DCFS Services to Mentally Ill Parents
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Mental Illness is More Common and Concentrated Than Thought Always Ask These Two Questions DCFS Clinical Division Initiatives to Help Practitioners With Mental Illness
Cases Practice Guides - One aspect of the division's work with parental mental
illness is the development of practice guides that workers can use to screen
for adult and child mental illness. These guides are being reviewed by Best
Practice Work Groups in DCFS and will provide a standard format for behavioral
observation of the parent, the child, and their interaction. It is expected
that when the Behavioral Observation Screens are implemented in the field, workers
will have a better understanding of the impact mental illness has on the family
and a guide to improved decision-making.
Concept Paper - The Clinical Services Division has completed a concept
paper on Family Services to Children and Families Challenged by Mental Illness.
This concept paper will provides direction for new policy and practice in the
field, integrated service planning and improved service delivery to families.
The paper was presented to the best practice committee and is awaiting further
development.
Consultation - The Clinical Services Division offers consultation to
DCFS staff, particularly in the Division of Child Protection, in evaluating
the impact of mental illness in specific cases. This consultation brings workers
and supervisors together with professionals from a variety of social service
areas to improve case planning and service delivery. The staffing team examines
social histories, psychological assessments and hospitalization records in order
to make decisions about child safety and welfare.
Parenting Assessment Teams - Finally, the Parenting Assessment Teams
were formed to evaluate the impact of parental mental illness on child safety
and welfare. These teams provide a multidisciplinary and comprehensive assessment
of the history and functioning of the parents, the children, and the parent
and children together. The recommendations of the teams are used to establish
permanency goals, as well as to make decisions in child welfare investigations
and intact family cases. Although parenting teams serve only Cook County, it
is expected that Parenting Assessment Teams will be available in all Regions
in the near future. At the present time, if a parenting assessment is needed
outside of Cook County, the DCFS Parenting Assessment Team Coordinator would
work with the region in linking them to appropriate existing resources to provide
the assessment. The current DCFS Parent Assessment Team Coordinator is Paul
Curtis. He can be reached at (312) 814-4153.
The Three Cook County Teams - There are three teams at this time, one
in each Cook County Region. Cook North is served by the Threshold's Mother's
Project (See Article #7 in this issue for other activities
of The Mother's Project). The Cook Central Region is served by the Parenting
Assessment Team at the University of Illinois, Chicago and Cook South is served
by the Parenting Assessment Team at Community Mental Health Council (CMHC).
Parents are eligible for parenting assessment by a team if they meet the following
criteria: How the Teams Work - The Parenting Assessment Teams provide a standardized
intake and assessment process for the parents served in order to improve reliability
and validity of the assessments. One important feature of the Teams' reports
is the specific recommendations made about the services that are needed to enhance
parenting skills. If the parents' mental illness precludes successful parenting,
that is also clearly noted. In the past, Parenting Assessments have occurred
toward the end of the permanency process. With the addition of the third team
in July 1999, assessments can be made earlier in the life of a case, resulting
in faster permanency decisions and better services to families. Both DCFS and
Purchase of Service staff can request referrals to a Parenting Assessment Team.
Making a Referral - In order to make a referral to one of the three
parenting assessment teams, the worker or the supervisor would contact the Parenting
Assessment Team Coordinator for their region and provide them with the referral
information. The coordinators are:
For More Information *Kessler, R. C. et al (1997). "Lifetime Co-occurrence of DSM-III-R Alcohol
Abuse and Dependence With other Psychiatric Disorders in the National Comorbidity
Study." Archives of General Psychiatry v54 p313-21.
1.
Case Workers Need Knowledge and Skills Training top
Raske, Martha (1997). "Training Rural Child Welfare Workers for Service
to Families With Maternal Mental Illness: A Multi-Method Study." Children and
Family Research Center, School of Social Work, University of Illinois at Urbana-Champaign.
