Parents with Mental Illness in the Child Protection System Susan Smalling

Background Deinstitutionalization leads to more people with mental illness in the community Deinstitutionalization leads to more people with mental illness in the community Services focus on job readiness and dealing with parents and siblings (not parenting) Services focus on job readiness and dealing with parents and siblings (not parenting) Women with mental illness equally as likely to have children as women without Women with mental illness equally as likely to have children as women without Male focused treatment paradigms do not fit for parenting women Male focused treatment paradigms do not fit for parenting women At higher risk for losing their children At higher risk for losing their children

Concerns for mentally ill parents in the child protection system False assumptions about parenting capacity False assumptions about parenting capacity Parenting assessments looking at intellectual functioning and diagnosis versus functional assessments of parenting Parenting assessments looking at intellectual functioning and diagnosis versus functional assessments of parenting Lack of understanding among mental health professionals of the child protection system Lack of understanding among mental health professionals of the child protection system Lack of communication between the mental health and child protection systems Lack of communication between the mental health and child protection systems Available services for parents insufficient Available services for parents insufficient

Research questions What is the prevalence of parental mental illness in the child protection cases for St. Louis County? What is the prevalence of parental mental illness in the child protection cases for St. Louis County? To what extent are parents with mental illness involved in the child protection system receiving mental health treatment and/or case management addressing their parenting needs? To what extent are parents with mental illness involved in the child protection system receiving mental health treatment and/or case management addressing their parenting needs? To what extent do child protection workers feel they are able to coordinate with the mental health system to best meet parenting needs? To what extent do child protection workers feel they are able to coordinate with the mental health system to best meet parenting needs?

Research Design Three phases of research Three phases of research –Quantitative  50 sampled child protection cases  Survey of worker opinions on the issues –Qualitative  10 interviews with child protection workers

Sampled Child Protection Cases Surveyed 50 cases for the following data Surveyed 50 cases for the following data –Presence or absence of a diagnosis of mental illness –Whether or not the worker suspected mental illness was present (also asked to indicate why) –Whether or not the client receives Rule 79 case management –Whether or not the client receives mental services in the community –Demographic information (age of primary caregiver, ethnicity and number of children)

Child Protection Worker Survey How well the child protection and mental health systems coordinate How well the child protection and mental health systems coordinate Quality of parenting assessments Quality of parenting assessments Ability of both the systems and workers to meet the needs of parents with mental illness and their children Ability of both the systems and workers to meet the needs of parents with mental illness and their children Training needs Training needs Interviews ask for elaboration on these issues Interviews ask for elaboration on these issues

Results

Prevalence of Parents with Mental Illness Parents with diagnosis of mental illness 50% Suspected mental illness 17% Combined67%

Mental health services received Of the 24 cases with a diagnosis of mental illness, 5 receive Rule 79 case management (21%) Of the 24 cases with a diagnosis of mental illness, 5 receive Rule 79 case management (21%) Of the 24 cases with a diagnosis of mental illness, 17 receive other mental health services (71%) Of the 24 cases with a diagnosis of mental illness, 17 receive other mental health services (71%) 79% of those with diagnosis receive services of some kind 79% of those with diagnosis receive services of some kind Only three specify parenting services (parenting group at HDC, family services through CAIR) Only three specify parenting services (parenting group at HDC, family services through CAIR) Seven received unspecified services through HDC or CAIR (may have had specific parenting component) Seven received unspecified services through HDC or CAIR (may have had specific parenting component) Only half of those receiving services appear to be getting services specific to their parenting needs Only half of those receiving services appear to be getting services specific to their parenting needs

Parents with suspected mental illness None receive Rule 79 case management None receive Rule 79 case management One third receive other mental health services One third receive other mental health services

Differences by ethnicity: White Primary caregivers 25 of 47 cases with white primary caregiver 25 of 47 cases with white primary caregiver 12 of the 25 have diagnosis of mental illness (48%) 12 of the 25 have diagnosis of mental illness (48%) 3 of remaining 13 have suspected mental illness (12%) 3 of remaining 13 have suspected mental illness (12%) 60% of white primary caregivers have either a diagnosis or suspected mental illness 60% of white primary caregivers have either a diagnosis or suspected mental illness

Differences by ethnicity: American Indian primary caregivers 16 of 47 cases with American Indian primary caregiver 16 of 47 cases with American Indian primary caregiver 10 of the 16 have diagnosis of mental illness (62%) 10 of the 16 have diagnosis of mental illness (62%) 3 of remaining 6 have suspected mental illness (19%) 3 of remaining 6 have suspected mental illness (19%) 81% of American Indian primary caregivers have either a diagnosis or suspected mental illness 81% of American Indian primary caregivers have either a diagnosis or suspected mental illness

Child protection worker survey results I am confident that the mental health system can address parenting needs in mental health assessments of caregivers for families on my caseload. Disagree U Agree Disagree U Agree 56% 31% 13% 56% 31% 13% I am satisfied with the level of coordination between my case management and Rule 79 case management services to meet the needs of parents in child protection cases. Disagree U Agree Disagree U Agree 44% 25% 31% 44% 25% 31% I am satisfied with the level of coordination between my case management and mental health services in the community to meet the needs of parents in child protection cases. Disagree U Agree Disagree U Agree 62% 13% 25% 62% 13% 25% I am confident that the level of coordination between my case management and Rule 79 case management best meets the needs of children of parents with mental illness on my caseload. Disagree U Agree Disagree U Agree 31% 50% 19% 31% 50% 19%

Survey results continued I am confident that the level of coordination between my case management and mental health services in the community best meets the needs of children of parents with mental illness on my caseload. Disagree U Agree 56% 25% 19% 56% 25% 19% I am confident in my ability to meet the parenting needs of parents with mental illness on my caseload. Disagree U Agree 31% 31% 38% 31% 31% 38% I am confident in my ability to meet the needs of children of parents with mental illness on my caseload. Disagree U Agree 19% 6% 75% 19% 6% 75% I believe there are specific protective factors that increase the capacity of a person with mental illness to parent. Disagree U Agree 75% 13% 13% 75% 13% 13%

Survey results I believe our child protection system adequately addresses the needs of mentally ill parents. Disagree U Agree 75% 13% 13% 75% 13% 13% I believe I have adequate training to deal with the needs of parents with mental illness on my caseload. Disagree U Agree 44% 56% 44% 56%

Themes emerging from the qualitative interviews Biggest barrier is the court system Biggest barrier is the court system –Parents struggle to understand timelines and requirements –Adversarial nature of court action –Parents need mental health advocate to explain things effectively Parenting assessments including home visits (and more than one shot assessment) Parenting assessments including home visits (and more than one shot assessment) Waiting list for psychological evaluations Waiting list for psychological evaluations

Interview themes Communication good among workers from different perspectives Communication good among workers from different perspectives Parents need support system (primary protective factor) Parents need support system (primary protective factor) Parents tend to be isolated (primary risk factor) Parents tend to be isolated (primary risk factor) Fostering medication compliance Fostering medication compliance More specific parenting programs More specific parenting programs