Relative caregiving. An effective option for permanency.

Children affected by HIV/AIDS are at high risk for multiple placements as the adults in their lives are often too incapacitated to provide stable, consistent care for them. This article provides a historical overview of child caregiving, describes the complex needs of HIV/AIDS affected children and their relative caregivers, usually grandparents, and suggests that with necessary supports, placement with relatives can be a thoughtful, realistic option for permanency.

Intensive, integrated, in-home psychiatric services. The catalyst to enhancing outpatient intervention.

The authors introduce the Yale Intensive In-Home Child and Adolescent Psychiatric Service, a model of home-based care for children with severe psychiatric disturbances. This model synthesizes the principles and method of the wrap-around paradigm and in-patient child psychiatric practice within the reality of the managed care system. A clinical team, under the direct supervision of a child psychiatrist, works directly within the family to understand and address the multilevel transactions that have affected the child's ability to function in various domains and resulted in recommendations for intensive intervention, including psychiatric hospitalization. This article suggests that if the psychiatrist is to provide the highest level of care, cognizance of and involvement in the child's ecology are as essential for the child and adolescent psychiatrist as other aspects of the child's world and life. In the days of ever shortening patient lengths of stay, this model of care offers promise for both clinical and fiscal effectiveness.

Crisis placement.

This article reviews some factors that influence the crisis placements of high-risk children, and describes an intervention designed to ensure safety and permanence for children, by supporting biological and kinship families, preventing unwarranted family disruption, and reducing the need for multiple placements. Some of the barriers to thoughtful risk-taking and decision-making in child protective service systems are discussed and the importance of collaboration among child protection, health, and mental health professionals is emphasized.

Evaluating systems of care for children: utility of the clinical case conference.

A clinical assessment of the Mental Health Services Program for Youth, a national initiative to integrate systems and coordinate care for severely emotionally disturbed children, was designed to augment and enrich the larger evaluation of program structure. Case conferences were used as a method of examining the effects of collaborative systems of care on vulnerable individuals and of generating clinical insight and understanding. Case vignettes are presented and discussed in terms of the contributions and shortcomings of current system-of-care efforts.

The psychological effects of parental human immunodeficiency virus infection on uninfected children.

OBJECTIVES: To assess the mental health of children of mothers infected with the human immunodeficiency virus. DESIGNS: Matched comparison of 26 children of mothers infected with the human immunodeficiency virus and 26 children with no experience of human immunodeficiency virus infection within their families. SETTINGS: Subject children were identified through hospital acquired immunodeficiency syndrome clinics and comparison children were identified through the primary care center of the same hospital. PARTICIPANTS: Subjects and controls were aged 6 to 16 years and matched by age, sex, race, and maternal marital and employment status. MAIN OUTCOME MEASURES: Parents completed the Child Behavior Checklist and the children completed the Revised Children's Manifest Anxiety Scale and the Children's Depression Inventory. RESULTS: Controlling for confounding variables, subjects were found by the Child Behavior Checklist to be significantly more withdrawn (P < .05) and to have more problems with attention (P < .005) than controls, although total Child Behavior Checklist scores were not significantly different. Compared with control children, the subject children reported more depression on the Children's Depression Inventory (P < .05) but were not more anxious. However, compared with children of asymptomatic mothers, the children of symptomatic mothers were reported to be significantly more anxious and/or depressed on the Child Behavior Checklist (P < .01) and the children reported more anxiety on the Revised Children's Manifest Anxiety Scale (P < .05). CONCLUSIONS: This study focusing specifically on uninfected children in families affected by the human immunodeficiency virus demonstrates some of the psychological ramifications of this disease. Larger studies are required to identify factors that contribute to the vulnerabilities and resilience of such children. Attention needs to focus on ameliorating these adverse effects on the children of the acquired immunodeficiency syndrome epidemic.

Complicating the theory. The application of psychoanalytic concepts and understanding to family preservation.

Anna Freud's recognition of the complex interactions between endowment and maturation, innate structuralization and environmental influences, have had a profound influence on the development of policies and programs in the United States that attempt to improve the adverse conditions, strengthen the tenuous maternal ties, and reduce the potential for behavioral problems and intrapsychic distress in certain high-risk families. This paper describes and provides a case illustration of the application of Ms. Freud's psychoanalytic theories to the Yale Family Preservation and Support Programs. It reviews and comments on national policies regarding the risks and benefits of family preservation and child placement, identifies a paradigmatic shift in the provision of mental health care, and cautions against overconfidence in our ability to intervene effectively.

Children's mental health service needs and utilization patterns in an urban community: an epidemiological assessment.

To assess children's mental health service needs and utilization patterns for a state planning effort, a cross-sectional survey that sampled 822 children aged 6 to 11 of a metropolitan center was conducted. When reports of parents and teachers were combined, 38.5% of children were screened to be at risk of psychiatric disturbance. Only 11% of children at risk received treatment in mental health settings, fewer than in schools (37%) or medical settings (13%). The findings illustrate the importance of interagency collaboration and the need to consider reports of parents and teachers and different dimensions of psychopathology in future planning and research.

Preventing out-of-home placement for high-risk children.

Preventing the removal of high-risk children from their families is investigated through two community-based programs. One program followed a day treatment model; the other used a home-based approach. These programs treated populations that shared common features but also had important differences. In both programs, a high percentage of children were maintained in the home and were still at home one year after discharge. It is suggested that such community-based intervention programs enhance the likelihood that high-risk children can remain with their families.