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.

'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.

[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.

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.

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.

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.

[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.

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.

AACAP Official Action. Summary of the practice parameters for child custody evaluation.

This summary is presented as a guide for clinicians evaluating the often delicate and complex issues surrounding a child custody dispute. The historical basis of child custody and the various judicial presumptions that have guided courts, as well as the differences between performing child custody evaluation and engaging in traditional clinical practice, are reviewed in the complete document. Issues that are common to all child custody disputes are presented, including continuity and quality of attachments, preference, parental alienation, special needs of children, education, gender issues, sibling relationships, parents' physical and mental health, parents' work schedules, parents' finances, styles of parenting and discipline, conflict resolution, social support systems, cultural and ethnic issues, ethics and values, and religion. In addition, special issues that complicate custody evaluations are presented, including infants in custody disputes, homosexual parents, grandparents' rights, parental kidnapping, relocation problems, allegations of sexual abuse, and advances in reproductive technology, such as frozen embryos, oocyte donation, and artificial insemination.

National and state policies influencing the care of children affected by AIDS.

The portrait of HIV-affected children and youth that emerges from this policy overview is still one of children obscured from view by the shadow of their parents' and siblings' illness and policies that only address the needs of HIV-infected individuals. In addition, the secrecy and stigma that still surround HIV and AIDS make it difficult for HIV-affected children and youth to benefit as fully as they might from policies and programs that provide more generic types of care and assistance. Our failure as a nation to better illuminate the plight of HIV-affected children and youth can only leave us with a generation of children who are at greater risk of psychiatric illness, involvement with the criminal justice system, substance abuse, and contracting HIV. To avoid these consequences, both public and private sectors must place the spotlight on the development of new policies and programs designed to specifically meet their needs. Because the solutions defy traditional disciplinary and administrative boundaries, we also need to become more skilled at interagency planning and collaboration. No one system alone can be responsive to the many social, mental health, legal, and support needs of these children and their caretakers. More specifically, recommendations for improved systems of care to HIV-affected children, youth, and their families are as follows: To promote and fund cross-disciplinary initiatives among agencies that administer child welfare services, income supports, AIDS care, and children's mental health services at the national, state, and local levels to specifically meet the mental health, psychosocial, and permanency planning needs of HIV-affected children and youth. To provide training opportunities for Ryan White Title I, II, and III case managers on assessing the needs of HIV-affected children and youth, developmental theories and concepts, principles of family-centered care, and child welfare issues. To increase funding of the Ryan White CARE Act to permit a more family-centered approach to care across Titles. To establish clearer guidelines for establishing a proportional basis for funding services to infants, children, and women under the Ryan White CARE Act. To support legislative, educational, and advocacy efforts to make managed care and welfare reform more responsive to the needs of HIV-affected children, youth, and their families. To encourage states to provide additional funding for mental health services specifically targeted to HIV-affected children and youth that are sufficiently flexible and of a long enough duration to adequately meet their needs. Surely, as we move into a new millennium with the capacity to map the human genome and clearly view distant galaxies, we should be able to marshal the will and resources necessary to formulate a sufficiently focused effort to respond compassionately and effectively to the needs of a generation of AIDS-affected children and youth.

Prevalence and outcomes for parents with disabilities and their children in an Australian court sample.

OBJECTIVE: The purpose of this study was to obtain sound prevalence and outcomes data on parents with disabilities and their children in statutory child protection proceedings. METHOD: The court files of all care and protection matters initiated by the statutory child protection authority and finalized in a 9-month period (n=285) at two Children's Courts in NSW, Australia were reviewed. RESULTS: Parents with disabilities featured in almost one-third of the cases (29.5%). Parental psychiatric disability was most prevalent at 21.8% followed by parental intellectual disability (mental retardation) at 8.8%. Significant associations were found between parental disability and court outcome with a disproportionately large number of children of parents with intellectual disability being made wards of the state. CONCLUSIONS: The findings demonstrate that parents with disabilities are significantly over-represented in statutory child protection proceedings and that the outcomes of these proceedings vary according to disability type.

Diagnosed intellectual and emotional impairment among parents who seriously mistreat their children: prevalence, type, and outcome in a court sample.

