Hospitals implementing changes in law to protect children of ill parents: a cross-sectional study.

BACKGROUND: Norway is one of the first countries to require all health professionals to play a part in prevention for children of parents with all kinds of illnesses (mental illness, drug addiction, or severe physical illness or injury) in order to mitigate their increased risk of psychosocial problems. Hospitals are required to have child responsible personnel (CRP) to promote and coordinate support given by health professionals to patients who are parents and to their children. METHODS: This study examined the extent to which the new law had been implemented as intended in Norwegian hospitals, using Fixsen's Active Implementation Framework. A stratified random sample of managers and child responsible personnel (n = 167) from five Hospitals filled in an adapted version of the Implementation Components Questionnaire (ICQ) about the implementation of policy changes. Additional information was collected from 21 hospital coordinators (H-CRP) from 16 other hospitals. RESULTS: Significant differences were found between the five hospitals, with lowest score from the smallest hopitals. Additional analysis, comparing the 21 hospitals, as reported by the H-CRP, suggests a clear pattern of smaller hospitals having less innovative resources to implement the policy changes. Leadership, resources and system intervention (strategies to work with other systems) were key predictors of a more successful implementation process. CONCLUSIONS: Legal changes are helpful, but quality improvements are needed to secure equal chances of protection and support for children of ill parents. TRIAL REGISTRATION: The study is approved by the Regional Committee on Medical and Health Research Etics South-East (reg.no. 2012/1176 ) and by the Privacy Ombudsmann.

[Predictors of Psychological Evaluation Recommendations in Child Custody and Access Proceedings]. / Prädiktoren psychologischer Empfehlungen in der familienrechtspsychologischen Begutachtung bei Verfahren zum Sorge- und Umgangsrecht.

Predictors of Psychological Evaluation Recommendations in Child Custody and Access Proceedings Psychologists can make an important contribution to decision making in custody and access proceedings by providing expert opinions to the courts, addressing the best interests of the child. This study aims to investigate quantified effects of indicators on recommendations of psychological evaluators in custody and access proceedings. This data is based on 179 psychological evaluations that were conducted from 2008 to 2012 at an evaluator association in Bremen, Germany. The data is assessed in a quantitative content analysis. Using logistic regression analysis, the influence of child- and parent-related factors on the recommendations of the evaluators is investigated both in custody and in access proceedings. In cases addressing child custody, substance abuse and dependency of the mother and a child's preference for living with the father are significant predictors for the evaluators' recommendation. In cases concerning visitation rights, the child refusing contact with the father and the child experiencing physical abuse are identified as significant predictors. In the present study, the effects of relevant factors on the recommendation of psychological evaluators in family proceedings were first examined on a German sample. This study thus makes an important contribution to the empirical research in the field of psychology and family law.

'Framed': Terminating the Parenting Rights of Parents with Intellectual Disability in Iceland.

BACKGROUND: The aim was to investigate the role of measured intellectual function in framing parents as 'unfit' in child custody deprivation cases. METHOD: Grounded theory was used to analyse a national sample of custody deprivation cases in Iceland 2002-2014. RESULTS: The terminology used to evaluate and describe the intellectual and developmental status of parents in child deprivation custody cases served as a device to define and shape the 'unfit parent'. Intellect itself, whether as low, average or even above average at times acts as a master narrative which informs and explains all manner of perceived parental deficiencies. CONCLUSION: The intellectual and developmental status served as a yardstick of identifying, understanding and interpreting the unfit parent. As a tool to achieve an end, parents were framed in language and culture using underlying belief set to make sense of events and issues.

A gap between the intention of the Swedish law and interactions between nurses and children of patients in the field of palliative oncology - The perspective of nurses.

PURPOSE: Children who have a parent with incurable cancer are in a vulnerable situation and the Swedish law tries to protect them. This article aims to explore the interactions between nurses and children of patients with incurable cancer from the nurses' perspective. METHOD: Semi-structured interviews with nine nurses in palliative oncology in Southern Sweden. Latent content analysis was carried out, inspired by Lundmann and Graneheim. RESULTS: Parents are gatekeepers to the children's involvement and meetings with the healthcare professionals. Therefore the nurses were dependent on the parents for contact with their children. Additionally, nurses were subject to the structural frame of their working environment in terms of time, economy, resources and the medical logic ruling the priorities for nursing during their daily working day. The opportunities to pay attention to the children of patients were limited, despite good intentions, willingness and a favourable legal framework. Teenagers were regarded as a challenge, and per se they challenged the nurses' opportunities to gain control of the meetings and situations around the families. CONCLUSIONS: Often nurses did not see and acknowledge the children of the palliative patient. They knew that the children were there and that it was important that they were there, but they challenged the order in the working environment in relation to time-allocated tasks and working flow. In the working environment patients were prioritised over relatives. From the perspective of nurses, there is a gap between the intentions of the Swedish law and the interactions between nurses and children.

