Work, Life, and the Mental Health System of Care: A Guide for Professionals Supporting Families of Children with Emotional or Behavioral Disorders (SCCMH) - Softcover

Rosenzweig "Ph.D. LCSW", Julie; Brennan Ph.D., Eileen

Softcover

ISBN 10: 1557668272 ISBN 13: 9781557668271

Publisher: Brookes Publishing, 2008

Synopsis

When a child has an emotional or behavior disorder, parents experience a host of extra challenges as they attempt to meet their caregiving and employment responsibilities: stigma, increased stress, child care difficulties, lack of workplace supports. Professionals need to know how to help parents address these critical issues-and now there's a book that shows the way. Expertly researched and enhanced with actual strategies used by parents, this accessible resource gives professionals the up-to-date knowledge they need to support entire families, ease the pressures they face, and connect them with the best help and services.

Readers will start with an inside look at what happens within a family when a child has an emotional or behavior disorder. Then they'll get a primer on parents' support needs and in-depth information and guidance they'll use to help parents

• overcome stigma, an inhospitable workplace culture, and other challenges to work–life integration
• communicate effectively on the job and with service providers to receive support and information
• solve the child care dilemma with options such as flexible work schedules, in-home care, and the use of inclusive child care centers
• improve access to school programs—and their child's outcomes
• navigate the complex mental health system
• manage the direct and indirect financial costs of having a child with an emotional or behavior disorder
• connect with community supports through the neighborhood, churches, cultural groups, friendship networks, and peer support groups

Throughout the book, expert contributors blend the latest research with candid stories from parents, giving readers the wisdom and sensitivity they need to work skillfully with families. And to help professionals move the field forward with confidence, the book clarifies current policies, pinpoints gaps in knowledge, and maps out what needs to be done to improve family supports and services. A clear and informative resource that will benefit a wide range of readers—including social workers, special educators, psychologists, human resource professionals, and family support specialists—this is the book professionals need to empower and educate families in their quest for successful work–life integration.

Learn more about the series.

About this title

About the Author:

Julie M. Rosenzweig, Ph.D., LCSW is Co-Principal Investigator of the Work–Life Integration Project at the Research and Training Center on Family Support and Children's Mental Health; and Associate Professor of Social Work at Portland State University, Oregon. Dr. Rosenzweig's research focuses on the work–life integration experiences of parents whose children are struggling with serious emotional or behavioral disorders. Her research projects in this area have received funding through the National Institute of Disability and Rehabilitation Research. Of particular interest to Dr. Rosenzweig are the challenges faced by parents of children with mental health disorders in the workplace and the strategies they develop to meet both employment and exceptional caregiving responsibilities. In addition, she is concerned with work–life integration supports available in the employing organizations, including formal support through policies and informal support provided by human resource professionals, supervisors, and coworkers. Dr. Rosenzweig has been teaching at the School of Social Work at Portland State University for more than two decades and is a licensed clinical social worker.

Eileen M. Brennan, Ph.D. is Co-Principal Investigator of the Work–Life Integration Project at the Research and Training Center on Family Support and Children's Mental Health; and Associate Dean and Professor of Social Work at Portland State University, Oregon. Since the early 1990s, Dr. Brennan has been a principal or co-principal investigator of federally funded research and training projects on the social and emotional health of children and support for their families. Her research has examined the challenges faced by employed parents of children and adolescents who have emotional or behavioral disorders and the strategies the families have used to meet these challenges. A developmental psychologist, Dr. Brennan has also examined the importance to families of the successful inclusion of children with mental health difficulties in child care. Currently, she is participating in research on transforming transitions to kindergarten for children with emotional or behavioral challenges and their families.

The late Jane Knitzer, Ed.D. was Director of the National Center for Children in Poverty, and Clinical Professor of Population and Family Health in the Mailman School of Public Health at Columbia University in New York.

