The role of mental health professionals contributes to mental health promotion and prevention: innovative programmes in Serbia

It has been estimated that 9 to 13% of children and adolescents have a mental disorder that causes significant functioning impairment and that only one fifth of those who need mental health services actually receive them. The majority of children and adolescents are enrolled in schools, where they spend a considerable amount of time, and this is followed by the increasing efforts to establish collaboration between mental health professionals and school personnel. The role of mental health professionals is crucial in improving children’s mental health, as well as for providing better response to parents, educational staff and other agencies. There are several ways for a child psychiatrist to reach children and adolescents in a school setting: through individual student consultations (case consultations), through consultations to schools on general mental issues (systems consultations) and through promotion of mental health by creating and demonstrating evidence-based programmes for children, parents, school staff and others who are involved in child’s care. In order to achieve these goals, we need to establish partnerships and to define roles among organisations and individuals in the wider school environment, such as schools and school management, municipal authorities and administration, media, police, social welfare centres, health centres, parents and youth associations.     

The prevalence of child maltreatment in the Netherlands across a 5-year period

The prevalence of child maltreatment in the Netherlands was in 2005 first systematically examined in the Netherlands’ Prevalence study on Maltreatment of children and youth (NPM-2005), using sentinel reports and substantiated CPS cases, and in the Pupils on Abuse study (PoA-2005), using high school students’ self-report. In this second National Prevalence study on Maltreatment (NPM-2010), we used the same three methods to examine the prevalence of child maltreatment in 2010, enabling a cross-time comparison of the prevalence of child maltreatment in the Netherlands. First, 1,127 professionals from various occupational branches (sentinels) reported each child for whom they suspected child maltreatment during a period of three months. Second, we included 22,661 substantiated cases reported in 2010 to the Dutch Child Protective Services. Third, 1,920 high school students aged 12–17 years filled out a questionnaire on their experiences of maltreatment in 2010. The overall prevalence of child maltreatment in the Netherlands in 2010 was 33.8 per 1,000 children based on the combined sentinel and CPS reports and 99.4 per 1,000 adolescents based on self-report. Major risk factors for child maltreatment were parental low education, immigrant status, unemployment, and single parenthood. We found a large increase in CPS-reports, whereas prevalence rates based on sentinel and self-report did not change between 2005 and 2010. Based on these findings a likely conclusion is that the actual number of maltreated children has not increased from 2005 to 2010, but that professionals have become more aware of child maltreatment, and more likely to report cases to CPS.     

The "geography" of child maltreatment in Israel: Findings from a national data set of cases reported to the social services

OBJECTIVES: This article examines the "geography" of reported cases of child maltreatment in Israel by determining its frequency and rates according to nationality, area of residence, and size and type of locality. METHOD: The study collected data at the local level in Israel based on reports to social services of cases of child maltreatment during 2000; locality is the unit of analysis. RESULTS: The rate of reported cases of child maltreatment was 17.8 per 1,000 children in Israel in 2000. The rates varied, however, among different localities. They were lower in Arab localities (9 per 1,000 children) than in the Jewish ones (20 per 1,000), higher in large cities and other socioeconomic affluent localities (19 per 1,000), and varied according to the geographic area. CONCLUSIONS: This study demonstrates considerable variation in rates of reported cases of child maltreatment by locality and by population makeup. Thus, to fulfill the Israeli legislation of mandatory reporting of any reasonable suspicion of child maltreatment, the state should better develop policies and services that encourage reporting of child maltreatment among the Arab and ultraorthodox populations and in smaller or socioeconomic disadvantaged localities. Furthermore, the social services must build a bridge to the minority populations in Israel, developing their trust in these services and increasing their propensity to use them.     

Why are suspected cases of child maltreatment referred by educators so often unsubstantiated?

