Muslim women's service utilization for intimate partner violence: Front line service providers' perceptions of what constitutes a culturally informed response.

We explored Muslim women's involvement in social services in response to intimate partner violence [IPV] from the perspective of frontline service providers. Participants identified several barriers embedded in current services including the absence of individualized support which offers women a continuum of options based on their needs and preferences. Furthermore, lack of sensitivity and appropriate response to abuse experiences based on women's culture leads to further marginalization of women in services, which decreases service utilization. Participants suggested a strong collaboration among mainstream services, and Muslim centered services providing coordinated community response to IPV. Given women's collectivist culture, involvement of women's collective such as family member, and cultural community leaders upon women's discretion was also recommended. Finally, participants recommended cultural diversity of service providers, while providing an ongoing education on culturally informed practices for all frontline workers. Our results support the development of survivor-defined and culturally informed services in addressing varied needs. To do so, we recommend building a bridge between Muslim communities and formal services, which help with the development of high quality services, and also facilitate women's access to and use of formal support for IPV.

Predicting patterns of service utilization within children's mental health agencies.

BACKGROUND: Some children with mental health (MH) problems have been found to receive ongoing care, either continuously or episodically. We sought to replicate patterns of MH service use over extended time periods, and test predictors of these patterns. METHODS: Latent class analyses were applied to 4 years of visit data from five MH agencies and nearly 6000 children, 4- to 13-years-old at their first visit. RESULTS: Five patterns of service use were identified, replicating previous findings. Overall, 14% of cases had two or more episodes of care and 23% were involved for more than 2 years. Most children (53%) were seen for just a few visits within a few months. Two patterns represented cases with two or more episodes of care spanning multiple years. In the two remaining patterns, children tended to have just one episode of care, but the number of sessions and length of involvement varied. Using discriminant function analyses, we were able to predict with just over 50% accuracy children's pattern of service use. Severe externalizing behaviors, high impairment, and high family burden predicted service use patterns with long durations of involvement and frequent visits. CONCLUSIONS: Optimal treatment approaches for children seen for repeated episodes of care or for care lasting multiple years need to be developed. Children with the highest level of need (severe pathology, impairment, and burden) are probably best served by providing high intensity services at the start of care.

Direct and indirect forms of childhood maltreatment and nonsuicidal self-injury among clinically-referred children and youth.

BACKGROUND: Although exposure to direct forms of childhood maltreatment is among the most widely studied risk factors for nonsuicidal self-injury (NSSI), research on NSSI has largely overlooked the role of exposure to indirect forms of child maltreatment (i.e., witnessing domestic violence). To address this gap in the literature, the present study examined associations among both direct and indirect forms of child maltreatment and NSSI among clinically-referred children and youth. METHODS: Data was collected using the interRAI Child and Youth Mental Health Assessment (ChYMH) at ten mental health agencies. The ChYMH is a comprehensive standardized clinical assessment tool completed by trained assessors using multiple sources. The study included a convenience sample of 747 children and youth (68% male) between ages 8-18 with complex mental health histories referred for inpatient or outpatient care in Ontario, Canada. RESULTS: Univariate chi-square analyses indicated positive associations with NSSI and both direct (i.e., physical, sexual) and indirect child maltreatment (i.e., witnessing domestic violence). In a binary multivariate logistic regression analysis controlling for participant age and sex, only exposure to indirect child maltreatment emerged as multivariate predictor of NSSI. LIMITATIONS: The sample was limited to only 10 mental health agencies and only consenting parents/guardians referred to mental health services suggesting the study may not be generalizable to all clinical samples. CONCLUSION: The present study provides evidence that witnessing domestic violence in childhood is an important risk factor for NSSI. Clinical relevance includes implications for clinicians to develop targeted intervention and prevention strategies for NSSI for children who have witnessed domestic violence.

BCFPI Validation for a High-risk High-needs Sample of Children and Youth Admitted to Tertiary Care.