Fifteen social workers at Southern Illinois Department of Children and Family
Services field offices participated in focus groups to determine what training
they needed to serve families with mentally ill mothers. The following training
needs were found.
Changes in values are required to help workers:
Workers need knowledge in these areas:
Workers need skills to accomplish these tasks:
2. Mentally Ill Mothers Often Have Multiple Risk Factors top
Zemencuk, Judith, Fred A. Rogosch and Carol T. Mowbray (1995). "The Seriously
Mentally Ill Woman in the Role of Parent: Characteristics, Parenting Sensitivity,
and Needs." Psychosocial Rehabilitation Journal, v18 n3 p77-92.
Many rehabilitation professionals know little about seriously mentally ill
mothers' parenting roles, their needs, and the supports available to them. But
if programs provided these mothers with specialized treatment, more mothers
might be able to parent successfully and maintain custody of their children.
In addition to benefitting children, successful parenting may have positive
therapeutic results for seriously mentally ill mothers.
Demographic Characteristics The Risk Factors Services Should Include
3. Many Homeless Mothers Are Also Mentally Ill top
Zima, Bonnie T., Kenneth B. Wells, Bernadette Benjamin, and Naihua Duan
(1996). "Mental Health Problems Among Homeless Mothers: Relationship to Service
Use and Child Mental Health Problems." Archives of General Psychiatry, v53 n4
p332-338.
This study surveyed a population of 110 mothers and their children living
in homeless shelters. The results show that homeless families have high rates
of stressors that put mothers and their children at increased risk for mental
health problems. Although mental illness among homeless mothers is prevalent,
many of their mental health needs go unmet. Greater efforts must be made to
identify and serve these families.
Since half of the homeless mothers interviewed had contacted a health care
center, integrating psychiatric evaluations and mental health treatment referrals
into general health care programs may be a way to better identify and serve
this group.
4.
Interventions Should Include... top
Nicholson, Joanne and Andrea Blanch (1994). "Rehabilitation for Parenting
Roles for People With Serious Mental Illness." Psychosocial Rehabilitation Journal,
v18 n1 p109-119.
Mentally ill adults experience normal desires to have children, but without
effective rehabilitation services, they may fail in the parental role.
A 1990 national survey of the state mental health authorities indicated that
despite the need for such services there are few programs targeted toward mentally
ill parents and their children. Out of 69 programs reporting, only 9 focused
on the needs of mentally ill mothers and their offspring.
Effective rehabilitation for mentally ill parents requires a comprehensive
approach including:
A number of barriers may arise when developing or implementing a program for
mentally ill parents and their children, including:
However, practitioners working outside a comprehensive program can still be
very helpful by making basic efforts to assess client needs and arrange for
appropriate services.
5. How to Help Schizophrenic Mothers top
Seeman,
Mary V. "The Mother With Schizophrenia." Pages 190-200 in Parental Psychiatric
Disorder: Distressed Parents and Their Families. Cambridge, England: Cambridge
University Press, 1996.
Schizophrenic mothers require on-going, comprehensive treatment both for themselves
and as a preventative measure for their children. Effective clinical intervention
can help during each of the various stages of child-rearing discussed below:
Pregnancy: Women with schizophrenia may not realize they are pregnant
or seek adequate prenatal care. Health professionals should stay attuned to
the needs of these women in their reproductive years.
Postpartum Period: Normative postpartum blues may escalate into postpartum
psychosis. Health professionals should pay close attention and provide adequate
support for mothers during this period.
Infancy: Mothers and children may be best served with in-home care
and support rather than by moving the children to foster care, even though the
mothers' parenting skills are deficient.
Independence: The toddler stage may be problematic because mothers
can feel betrayed by their children's emerging independence. Parenting classes
or groups can teach mothers about normal child development stages and provide
them with peer support.
Intimacy: Some mothers with schizophrenia find closeness and affection
with their children difficult and may benefit from behavior rehearsals and training
in expressing positive emotions.