School professionals have a unique vantage point for identifying child maltreatment and they are a frequent source of referral to child protective services. Disturbingly, past studies have found that maltreatment concerns reported by educators go unsubstantiated by child protective services at much higher rates than suspected maltreatment reported by other professionals. This study explores whether there are systematic differences in the characteristics of cases reported by educators as compared to other professionals and examines whether such variation might account for differences in investigation outcome. Analyses were based on 7,725 cases of suspected maltreatment referred by professionals to child protective services from the Canadian Incidence Study of Reported Child Abuse and Neglect – 2003 a national database on the characteristics of children and families investigated by child protective services. School professionals were responsible for 35.8% of professional referrals. Reports by educators were much more likely to be unsubstantiated (45.3%) than those by other professionals (28.4%) in subsequent child protective investigation. Cases reported by educators were found to contain significantly more child risk factors (e.g., child emotional and behavioural problems) and fewer caregiver and family risk factors (e.g., caregiver mental health problem, single parent family) than cases reported by other professionals. Even controlling for these differences, educator-reported concerns were still 1.84, 95% CI [1.41, 2.40] times as likely to be unsubstantiated as reports from other professionals. Contrary to the notion that educators are mostly reporting non-severe cases, suspected/substantiated cases reported by school professionals were more likely to be judged as chronic and more likely to involve families with a previous child protection history. Results are concerning for the capacity of the education and child protection systems to work together to meet their shared goal of promoting healthy child development. Additional research is needed on the way in which child risks and problems influence child protective service, particularly in the context of chronic abuse and neglect and lack of availability of child and family mental health interventions. Potential problems with credibility of school professionals as reporters of child maltreatment concerns also warrant further investigation.     

Including children with selective mutism in mainstream schools and kindergartens: problems and possibilities

There is little research on inclusion of children with selective mutism in school/kindergarten. Moreover, few studies have tried to understand selectively mute children’s interactions in the natural surroundings of their home and school/kindergarten. Five children meeting the DSM‐IV criteria for selective mutism were video‐observed in social interactions in kindergarten/school and at home. Their parents and the staff in kindergarten/school took part in semi‐structured interviews. Themes arising from the data were: (1) assessment by the school/kindergarten; (2) interactions in the classroom/kindergarten: inadvertent maintenance of mute behaviour; (3) interactions in the classroom/kindergarten: overcoming selective mutism; (4) school/kindergarten contacts with parents; and (5) tensions in cooperation between home and kindergarten/school. Kindergartens/schools that succeeded in including children with selective mutism found that the child started to speak after a year with encouragement and gentle support from adults and other children. In those cases where the children maintained their selectively mute behaviour, teachers and other children either accepted their refusal to speak and their exclusion of themselves, or selectively reinforced the maladaptive behaviour.     

Marginalisation,autism and school exclusion: caregivers' perspectives

The article presents findings from interviews with five caregivers of children with autism excluded from schools in England. Objectives : to determine the barriers and enablers to mainstream schooling for children with autism and to explore the emotional effect of the journey to school exclusion on the child and caregivers. Background : research has highlighted that some mainstream schools do not listen to caregivers concerns about their child's development, behaviours and mental health. Methods : interpretative phenomenological analysis was employed to understand how participants made sense of their lived experiences, revealing four superordinate themes: inadequate special educational needs and disability (SEND) support, psychological impact, health-imposed barriers to diagnoses, and effective support. Findings : Theographs present the caregivers' journeys, illustrating that the onus fell on the caregivers to advocate for effective support from schools. A lack of prompt diagnose and effective school support is detrimental to the emotional and physical health of both children and caregivers. Training is needed to ensure thresholds for education, health and care needs assessments are understood, alongside evidence-based approaches to support children with SEND. There is a policy need to address barriers to prompt health assessments across services and the impact of decreased funding on schools.     

Self reported awareness of child maltreatment among school professionals in Saudi Arabia: impact of CRC ratification

Objectives

The Convention on the Rights of the Child (CRC) was ratified by Saudi Arabia 15 years ago; yet addressing the issue of child maltreatment only began in more recent years. School professionals play a significant role in children's lives, as they spend a great deal of time with them and are hence essential to protecting and identifying those in danger or at risk. The objective of this study is to identify school professional's awareness of child maltreatment and the existing national policies and procedures to examine the extent of efforts made in Saudi Arabia and to activate the roles of schools and school professionals in protecting children from violence and implementation of Article 19 of the CRC.

Methods

This was a cross-sectional study, where school professionals from randomly selected schools throughout the country were invited to participate in a self-administered questionnaire.