OBJECTIVE: This study examined the validity and reliability of the Brief Child and Family Phone Interview (BCFPI) in a sample of high-risk, high-need children and youth admitted to a tertiary residential psychiatric facility. This is the first validation study of the BCFPI with children and youth functioning at the extreme clinical range. METHOD: Participants consisted of children and youth in a southwestern Ontario tertiary residential mental health facility. Two hundred twenty seven children and youth aged 6.28 to 16.74 (M = 12.06 years, SD = 2.46) were evaluated. Internal consistencies of each scale were tested using Cronbach's alpha, and subsequently confirmed with unidimensional principal components analyses. Concurrent validity was evaluated through Pearson product-moment correlations between each subscale and the empirically validated subscales in the Conners' Rating Scales. RESULTS: With exception of the conduct subscale (alpha =.68), all Cronbach's alpha estimates were in the acceptable range. Each scale demonstrated acceptable factor loadings on a single-factor principal components extraction derived from the pool of items within each scale. Concurrent validity was evidenced by moderate to strong correlations identified with selected measures of the Conners' Parent Rating Scale. CONCLUSIONS: Considered together, the results of this study indicate that the BCFPI is a reliable and valid indicator of child functioning within this client population, and is recommended in the assessment of tertiary populations.

OBJECTIF: Cette étude a examiné la validité et la fiabilité de la Brief Child and Family Phone Interview (BCFPI, enquête téléphonique abrégée pour l'enfant et la famille) dans un échantillon d'enfants et d'adolescents à haut risque et à besoins élevés, hospitalisés dans un établissement psychiatrique résidentiel tertiaire. Il s'agit de la première étude de validation de la BCFPI pour des enfants et des adolescents fonctionnant à l'extrémité de l'échelle clinique. MÉTHODE: Les participants étaient des enfants et des adolescents dans un établissement de santé mentale résidentiel tertiaire du Sud-Ouest de l'Ontario. Deux cent vingt-sept enfants et adolescents âgés de 6,28 à 16,74 ans (M = 12,06 ans, ET = 2,46) ont été évalués. La cohérence interne de chaque échelle a été vérifiée à l'aide de l'alpha de Cronbach, et subséquemment confirmée par des analyses en composantes principales unidimensionnelles. La validité concourante a été évaluée par les corrélations produit-moment de Pearson entre chaque sous-échelle et les sous-échelles validées empiriquement des échelles d'évaluation Conners. RÉSULTATS: À l'exception de la sous-échelle des conduites (alpha = 0,68), toutes les estimations alpha de Cronbach étaient dans un intervalle acceptable. Chaque échelle démontrait des saturations de facteur acceptables sur une extraction d'un seul facteur par l'analyse en composantes principales, dérivée du groupe d'items de chaque échelle. La validité concourante a été mise en évidence par des corrélations de modérées à fortes, identifiées par des mesures choisies de l'échelle d'évaluation Conners pour les parents. CONCLUSIONS: Pris en compte ensemble, les résultats de cette étude indiquent que la BCFPI est un indicateur fiable et valide du fonctionnement de l'enfant au sein de cette population de clients, et qu'elle est recommandée pour l'évaluation des populations tertiaires.

The association of readiness to change and motivational interviewing with treatment outcomes in males involved in domestic violence group therapy.

The present study investigated the impact of motivational interviewing (MI) and stage of change on a self-report measure of global functioning (Outcome Questionnaire [OQ 45.2]). Participants were men mandated to attend the Responsible Choices for Men (RCM) group therapy program following an incident of domestic violence. The study design utilized a quasi-experimental between-groups comparison utilizing data collected at three time points (pregroup, first group session, and final group session). One group of mandated program attendees received two sessions of MI (n = 106), whereas the comparison group did not (n = 106). Stage of change was assessed using the URICA-G and the URICA-DV (University of Rhode Island Change Assessment--Domestic Violence). Multilevel growth modeling indicated that stage of change has a significant relationship to global functioning. Discussion focuses on the potential benefits of MI as a pregroup treatment and the importance of accounting for individual readiness to change.

Youth justice and mental health in perspective.

Research indentifies that a significant proportion of youth within the justice system possess some form of mental health disorder, and that the presence of an emotional disorder can provide important explanatory value regarding the causes of crime. Evidence is now overwhelming that services within the youth justice system need to account for the causes of crime in order to effectively reduce the likelihood of reoffending. Such an ethic within youth justice service delivery not only reduces symptoms and risk within the youth and their families but also is linked to increasing community safety through reductions in reoffending. This review characterizes the relevance of mental health disorder in considering the needs of anti-social youth, and how this appreciation is linked to the delivery of effective services as well as what constitutes supportive youth justice legislation.

