“We Wanted to Get Her Help”: Child-Welfare-Involved Caregivers’ Perceptions of Decision-Making When Accessing Residential Treatment

Abstract

Despite increased research and policy interest in reducing the use of residential treatment settings (RTS), there have been few studies of caregivers’ experiences accessing these settings. This study aimed to explore how caregivers perceive their role in decision-making when accessing RTS for youth using interpretive phenomenological analysis. Themes included gaining a voice, losing power as services intensified, challenging journey, and inflection point. Findings suggest providers act as gateways to RTS for youth for those parents who currently do not have access to these settings. Implications for practice include increasing caregiver knowledge about how to navigate mental health service systems may improve their sense of empowerment to make decisions and that more resources are needed for caregivers.

Keywords

qualitative research methods and analytics phenomenology residential care caregiving family systems and functioning subjects of practice child welfare access to services disparities/social determinates of health

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References

Anderson

J. K.

Howarth

Vainre

Jones

P. B.

Humphrey

(2017). A scoping literature review of service-level barriers for access and engagement with mental health services for children and young people. Children and Youth Services Review, 77, 164–176. https://doi.org/10.1016/j.childyouth.2017.04.017

Annie E. Casey Foundation, KIDS COUNT Data Center, https://datacenter.kidscount.org.

Barnert

E. S.

Abrams

L. S.

Bath

E. P.

(2019). Solving the high unmet behavioral health treatment needs of adolescents involved in the justice system. Journal of Adolescent Health, 64(6), 687–688. https://doi.org/10.1016/j.jadohealth.2019.03.018

Barth

R. P.

(2005). Residential care: From here to eternity. International Journal of Social Welfare, 14, 158–162. https://doi.org/10.1111/j.1468-2397.2005.00355.x

Barth

R. P.

Greeson

J. K.

Guo

Green

R. L.

Hurley

Sisson

(2007). Outcomes for youth receiving intensive in-home therapy or residential care: A comparison using propensity scores. American Journal of Orthopsychiatry, 77(4), 497–505. https://doi.org/10.1037/0002-9432.77.4.497

Becci

A. A.

Brook

Lloyd

M. H.

(2015). Co-occurrence of parental substance abuse and child serious emotional disturbance: Understanding multiple pathways to improve child and family outcomes. Child Welfare, 94(4), 71–96.

Bekaert

Paavilainen

Schecke

Baldacchino

Joet

Zablocka-Zyta

Bachi

Bartoli

Carra

Cioni

R. M.

Crocamo

Appleton

J. V.

(2021). Family members’ perspectives of child protection service, a metasynthesis of the literature. Children and Youth Services Review, 128, 106094. https://doi.org/10.1016/j.childyouth.2021.106094

Brimblecombe

Knapp

Murguia

Mbeah-Bankas

Crane

Harris

Evans-Lacko

Ardino

Iemmi

King

(2017). The role of youth mental health services in the treatment of young people with serious mental illness: 2-year outcomes and economic implications. Early Intervention in Psychiatry, 11, 393–400.

Brown

LaBrenz

C. A.

Fong

(2018). From adoption to residential treatment centers. Adoption Quarterly, 21(3), 182–200. https://doi.org/10.1080/10926755.2018.1488331

10.

Bunger

A. C.

Chuang

McBeath

(2012). Facilitating mental health service use for caregivers: Referral strategies among child welfare caseworkers. Children and Youth Services Review, 34(4), 696–703. https://doi.org/10.1016/j.childyouth.2011.12.014

11.

Bunger

A. C.

Stiffman

A. R.

Foster

K. A.

Shi

(2010). Child welfare workers’ connectivity to resources and youth’s receipt of services. Advances in Social Work, 10(1), 19–38.

12.

Burns

B. J.

Phillips

S. D.

Wagner

H. R.

Barth

R. P.

Kolko

D. J.

Campbell

Landsverk

(2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 960–970. https://doi.org/10.1097/01.chi.0000127590.95585.65

13.

Castro-Ramirez

Al-Suwaidi

Garcia

Rankin

Ricard

J. R.

Knock

M. K.

(2021). Racism and poverty are barriers to the treatment of youth mental health concerns. Journal of Clinical Child & Adolescent Psychiatry, 50(4), 534–546. https://doi.org/10.1080/15374416.2021.1941058

14.

