Outcomes of programs serving mothers with psychiatric disabilities and their young children: a multisite case file abstraction study.

OBJECTIVE: This multisite study examined outcomes of mothers with mental illnesses receiving integrated clinical, rehabilitation, and parenting services for their preschool-age children. Mothers' outcomes included independent living and employment status, custody loss and reunification, psychiatric hospitalization, and substance abuse. METHOD: Retrospective case file abstraction yielded data regarding 104 mothers served over 12-month periods during 1995-1999 at 4 programs located in 3 different states. Multivariable logistic regression (MLR) analysis explored associations between outcomes and predictors from prior research, controlling for study site. RESULTS: During their first 12 months of program participation, significant increases were found in the proportions of mothers employed and living independently. Significant decreases were noted in the proportion of mothers abusing substances. Although 10% of the women served lost formal custody during their first year of participation, 22% were reunited with 1 or more children. In MLR analysis, mothers who abused substances were more likely to have experienced childhood sexual abuse and custody loss; those who were psychiatrically hospitalized were more likely to have abused substances, lost custody of 1 or more children, and had more disabling forms of mental illness; and those who lost custody of 1 or more children were more likely to have experienced a psychiatric hospitalization and less likely to be residing with 3 or more children. CONCLUSIONS: Programs for mothers with mental illness and their preschool children address service needs in an integrated fashion that appears to improve clinical and rehabilitation outcomes, while preventing custody loss and supporting reunification.

Pediatric emotional dysregulation and behavioral disruptiveness treated with hypnosis: a time-series design.

A case of pediatric oppositional defiant disorder (ODD) with concomitant emotional dysregulation and secondary behavioral disruptiveness was treated with hypnosis by means of the hypnotic hold, a method adapted by the authors. An A-B-A-B time-series design with multiple replications was employed to measure the relationship of the hypnotic treatment to the dependent measure: episodes of emotional dysregulation with accompanying behavioral disruptiveness. The findings indicated a statistically significant relationship between the degree of change from phase to phase and the treatment. Follow-up at 6 months indicated a significant reduction of the frequency of targeted episodes of emotional dysregulation and behavioral disruptiveness at home.

A 3 year national longitudinal study comparing drug treatment outcomes for opioid users with and without children in their custodial care at intake.

The aim of this research was to measure the longitudinal effects of having children in a client's custodial care, on opioid treatment outcomes. A 3 year national, longitudinal study was implemented. Outcomes were measured using the Maudsley Addiction Profile, 404 clients (75% male) were recruited and 97% were located at 3 years. At 1 year significantly fewer of those with children in their care were using heroin, benzodiazepines and cannabis but having children in a client's care at intake was a significant and positive predictor of using other opioids at 1 year. Analysis also revealed that there was a significant reduction in the proportion using alcohol in the last 90 days and in the mean days alcohol was used among those with no children in their care. Results demonstrate that having children in a client's care improves outcomes for heroin use but also suggest the possible use of substitution substances.

Forensic psychiatry in France: the Outreau case and false allegations of child sexual abuse.

During the Outreau case in France, 13 individuals were falsely accused of child sexual abuse and incarcerated. The author of this article testified as a psychiatric expert when the convictions were appealed. He explains how purposeful false statements by adults, inept expert witnesses, and the judicial assumption that children do not lie converged to create a tragic legal outcome. This article explains how psychiatric experts should conduct evaluations in cases of alleged child sexual abuse.

Integrative family therapy for high-conflict divorce with disputes over child custody and visitation.

A growing number of divorcing families become locked in intractable disputes over child custody and visitation. This article describes an integrative family therapy approach targeted toward such families. Aspects of this treatment include negotiating a clear therapy contract, creating a multipartial alliance with all parties, assessing through the lens of specific understandings about these cases, incorporating multiple therapy session formats, holding both systemic and individual focused perspectives, incorporating a solution-oriented focus, and drawing upon a wide range of intervention techniques. The treatment aims to create a good-enough postdivorce climate in which a new family structure can be constituted in which parents maintain distance from one another, and conflict and triangulation can be minimized.

On cross-cultural conflict and pediatric intervention.

A critical examination of Richard Miller's position in his recent Children, Ethics, and Modern Medicine on how to handle pediatric interventions in cases of cross-cultural conflict between parents and doctors with respect to treating young children. Particular emphasis is placed on Miller's interpretation of and arguments about a Hmong case extensively researched by Anne Fadiman in her The Spirit Catches You and You Fall Down. The conclusion drawn is that Miller's position requires further nuance and development, and some recommendations are made toward that end.

