Risk and Protective Factors Among Parents Served By ACT Teams

Background and Purpose

Among the one-third of American women and one-fifth of American men with severe mental illness (SMI), an estimated 65% are mothers and 52% are fathers. Compared to parents without mental illness, those with SMI are more likely to be unemployed, experience higher levels of stigma and victimization, and are three times more likely to be involved with child protective services. Limited support from family and financial strains coupled with medication side effects and symptoms may interfere with parenting proficiency.  Up to 80 per cent lose custody of at least one child. Among those individuals cared for by Assertive Community Treatment (ACT) teams because of particularly severe symptoms, little is known about parenting status or concerns. Thus we conducted a preliminary assessment of ACT team providers across New York State (NYS) to begin to identify needs and associated risk and protective factors experienced by “parent consumers”.   

Method

Using a cross sectional design we surveyed 81 NYS ACT team leaders to determine 1) number of parent consumers served, 2) extent and nature of their caregiving responsibility, and 3) staff perspectives regarding   both the needs of parents and how to best attend to these needs.  We used descriptive and bivariate statistics and content analysis to consolidate quantitative and qualitative findings among the 46% of teams that responded.

Results

Our findings indicate  that NY State ACT teams serve an average of 6.5 parents consumers (about 10% of total census) of whom about 16% have full caregiving responsibility. The average number of children per parent is two. Prominent areas of assistance reported include attention to: 1) custody concerns regarding contact and legal issues, 2) parent support services referrals, 3) emotional support regarding strained relationships and/or separation, and 4) housing. Challenges for providers include limited ability to address parental concerns given time constraints, overarching substance abuse issues, and limited communication between ACT and child protective services. Providers further identify the need for professional training to develop their knowledge base regarding basic parenting skills and how to impart these effectively to consumers, as well as strategies to mobilize community resources and build interagency care coordination.

Conclusions and Implications

Our findings support emerging literature on the complex challenges experienced by individuals who face the competing demands of SMI and parenting. Implications for practice include the need for: 1) models of behavioral health care that identify protective factors associated with parenting as well as risk factors 2) shifting models of care from individual recovery to family oriented recovery, 3) increased awareness regarding proximal and distal factors associated with wellness, illness, intersectionality and community integration for this unique population, and 4) improved interagency collaboration.  Implications for further research include the need for a nationally focused needs and assets assessment of ACT teams that utilizes both quantitative and qualitative approaches to gather the perspectives of ACT parent consumers and their children in addition to those of providers. This would offer a critical step towards building effective practice and policy in this arena.