Stimulation: It may be very difficult for these mothers to motivate
and inspire their children. Drug dosages and programs should be carefully monitored
in order to reduce the mothers' lethargy as much as possible.
Socialization: Home-care teams are best to help psychotic mothers and
their children deal with the mothers' suspiciousness and isolation from the
outside world.
Fears of Attack: The potential violence that mothers may show in trying
to protect their children from perceived threats may be monitored by close and
regular visits with a mental health professional.
Communication: Disturbed communication is common in schizophrenic mothers.
Pharmaco- therapy, parenting groups, psychotherapeutic support, or behavioral
techniques may help to improve verbal communication between mothers and children.
Intrusiveness: Parents' groups that address parenting fears may help
to alleviate the mothers' overzealous intrusion into their children's lives.
Bridging Function: Mothers with schizophrenia often do not provide
good social models for their children. Children are not prepared to interact
socially with others and may benefit greatly from intervention efforts.
6.
Ten Programs Evaluated top
Oyserman, Daphna, Carol T. Mowbray, and Judith K. Zemencuk (1994). "Resources
and Supports for Mothers With Severe Mental Illness." Health and Social Work,
v19 n2 p132-142.
The authors reviewed and evaluated ten intervention programs for severely
mentally ill mothers and their children. They found three basic types of programs,
all of which were less than comprehensive.
Hospital Mother-Baby Units Hospital Mother-Baby Units With In-Home Care Home-Care Programs Programs for mentally ill mothers should follow the principles of psychosocial
rehabilitation, including:
While severely mentally ill mothers have diverse needs and problems, there
are few programs that target them, and these programs are often inadequately
evaluated. With appropriate psychosocial rehabilitation assistance, mothers
with severe mental illness should be able to reach their desired rehabilitation
goals, including those of parenting.
7.
The Mothers' Project top
Zeitz, Mary Ann (1995). "The Mothers' Project: A Clinical Case Management
System." Psychiatric Rehabilitation Journal, v19 n1 p55-62.
The Mothers' Project at Thresholds, Inc. in Chicago is an innovative, primary
intervention program for high risk, significantly mentally ill women and their
children. The program's goals include:
The Mothers' Project includes these components:
8.
An Evaluation of The Mothers' Project top
Cohler, Bertram J., Frances M. Stott and Judith S. Musick. "Distressed
Parents and Their Young Children: Interventions for Families at Risk." Pages
107-134 in Parental Psychiatric Disorder: Distressed Parents and Their Families.
Cambridge, England: Cambridge University Press, 1996.
The authors report on an evaluation of the Thresholds Mothers' Project that
made use of a comparison group of mothers who were visited weekly, but did not
participate in any of the other aspects of the program. The evaluation program
was completed in two years, with a follow-up evaluation at three years.
Hospitalization Reduced and Children Helped Areas of Less Improvement
9.
Project CHILD in the UK top
Rubovits, Pamela Charles. "Project CHILD: An Intervention Programme for
Psychotic Mothers and Their Young Children." Pages 161-169 in Parental Psychiatric
Disorder: Distressed Parents and Their Families. Cambridge University Press,
1996.
The Providence Center for Counselling and Psychiatric Services, located in
the UK, has a model, multifaceted intervention program that serves psychotic
mothers and their children under five. The goals of the children's interventions are to provide a consistent,
responsive, safe, and well-structured environment and to help children deal
with separation from their mothers. The activities help to develop language
skills, improve attention, deal with anger, practice reality testing, and learn
object permanence and cause and effect.
The program components include: The mother-child baby school activities are designed to give mothers
and children carefully managed experiences of separation and togetherness. During
teaching time, mothers are encouraged to participate in games or specific
teaching tasks with their children. Staff members model how to present material,
organize tasks, and praise and correct the children. During discussion time,
mothers talk about common life or parenting stressors, their adjustment problems,
effects of their illnesses on their children, or their medication use and side
effects.