Using grounded theory to generate a theoretical understanding of the effects of child custody policy on women's health promotion in the context of intimate partner violence.

Women's health is frequently influenced by social and structural factors, largely beyond women's control, and often entrenched in public policy. Although health is acknowledged to be socially determined, the ways that social conditions affect health are rarely explicated. Grounded theory is a useful method for discovering how structural conditions influence patterns of behavior. We used grounded theory to generate a theoretical understanding of how justice system policy and services related to child custody influence health promotion processes of women and their children after leaving abusive male partners/fathers. In two diverse Canadian provinces, we interviewed single mothers who had left abusive partners as well as frontline workers and policymakers in the justice system. We identified the key dimensions of policy and services that influence the ways in which women and their children promote their health in the context of varying levels of ongoing intrusion as information, eligibility, accessibility, timeliness, human resources, safety, and diversity. In this article, the interplay between theses policy and service dimensions and women's health promotion after leaving abusive partners is discussed and suggestions are made for strengthening "healthy" custody policy.

Integrative family therapy for disputes involving child custody and visitation.

This article describes integrative multilevel family therapy for disputes involving child custody and visitation, a multiple-level systems-based treatment specifically targeted at those engaged in intractable conflicts over child custody and visitation. Parents and children engaged in these conflicts are at risk for a variety of difficulties. Key aspects of the approach include the articulation of clear therapy contracts, the utilization of multiple therapy session formats, the maintenance of a systemic perspective, intervention on multiple system levels, the tailoring of intervention strategy based in an assessment of the locus of difficulty in each case, planning for intervention over time, and working at the interface of the legal system in order to impact on these problems.

Finnish families' need for special support as evaluated by public health nurses working in maternity and child welfare clinics.

The purpose of this study was to describe public health nurses' views of the everyday problems of families and their needs for special support. Seventy-four nurses filled in a tripartite questionnaire. The needs varied by region and were seen in 4% to 23% of all families expecting a baby or with a child younger than 3 age in the nurses' clientele. Approximately one-third of the families were considered to have a pressing need for support. More than half of families (54%) had difficulties coping with parenthood and family structure, almost one-third (30%) with raising their children and with childcare, and nearly one-third (27%) with their social network. In 20% of the families, the parents experienced problems relating to their relationship as a couple; 20% of the families had problems connected to the children's development, growth, and health; and in 19% of the families, the parents had health problems. Special needs were also caused by the parents' use of alcohol (15%) and by disputes over the children's custody and visiting rights (7%). The information provided by the study can be used in developing clinical services and the family work supporting them.

A comparison of pregnant women presenting for alcohol and other drug treatment by CPS status.

OBJECTIVE: The purpose of this study was to describe the demographic, substance use, and treatment variables of alcohol and other drug (AOD) treatment seeking pregnant women. This study also compared women on these variables based on Child Protective Service (CPS) status. METHOD: Secondary data of all pregnant women with at least one child entering all publicly funded AOD treatment programs (N=678), in a southwest county, over a 3-year period were analyzed to examine the differences between pregnant women also involved with CPS and those not involved with CPS. RESULTS: Pregnant women reporting CPS involvement were similar to non-CPS women on demographic variables but differed on drug use and treatment variables. CPS women were more likely to report marijuana use as their primary problem drug, be mandated to treatment, attend day treatment and be released from treatment unsatisfactorily compared to the non-CPS pregnant women. Those without CPS involvement were more likely to report cocaine or crack as their primary drug, attend outpatient treatment and be found to have a satisfactory release from treatment compared to those with CPS involvement. Results from the multiple logistic regression analysis found that the significant predictors of CPS involvement were mandated status and unsatisfactory treatment release. CONCLUSIONS: Differences in treatment outcomes may be based on AOD agencies' difficulty in working with mandated clients and/or with the multiple demands placed by CPS on clients as part of their treatment plans. Further research is needed to determine reasons for CPS clients' high failure rates in AOD treatment.

[From program to metaphor--managing the needs of children in a separation or divorce process involving their parents]. / Vom Programm zur Metapher--den Bedürfnissen der Kinder im Trennungs- und Scheidungsprozess ihrer Eltern gerecht werden.