Punishing parents: child removal in the context of drug use.

New amendments to child welfare policy in New South Wales turn a spotlight on parents who use drugs and raise concerns about adequate provision of services for families facing issues with alcohol and other drug use. Sections of the new legislation are explicitly focused on parents who use illicit drugs, expanding the reach of child protection services over expectant parents during pregnancy. This targeting of women who are 'addicted' highlights the ambiguous scientific and moral attention to drug use in pregnancy. It also raises practical questions about the potential for the legislation to increase stigma towards drug use and disproportionately affect vulnerable and disadvantaged families.

Termination of parental rights for parents with substance use disorder: for whom and then what?

The purpose of this study is to investigate the correlates of termination of parental rights (TPR) for parents with substance use disorder (SUD) and to determine what happens with regard to permanency once a TPR decision is made. Bivariate techniques and hierarchical nonlinear modeling are used. Parents of older youth, boys, and Hispanics were less likely, whereas parents who failed to make progress in substance use treatment and parenting skills are more likely to experience TPR. At follow up, 85% of the children were adopted, 7% remained in a substitute care settings, and 7% were reunified with their parents. Concerns remain for children without a permanent home setting.

Do specialty courts achieve better outcomes for children in foster care than general courts?

OBJECTIVE: This study assessed the effects of unified family and drug treatment courts (DTCs) on the resolution of cases involving foster care children and the resulting effects on school performance. METHOD: The first analytic step was to assess the impacts of presence of unified and DTCs in North Carolina counties on time children spent in foster care and the type of placement at exit from foster care. In the second step, the same data on foster care placements were merged with school records for youth in Grades 3-8 in public schools. The effect of children's time in foster care and placement outcomes on school performance as measured by math and reading tests, grade retention, and attendance was assessed using child fixed-effects regression. RESULTS: Children in counties with unified family courts experienced shorter foster care spells and higher rates of reunification with parents or primary caregivers. Shorter foster care spells translated into improved school performance measured by end-of-grade reading and math test scores. Adult DTCs were associated with lower probability of reunification with parents/primary caregivers. CONCLUSION: The shortened time in foster care implies an efficiency gain attributable to unified family courts, which translate into savings for the court system through the use of fewer resources. Children also benefit through shortened stays in temporary placements, which are related to some improved educational outcomes.

Criminal conviction among offspring with parental history of mental disorder.

BACKGROUND: Offspring of parents with mental disorder are at risk of a range of adverse outcomes. We sought to establish whether such risks extend to offending by examining rates of criminal conviction, including conviction for violent and sexual offences, among offspring of parents with mental disorder compared to offspring without parental disorder. METHOD: From a random sample of the Danish population, a cohort aged ≤15 years (n=412,117) was followed for the occurrence of conviction between January 1981 and December 2006. Incidence rate ratios (IRRs) and cumulative incidences for offspring conviction by parental mental disorder status were calculated using a Cox regression model. Analyses were repeated for conviction for a serious first offence. RESULTS: Offspring with history of parental mental disorder had higher rates of conviction than those without parental disorder; rates were highest for those with two affected parents [IRR 3.39, 95% confidence interval (CI) 3.08-3.73]. The association persisted when parental gender, offspring gender and the nature of parental disorder were considered. Absolute rates were lower but relative rates higher for female offspring (IRR 3.26 for males with two affected parents, 4.52 for females). Similar patterns were seen for conviction for serious offences. Associations were attenuated after adjustment was made for family socio-economic position (SEP) and parental criminality. CONCLUSIONS: Offspring of parents with mental disorder represent a group at elevated risk of criminality. This raises the possibility of shared familial vulnerability for mental disorder and criminal behaviour, and highlights the need to consider early identification and intervention in this group.

