Parents Involved with Child Welfare: Their Perceptions of Mental Health Services

BACKGROUND:  Parents involved with child welfare frequently use mental health services, for themselves and/or their children.   Information from parents about their perceived needs and concerns could shed light on obstacles to treatment participation. This poster describes a study with the primary research question of: How do parents involved with child welfare perceive the mental health services that they and their children had received?  

METHODS:  Semi-structured interviews consisting of open-ended questions were conducted with 20 mothers recruited through three agencies providing home-based services to families referred by public child welfare.  Interviews were audio recorded and transcribed verbatim.  Initial coding consisted of developing categories that described substantive pieces of text. This was an iterative and recursive process of reading, identifying themes, re-reading, and comparing themes and content across transcripts to identify patterns in the data (conducted by PI and 2 RA’s).  The mean age of the mothers was 39.5. Three were African-American; 17 were European-American.  Most had a high school education (or GED) or less, whereas six had some college education. All received some type of public assistance.  Children received mental health services for a variety of reasons, including aggression, ADHD, bipolar disorder, and anxiety. Anxiety and depression were the primary reasons parents received treatment.

 RESULTS:  Similar sentiments were expressed whether treatment was child or parent focused. Four primary themes emerged:  relationships with therapists, perceived treatment benefits, treatment availability and accessibility, and treatment expectations.  Quotes will be incorporated in the poster to illustrate each theme. The relationship with the therapist facilitated or hindered treatment participation.  Perceived professional and social distance was a barrier to forming a relationship.  Parents were put off by therapists who offered advice prior to “knowing” them.  The extent to which parents perceived treatment benefits influenced their evaluation of it and their continuation with or termination of treatment.  Benefits included help with basic resources and medication, as well as improved child behavior. Three issues related to availability and accessibility:  transportation; waiting time for, and inconvenient, appointments; and availability of therapists outside of scheduled sessions.  In relation to treatment expectations, many had little idea what to expect from mental health services: “You see both versions on TV, you know. Is it they ask questions and help you figure your problems out, or is it, you tell them and they’re going to figure it all out for you? Well, it’s the first way.”  Many parents had expectations for help with basic resources, but did not receive them. Disagreement and concern about medication emerged and parents were also frustrated with the amount and types of questions that therapists asked.

 IMPLICATIONS:  Recommendations include: 1) assessing for the need for basic resources, making appropriate referrals for these, and understanding how these needs can take priority over treatment participation, 2) asking what parents want from treatment and explaining the treatment process to them, 3) monitoring how parents perceive the process and benefits of treatment, and 4) addressing concerns concerning treatment recommendations, especially for medications.