Providers' experiences collaborating with child welfare workers: The good, the bad, and the impacts.

BACKGROUND: Successful interprofessional collaborations have been identified as a potential solution to mitigate problems associated with negative outcomes for clients involved with the child welfare system. The barriers to collaborative relationships need to be better understood and effectively addressed. OBJECTIVE: To understand the characteristics, barriers, and facilitators of collaborations between different types of providers and child welfare workers, as well as their impacts. PARTICIPANTS AND SETTING: Mental health professionals, foster and kinship parents, legal professionals, and other providers responded to an online survey distributed in a Northeastern State of the United States of America. METHOD: Participants (n = 208) completed the Quality of Collaboration with Child Welfare survey. Qualitative responses were analyzed by three coders using three levels of axial coding with constant comparison. RESULTS: Participants identified different aspects of communication, relationships, and follow-through as key elements of successful collaborations, as well as the items most likely to interfere with their formation. Providers differed somewhat in how concerned they were with various aspects of collaborations in accordance with their professional roles. Barriers to successful collaborations included both individual and systemic factors which often resulted in negative outcomes. Overall, more negative experiences were offered than positive ones. CONCLUSIONS: Strategies are needed to improve communication, promote positive relationships, and address systemic barriers to enhance collaboration and, in turn, improve outcomes for child welfare-involved clients.

Trauma in Context: an Integrative Treatment Model.

Evidenced based trauma treatments benefit children, but they rarely suffice for youth with multiple and complex comorbidities. After the completion of standard treatments, many children continue to show residual social, behavioral, and emotional difficulties. Part of the difficulty is that while the literature on trauma describes numerous facets that contribute to the severity, expression, and outcomes of trauma exposure, clinical assessments and interventions do not sufficiently reflect that literature. Clinicians thus have little guidance on how to integrate the intricacies of client's circumstances into a trauma-informed framework. To expand the scope and efficacy of treatments and guide clinicians in selecting appropriate interventions, this paper explores factors associated with pretreatment traumatic responses and proposes an integrative treatment model that includes the trauma experience, itself, combined with pre- and post-trauma factors that are both internal and external to the child and family. Pre-trauma experiences influence the severity of traumatic responses, while post-trauma factors impact a person's ability to cope and recover. Both are important targets for direct intervention.

Debate: Coping and resilience in the time of COVID-19 and structural inequities.

The hardships associated with COVID-19 have highlighted the importance of coping and resilience, and many mental health providers and organizations have responded by promoting the use of individual and familial coping tools. While individually oriented techniques benefit many, they can also disadvantage populations struggling the most. They exact a cost by placing a higher burden on those with fewer resources and thus risk widening structural inequities. Since community-level interventions can also enhance resiliency and are cheaper and more sustainable, more effort should be put into developing and deploying them. At a time in which hardship is widespread, parents are overwhelmed by multiple demands, structural inequities are rampant, and demand for services outpaces capacity, the mental health field must prioritize more equitable methods of assisting large numbers of children and families.

Soapbox: Class matters in parenting interventions.

Class and income level influence parenting styles and values, yet are rarely discussed in treatment approaches and parenting interventions with families. In this soapbox article, I argue that discrepancies in outcome, retention, and participation could be fruitfully addressed through a fuller understanding of the needs, realities, and parenting goals of families struggling with financial disadvantage. I compare and contrast ethnographic studies of parenting in low socioeconomic environments with the types of strategies and interventions commonly advanced in parent training programs and suggest that clinicians must become more aware of the cultural and socioeconomic overtones of those interventions in determining whether, how, and when to use them with families.

Clinical competencies for the effective treatment of foster children.

Despite a high level of documented mental health needs among children who have experienced foster care, research indicates that treatment outcomes are often disappointing. In order to improve outcomes, evidence-based treatments for attachment, trauma and behavioral difficulties are often promoted for this population. However, little research exists on whether or not those interventions effectively address the unique and complex mental health needs of many foster children. While a rather robust literature exists on foster children's multifaceted difficulties, most treatments do not fully represent that range and complexity in their interventions. This article attempts to begin to fill that gap by outlining the knowledge and skills clinicians must acquire if they are to effectively treat foster children. Treatment of foster children should be seen as a subspecialty within the field of child mental health, and trainings that help clinicians gain more knowledge of foster children's unique needs should be more available.

Neurocognitive considerations in the treatment of attachment and complex trauma in children.

Accumulating evidence suggests that children suffering deprivation and maltreatment at critical times in their development often pay a cognitive toll. While children vary to the extent that neurocognitive domains are affected, those factors influence how children process, manage and understand traumatic and attachment experiences as well as how they respond to treatment. Current research on trauma and attachment favor some aspects of cognition over others. The literature discusses attention, memory, cognitive biases, internal working models, beliefs and attributions as ways that impact an individual's understanding of experience. Other categories such as working memory, processing speed, verbal, auditory or perceptual processing, metacognitive skills, and cognitive rigidity or flexibility rarely surface. This paper examines what is and is not known about the interface of cognition with attachment and complex trauma and how that knowledge can inform treatment. It explores existing research and offers a case vignette as an example of how that knowledge can be integrated into treatment strategies.

The use and limitations of attachment theory in child psychotherapy.

Attachment theory and research has proliferated in recent years, spawning new ideas and applications to child therapy. Some of those interventions are creative and useful and rest on solid theory and research, whereas others derive from tenuous assumptions. As an important developmental construct, attachment plays a role in every therapy, but defining that role can be difficult. Therapists must recognize the significance of attachment in treatment but not at the expense of recognizing and treating other issues. This article provides an overview of attachment theory and attachment-based interventions and discusses how to apply those constructs to therapeutic work with children. It reviews attachment theory, assessment, and treatments, and discusses how attachment-focused interventions can be combined with other therapeutic needs and methods. It also considers limitations in the current clinical application of attachment and makes recommendations for further research. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Clarifying core characteristics of attachment disorders: a review of current research and theory.

Reactive attachment disorder is a relatively new diagnosis that is not well studied. Conflicting ideas about its etiology and presentation pervade the theoretical, research, clinical, and popular literature. Clarifying core characteristics of this disorder and distinguishing them from comorbid conditions are critical for improved diagnosis and treatment of children with attachment problems.