Individuals with severe mental illness (SMI) and served by Assertive Community Treatment (ACT) teams are as likely as the general population to be parents of young children; in the US an estimated 65% are mothers and 52% are fathers. Yet cross- system challenges including poverty, food and housing insecurities, racism, stigma and cumulative trauma heighten the risk of child protective services involvement, contributing to negative assumptions regarding parenting capacity. Regaining custody can be daunting, given systemic hurdles exacerbated by symptoms of SMI. Differential needs of mothers and fathers are poorly documented.
To identify risk and protective factors for parenting effectiveness among this vulnerable group, investigators conducted a two-part qualitative study in a major city in the Eastern United States in 2017.
The study included 1) five focus groups among ACT team providers to assess their perspectives on concerns for parents served, and 2) in-depth interviews with parents from each team. All were audio-taped and transcribed. Conventional content analysis of transcripts using both hand coding and/or N-Vivo led to overarching themes drawn from individual codes and code families.
Focus groups included 21 women and nine men from five teams, representing diverse ethnicities, and an average ACT service of 4.6 years. Parent interviewees included eight women and seven men (average age 38.8 years), identifying as white (1), Latino (5), black (7) and bi-racial (2). Parents averaged two children aged 18 or younger and had received ACT services for about four years. Few parents lived with their children; however 11 described shared parenting with a family member or former partner. All but three had lost custody at some point.
Analysis of focus groups elicited four overarching themes: 1) tensions involved in balancing parental needs while ensuring child safety, 2) siloed city services that render providers powerless and set parents up for failure because of competing demands from child protective services and legal mandates for unification (e.g. housing/employment stability), 3) need for peer specialists/advocates that identify with parental concerns, and 4) need for ongoing training to heighten skills regarding these complex issues.
Themes drawn from parental interviews were consistent for both mothers and fathers, including 1) affirmation that parenting motivated efforts to recover, serve as role models and/or regain custody, 2) overwhelming commitment towards their children, 3) fear and loss of personal agency associated with the demands of child protective and related services that hinder reunification for those who lost custody, and 4) the invaluable contribution of familial and ACT support.
Findings support the need to 1) build narratives and trainings that reinforce the positive as well as challenging aspects of parenting in the context of recovery-oriented services for SMI, 2) develop culturally-sensitive care strategies and tools that recognize and build parental strengths, and 3) promote information sharing/learning exchange among city services to more effectively bridge ACT, child protective, and other critical systems affecting parents. Involving more peer specialists/advocates as ACT providers could promote connection and involvement among parents served, in turn propelling personal advocacy and supporting recovery.