PARENT-FOCUSED INTERVENTIONS

A multitude of effective preventive and treatment models exist for parenting interventions, said John Landsverk, director of the Child and Adolescent Services Research Center at Rady Children’s Hospital in San Diego. The primary problem is the translation of those interventions into child welfare service systems and other systems such as child mental health care.

Effective parent-mediated interventions have many elements, including nonharsh methods such as timeouts, consistent consequences for behavior problems, homework, and in vivo practice. Also, a wealth of data is available to support these interventions. A meta-analysis of child psychotherapy trials between 1963 and 2002 grouped trials by issue, finding 94 publications focused on anxiety or fears, 23 dealing with depression, 135 on conduct-related disorders and problems, and 35 on parent-focused or parent-mediated interventions (Weisz et al., 2004). Many issues have been well studied using randomized controlled trials, said Landsverk.

Mental Health Services for Children

Traditionally, child welfare is organized around three mission elements: safety, permanence or stability, and well-being. Child welfare systems typically have been comfortable taking responsibility for the first two, but considerable ambivalence surrounds well-being. It is the most difficult to assess. It also is seen as requiring expertise and resources of sister agencies such as child mental health, developmental services, health, and education.

Parenting interventions can be focused either on the abusive and neglectful behaviors that put children at risk or on the behavior resulting from abusive and neglectful parenting behaviors, said Landsverk. In the latter category, not much diagnostic information exists about externalizing problems. But a San Diego study of more than 400 children dependent on the child welfare system found 42 percent with a diagnosis of moderate impairment, including attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (Garland et al., 2001). Similarly, a National Survey of Child and Adolescent Well-Being (NSCAW) study on mental health service use found that 45 percent of the sample population met Child Behavior Checklist criteria for behavior problems (Orton et al., 2009).

Current data show that the deeper children get into the child welfare system, the more likely they are to be referred to specialty mental health



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