Multiple Family Groups and Child Welfare Involved Families

描述(由申请人提供)：在儿童福利调查后留在家中与其长期照顾者在一起的儿童(即未被寄养的儿童)中，近一半的儿童表现出很高的精神健康需求，但很少有儿童从事或仍在接受精神健康治疗(Burns等人，2004；Lau&Weisz，2003)。这一点尤其令人担忧，因为这些涉及儿童福利的家庭(CWIF)的儿童表现出不成比例的行为困难(ACF，2005；Burns等人，2004)。市中心社区缺乏可用的儿童心理健康服务提供者(Asen，2002)，这给获得治疗造成了更大的障碍。减少儿童破坏性行为障碍的多家庭小组(MFG)服务提供模式(DBDS；Franco等人，2008；Gopalan&Franco，2009；McKay等人，1995；1999；2002；Stone，McKay，&Stoops，1996)目前正在NIMH资助的有效性研究中进行测试。这种模式对CWIF来说可能是有益的，因为它是一种创新的、引人入胜的心理健康干预措施，可以解决市中心服务能力的限制。虽然初步数据表明，CWIF在MFG中表现出很高的参与率，但CWIF有大量的需求(例如，父母抑郁)，这可能超过MFG模型目前的能力。因此，MFG模式可能需要适应CWIF。因此，拟议奖学金的目标包括(1)增加申请者在儿童精神健康服务和干预科学方面的理论知识和方法专长；(2)增加儿童智力障碍服务和家庭治疗方面的理论知识；以及(3)使申请者做好准备，为儿童智力障碍儿童发展和试行以家庭为基础的精神健康干预措施，以减少儿童智力障碍。本申请的具体目标是通过两项研究来实现的，这两项研究检查了CWIF护理者对MFG模型的反应，并确定了可能需要修改的地方。使用定性方法，研究1将确定CWIF照顾者对影响服务交付的因素(即参与度、计划的帮助程度、相关性和激发做出家庭层面改变的动机的能力)的看法，并提出改进建议。研究2涉及量化的次要数据分析，以评估CWIF的状况是否会随着时间的推移而影响MFG的治疗效果，这些因素涉及(1)服务提供的参与度和过程特征(即与服务提供者的关系、MFG成员之间的关系、父母和青少年实现治疗目标的动机、感知到的治疗障碍)、(2)家庭层面的结果和父母特征(即育儿技能、家庭沟通、家庭支持、父母/子女互动、父母压力、父母抑郁、父母应对)，以及(3)青年层面的结果(即外化行为困难和功能能力)。在调整MFG模型时，可以针对那些MFG治疗效果减弱的结果进行进一步修订。这两项研究都将提供初步数据，用于开发和试验以家庭为基础的心理健康干预，以减少CWIF儿童DBD。因此，可以改善针对多样化和弱势群体的心理健康治疗。 公共卫生相关性：目前的申请提出了两项研究，考察有儿童福利服务接触的家庭(即没有寄养安置的公开儿童福利案例，先前接触儿童福利服务)如何响应多家庭小组(MFG)服务提供模式，以减少儿童破坏性行为障碍(DBDS；Franco等人，2008；Gopalan&Franco，2009；McKay，等人，1995；1999；2002；Stone，McKay，&Stoops，1996)关于参与、服务提供特征以及家庭和青年一级的结果。将利用定性和定量技术来确定可能需要修改的地方，以便为这些涉及儿童福利的家庭调整MFG干预措施。尽管儿童行为困难的比率很高(ACF，2005；Burns等人，2004)，但CWIF儿童通常不从事或保持儿童心理健康服务(Burns等人，2004；Lau&Weisz，2003)，开发一种有效的、有吸引力的和创新的精神健康服务将帮助CWIF儿童获得并受益于所需的治疗。

DESCRIPTION (provided by applicant): Close to half of all children who remain at home with their permanent caregivers following a child welfare investigation (i.e., not placed into foster care) manifest high rates of mental health need, yet few engage or remain in mental health treatment (Burns et al., 2004; Lau & Weisz, 2003).This is particularly concerning as children from these child welfare involved families (CWIFs) manifest disproportionately high rates of behavioral difficulties (ACF, 2005; Burns et al., 2004). Lack of available child mental health service providers in inner-city communities (Asen, 2002) creates even greater obstacles to accessing treatment. The Multiple Family Group (MFG) service delivery model to reduce childhood disruptive behavior disorders (DBDs; Franco et al., 2008; Gopalan & Franco, 2009; McKay, et al., 1995; 1999; 2002; Stone, McKay, & Stoops, 1996) is currently being tested in an NIMH-funded effectiveness study. This model may be beneficial for CWIFs as an innovative, engaging mental health intervention that addresses inner-city service capacity limitations. Although preliminary data indicate that CWIFs manifest high engagement rates in MFGs, CWIFs have substantial needs (e.g., parental depression) which may exceed the MFG model's current capacities. As a result, the MFG model may require adaptation for CWIFs. Consequently, the goals of the proposed fellowship include (1) increasing the applicant's theoretical knowledge and methodological expertise in child mental health service and intervention science; (2) increasing theoretical knowledge in services for CWIFs and family-based treatment of childhood DBDs; and (3) preparing the applicant to develop and pilot a family-based mental health intervention for CWIFs to reduce childhood DBDs. The specific aims of the current application are met through two studies examining CWIF caregiver responses to the MFG model and identifying where modifications, if any, may be necessary. Using qualitative methods, Study #1 will identify CWIF caregiver perceptions of factors that influence service delivery (i.e., engagement, program helpfulness, relevance, and ability to stimulate motivation to make family- level changes), and recommendations for improvement. Study #2 involves quantitative, secondary data analyses to assess if CWIF status moderates the MFG treatment effect over time regarding (1) engagement and process characteristics of service delivery (i.e., relationship with service provider, relationships between MFG members, parental and youth motivation to address treatment goals, perceived barriers to treatment), (2) family-level outcomes and parent characteristics (i.e., parenting skills, family communication, within family support, and parent/child interaction, parent stress, parent depression, parent coping), and (3) youth-level outcomes (i.e., externalizing behavioral difficulties and functional capacities). Those outcomes where the MFG treatment effect is attenuated can be targeted for further revision when adapting the MFG model. Both studies will provide preliminary data used to develop and pilot a family-based mental health intervention to reduce child DBD's for CWIFs. Thus, mental health treatment may be improved for a diverse and vulnerable population. PUBLIC HEALTH RELEVANCE: The current application proposes two studies which examine how families with child welfare services contact (i.e., open child welfare case without foster care placement, prior child welfare services contact) respond to the Multiple Family Group (MFG) service delivery model to reduce childhood disruptive behavior disorders (DBDs; Franco et al., 2008; Gopalan & Franco, 2009; McKay, et al., 1995; 1999; 2002; Stone, McKay, & Stoops, 1996) regarding engagement, service delivery characteristics, as well as family- and youth-level outcomes. Qualitative and quantitative techniques will be utilized to identify where modifications, if any, may be necessary in order to adapt the MFG intervention for these child welfare involved families (CWIFs). Given that CWIFs often do not engage or remain in child mental health services (Burns et al., 2004; Lau & Weisz, 2003) despite high rates of child behavioral difficulties (ACF, 2005; Burns et al., 2004), developing an effective, engaging, and innovative mental health service will help children from CWIFs access and benefit from needed treatment.