Effectively Addressing Mental Health Issues in Child Welfare Practice: The Family Connection

By Pufahl, Elisabeth | Child Welfare, September/October 2007 | Go to article overview

Effectively Addressing Mental Health Issues in Child Welfare Practice: The Family Connection


Pufahl, Elisabeth, Child Welfare


Nonprofit family-run organizations, such as Tennessee Voices for Children (TVC), are providing leadership in advocating for and delivering services to children and families in need. Utilizing a family-driven approach and a staff partially comprised of parent-professionals, TVC's Nashville Connection and Family Connection programs have strengthened families by providing alternatives to state custody for children and families living with serious emotional or behavioral problems. TVC's Nashville Connection and Family Connection programs did this by coordinating support services, building community bridges, and providing comprehensive in-home services.

The following is a true account of a family referred to and enrolled in Tennessee Voices for Children's Family Connection program. Their names have been changed, but through the course of this paper, their journey to a stable and loving home environment is documented.

Donald and his three younger brothers were about to move again. All four boys had been in and out of protective custody due to parental drug use and environmental neglect. Reunification was attempted unsuccessfully several times. Their mother tried diligently but was unable to meet their needs, ultimately leaving them to fend for themselves for days on end. Donald, the oldest at 17, had an unaddressed drug habit despite several stints in foster care. His younger brother, Kevin, was the caretaker of the family and was so focused on getting the younger two to school that he had not attended school himself in weeks. The two younger boys were not at grade level in school and were scared they would be forced to move again. Their three younger sisters had already been removed to a foster home. The boys did not want to be separated. They called themselves the 'Rat Pack' (K. Ellis, personal communication, November 2006).

This story illustrates one family's experience in this family-run program, which provides alternatives to state custody for children and families living with serious emotional and behavioral problems by putting the family first. As will be demonstrated throughout this paper, Tennessee Voices for Children's Family Connection program did this by coordinating support services, building community bridges, and providing comprehensive in-home services.

In the United States today, more than 500,000 children are involved with the foster care system, with over 11,000 of them living in the state of Tennessee. Despite our best efforts, research shows that foster care is a poor substitute for a loving and stable home environment. In fact, due to the nature of the foster care system, children experience frequent disruptions, oftentimes never experiencing a nurturing, stable home environment. Unfortunately, most children are in foster care for at least one year, if not more. According to a 2000 report on the status of children in custody in the state of Tennessee, children ages 6-12 remained in custody an average of 1,188 days, which is more than three years and longer than any other age group (Tennessee Commission on Children and Youth, 2000). Additionally, many of these children have been the victims of abuse and neglect, have disproportionately high rates of physical, developmental, and mental health problems, and often have many unmet medical and mental health care needs (Committee on Early Childhood, Adoption and Dependent Care, 2000; Children's Defense Fund, 2006). According to the June 2000 edition of the Tennessee Commission on Children and Youth's The Advocate, one in four children in the state of Tennessee's foster care program were allegedly physically or sexually abused and 38% of children had a formal mental health diagnosis.

Moreover, while reunification is most often the goal, children in custody have family members with great needs that must be addressed prior to that happening. Per Tennessee data, 62% of children in custody had parents with substance abuse issues, 59% had parents who were or had been incarcerated, 43% were from homes below poverty level, and 32% of the children had experienced domestic violence in the home (Tennessee Commission on Children and Youth, 2000). …

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Effectively Addressing Mental Health Issues in Child Welfare Practice: The Family Connection
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