In addition to her work with the National Center for Children in Poverty, Dr. Knitzer was also a Clinical Professor of Population and Family Health at the Mailman School of Public Health at Columbia University. As a psychologist, Dr. Knitzer focused her own research on improving public policies related to children's mental health, child welfare, and early childhood. Her work on mental health included the ground-breaking policy report, Unclaimed Children: The Failure of Public Responsibility to Children and Adolescents in Need of Mental Health Services (Children's Defense Fund, 1982). Most recently, she was a leader in calling attention to the importance of addressing social and emotional issues in young children. Dr. Knitzer was on the faculty at Cornell University, New York University, and Bank Street College of Education. She was a member of the New York State Permanent Judicial Commission on Justice for Children and a past president of Division 37: Child, Youth, and Family Services of the American Psychological Association, and a member of the American Association of Orthopsychiatry. She was the first recipient of the Nicolas Hobbs Award for Distinguished Service in the Cause of Child Advocacy from the American Psychological Association.

Ms. Spencer has navigated a highly visible career path through local family organizing, state level systems of care development, advocacy, national meeting planning for both the Federation of Families for Children’s Mental Health and the Technical Assistance Partnership, and providing training and technical assistance to family-run organizations. Ms. Spencer has become a much sought after public speaker on the subject of children’s mental health from a national as well as a parent’s perspective. Her combination of passion and experience validates her message.

Ms. Penn began to navigate the children’s mental health system through efforts to care for her own son and subsequently became an advocate for other families. She was the founding executive director of the Family Support Organization of Burlington County, and currently serves as a consultant on building family leadership within child-serving systems to communities and universities throughout the country.

Excerpt. © Reprinted by permission. All rights reserved.:

Excerpted from Chapter 2 of Work, Life, and the Mental Health System of Care: A Guide for Professionals Supporting Families of Children with Emotional or Behavioral Disorders, by Julie M. Rosenzweig, Ph.D., LCSW, and Eileen M. Brennan, Ph.D.

Copyright © 2008 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Domains of Support for Families Who Have Children with Mental Health Difficulties

Families of children with mental health difficulties may need support and services in many areas of their daily lives. Seven key domains are 1) family relations, 2) mental health, 3) employment, 4) child care, 5) education, 6) economic arrangements, and 7) community involvement. Using a family support lens, each domain will be discussed briefly in this chapter. Other chapters in this volume will take up each support domain in greater depth.

Family Relations

Although some parents report that raising a child with emotional or behavioral difficulties can have positive effects on family members, high levels of caregiver strain have also been documented (Brannan, Heflinger, & Bickman, 1997; Kendall, 1998; McDonald, Poertner, & Pierpont, 1999; Smith, Oliver, & Innocenti, 2001; Yatchmenoff, Koren, Friesen, Gordon, & Kinney, 1998). Children who exhibit high levels of troubling or difficult behavior, who are suspended or expelled from school, or who are involved in the juvenile justice system can heighten parental stress levels and set up disputes between parents about how to deal with their childā€™s behavior (Brannan & Heflinger, 2001; Kendall & Shelton, 2003). Family members who are caring for children with social or emotional difficulties may also be in constant conflict with their youngsters and may need support and relief (Early, Gregoire, & McDonald, 2002; Kendall, 1998).

Extended family members and friends may offer some of the emotional support and parenting advice that parents need and may agree to care for the child to provide respite for the parents; however, when parents are geographically removed from their families, have relatives who are unable or unwilling to provide support and respite, or are overwhelmed despite help from friends and extended family, support services may be needed to provide the necessary counseling, parenting education, and respite (Bruns & Burchard, 2000; Friesen & Brennan, 2005). Interpersonal relations and family management may improve with this support, which will lower caregiver strain and enable employed caregivers to work with fewer interruptions and distractions.

Mental Health

As each child is added to the family, parents travel a new pathway of human development, which varies according to the biological endowments and life experiences of that son or daughter. Many parents detect early mental health problems within the family home, which are subsequently confirmed by child care providers or primary health care providers; the lag between identification of the problem and reception of services often stretches to 2 years or more (Kutash, Duchnowski, & Friedman, 2005). Other parents struggle to care for children who have been affected by traumatic events or whose early life circumstances have been harsh and debilitating (Glazer, 2000; National Scientific Council on the Developing Child, 2004). Their childrenā€™s difficulties may put them on a long and complicated journey leading to a formal diagnosis of a mental health disorder and participation in treatment planning for their children. Diagnosis, treatment planning, and even participation in treatment can be very time consuming, and health and mental health systems are often set up with the presumption that a parent is available during the workday (Kagan, Lewis, & Heaton, 1998). Parents arrange the transportation of their children to mental health appointments, attend meetings with mental health service providers, and sometimes enter into treatment with their children. If their children have major mental health crises, parents may even take extended time off from work to ensure that their childrenā€™s condition is stabilized or that they get more intensive services (Rosenzweig, Brennan, & Ogilvie, 2002; see also Chapter 5).