Legislation affecting governmental assistance for children of parents with substance use: a policy analysis of social justice.

There is legislation that withdraws governmental assistance where parents are using drugs. Social justice is an important consideration in any policy that modifies governmental assistance that benefits vulnerable children. The purpose of this policy analysis is to analyze identified legislation that effect governmental assistance for children in response to parents' substance misuse. A selective review of data-driven studies examined findings describing actual or potential effects on children of legislation targeting parental substance misuse. Challenges in design, processes, and implementation contribute to poor child outcomes. Identifiable constructs of social justice were missing in the reviewed legislation. Social injustice is a potential outcome for children when legislative intent focuses solely on addressing parental drug behaviors. Legislative alternatives to withdrawing support can address substance abuse while maintaining health promotion for these vulnerable children.

Visitation arrangements for impaired parents.

Forensic mental health professionals are frequently asked to evaluate the parenting skills of divorcing parents because the court seeks help in determining the custody, visitation, and parenting time arrangements for the children. When one of the parents is impaired, the court wants to know the way to help the children have a good relationship with that parent and keep the children safe. There is little empirical research to answer such questions. In this article, the authors describe their methodology for providing useful clinical information to the court to help guide their decisions regarding visitation with impaired parents.

Estimating present and future damages following child maltreatment.

The child psychiatric forensic evaluation of children and adolescents who are plaintiffs in civil lawsuits regarding their present and future damages from child maltreatment requires knowledge of current research findings on the short-term and long-term consequences of child maltreatment, evidence-based treatments for psychological trauma, and relevant professional guidelines, along with knowledge of the ethics and laws governing mental health expert practice and testimony in personal injury litigation. This article reviews current research and recommends an approach to these evaluations and expert testimony that is informed by current research findings, recently developed professional guidelines, and many years of professional experience.

The inclusion of disability as a condition for termination of parental rights.

OBJECTIVES: All 50 states and the District of Columbia have statutes outlining the grounds for terminating parental rights (TPR) in relation to child abuse and neglect. Although recent research has found that parents with disabilities are not more likely to maltreat their children than parents without disabilities (Glaun & Brown, 1999; Oyserman, Mowbray, Meares, & Firminger, 2000), studies have found very high rates of TPR of parents with disabilities (Accardo & Whitman, 1989). The objective of this study is to examine how states are including disability in their TPR statutes. METHODS: This study used legal document analysis, consisting of a comprehensive Boolean search of the state codes of the 50 states and District of Columbia (DC) relating to TPR, using the most recent state code available on Lexis-Nexis in August 2005. TPR and related statutes were searched for contemporary and historical disability related terms and their common cognates, such as: "mental," "disability," "handicap," and "incapacity." Two researchers independently conducted the searches, and the searches were reconciled. A code list was then developed to measure for inclusion of disability, preciseness, scope, use of language, and references to accessibility or fairness. Statutes were then reanalyzed, and groupings developed. RESULTS: Thirty-seven states included disability-related grounds for termination of parental rights, while 14 states did not include disability language as grounds for termination. Many of these state codes used outdated terminology, imprecise definitions, and emphasized disability status rather than behavior. All of the 14 states that do not include disability in TPR grounds allowed for termination based on neglectful parental behavior that may be influenced by a disability. CONCLUSIONS: The use of disability language in TPR statutes can put an undue focus on the condition of having a disability, rather than parenting behavior. IMPLICATIONS: This paper recommends that states consider removing disability language from their statutes, as such language risks taking the emphasis away from the assessment based on parenting behavior.

Childhood risk factors for offending before first psychiatric admission for people with schizophrenia: a case-control study of high security hospital admissions.

BACKGROUND: People with schizophrenia who offend do not constitute a homogenous population. Pre-illness characteristics may distinguish groups. AIMS: To test for differences in prevalence of childhood risk factors for offending between serious offenders with schizophrenia who had started offending before their first ever psychiatric admission (pre-admission offenders) and those who had started after it (post-admission offenders). Our hypothesis was that such adverse childhood factors would be more prevalent in the pre-admission offenders. METHOD: Retrospective interview and records case-control study of all first high security hospital admissions diagnosed with schizophrenia in England 1972-2000. Risk factors were identified by multivariate logistic regression. RESULTS: 853 patients were pre- and 741 post-admission offenders. Our hypothesis was confirmed in that factors associated with pre-admission offending were paternal criminal convictions, larger family size, and younger age at first use of illicit drugs, on first smoking cigarettes, and at maternal separation. There were differences too in pre-high security hospital treatment: pre-admission offenders had been younger at first court appearance and had more criminal justice system disposals, post-admission offenders were younger at first ever psychiatric hospital admission and more often hospitalized. CONCLUSIONS: While early offending among people with schizophrenia may delay treatment, making the distinction between pre-admission and post-admission offending may be useful in understanding the aetiology of the offending, and establishment of such a history may help in targeting interventions supplementary to treatment specific for the psychosis.

