Best Practices for Mental Health in Child Welfare: Parent Support and Youth Empowerment Guidelines
Romanelli, Lisa Hunter, Hoagwood, Kimberly E., Kaplan, Sandra J., Kemp, Susan P., Hartman, Robert L., Trupin, Casey, Soto, Wilfredo, Pecora, Peter J., LaBarrie, Theressa L., Jensen, Peter S., Child Welfare
This paper, the second in a series of two guideline papers emerging from the 2007 Best Practices for Mental Health in Child Welfare Consensus Conference, provides an overview of the key issues related to parent support and youth empowerment in child welfare and presents consensus guidelines in these important areas. The paper also discusses some of the implications these guidelines have for the child welfare field.
As mentioned in the preceding paper about screening, assessment, and treatment guidelines, the 2007 Best Practices for Mental Health in Child Welfare Consensus Conference brought together parent and youth child welfare advocates as well as research, policy, and services experts in the fields of child welfare and mental health to develop guidelines for addressing mental health in child welfare. This paper presents the guidelines in the areas of parent support and youth empowerment. It begins with an overview of the key issues related to parent support and youth empowerment in child welfare. Next, we briefly describe the guideline development process. The parent support and youth empowerment guidelines along with their rationale follow. The paper ends with a discussion of some of the implications these guidelines have for child welfare.
The Need for Parent Engagement in Child Welfare
Studies have found that, when families are actively engaged in health and mental health services for children, children are more likely to benefit from the care they receive (Hoagwood, 2005; McKay & Bannon, 2004). Not only does access to services depend on the recognition and actions of key adults (Angold, Messer, Stangl, Farmer, Costello, & Burns, 1998; Farmer, Burns, Angold, & Costello, 1997; Pescosolido, 1992; Proctor & Stiffman, 1998), but families provide the major context for children's learning, and they can either promote or undermine the benefits that can accrue from treatment. For children with mental health issues, underrecognition of emotional or behavioral problems is, unfortunately, welldocumented and can lead to escalating problems that often drive both youth and families into more expensive, more restrictive, and less community-based treatment or service options (Walker & Sprague, 1999). Lack of recognition exists in most of the nonspecialty care sectors and is of particular concern in gate-keeping systems such as schools, primary care settings, and, for children with very high-risk profiles, child welfare agencies (U.S. Public Health Service [USPHS], 2001). Underrecognition combined with limited access to services can exacerbate the challenges for parents, making involvement in their child's care even more difficult.
For children involved in the child welfare system, engaging both them and their families can be particularly challenging (Kemp, Marcenko, Hoagwood, & Vesneski, 2009). For example, although the NSCAW study indicated child welfare workers reported problematic substance abuse for 10.7% of caregivers, only 20% to 50% of substance-using parents enter into and complete substance abuse treatment (Grégoire & Shultz, 2001; U.S. Department of Health and Human Services, 2005). Even when faced with termination proceedings, many parents fail to undertake or complete court-mandated services (Atkinson & Butler, 1996; Butler, Radia, & Magnatta, 1994; Jellinek, Murphy, Poitrast, Quinn, Bishop, & Goshko, 1992), including regular visits with their children (Perkins & Ansay, 1998). Particularly troubling is evidence that families of color generally receive and use fewer services and supports through the child welfare system than white families do (Benedict, White, Stallings, & Corneley, 1989; Courtney, Barth, Berrick, Brooks, Needell, & Park, 1996; Hill, 2006; Libby Orton, Barth, Webb, Burns, Wood, & Spicer, 2006; Rodenburg, 2004). Low rates of service use reduce the likelihood that parents can address the problems that precipitated child welfare involvement, demonstrate change, make progress toward reunification with their children, and maintain positive gains following reunification (Bellamy, 2008; Carlson, Matto, Smith, & Eversman, 2006; Lau, Litrowik, Newton, & Landsverk, 2003). …