Cénat

J. M.

McIntee

S. E.

Mukunzi

J. N.

Noorishad

P. G

. (2021). Overrepresentation of Black children in the child welfare system: A systematic review to understand and better act. Children and Youth Services Review, 120, 105714. https://doi.org/10.1016/j.childyouth.2020.105714

15.

Chuang

Wells

(2010). The role of inter-agency collaboration in facilitating receipt of behavioral health services for youth involved with child welfare and juvenile justice. Children and Youth Services Review, 32(12), 1814–1822. https://doi.org/10.1016/j.childyouth.2010.08.002

16.

Colder

C. R.

Frndak

Lengua

L. J.

Read

J. P.

Hawk

L. W.

Jr. Wieczorek

W. F.

(2018). Internalizing and externalizing problem behavior: A test of a latent variable interaction predicting a two-part growth model of adolescent substance use. Journal of Abnormal Child Psychology, 46(2), 319–330. https://doi.org/10.1007/s10802-017-0277-6

17.

Connelly

L. M.

(2016). Trustworthiness in qualitative research. MedSurg Nursing, 25(6), 435–436.

18.

Costello

E. J.

Pescosolido

B. A.

Angold

Burns

B. J.

(1998). A family network-based model of access to child mental health services. Research in Community and Mental Health: Social Networks and Mental Illness, 9, 165–190.

19.

Damian

A. J.

Gallo

J. J.

Mendelson

(2018). Barriers and facilitators for access to mental health services by traumatized youth. Children and Youth Services Review, 85, 273–278. https://doi.org/10.1016/j.childyouth.2018.01.003

20.

D’Arrigo-Patrick

Hoff

Knudson-Martin

Tuttle

(2017). Navigating critical theory and postmodernism: Social justice and therapist power in family therapy. Family Process, 56(3), 574–588. https://doi.org/10.1111/famp.12236

21.

de Boer

Cameron

Frensch

. (2007). Siege and response: Reception and benefits of residential children’s mental health services for parents and siblings. Child Youth Care Forum, 36, 11–24. https://doi.org/10.1007/s10566-006-9028-5

22.

DeNard

Garcia

Circo

(2017). Caseworker perspectives on mental health disparities among racial/ethnic minority youth in child welfare. Journal of Social Service Research, 43(4), 470–486. https://doi.org/10.1080/01488376.2017.1299827

23.

Department of Health & Human Services, Administration for Children and Families, Children’s Bureau. (2015). A national look at the use of congregate care in child welfare.

24.

Dorsey

Kerns

S. E. U.

Trupin

E. W.

Conover

K. L.

Berliner

(2012). Child welfare caseworkers as service brokers for youth in foster care: Findings from project focus. Child Maltreatment, 17(1), 22–31. https://doi.org/10.1177/1077559511429593

25.

Eatough

Smith

J. A.

(2017). Interpretative phenomenological analysis. In Willig

Stainton-Rogers

(Eds.), Handbook of qualitative psychology (2nd ed., pp. 193–211). Sage.

26.

Esmaeelzadeh

Moraros

Thorpe

Bird

(2018). Examining the association and directionality between mental health disorders and substance use among adolescents and young adults in the U.S. and Canada: A systematic review and meta-analysis. Journal of Clinical Medicine, 7, 543–567. https://doi.org/10.3390/jcm7120543

27.

Fitzgerald

M. M.

Torres

M. M.

Shipman

Gorrono

Kerns

S. E. U.

Dorsey

(2015). Child welfare caseworkers as brokers of mental health services: A pilot evaluation of Project Focus Colorado. Child Maltreatment, 20(1), 37–49. https://doi.org/10.1177/1077559514562448

28.

Fong

Alegria

Bair-Merritt

M. H.

Beardslee

(2018). Factors associated with mental health services referrals for children investigated by child welfare. Child Abuse & Neglect, 79, 401–412. https://doi.org/10.1016/j.chiabu.2018.01.020

29.

Freundlich

Avery

R. J.

Padgett

(2007). Care or scare: The safety of youth in congregate care in New York City. Child Abuse & Neglect, 31(2), 173–186. https://doi.org/10.1016/j.chiabu.2006.09.002

30.

