Multiple Family Groups and Child Welfare Involved Families

描述（由申请人提供）：在一项儿童福利调查后，近一半留在家中与永久照顾者在一起的儿童（即未被安置在寄养家庭）表现出很高的心理健康需求，但很少有人从事或继续接受心理健康治疗（Burns等人，2004年；Lau & Weisz， 2003年）。这一点尤其值得关注，因为来自这些儿童福利家庭的儿童表现出不成比例的高行为困难率（ACF, 2005; Burns et al., 2004）。市中心社区缺乏可用的儿童心理健康服务提供者（Asen， 2002年），这对获得治疗造成了更大的障碍。减少儿童破坏性行为障碍（dbd； Franco等人，2008年；Gopalan和Franco， 2009年；McKay等人，1995年；1999年；2002年；Stone, McKay, & Stoops， 1996年）的多家庭小组（MFG）服务提供模式目前正在nimh资助的有效性研究中进行测试。作为一种创新的、引人入胜的心理健康干预措施，这种模式可能对社区服务中心有益，解决了城市内部服务能力的限制。虽然初步数据表明，在MFG中，CWIFs表现出较高的参与率，但CWIFs有大量需求（如父母抑郁），这可能超出了MFG模型目前的能力。因此，MFG模型可能需要对cifs进行调整。因此，该奖学金的目标包括：(1)增加申请人在儿童心理健康服务和干预科学方面的理论知识和方法专长；(2)增加家庭服务和儿童dbd家庭治疗的理论知识；(3)为申请人准备发展及试行一项以家庭为本的心理健康干预措施，以减少儿童忧郁症。当前应用程序的具体目标是通过两项研究来实现的，这些研究检查了CWIF护理人员对MFG模型的反应，并确定了可能需要修改的地方（如果有的话）。使用定性方法，研究#1将确定CWIF护理人员对影响服务提供的因素的看法（即，参与，项目有用性，相关性和激发家庭层面改变动机的能力），并提出改进建议。研究#2涉及定量、二次数据分析，以评估CWIF状态是否会随着时间的推移调节MFG治疗效果，包括：(1)服务提供的参与和过程特征（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、治疗的感知障碍）；(2)家庭层面的结果和父母特征（即养育技能、家庭沟通、家庭支持内的沟通）；父母/子女互动、父母压力、父母抑郁、父母应对)和(3)青少年水平的结果（即外化行为困难和功能能力）。当采用MFG模型时，那些MFG治疗效果减弱的结果可以作为进一步修订的目标。这两项研究都将提供初步数据，用于开发和试点以家庭为基础的心理健康干预措施，以减少外籍人员的儿童DBD。因此，可以针对不同的弱势群体改善心理健康治疗。

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.