Assessing historical abuse allegations and damages.

Practitioners may be called upon to assess adults who have alleged child abuse as a minor and are seeking reparations. Such assessments may be used by the courts to determine harm and assess damages related to their claim or testimony. Our clinical/research team has conducted many such evaluations and reported the findings pertaining to the psychological harm stemming from historical abuse in published studies. We use the opportunity provided by this new section on Practical Strategies to describe the role of the assessor, and to provide details concerning our methods for preparing these assessments and reporting the findings for the purpose of civil or criminal actions. Specific recommendations for wording of written reports are provided.

The relationship of child neglect and physical maltreatment to placement outcomes and behavioral adjustment in children in foster care: a Canadian perspective.

Dramatic increases in child welfare rates in Canada over recent years have been largely driven by an increased reporting of neglect cases (Trocmé, Fallon, MacLaurin, & Neves, 2005). To a large extent, exploring the importance of neglect separate from physical maltreatment has been ignored in the child maltreatment literature. This study examined the differential effects of foster care in the child welfare system with children who presented as either experiencing physical maltreatment or neglect prior to their admission to care. Findings from this study are important to child welfare decision making about the differential needs of these two groups of children. The files of a sample of 110 children (79 neglected children and 31 physically maltreated children) were examined for differences in their adjustment while in foster care and on discharge. Some distinct differences in presentation were noted between the children experiencing the two types of maltreatment. Children experiencing neglect were younger, were more likely to have caregivers diagnosed with a substance abuse disorder, and had higher rates of exposure to spousal violence than maltreated children. Physically maltreated children displayed greater difficulty during their foster care adjustment. Once discharged from care, neglected children were more likely to be returned to the care of the agency. This study draws attention to the differential needs of children who experience neglect prior to their admission to a child welfare agency. Longer-term outcome studies are necessary to more completely understand how these two types of maltreatment influence the outcomes of children who are provided care within the child welfare system.

Who is caring for our most vulnerable children? The motivation to foster in child welfare.

OBJECTIVE: Responding to the need for more foster families to provide care for increasing numbers of children coming into care, this study was designed to understand the motivations and needs of foster parents in order to improve recruitment and retention. To meet this goal, the study identified characteristics of current foster families, performed a factor analysis on the Foster Parent Satisfaction Survey (FPSS) (Denby, R. W., Rindfleisch, N., & Bean, G. 1999). Predictors of foster parent's satisfaction and intent to continue to foster were identified, and the results were used to differentiate between foster parents who did and did not consider quitting fostering. METHOD: A sample of 652 foster parents completed a survey of 139 items including the Foster Parent Satisfaction Survey [Denby, R. W., Rindfleisch, N., & Bean, G. (1999). Predictors of foster parent's satisfaction and intent to continue to foster. Child Abuse & Neglect, 23, 287-303]. RESULTS: Foster parents were motivated by wanting to be loving parents to children and saving children from harm. The factor analysis of the FPSS resulted in five factors that were consistent with typical scoring methods of the instrument. A discriminant function analysis using these factors and whether parents had considered quitting fostering revealed that one factor, Challenging Aspects of Fostering, correctly classified 75.5% of parents. CONCLUSIONS: Foster parents' satisfaction is related to their perceptions about teamwork, communication, and confidence in relation to both the child welfare agency and its professionals. Further, the most frequently endorsed reasons for fostering reflected foster parents' altruistic and internal motivations to foster. Negative relationships with professional staff from the child welfare agency were linked to considering quitting fostering.

The empirical basis of risk assessment in child welfare: the accuracy of risk assessment and clinical judgment.

The importance of risk assessment is juxtaposed with the lack of empirical support regarding the validity of risk inventories. This study compared risk ratings of one risk assessment tool to decisions made by case managers. The researchers sampled 450 children and compared predictive utility of risk assessment to child protection decisions. Risk assessment was consistent with clinical judgment in 74% to 81% of cases, more than previously reported in studies of risk assessment validity. Further analyses identified discriminate functions at the instrument's category and individual-item levels. The results have implications for the validity of the instrument and its utility in child welfare.