Garcia

Kim

Barnhart

(2022). Do mental health services influence child welfare involvement among juvenile justice system involved youth? Journal of Child and Family Studies, 31, 1908–1921. https://doi.org/10.1007/s10826-021-02143-7

31.

Garcia

A. R.

Courtney

. (2011). Prevalence and predictors of service utilization among racially and ethnically diverse adolescents in foster care diagnosed with mental health and substance use disorders. Journal of Public Child Welfare, 5(5), 521–545. https://doi.org/10.1080/15548732.2011.617277

32.

Garcia

A. R.

Circo

DeNard

Hernandez

(2015). Barriers and facilitators to delivering effective mental health practice strategies for youth and families served by the child welfare system. Children and Youth Services Review, 52, 110–122. https://doi.org/10.1016/j.childyouth.2015.03.008

33.

Gunawan

(2015). Ensuring trustworthiness in qualitative research. Belitung Nursing Journal, 1(1), 10–11. http://doi.org/10.33546/bnj.4

34.

Hess

J. Z.

Bjorklund

Preese

Janet

(2012). “Okay, what do we do now?!” A qualitative study of transition home following youth residential treatment. Residential Treatment for Children and Youth, 29(3), 155–201. http://doi.org/10.13140/RG.2.1.1108.6326

35.

Hoffman

J. A.

Bunger

A. C.

Robertson

H. A.

Cao

West

K. Y.

(2016). Child welfare caseworkers’ perspectives on the challenges of addressing mental health problems in early childhood. Children and Youth Services Review, 65, 148–155. http://doi.org/10.1016/j.childyouth.2016.04.003

36.

Isobel

Wilson

Gill

Howe

(2021). What would a trauma-informed mental health service look like? Perspectives of people who access services. International Journal of Mental Health Nursing, 30, 495–505. https://doi.org/10.1111/inm.12813

37.

James

Alemi

Zepeda

(2012). Effectiveness and implementation of evidence-based practices in residential care settings. Children and Youth Services Review, 35, 642–656. https://doi.org/10.1016/j.childyouth.2013.01.007

38.

James

Landsverk

Leslie

L. K.

Slymen

D. J.

Zhang

(2008). Entry into restrictive care settings: Placements of last resort? Families in Society: The Journal of Contemporary Social Science, 89(3), 348–359.

39.

James

Leslie

L. K.

Hurlburt

M. S.

Slymen

D. J.

Landsverk

Davis

Mathisen

S. G.

Zhang

(2006). Children in out-of-home care: Entry into intensive or restrictive mental health and residential care placements. Journal of Emotional and Behavioral Disorders, 14(4), 196–208.

40.

Jolles

M. P.

Givens

Lombardi

Cuddeback

G. S.

(2019). Welfare caseworkers’ perceived responsibility for the behavioral needs of children: A national profile. Children and Youth Services Review, 98, 80–84. https://doi.org/10.1016/j.childyouth.2018.12.023

41.

Kerns

S. E.

Pullmann

M. D.

Putnam

Buher

Holland

Berliner

Silverman

Payton

Fourre

Shogren

Trupin

E. W.

(2014). Child welfare and mental health: Facilitators of and barriers to connecting children and youths in out-of-home care with effective mental health treatment. Children and Youth Services Review, 46, 315–324. https://doi.org/10.1016/j.childyouth.2018.01.003

42.

Krefting

(1991). Rigor in qualitative research: The assessment of trustworthiness. The American Journal of Occupational Therapy, 45(3), 214–222. https://doi.org/10.5014/ajot.45.3.214

43.

LaBrenz

C. A.

Fong

Brown

Findley

(2020). Adoptive families’ views about effective services prior to residential treatment center placement. Adoption Quarterly, 23(3), 219–241. https://doi.org/10.1080/10926755.2020.1790453

44.

Lanier

Rose

R. A.

(2017). Admission to psychiatric residential treatment facilities among youth from families investigated for maltreatment. Journal of Child and Family Studies, 26(1), 306–316. https://doi.org/10.1007/s10826-016-0541-3

45.

Leslie

L. K.

Hurlburt

M. S.

James

Landsverk

Slymen

D. J.

Zhang

(2005). Relationship between entry into child welfare and mental health service use. Psychiatric Services, 56(8), 981–987. https://doi.org/10.1176/appi.ps.56.8.981

46.

