental health services. These results indicate a need for a co-ordinated action by housing, social services, education, health services, and the police to prevent families from becoming homeless by protecting victims of domestic and neighbourhood violence from further violence and intimidation. Hence the need to rapidly re-house into permanent accommodation those who do become homeless, to maintain education for their children, and to ensure that such families have access to effective social support and healthcare.Previous research indicates that children in homeless families have a high risk of physical and mental illness. This study reports the initial stage of a longitudinal research programme to measure the prevalence of psychiatric disorders among parents and children in homeless families. A sample of parents in 113 homeless families were interviewed within 2 weeks of admission to seven homeless centres in the City of Birmingham, and compared with a sample of 29 low-income families who were not homeless. Both sets of interviews used the Child Behaviour Checklist (CBCL), the Communication Domain of the Vineland Adaptive Behaviour Scales (VABS), the General Health Questionnaire (GHQ), the Interview Schedule for Social Interaction (ISSI), and height and weight percentiles. A sub-sample of children was also interviewed. The results indicate that 85% of families became homeless because of domestic or neighbourhood violence, that in 54% of families in homelessness coincided with the separation of the partners, and that 49% of mothers had current psychiatric morbidity. Children in homeless families had delayed communication and higher mean scores for mental health problems than the comparison sample. Homeless children were also more likely to have had histories of abuse, and less likely to have attended school or nursery school since becoming homeless. Homeless families had high rates of contact with primary healthcare and social services, but few had been in contact with specialist child and adolescent mental health services. These results indicate a need for a co-ordinated action by housing, social services, education, health services, and the police to prevent families from becoming homeless by protecting victims of domestic and neighbourhood violence from further violence and intimidation. Hence the need to rapidly re-house into permanent accommodation those who do become homeless, to maintain education for their children, and to ensure that such families have access to effective social support and healthcare.

Secondary Healthcare and Learning Disability Results of Consensus Development Conferences

Many people with learning disabilities live shorter lives and have poorer health than the rest of the population. This results in part from less access to healthcare, and several studies have evaluated ways of improving primary healthcare for this group. Much less attention has been paid to the experiences of people with a learning disability in general hospitals. This exploratory study used consensus development conferences of people with a learning disability, their supporters, family, professionals and managers. It was reported that hospitals frequently failed to communicate with, provide emotional support for, or adapt to the specific needs of patients with a learning disability. Hospital staff noted that community services failed to provide information about patients, and that hospital staff lacked training in communicating with people with a learning disability. Fieldwork identified a range of solutions to deal with these problems, most of which involved incremental changes in hospital and community health procedures.

A DESCRIPTION OF A FORENSIC DIVERSION SERVICE IN ONE CITY IN THE UNITED KINGDOM

This paper describes some recent research on forensic diversion services and the application of such services in Birmingham, UK. Key components include the diversion scheme in court, diversion at point of arrest, and the remand prison liaison scheme. Various community facilities, such as a specialized bail hostel and landlady schemes to which offenders are possibly referred, are also briefly described. We advocate the need for further research in order to examine the effectiveness of the services in Birmingham.

One hundred admissions to a regional secure unit for people with a learning disability

Abstract Information was collected about 100 successive admissions to a regional secure unit for people with a learning disability (mental handicap). Most of the patients were males under the age of 30, with a mild or borderline learning disability. A majority also had a psychiatric disorder. The most common offences committed were sexual, arson and assault. After discharge, most patients returned either to the community or to a mental handicap hospital. A comparison of the first cohort of 50 admissions with the second cohort of 50 admissions showed that the unit had changed its admission policy and had increasingly admitted those with a mild or moderate learning disability referred by the courts. In addition, the average length of stay had doubled, and the number of admissions each year had halved. This reflects a lack of local facilities which can provide intensive supervision.

Penile hygiene : puberty, paraphimosis and personal care for men and boys with an intellectual disability

BACKGROUND Supporting men and boys with an intellectual disability (ID) to meet their penile hygiene needs is perhaps one of the least acknowledged but most confronting issues facing care staff. The delivery of intimate hygiene can be a challenging topic particularly as it has been drawn into the emerging sexuality discourse and the ongoing abuse narrative. Compounding this challenge is the lack of guidance in intimate care for support staff. In addition, whereas the male with an ID outnumber the female, female care staff greatly outnumber male staff. Whether this situation affects outcomes for men and boys with an ID is unknown but it is an issue which should be examined. METHOD This paper reports data from two separate studies, one quantitative the other qualitative, which sought to explore penile hygiene as a male health issue. RESULTS Results show the practice of care staff to be inconsistent, the views and values of care staff to be divergent. Some patterns and contextual differences were identified depending upon the gender of care staff. An emerging dialogue described some of the positive contributions that male staff make to men and boys with an ID. CONCLUSIONS The penile health needs of men and boys with an ID are being compromised by a lack of guidance, training, knowledge and limited gender-sensitive care.

Quality of Life and Psychological Well-Being of Mentally Disordered Offenders after Court Diversion: A 6-Month Follow-Up

This study was conducted to examine the quality of life and the psychological well-being of mentally disordered offenders 6 months after being diverted from one court diversion scheme in England. A total of 65 offenders (58 male, 7 female) participated in the study, which used the Life Experiences Checklists (LEC) and the General Health Questionnaire (GHQ). The results showed that, when compared with the data of the standardized urban samples of Ager, the quality of life of offenders was significantly lower than that of the standardized population. Further analyses demonstrated that there were significant differences in the quality of life between the offenders who lived in private households, prisons, hostels, and hospitals.

Mother and teacher ratings of maladaptive behaviour in children with special needs

ABSTRACT Parents and teachers of 109 children selected from the Special Needs Register and living in a multiethnic urban health district participated in the study. Their perceptions of childrens behaviour at home and at school were measured by the Aberrant Behavior Checklist(ABC). About two‐thirds of the subjects presented with at least one type of maladaptive behaviour of at least moderate severity within their family, and 50 per cent had similar difficulties at school. The dimensions of hyperactivity and irritability were the main causes for concern by both sources. Contrary to previous studies, high rates of parent‐teacher agreement were found. This significant association was not affected by factors such as age, ethnicity or type of school. The implications for the provision of services for children in special education are discussed.