A substantial body of research evidence over the past three decades has indicated that intellectual and emotional impairment among parents is a factor contributing to child abuse and neglect. This study examined the court records of 206 seriously abused or neglected children and their families in a large urban area and found that in over half the records a parent had been diagnosed as having an emotional disorder and/or low IQ, with a majority of these diagnoses indicating significant impairment. Although type of impairment (emotional, low IQ, and a subsample of substance abusers) did not predict type of mistreatment, higher predicted risk for continued mistreatment, or greater likelihood of permanent removal of the child by the court, low IQ parents revealed significantly less prior court involvement and greater acceptance of court-ordered services. Parents diagnosed with serious emotional disorders were significantly more likely than less disturbed parents to have their children permanently removed despite findings of no significant differences in risk or compliance factors.

Deadbeat dads or inept states? A comparison of child support enforcement systems.

This article provides information on the effectiveness of state child support enforcement systems. We use individual level data from the Child Support Supplements of the Current Population Surveys (1978-1992) to create an index of state effectiveness that captures success at securing child support awards, setting award levels, and collecting obligations. We identify states that were performing above or below the national average in the late 1980s to early 1990s and states that showed substantial improvement or decline in child support effectiveness during the 1980s. Identifying successful states will help researchers to determine what policies and practices are associated with successful enforcement. These variations in state effectiveness also suggest that low levels of child support are not due to deadbeat dads alone but also to inept states.

The youngest victims of child maltreatment: what happens to infants in a court sample?

Current data show that infants represent an increasing proportion of cases of child maltreatment. To learn more about how infants fare in the current system and to provide baseline data against which to compare outcomes following recent legislative reforms, this study examined a subsample of infants in a sample of 200 care and protection cases brought before the Boston Juvenile Court in 1994. Child, parent, and case characteristics of infants 0 to 3 months of age (n = 46) were compared with characteristics of older children in the sample. All cases were followed prospectively for 4 years, and data were abstracted from court records. Results revealed that the infants were primarily children of substance abusers who had extensive prior histories of child protective service system involvement. Although the majority of the infants were eventually permanently removed from parental custody and adopted, many experienced time delays and multiple placements before achieving permanent homes.

Ethical and moral dilemmas in the treatment of an abusive parent--the occupational therapy perspective.

Treating patients who physically abuse their children creates in the therapist moral and ethical dilemmas which challenge his or her ability to maintain a professional conduct and attitude. In such cases the therapist usually finds himself or herself confronted with the following dilemmas: (a) treatment of a patient who experiences therapy as a no-choice situation; (b) treatment of a patient whose conduct is in conflict with the moral values of the therapist; (c) the obligation of the therapist to report the abusive acts to the authorities versus his or her duty to protect the patient's right to confidentiality; and (d) the therapist's loyalty to the patient's welfare, when it is in conflict with the abused person's welfare. These issues are illustrated through the following case study examined in the context of occupational therapy (OT): A 26-year-old married woman, mother to a four-month-old infant was referred to therapy after causing severe burns to her daughter's hands. As a child the patient experienced physical abuse by her parents. The patient viewed treatment as her only possible means of keeping her child. On the other hand, she was suspicious of verbal therapy, as she assumed that the contents might incriminate her. Occupational therapy was therefore a major therapeutic modality used to assess and improve her disturbed psychosocial occupational performances. The article describes the way in which the OT approach helped overcome and resolve the moral and ethical dilemmas raised in the case.

[Legal family assessment in the case of alcoholic parents]. / Familienrechtliche Begutachtung bei Alkoholerkrankung der Eltern.

Legal testimony in families with alcohol abusing parents requires extensive psychological assessment concerning developmental risks and coping resources of the children, specific characteristics of abuse, abuse related behaviour and comorbidity of the alcohol abusing parent als well as morbidity of the non-alcoholic parent. Children of alcoholics and their parents themselves need long-term help beyond the process of divorce and legal activities which demands close cooperation between social institutions involved.

[Problems in expert assessment in child custody cases according to sections 1666, 1666a BGB in the controversy between control and assistance]. / Gutachterliche Probleme beim Sorgerechtsentzugsverfahren nach sections 1666, 1666a BGB im Spannungsfeld zwischen Kontrolle und helfender Funktion.

The restriction of parental rights includes not only legal but also therapeutic aspects. The therapeutic aspects refer first to the child's disorder and then to its resulting needs. Furthermore a restriction of parental rights could be necessary for therapeutic reasons when the parents' reaction to reality is insufficient, usually caused by parental psychiatric disorders. The expert's counsel should facilitate the communication with disturbed parents thus engendering an improved reality-insight by the parents. Successful helping strategies can thus be made workable. The expert, the judge and the local authority social services should mutually respect specifically defined role-functions. The communication barriers between parents and helpers can only this way be partially resolved. The expert's evidence requires a high professional competence and responsibility and goes over and above the professional contribution from family therapy.