Lynch

Bautista

Freer

Kalynych

Hendry

(2015). Child mental health services in the emergency department: Disparities in access. Pediatric Emergency Care, 31(7), 473–478.

47.

Markoulakis

Chan

Levitt

(2020). The needs and service preferences of caregivers of youth with mental health and/or addictions concerns. BMC Psychiatry, 20(1), Article 409. https://doi.org/10.1186/s12888-020-02801-y

48.

Markoulakis

Da Silva

Kodeeswaran

Levitt

(2022). Youth mental health and/or addiction concerns and service needs during the COVID-19 pandemic: A qualitative exploration of caregiver experiences and perspectives. Child and Adolescent Psychiatry and Mental Health, 16(35), 1–12. https://doi.org/10.1186/s13034-022-00471-0

49.

Marshall

M. N

. (1996). Sampling for qualitative research. Family Practice, 13(6), 522–525. https://doi.org/10.1093/fampra/13.6.522

50.

Mazzini

Nocentini

Menesini

(2018). Bullying and peer violence among children and adolescents in residential care settings: A review of the literature. Aggression and Violent Behavior, 38, 101–112. https://doi.org/10.1016/j.avb.2017.12.004

51.

McGorry

P. D.

Mei

(2018). Early intervention in youth mental health: Progress and future directions. Evidence Based Mental Health, 21(4), 182–184. https://doi.org/10.1136/ebmental-2018-300060

52.

McLean

Clarke

Scott

Hisckock

Goldfeld

(2020). Foster and kinship carer experiences of accessing healthcare: A qualitative study of barriers, enablers, and potential solutions. Children and Youth Services Review, 113, 104976. https://doi.org/10.1016/j.childyouth.2020.104976

53.

Miller

Sukhera

Lynch

Wardrop

(2017). Voices unheard: Exploring the caregiver experience for caregivers of emerging adults with mental illness. Families in Society: The Journal of Contemporary Social Services, 98(4), 310–318. https://doi.org/10.1606/1044-3894.2017.98.36

54.

Narendorf

S. C.

Fedoravicius

McMillen

J. C.

McNelly

Robinson

D. R.

(2012). Stepping down and stepping in: Youth’s perspectives on making the transition from residential treatment to treatment foster care. Children and Youth Services Review, 34(1), 43–49. https://doi.org/10.1016/j.childyouth.2011.08.031

55.

National Conference of State Legislatures. (2020). Congregate care, residential treatment, and group home state legislative enactments 2014-2019. Retrieved from: https://www.ncsl.org/research/human-services/congregate-care-and-group-home-state-legislative-enactments.aspx

56.

Odero

Pongy

Chauvel

Voz

Spitz

Petre

Baumann

(2020). Core values that influence the patient-healthcare professional power dynamic: Steering interaction towards partnership. International Journal of Environmental Research and Public Health, 17, 8458. https://doi.org/10.3390/ijerph17228458

57.

Padgett

D. K.

(2016). Qualitative methods in social work research (3rd ed.). Sage.

58.

Patel

Head

Dwyer

Preyde

(2019). Youth transition home from residential mental health treatment: Caregivers’ perspective. Child and Adolescent Social Work Journal, 36(5), 1–10. https://doi.org/10.1007/s10560-018-0572-2

59.

Pescosolido

B. A.

Gardner

C. B.

Lubell

K. M.

(1998). How people get into mental health services: Stories of choice, coercion, and “muddling through” from “first timers.” Social Science Medicine, 46(2), 275–286. https://doi.org/10.1016/s0277-9536(97)00160-3

60.

Pietkiewicz

Smith

J. A.

(2014). A practical guide to using Interpretive Phenomenological Analysis in qualitative research psychology. Psychological Journal, 20(1), 7–14. https://doi.org/10.14691/CPPJ.20.1.7

61.

Pinto

R. J.

Maia

A. C.

(2013). Psychopathology, physical complaints and health risk behaviors among youths who were victims of childhood maltreatment: A comparison between home and institutional interventions. Children and Youth Services Review, 35(4), 603–610. https://doi.org/10.1016/j.childyouth.2013.01.008

62.

