ABSTRACT
This article analyzes the self-reports of 384 adults who responded to a survey of people abused physically, sexually, or emotionally by family members in childhood. Most of the respondents sought help as adults from social workers and other mental health professionals for the long-term effects of their abusive experiences. This article analyses the reports of their help-seeking experiences against a backdrop of the reports of clinicians and researchers on working with survivors, as reported in the literature. Although survivors of childhood abuse often are described as having difficulty relating to professionals, these respondents persisted in seeking help and tended to report at least one experience with professional services that was very helpful. Their self-esteem and family functioning in adulthood was associated with having had a very helpful professional or service provider. The findings describe the responses most valued by survivors, as well as their views of the limitations of available services.
Subject(s)
Child Abuse/psychology , Mental Health Services/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Data Collection , Female , Humans , Male , Middle Aged , Ontario , Patient Acceptance of Health Care/psychology , Patient Satisfaction , Social Work, PsychiatricABSTRACT
This study is based on the reports of 384 adults who were abused physically, sexually, and/or emotionally in childhood by family members. It describes the survivors' attempts, as children, to get help by disclosing the abuse to someone who might intervene; those who did not disclose explain their reasons. The results indicate that disclosure usually did not bring an end to the abuse, and that little action was taken to control the perpetrator, even after disclosure took place. The responses received by the children to their disclosure are linked to their levels of self-esteem and family functioning as adults.
Subject(s)
Child Abuse/psychology , Family/psychology , Self Disclosure , Survivors/psychology , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Self Concept , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To develop learning objectives for teaching child psychiatry to family medicine trainees and to evaluate the best method of teaching these objectives. METHOD: For this descriptive study, knowledge, attitude, and skill objectives were presented to trainees at the start of a 6-month rotation, and an evaluation mechanism was developed based on the learning objectives. The method of instruction in each of the training locations was described independently by the child psychiatry consultant and attending family physician. The trainees' evaluations were presented according to training locations. RESULTS: Family medicine trainees perceived the teaching-consultation method, with live interviews, to be the most helpful and the didactic lecture format to be least helpful. CONCLUSION: The importance of teaching family medicine residents to recognize mental health problems in children and adolescents, preferably by using live interviews, and the implications for postresidency practice are emphasized.
Subject(s)
Adolescent Psychiatry/education , Child Psychiatry/education , Family Practice/education , Internship and Residency , Adolescent , Attitude of Health Personnel , Child , Clinical Competence , Curriculum , HumansABSTRACT
OBJECTIVE: To determine whether the psychiatric profile of children in foster care is more similar to clinical or community profiles. METHOD: Caregiver and teacher ratings of DSM-III-R externalizing and internalizing symptoms were collected for 3 groups of children: children in foster care, children assessed at a children's mental health centre, and a community sample. RESULTS: Children in foster care approximated the numbers and types of symptoms of the clinical sample. Coming from a family on social assistance, having a parent with a criminal history, and being of the male gender were correlated with higher externalizing and internalizing symptom scores independent of group membership. Group membership accounted for less than 5% of the variance in psychiatric symptom scores. CONCLUSIONS: The high symptom burden of children in care is substantially attributable to their high-risk histories, and treatment should be designed with this in mind.
Subject(s)
Foster Home Care , Mental Disorders/psychology , Adolescent , Caregivers , Child , Child, Preschool , Humans , Psychiatric Status Rating Scales , Risk FactorsABSTRACT
This paper examines psychiatric symptoms and disorders in children in the care of a Children's Aid Society. Youth, caretaker and teacher scores on the Standardized Clinical Information System questionnaire were correlated with demographic and maltreatment data gathered from the files of children from a Children's Aid Society. Mean externalizing and internalizing scores for the study group were significantly elevated above the norm on the youth, caretaker and teacher reports; externalizing more so than internalizing. Forty-one percent to 63% of the children studied scored in the pathological range for one or more disorders. Conduct disorder was the most common disorder (30% to 50%). Within the study sample, temporary wards and children with a history of having been abused had more elevated scores. The authors conclude that children in foster care have significant psychiatric morbidity reflective of the extreme adversity and maltreatment they have experienced.