Results

A total of 3,777 school professionals participated in the study. Fifty-five percent of professionals had at least 10 years of work experience. A low-level of awareness of child maltreatment was found in about 1/3 of school professionals. Only 1.9% of school professionals had ever attended any sort of specific training on child maltreatment, though 69.3% of those who had not, were willing to attend future training. With regards to awareness of CRC Article 19 or policies and procedures addressing child maltreatment, only 22% reported being aware of it.

Conclusion

The majority of school professionals in Saudi Arabia have a low-intermediate level of awareness of child maltreatment, ratification of CRC, and related national policies and procedures, yet most are willing to attend training programs on this subject matter. Efforts need to be made in the country to fill this gap.     

Promoting effective parenting practices and preventing child behavior problems in school among ethnically diverse families from underserved, urban communities

This study examines the efficacy of ParentCorps among 4-year-old children (N = 171) enrolled in prekindergarten in schools in a large urban school district. ParentCorps includes a series of 13 group sessions for parents and children held at the school during early evening hours and facilitated by teachers and mental health professionals. ParentCorps resulted in significant benefits on effective parenting practices and teacher ratings of child behavior problems in school. Intervention effects were of similar magnitude for families at different levels of risk and for Black and Latino families. The number of sessions attended was related to improvements in parenting. Study findings support investment in and further study of school-based family interventions for children from underserved, urban communities.     

Post-traumatic stress disorder among school age Palestinian children

OBJECTIVES: This study was designed to assess the prevalence of PTSD among Palestinian school-age children. Variables that distinguish PTSD and non-PTSD children were examined, including child characteristics, socioeconomic status, family environment, and parental style of influence. METHOD: Participants were 1,000 children aged 12 to 16 years. They were selected from governmental, private, and United Nations Relief Work Agency (UNRWA) schools in East Jerusalem and various governorates in the West Bank. Questionnaires were administered in an interview format with children at school, and with the available parent at home. RESULTS: A substantial number of children experienced at least one lifetime trauma (54.7%). Post-traumatic stress disorder (PTSD) was diagnosed in 34.1% of the children, most of whom were refugees, males, and working. Although the expected association between family environment, parental style of influence and PTSD symptomatoplogy was found in this study, family ambiance (child's experience of anxiety in home environment) was the only predictor in the final model. CONCLUSIONS: The results stress the importance of assessing PTSD in schools settings.     

Working together: Lessons learned from school,family, and community collaborations

Recent advances in treatment modalities and the manner in which services are organized have made it possible to serve children with severe emotional or behavioral disorders (EBD) in a more responsive and less restrictive manner. Current approaches rely on collaboration among child‐serving agencies as well as between parents and service providers. In this article, we explore the role of schools in collaborative efforts on behalf of children with EBD. The demands on school personnel in local school districts are examined, the elements required for effective collaboration are articulated, and an exemplary model of comprehensive collaboration is described. Impediments to effective collaboration are summarized, and suggestions for how to create and sustain reliable partnerships are offered at the level of individual provider and child‐serving organization. Attention is given to contextual factors, such as financing and organizational structure, and also to programmatic issues. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 419–428, 2006.     

Key workers and schools: meeting the needs of children and young people with disabilities

Across the world countries are advocating the education of children and young people with disabilities in mainstream schools. There is also increasing interest in developing effective coordination of the specialist services pupils with disabilities receive from different agencies. This is accompanied by growing recognition that such care coordination can positively influence the experience of inclusion for children and their families. However, while the literature of care coordination generally includes education as a core provider, there is little evidence on involvement of education professionals and the outcomes for children and schools. These issues are addressed by the findings reported here on the role of key workers in care coordination and their relationship with schools. The findings draw on interviews with professionals from seven key worker services across England and Wales, parents and carers who were recipients of these services and teachers in schools serving children supported by key workers. These interviews are part of a wider multi‐method study exploring the effectiveness and costs of different models of key worker services for disabled children. The data reveal the range of education and school issues addressed by key workers and the factors influencing their work with teachers. The benefits for children, families and schools of key worker involvement are identified and the implications for schools explored. Consideration is also given to the advantages and disadvantages of teachers themselves taking on the role of key workers. It is argued that key workers can improve home–school relationships, facilitate the contribution of teachers in inter‐agency working, enable mainstream schools to better meet the individual needs of pupils with disabilities and improve their inclusive practice.     

The school: Liberator or censurer?