Preyde

Bartlett

Carter

Walraven

Ogilvie

Ashbourne

(2018). Exposing challenges in transitioning post residential mental health treatment: The case of the “Poster child.” Residential Treatment for Children and Youth, 35(4), 336–349. https://doi.org/10.1080/0886571X.2018.1485127

63.

Renaud

Seguin

Lesage

A. D.

Marquette

Choo

Turecki

(2014). Service use and unmet needs in youth suicide: A study of trajectories. Canadian Journal of Psychiatry, 59(10), 523–530.

64.

Rose

R. A.

Lanier

(2017). A longitudinal study of child maltreatment and mental health predictors of admission to psychiatric residential treatment facilities. International Journal of Environmental Research and Public Health, 14(10), 1141. https://doi.org/10.3390/ijerph14101141

65.

Rubin

(2000). Standards for rigor in qualitative inquiry. Research on Social Work Practice, 10(2), 173–178. https://doi.org/10.1177/104973150001000201

66.

Sallis

Szekely

Neumann

Jolicoeur-Martineau

van IJzendoorn

Hillegers

Greenwood

C. M. T.

Meaney

M. J.

Steiner

Tiemeier

Wazana

Pearson

R. M.

Evans

(2019). General psychopathology, internalising and externalising in children and functional outcomes in late adolescence. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 60(11), 1183–1190. https://doi.org/10.1111/jcpp.13067

67.

S.B. 128, 2019 General Session. (Utah, 2019). https://le.utah.gov/~2019/bills/sbillenr/SB0128.pdf

68.

Schneiderman

J. U.

Smith

Palinkas

L. A.

(2012). The caregiver as gatekeeper for accessing health care for children in foster care: A qualitative study of kinship and unrelated caregivers. Children and Youth Services Review, 34, 2123–2130. https://doi.org/10.1016/j.childyouth.2012.07.009

69.

Schneiderman

J. U.

Villagrana

(2010). Meeting children’s mental and physical health needs in child welfare: The importance of caregivers. Social Work in Health Care, 49(2), 91–106. https://doi.org/10.1080/00981380903158037

70.

Smith

J. A.

Jarman

Osborn

(1999). Doing interpretive phenomenological analysis. In Murray

Chamberlain

(Eds.), Qualitative health psychology: Theories and methods (pp. 218–241). Sage.

71.

Stiffman

A. R.

Pescosolido

Cabassa

L. J.

(2004). Building a model to understand youth service access: The gateway provider model. Mental Health Services Review, 6(4), 189–198. https://doi.org/10.1023/b:mhsr.0000044745.09952.33

72.

Timmerman

M. C.

Schreuder

P. R.

Kievitsbosch

A. F.

(2017). Professional proximity in perceiving child sexual abuse in residential care: The closer the better? Children and Youth Services Review, 76, 192–195. https://doi.org/10.1016/j.childyouth.2017.02.037

73.

Tufford

Newman

. (2012). Bracketing in qualitative research. Qualitative Research, 11(1), pg. 1–17. https://doi.org/10.1177/1473325010368316

74.

Urdapilleta

Kim

Wang

Howard

Varghese

Waterman

Busam

Palmisano

(2012). National evaluation of the Medicaid demonstration waiver home- and community-based alternatives to psychiatric residential treatment facilities: Final report. IMPAQ International.

75.

Verbeke

Vanheule

Cauwe

Truijens

Froyen

(2019). Coercion and power in psychiatry: A qualitative study with ex-patients. Social Science & Medicine, 223, 89–96. https://doi.org/10.1016/j.socscimed.2019.01.031

76.

Villagrana

Palinkas

L. A.

(2012). Caregivers’ endorsement of barriers to mental health care services for children and youth in child welfare. Journal of Family Social Work, 15(2), 111–125. https://doi.org/10.1080/10522158.2012.662672

77.

Bozena

J. K.

Liu

Fan

Fuller

C. J.

(2010). Mental health service use among suicidal adolescents: Findings from a U.S. national community survey. Psychiatric Services, 61(1), 17–24. https://doi.org/10.1176/ps.2010.61.1.17

78.

Zajac

Sheidow

A. J.

Davis

(2015). Juvenile justice, mental health, and the transition to adulthood: A review of service system involvement and unmet needs in the US. Children and Youth Services Review, 56, 139–148. https://doi.org/10.1016/j.childyouth.2015.07.014

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