Parents often need special supports to negotiate the complexities and requirements of the mental health service delivery system while maintaining a work life. Individualized service plans that include wraparound family supports may lessen the difficulties of meeting their childrenā€™s and familyā€™s needs (Burchard, Bruns, & Burchard, 2002). Often, the teams supporting families through the wraparound process include family support specialists, who can advocate for the familyā€™s needs including arranging treatment around parent work hours (Walker & Schutte, 2005). When such comprehensive services are not available, parents may need to reach out to family resource networks to gain the assistance of peer navigators who have also had to find their way through the maze of mental health systems while maintaining employment.

Employment

The work experiences of family members can be greatly influenced by their childrenā€™s mental health difficulties and the types of supports available in their communities. Mental health service providers often expect parents to be available for appointments during the workday, child care providers or school personnel may pressure parents to intervene in crises, older children may call parents directly when their lives spiral out of control, and community program staff members may require parents to be present to supervise their children in daytime activities (Rosenzweig et al., 2002). To be able to maintain a work life while attending to the needs of their child with mental health problems, family members seek employment accommodations. Ideally, their job will allow employee-driven flexibility in work arrangements and will also provide medical leave in situations when the childā€™s care requires it (Galinsky, Bond, & Hill, 2004; Rosenzweig & Huffstutter, 2004). When employers do not permit these accommodations, some family members find jobs in more family–friendly organizations or even change the type of work they do in order to meet their childrenā€™s needs (Rosenzweig et al., 2002).

Family members may find real support in their workplaces from supervisors who are willing to allow flexibility through scheduling shifts, job shares, telecommuting, or working from home (Hopkins, 2005). Co-workers can also provide support by covering for an employed parent who needs to handle a childā€™s mental health crisis during work hours (Goshe et al., 2006). Both supervisors and co-workers can also provide the emotional support and validation the parent needs. More formal supports can also be found in the workplace through flexible work arrangements and leaves negotiated by human resources staff and employee assistance programs. Finally, family organizations are beginning to collaborate with other stakeholders to provide resources and supports for employees who are asking for flexibility due to their dependent care needs (Perrin et al., 2004).

Child Care

Unless they are able to work out care given by another parenting adult using work shifts that donā€™t overlap (tag-team parenting) or can take their children to work with them, family members need child care arrangements for their children who have difficult or troubling behavior (Boushey, 2006; Rosenzweig et al., in press). When childrenā€™s mental health difficulties surface in child care settings, employed parents may be interrupted at work and asked to pick up their children for the rest of the day or may even have their child care arrangement terminated (Gilliam, 2005; Gilliam & Shahar, 2006; Owens & Ring, 2007). Cultural and family values are usually key factors in child care choice (Bradley & Kibera, 2006), but if their children have social and emotional difficulties, parents sometimes settle for whatever child care arrangements will accommodate their children (Brennan, Bradley, Ama, & Cawood, 2003; Emlen & Weit, 1999; Lieberman, 2005).

Some families can count on child care help from extended family members, including grandparents and adult relatives, or on informal child care exchanges with their neighbors (Porter, 1998; Sonestein, Gates, Schmidt, & Bolshun, 2002). For most parents of children with mental health problems, these ā€œkith and kinā€ arrangements may not be practical because of the unique needs of their children (Rosenzweig et al., in press). Extended family members may only be willing to assume the care of children with difficult or troubling behavior if the time commitment is limited or if they have relevant experience or expertise. Alternatively, child care supports can be given in the familyā€™s own home by paid providers who either have been trained to handle the childā€™s needs or are willing to learn (Lieberman, 2005). Arrangements can also be made with child care centers and family child care homes that are willing to include children with mental health difficulties and receive specialized supports from mental health consultants (Alkon, Ramler, & MacLennan, 2003; Cohen & Kaufmann, 2000). Finally, parents may receive assistance in locating culturally appropriate and inclusive child care arrangements through child care resource and referral agencies (Smith, Vinci, & GalvĆ”n, 2003) or family support organizations. Even given these resources, for many working parents, finding and maintaining child care for their children with mental health difficulties remains a major obstacle to staying employed (Brennan & Brannan, 2005).