The lunch program connects baby school to real life activities for
mothers and children. Staff help mothers learn how to feed their children, and
the amounts and types of food their children should eat.
The primary goal of this program and its components are to help psychotic
mothers learn to read their children's cues accurately and sensitively. At the
same time, mothers are nurtured and encouraged to see themselves as worthy and
capable of getting their own needs met.
10.
Bronx Program Prevents Hospitalization top
Mohit, Diane L. (1996). "Management and Care of Mentally Ill Mothers of
Young Children: An Innovative Program." Archives of Psychiatric Nursing, v10
n1 p49-54.
Adapting to the stresses of motherhood may be especially problematic for seriously
mentally ill women, who already face the stresses of their illnesses. When the
mother role is not addressed in their treatment programs, these mothers often
require frequent hospitalization.
In an effort to reduce the need for hospitalization, the Bronx Veteran's Administration
Hospital's Intensive Psychiatric Community Care Program extended its services
to six seriously mentally ill mothers. A Psychiatric Clinical Nurse Specialist
(CNS) guided the program.
Weekly home visits by the CNS over a two-year period allowed assessment
of each mother's:
Through this intervention program, mothers were also provided with information
about:
During the two-year period, only two of the six participants required short
stays in psychiatric hospitals. Intervention programs like this may help to
reduce maternal role strain and may decrease the need for mothers' hospitalization.
11.
A Group Intervention that Worked for Children top
Finzi, Ricky and Dorit Stange (1997). "Short Term Group Intervention as
a Means of Improving the Adjustment of Children of Mentally Ill Parents." Social
Work With Groups, v20 n4 p69-80.
Children of mentally ill parents live in a state of prolonged crisis and,
as a result, often suffer from emotional, behavioral, and intellectual difficulties.
These children especially need:
With this need for social peer interaction in mind, the researchers designed
a group intervention to improve self-esteem and interpersonal skills in children
aged 10-11. The group met for 12, 90-minute sessions over a three-month time
period. The group's goals included:
The Group Sessions
Individual follow-up sessions were conducted two weeks after the last group
meeting. The children reported more self-confidence, social status improvement,
and greater success in social coping. The group was successful in improving
the adjustment of children with mentally ill parents. Although the children's
teachers did not appear to notice changes in the children's behavior, the authors
account for this failure, and note that parents were able to discern changes
in some areas of the children's functioning.
12.
NEW BOOK: A Practice Model Based on Strengths top
Rapp, Charles A. The Strengths Model: Case Management with People Suffering
From Severe and Persistent Mental Illness. New York: Oxford University Press,
1998. 240P. A new book available from the National Association of Social Workers Press
at 800-227-3590.
From the book jacket: Summary of Chapter 5 "Strengths Assessment: Amplifying the Well Part of
the Individual" As a result of friendly conversations over time in the client's own environment,
the assessment gathers specific information about these areas of her life:
Within each of these areas, information is sought about three facets:
The process is a mutual conversation, demonstrating that the client's feelings
are heard, and responses are worded to help him see his abilities. He may also
participate by recording the information or suggesting how information could
be phrased, and receives a written copy.
A review of the client's past experiences and accomplishments may reveal strengths
that have been forgotten. Also, meeting with the client in her environment may
draw attention to interests and abilities that she might neglect to mention.
Some clients will feel reluctant to participate in the assessment because
they see it as yet more intrusion into their lives. Others have come to rely
on a self concept of illness, not strengths. However, many clients find the
Strengths Assessment motivating and encouraging. It is followed by the "Personal
Planning" stage, in which the client and social worker create a mutual work
agenda to achieve the goals set by the client.
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Join a Social Work ListServ! top
ListServ Name: SOCWORK
by Cathy McNeilly, Revised by Paul Curtis
DCFS Clinical Services Division
Mental illness in the general population, including psychoactive substance use
disorders, is both more common and more concentrated than previously realized.