Subject(s)
Child Behavior Disorders/epidemiology , Child Welfare , Foster Home Care/statistics & numerical data , Adolescent , Age Factors , Caregivers/psychology , Child , Child Abuse/psychology , Child Abuse/statistics & numerical data , Child Abuse, Sexual/psychology , Child Abuse, Sexual/statistics & numerical data , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Child of Impaired Parents/psychology , Child, Preschool , Female , Humans , Internal-External Control , Male , Ontario/epidemiology , Personality Assessment , Personality Development , Sex FactorsABSTRACT
The influence of various risk and protective factors on the presence of one or more behavioral or emotional disorders in 3,294 children and adolescents between the ages of 4 and 16 is examined using data from the Ontario Child Health Study conducted in 1983. Multivariate analyses showed that family problems and parental problems heightened the risk for disorder, whereas being a good student, getting along with others, and participation activities reduced the risk of disorder. Some interaction effects between various factors are also reported. The models generated are compared with others reported in the literature. Future research and social policy implications are discussed.
Subject(s)
Mental Disorders/psychology , Achievement , Adolescent , Child , Child, Preschool , Family , Humans , Models, Psychological , Parents/psychology , Risk FactorsABSTRACT
This paper emphasizes the importance of primary prevention, reviews some of the conceptual underpinnings of the subject, considers promising intervention programs which could be utilized now, discusses the current state of research in the field and suggests roles for the psychiatrist.
Subject(s)
Affective Symptoms/prevention & control , Child Behavior Disorders/prevention & control , Canada , Child , Child Psychiatry , Humans , Risk Factors , Social EnvironmentABSTRACT
We developed the methodology for a community survey to determine the prevalence of emotional and behavioral disorders among children 4 to 16 years of age in Ontario, Canada. Our discussion includes the objectives of the survey, the measurement of disorder, sampling methods and survey design, and a description of the data collected and instrumentation. Among 2052 households with eligible children, 1869 (91%) participated in the survey. The results can be used to help plan the future allocation of mental health resources in Ontario.
Subject(s)
Affective Symptoms/epidemiology , Child Behavior Disorders/epidemiology , Data Collection/methods , Health Surveys , Adolescent , Affective Symptoms/diagnosis , Age Factors , Child , Child Behavior Disorders/diagnosis , Child, Preschool , Community Mental Health Services/organization & administration , Female , Health Planning , Humans , Interviews as Topic/methods , Male , Ontario , Research Design , Sex FactorsABSTRACT
We studied the six-month prevalence of four child psychiatric disorders (conduct disorder, hyperactivity, emotional disorder, and somatization) and patterns of service utilization for mental health and social services, ambulatory medical care and special education by different regions of Ontario, urban-rural residence, and age and sex groupings. Among children 4 to 16 years of age, the overall six-month prevalence rate of one or more of these disorders was 18.1%. The prevalences of hyperactivity and one or more disorders were significantly higher in urban areas than rural areas. The utilization data indicated that children with these psychiatric disorders, compared with children without these disorders, were almost four times more likely to have received mental health or social services in the six months preceding this study. However, five of six of these children had not received these specialized services in the previous six-month period. Over 50% of the children in the province had received ambulatory medical care in the last six months. Over 15% of the children in the province had received special education services at some time thus far in their school careers. Implications of these findings, especially for the provision of child mental health services, are discussed.
Subject(s)
Community Mental Health Services/statistics & numerical data , Mental Disorders/epidemiology , Social Work, Psychiatric/statistics & numerical data , Adolescent , Affective Symptoms/epidemiology , Affective Symptoms/therapy , Ambulatory Care/statistics & numerical data , Child , Child Behavior Disorders/epidemiology , Child Behavior Disorders/therapy , Child, Preschool , Community Mental Health Services/supply & distribution , Cross-Sectional Studies , Education, Special/statistics & numerical data , Female , Health Planning , Health Surveys , Humans , Male , Mental Disorders/therapy , Ontario , Rural Population , Somatoform Disorders/epidemiology , Somatoform Disorders/therapy , Urban PopulationABSTRACT
The Ontario Child Health Study (OCHS) was based on interviews of 1869 Ontario families who were selected by means of a stratified, multistaged sampling method from the 1981 census of Canada. Its primary purpose was to determine the prevalence and distribution of mental health problems in Ontario children aged 4 to 16 years and their families, but it also allowed an estimate of other significant medical conditions and provided an overview of these children's use of health care, education and social services. Our results are based on questionnaire responses concerning 3294 children. Limitation of function without a chronic illness or medical condition was reported in 1.9%, the converse in 14.0%, and a chronic illness or medical condition with limitation of function in 3.7%. When the three groups are considered together, 19.6% of Ontario children had a chronic health problem. Children of lower socioeconomic status were much more likely to have chronic health problems. Overall, children with chronic health problems were more likely to use physician, special education, social and mental health services. These findings have implications for those who provide services for children, plan community programs or train professionals in caring for children.