Education

Employed parents may experience their greatest difficulty integrating work and family responsibilities after their children enter the formal educational system.

If children exhibit difficult or troubling behavior in school, they may be referred for mental health and special education evaluation, and family members may be involved in multiple meetings to exchange information and plan for services, depending on the outcome of the evaluation processes. Children who receive a psychiatric diagnosis of a condition that puts them at risk for out-of-home placement may be classified as being Seriously Emotionally Disturbed (SED; Substance Abuse and Mental Health Services Administration, 1993) and are entitled to receive mental health services, sometimes school-based. When childrenā€™s mental health difficulties are classified to determine their eligibility for special education, they may be labeled as having an Emotional Disturbance (Center for Effective Collaboration and Practice, 2007; Kates-McElrath, Agnew, Axelrod, & Bloh, 2007). Finally, some children who have behavioral challenges, especially those with social difficulties, may not be identified for special education services but still may have emotional or behavior management needs that concern their classroom teachers. Even with supports such as school-based mental health services, special education services, and behavioral aides in place, children still may experience mental health crises in the school environment. When classroom teachers do not have the training to help children who are experiencing unusual emotional or behavioral difficulties and insufficient supports are in place, parents are often called at work to intervene (Rosenzweig et al., 2002). In extreme situations, children may be suspended or expelled from school because of their behavior, requiring working parents to find ways to monitor their children when they are not in school. Family members who participate in focus groups and interviews have reported that repeated work interruptions and absenteeism because of their childrenā€™s problems in school have led to their termination from work (Huffstutter, Bradley, Brennan, & Rosenzweig, 2007a; Rosenzweig et al., 2002).

What supports are available for families of school-age children with mental health difficulties? Parents report drawing on resources within the schools and their social networks to cobble together crisis plans (Rosenzweig et al., 2002). Co-workers may alert them to calls coming from school and cover for them at work while family members deal with immediate difficulties. In some communities, formal supports are also available through innovative school-based programs that involve parents in planning for their childrenā€™s services, provide training and support for monitoring and managing their childrenā€™s behavior, and reduce their isolation (Atkins et al., 2006; McKay, Nudelman, McCadam, & Gonzales, 1996; Pollio, McClendon, North, Reid, & Jonson-Reid, 2005; Stone, McKay, & Stoops, 1996). School-based services are integral to the successful building of a system of care (Stroul & Friedman, 1986) around children who are receiving mental health services. Considering the unique needs of families, these services may focus on parent education, family support, engagement in school programs, or the empowerment of parents (Hoagwood, 2005; Sims, 2002; see also Chapter 8). Family members who are engaged extend themselves to participate in prevention and treatment programs on behalf of their children (McKay & Bannon, 2004) and may support other parents participating in these programs. When families are empowered, parents take active roles in planning services for their children, participate in school and community decisions, and advocate for their childrenā€™s rights within treatment and wider community environments (Broussard, 2003; Heflinger & Bickman, 1996). Although family engagement and empowerment are critical for childrenā€™s successful participation in school and treatment services, actions related to their childrenā€™s needs may take considerable time. Family support in the form of flexibility in scheduling on the part of educators, treatment providers, and work supervisors may be necessary for parents to sustain the involvement that is pivotal for their childrenā€™s success in school environments.

Economic Arrangements

Having a child with an emotional or behavioral problem can have serious economic consequences for families. Although there is little research that addresses the economic costs for families, the few available studies have confirmed that there are considerable out-of-pocket expenses associated with their childrenā€™s mental health treatment (Farmer, Stangl, Burns, Costello, & Angold, 1999; Ringel & Sturm, 2001). Parents may need to direct substantial parts of their income to pay provider fees, co-payments associated with insurance plans, pharmacy bills for prescribed medications, transportation costs associated with going to and from treatment sessions, and child care for siblings (Lynch, 2007). There are also important indirect costs to parents who may have to work fewer hours to engage in treatment with their children or to respond to crises in child care settings or schools (Rosenzweig et al., 2002; Ward et al., 2006). When children have extended bouts of serious mental health difficulties, employed parents may need to request a leave of absence from work...

About this edition

• Publisher: Brookes Publishing
• Publication date: 2008
• ISBN 10: 1557668272
• ISBN 13: 9781557668271
• Binding: Paperback
• Edition number: 1
• Number of pages: 400