The community is faced with an increasing number of children suffering from social and emotional difficulties. As all children attend school, this is a highly suitable place to examine possible means of identifying and helping children suffering from social and emotional difficulties. For the last 20 years most schools have lagged in their adjustment to the full range of needs of students. They act as a censurer by: domination of academic requirements causing many to fail; failure to meet the expressed needs of children; inadequate teacher training; too little help given to children and often too late; uncoordinated assistance within the school or with community agencies; and by not reducing peer abuse. The school can play a significant role in child development, but for the child with adjustment difficulties coherent assistance is rarely offered. The school can liberate by: recognition of the needs of non-academic children; recognition of the affective needs of all; providing affective training for selected teachers; giving appropriate curriculum time for a programme in personal growth and social relationships; by developing a multidisciplinary community agency which interacts with the school. A model is proposed outlining how effective intervention will break and prevent the cycle of abusive behaviour. This programme proceeds sequentially through each grade. Basically it is one of effective student group interaction in the presence of a specially selected and trained group leader. Such a programme contributes to change in school philosophy, and increases the possibility of the child becoming a more adequate adult/parent. Negative emotional effects of bureaucracy and the Australian school institution on children are discussed. This paper looks critically at schools, outlines some ways in which such abuse is manifested and discusses how the schools can become factors in healing as well as preventing abuse.     

From maltreatment report to juvenile incarceration: the role of child welfare services

OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.     

The case for interprofessional education in teacher education and beyond

In many PreK-12 school environments, individuals with a variety of professional identities and roles provide services to students. Typically, these individuals are trained with minimal interaction with each other, yet they must work cooperatively with each other in the schools. Interprofessional education (IPE) provides a model whereby students in different disciplines learn to collaborate. This article describes the origins and current status of IPE in the health professions; suggests strategies for applying IPE to educator training; describes a promising example IPE project involving two distinct school-based professionals, pre-service special educators and school counsellors in training, including outcomes documented through student reflections; and offers implications for implementing and sustaining IPE in schools of education.     

Transitions and turning points: examining the links between child maltreatment and juvenile offending

OBJECTIVE: The links between child maltreatment and juvenile offending are well established. However, the majority of maltreated children do not offend. The research presented in this paper examines the impact that timing and chronicity of child maltreatment have on juvenile offending. METHODS: Administrative data were obtained on all children who were born in Queensland, Australia in 1983 or 1984 and had contact with child protective services for at least one child protection matter (N=5,849). For these children information was obtained on all child protection and juvenile justice contacts until the age of 17. These data were analyzed using the Semi-Parametric Group-Based trajectory analyses [Nagin, D., & Land, L. (1993). Age, criminal careers, and population heterogeneity: Specification and estimation of a nonparametric mixed Poisson model. Criminology, 31, 327-362]. RESULTS: Six distinctive maltreatment trajectory groups were identified, distinguished by the frequency of victimization, the age of onset and the duration of the maltreatment. Child maltreatment peaked around the transition from preschool to primary school and the transition from primary school to secondary school. Furthermore, children whose maltreatment trajectory started or extended into adolescence were more likely to offend as juveniles than children whose maltreatment occurred prior to, but not during, adolescence. CONCLUSIONS: Trajectory analysis provides a useful analytical tool for understanding heterogeneous nature of child maltreatment and the impact of maltreatment on subsequent juvenile offending.     

Nearly 4 years after an event: children's eyewitness memory and adults' perceptions of children's accuracy