In German-speaking regions there are several independent intervention programs, derived from concepts originating in the USA, which are designed to assist children whose parents are separated or divorced. Two of these programs will be presented here. Consistent with the thematic implication that divorce entails trauma and stress, the childrens' need of advice and help is placed at the conceptual center of the intervention. This results in a behavioral-cognitive training program, which should enable children to overcome the stress of their situation. In contrast to these two programs, an understanding of divorce may be achieved, through phenomenological analysis, which gives due consideration to the various aspects and meanings of the divorce process. The concept of intervention derived from this approach is to assist children in further developing their own search for solutions, focused on the parents-child-relation. The primary emphasis of this approach is not the childrens' difficulty in dealing with their parents' separation and divorce, but rather their own attempt to deal with the problem, as is visible in the metaphor of their spontaneous descriptions and images of experiences and events. The central concept of the proposed course is the further development of this creative process in the form of a dynamic-communicative group happening. Furthermore it is shown how children can be assisted in a practical way, and encouraged to create their individual and personally adequate solution to the experience of divorce.

Prenatal drug exposure and social policy: the search for an appropriate response.

Prenatal drug exposure continues to be a controversial topic. Views of what constitutes an appropriate response to drug-exposed infants vary, in large part due to the many complex issues endemic to perinatal substance use. The purpose of this article is to review the controversy surrounding prenatal drug exposure, outline the policy dilemmas that complicate attempts to respond appropriately, review current practice in this area and the effectiveness of those practices, and offer specific recommendations as a starting point for debate. It is suggested that earlier controversy regarding the sequelae of prenatal drug exposure may be decreasing as research identifies specific and subtle deficits in some affected infants. It is also suggested that the postnatal effects of parental substance abuse (e.g., in terms of abuse/neglect, attachment, and development) are the more appropriate focus of child protection efforts, and that different disciplines must collaborate to reach a consensus regarding the nature of these efforts.

[Dynamics of child suggestibility in accusations of sexual abuse in divorce proceedings]. / Zur Dynamik der kindlichen Suggestibilität beim Vorwurf des sexuellen Missbrauchs im Scheidungsverfahren.

A case of a mother confabulating an extended sexual abuse of her 13 and 15 year old children involving bizarre sadistic features is presented and discussed. The kinship to Munchhausen Syndrome by proxy, identity diffusion, Posttraumatic Stress Syndrome, folie à deux and other concepts is highlighted. It is suggested that sexual confabulations are generated within incestuous family structures as a means to stimulate and satisfy needs of personal closeness when losses and disruptive events have occurred. The disclosure or suspicion of sexual abuse may prove neither true nor false but may hint to an impending emotional breakdown of a parent and to ongoing subtle incestuous traumatisation of a child.

Adjudication of child sexual abuse cases.

This article discusses issues in the adjudication of child sexual abuse allegations. Such allegations may be tried in criminal court and/or civil court (in child abuse or divorce proceedings), and these forums are discussed. Often central to any of these proceedings is the necessity for a child to testify. The article reviews research about the believability of child witnesses and discusses accommodations for the child that could assist the child witness and encourage accurate testimony, as well as continue to protect the rights of the accused.

Childhood malignancies and decision making.

Failure to obtain "adequate" medical care for a child constitutes child neglect, which may be used as the basis for prosecution of parents, removal of the child from the home, or court-ordered medical treatment. "Adequate" care is usually construed as that which is given by a licensed physician, but, in case of dispute, courts almost never engage in choosing one medical approach over another. The principle that parents may not refuse medical care, however, is made very difficult when children have malignancies--the long-term nature of the treatment means that, if the child is left at home, court order or not, the parents may flee with their child. Removing the child from the home, however, adds that trauma to the ill child's burdens. Questions should be asked before making a request to a court to order a therapy which will prolong but not save a child's life if the parents would prefer to spare their child the side effects. Parents, however, may always refuse to permit their child to participate in research studies, no matter how promising. Adolescents are increasingly believed to be capable of medical decision making; most courts, however, would not allow an adolescent to refuse life-saving treatment.

The spiritual healing "defense" in criminal prosecutions for crimes against children.

Spiritual healing as a defense in cases of parents' rejection of medical treatment for their sick children involves questions of the rights of parents, of children, of the state, and of the U.S. Constitution. State legislation protecting rights of religion, long on the books, is coming into conflict with new legislation on child abuse. This article reviews the current picture of applicable laws in the states and in recent court cases. Limiting the use of spiritual healing as a legal defense is an emerging trend.

Children of divorce: predictors of change following preventive intervention.

Fifty-three fourth- and fifth grade children were tested on postdivorce adjustment immediately before and six months after participation in an eight-week preventive intervention program. At follow-up, most showed positive change, with those at special risk for adjustment problems showing substantial gains. Results did not vary with sociodemographic or divorce circumstances.