The recent National Comorbidity Study* (NCS) found that almost 50% of the population
aged 15-64 had met criteria during their lifetimes for one or more mental illnesses.
Severe mental illness is much less common, but it is likely to be clustered
as dual and multiple diagnoses. In the NCS, 90% of the severe diagnoses were
concentrated in only 14% of the population. Mental illness is most often chronic,
as well. In the NCS, three-fifths of those who had ever met criteria for a mental
illness still met those criteria, and of the two-fifths who did not, many may
have met partial criteria for an active diagnosis at the time of the survey.
Considering the prevalence of adult mental illness, it is critical for child
welfare staff to be able to make appropriate decisions relating to parenting
capability, child safety and well being. Two major questions are critical in
the decision-making process:
Service planning for families with mental illness is complex and the ability
of child welfare staff to do such planning is enhanced by the presence of appropriate
consultation and linkage to service providers. One of the responsibilities of
the Clinical Services Division of the Department of Children and Family Services
is to provide consultation and information to the field concerning parent and
child mental health issues. A number of projects are underway to support staff
as they work with difficult issues of parent and/or child mental illness. The
major initiatives in this area are described below.
The Parenting Assessment Team will work with the caseworker to clarify the referral
questions. Once the intake has been completed, and the necessary consents obtained,
the process can begin.
If you would like more information about parental mental health services in
the Clinical Services Division, you may call Paul Curtis at (312) 814-4153.
A sample of 48 hospitalized, seriously mentally ill mothers was surveyed. They
shared these basic demographic characteristics:
These mothers face multiple risk factors for parenting difficulties:
Seriously mentally ill mothers need support and assistance in dealing not only
with their illnesses, but also with life stressors, especially those of parenting.
Services to mentally ill mothers should:
In these programs, mothers and babies are admitted together in order to maintain
mother-infant contact, to continue the primary health care relationship, and
to allow staff to assess and develop the mothers' parenting skills. However,
because hospital settings are restricted environments, the benefits gained from
the programs may not apply to the mothers' community environments when they
leave.
Mothers begin these programs with an inpatient admission period and then move
back into their homes supported by intensive in-home visits. The programs focus
almost entirely on the mothers and little consideration is given to family dynamics
or to natural support systems that might be found outside the home.
The one program in this category provides in-home visits from mental health
staff. Little attention is given to socioeconomic context, barriers to effective
parenting, or modification of the mothers' environment.
The hospitalization rate for Thresholds participants was 35%, as opposed to
50% for the comparison group. This was due largely to success in keeping mothers
on their medications and reducing medication side effects. The Thresholds children
showed significant gains in cognitive abilities over the comparison group due
to the nursery program. The Thresholds group also reported greater ‘consumer
satisfaction.'
However, both groups showed a similar lack of improvement in the following areas:
mothers did not succeed in working outside the home, mothers did not show improved
sensitivity to or communication with their children, and mothers' personal distress
levels were not relieved. An evaluation of both groups of children showed that
at school the children worried about their mothers and were viewed by classmates
as being unpredictable. The mothers imposed restrictions on the children, interfered
in their lives, and attempted to bind their children to them. Less than a third
of the children (more likely to be of middle class) showed positive adjustment,
while another third showed potentially serious maladjustment.
The interventions aim to:
The Strengths Model is the first text to focus exclusively on the alternative
– the strengths model of practice – which focuses on helping people, not as
patients or clients, but as individuals. Empirical testing of this model and
its results have consistently shown that it is superior to traditional approaches
for serving people with mental illness. The text includes detailed discussions
of practice techniques such as engagement, strengths assessment, personal planning,
and resource acquisition.
The Strengths Assessment process provides the information that is the basis
of interventions, and unlike much activity in the helping professions, it focuses
on all that is well and working in a client rather than on his problems and
pathologies.
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