OBJECTIVE: The current study examined children's eyewitness memory nearly 4 years after an event and the ability of adults to evaluate such memory. METHOD: In Phase 1, 7- and 10-year olds were interviewed about a past event after a nearly 4-year delay. The interview included leading questions relevant to child abuse as well as statements designed to implicate the original confederate. In Phase 2, laypersons and professionals watched a videotaped interview (from Phase 1) that they were misled to believe was from an ongoing abuse investigation. Respondents then rated the child's accuracy and credibility, and the probability that the child had been abused. RESULTS: In Phase 1, few significant age differences in memory accuracy were found, perhaps owing in part to small sample size. Although children made a variety of commission errors, none claimed outright to have been abused. Nevertheless, some of the children's answers (e.g., saying that their picture had been taken, or that they had been in a bathtub) might cause concern in a forensic setting. In Phase 2, professional and nonprofessional respondents were unable to reliably estimate the overall accuracy of children's statements. However, respondents were able to reasonably estimate the accuracy of children's answers to abuse questions. Respondents were also more likely to think that 7-year olds compared to 10-year olds had been abused. Professionals were significantly less likely than nonprofessionals to believe that credible evidence of abuse existed. Professionals who indicated personal experience with child abuse or a close relationship with an abuse victim were more likely to rate children as abused. A gender bias to rate boys as more accurate than girls was apparent among laypersons but not professionals. CONCLUSIONS: Children were generally resistant to suggestions that abuse occurred during a long-ago generally forgotten event, but some potentially concerning errors were made. Both professionals and non-professionals had difficulty estimating the accuracy of children's reports, but adults were more likely to rate children as accurate if the children answered abuse-related questions correctly. Training and personal experience were associated with adults' ratings of children's reports. Implications for evaluations of child abuse reports are discussed.     

Leading educational change using a neuropsychological Response‐to‐intervention approach: Linking our past,present, and future

Neuropsychology may be described as the study of brain‐behavior relationships (National Academy of Neuropsychology [NAN], 2001). Clinical neuropsychology represents the application of knowledge of the intricacies of these relationships to individual cases. Several authors have advocated for the application of neuropsychology to the public schools, a specialty some have called “school neuropsychology” (D'Amato, 1990; Hynd & Obrzut, 1981). This area of study represents the application of neuropsychological knowledge to help understand (a) childhood behavior, (b) individual student strengths and needs, (c) how students learn, and (d) how teaching can be linked to brain‐based instructional practices (D'Amato, Fletcher‐Janzen, & Reynolds, 2005b; Hale & Fiorello, 2004; Sousa, 2006). Since the term was initially introduced by Hynd and Obrzut, considerable debate has arisen regarding training, credentialing, and the professional identity of this specialty (Crespi & Cooke, 2003; Parrish, 2005; Pelletier, Hiemenz, & Shapiro, 2004). This article briefly reviews the history of neuropsychology applied to work with children, describes credentialing and training of professionals trained in both school psychology and neuropsychology, presents models of applying neuropsychology within the school setting, and outlines potential benefits of using a neuropsychologically based Response‐to‐Intervention model in the schools. © 2008 Wiley Periodicals, Inc.     

An overview of parent training and counselling with the parents of children with mental disabilities and autism in Turkey

Parents are significant contributors to the development of their children. They are the primary caretakers, managers, behavior models, disciplinarians, and agents of socialization and change for their children. It is accepted that parents can be trained as effective teachers of their children with disabilities. In Turkey, there are very limited opportunities, services, schools, parent education and support services for children with disabilities and their parents. Therefore, we have been carrying out studies to contribute to the understanding of the parents, specifically, on how a child with a disability affects their life and how they can be trained to become co-teachers and co-therapists. These studies are reviewed here.     

Trends in child maltreatment in the US Army, 1975-1997.

OBJECTIVE: To examine trends by year in reports of victims of child maltreatment in the US Army Central Registry (ACR) during the period 1975-97. We report the rates/1,000 children of Army families of initial substantiated cases from 1988-97 and the number of cases of maltreatment as a percentage of total victims for each year from 1975-97. Army data are compared to published reports from military service child abuse registries. METHODS: Numbers of cases of child maltreatment for each year were obtained from the ACR for major, minor, and total physical abuse, sexual abuse, emotional abuse, and neglect. Population figures for numbers of children were obtained from the Defense Manpower Data Center. RESULTS: The rates/1,000 for neglect have decreased by 24% from 1991-97, although the decrease has not been steady. The rates/1,000 of minor physical abuse declined 28% from 1993-97. The rates/1,000 of major physical abuse were basically unchanged from 1988-96, although the highest rate was recorded in 1997. The rates/1,000 of sexual abuse were also basically unchanged with the exception of increases in 1992-94 after which time the rates/1,000 returned to the pre-1992 levels. The rates/1,000 of emotional abuse cases more than doubled from 1988-97. CONCLUSIONS: While minor physical abuse and neglect have shown decreases over the past decade, major physical abuse has remained virtually unchanged and sexual and emotional abuse have shown fluctuations. All these forms of maltreatment are challenges to the Army Family Advocacy Program.