The influence of father criminality on juvenile recidivism: testing for delinquent behaviors as a mediator.

This study investigates the relationships between father criminality, prior delinquency, and recidivism using data from 382 incarcerated juveniles assessed in Singapore's Juvenile Court in 2005. The juveniles are aged 13 to 16 years, with a mean of 14.55 years (SD = 0.93). Using Baron and Kenny's framework, this study tests the prediction that the prior delinquent behaviors of the juvenile mediate the relationship between father criminality and recidivism in a four-step process. When the juvenile's prior delinquent behaviors are included in the model, the previous significant relation between father criminality and recidivism disappears. Implications of findings in terms of applied and practical intervention and prevention work for youths in schools and those in incarceration are discussed.

Adoption and safe families act state statutes regarding parents with mental illnesses: a review and targeted intervention.

TOPIC: This paper describes an intervention targeting states that list a parental mental illness/disability as an "aggravated circumstance" under the Adoption and Safe Families Act of 1997 (ASFA), resulting in reasonable efforts not required to reunify a family. PURPOSE: This paper delineates the results from our review of ASFA state statutes, the development of a model ASFA statute, and strategies to educate legislators and the public about the impact of discrimination that parents with mental illnesses encounter because of ASFA legislation with the intent of modifying state ASFA legislation. SOURCES USED: The following sources were used for this educational initiative: a literature review and a review of ASFA state statutes. CONCLUSIONS: Adoption of the model ASFA state statute is simply a first step in an effort to end the discrimination that parents with psychiatric disabilities face; additional efforts are also noted.

[Reflections on the legal foundations of working together to safeguard children]. / Das Zusammenspiel der einzelnen Instrumente im Orchester des Kinderschutzes und seine rechtlichen Grundlagen.

The following essay outlines the legal foundations of child protection in Germany. It can be shown that constitutional law postulates a balance between parents responsibility on the one hand and public assignment to safeguard children on the other hand. The article focuses on the impact of legislative provisions on practitioners working together to safeguard children. Discussion of the demands of successful cooperation in the field of child protection shows that the political debate focuses somewhat to much on questions of control. It is argued that prospective development of child protection law should rather be based on a thorough debate of the demands in the respective professional domains.

Best interests in the MCA 2005--what can healthcare law learn from family law?

The 'best interests' standard is a highly seductive standard in English law. Not only does it appear to be fairly uncontroversial but it also presents as the most sensible, objective and 'fair' method of dealing with decision making on behalf of those who are perceived to be the most vulnerable within society. This article aims to provide a critical appraisal of how the standard has been applied within family law, to outline how the standard is to be applied within healthcare law and, finally, to assess the relevance of the family law experience of the best interests standard to the operation of the standards as envisaged by the MCA.

[Difficulties in appraisals of adolescents aged over 14 years with respect to custody and visitation rights]. / Problematik von Begutachtungen mit Sorge- und Umgangsrechtsfragen bei Jugendlichen über 14 Jahren.

This retrospective study analyses 55 custody- and visitation rights expert opinions furnished at the Department of Child and Adolescent Psychiatry at the University of Tübingen from 1990 to 2005. The aim of the study was to find out reasons and circumstances prompting judges to order appraisals of adolescents aged over 14 years during proceedings of custody and visitation rights. Expertises were examined for possible gender-specific differences. Further, a census of the judges was arranged. It became obvious that expertises were rarely requested during proceedings of custody and especially of visitation rights. Financial problems, parental alcoholism and educational incompetence or mental diseases of the adolescents and/or their parents were found in these extremely conflict-ridden family situations. Gender-specific variable results were found as far as the relationship of the young towards their parents and siblings is concerned, their wish for future residence, and the expert recommendation on provision for custody and visitation rights.