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Subjects:
Psychology
Concern is expressed in Australia about a group of children called dual-involvement children. Dual-involvement children live in families who have multiple complex needs, where a child is referred first to a child protection court and later to a juvenile justice court as the child has committed offenses. One concern is whether these families and children receive early intervention therapy. Method: The paper reviews research relevant to early intervention for children with an increased likelihood of developing a mental disorder and behaving aggressively. Results: Fifteen psychological models have generated evidence about risk factors for the healthy development of children. A framework is used to describe risk factors using headings of parental factors, childhood factors, and peer factors. The review summarizes effect sizes associated with each model. Conclusions: The review concludes that variables relevant to dual-involvement children can be integrated using the concept of role the of a parent. There is a need for a tiered system of intervention involving universal interventions that are supplemented by targeted interventions for families where children have heightened vulnerability due to a higher number of specific risk factors. Topics for further research are identified, including a need for research into how therapists who use a systemic approach might practice in ways that manage ethical dilemmas that arise when using systemic therapy with two members of a court-involved family.
- attributions
- children’s aggression
- co-occurring internalizing and externalizing behaviors
- court involved family
- dual-involved children
- early intervention therapy
- ethical dilemma
- proactive and reactive children’s aggression
Research is ongoing about how to identify children who are at risk of developing a mental disorder and about the most efficient methods to provide early intervention therapy for vulnerable children. Research interest has been extended beyond children in mainstream families to include children who are referred to child protection systems and who become involved in legal systems. The review focuses on research that is relevant for clinicians who provide therapy for families where a notification has been made to child protection authorities. The review focuses on interventions that can be provided by a clinician who follows a systemic approach by providing therapy simultaneously to a parent–child combination.
The traditional approach for providing therapy for a child is based on a diagnostic process where one family member is diagnosed as exhibiting a disorder, either a parent or a child, and treatment is provided for this family member. A second approach is emerging that focuses on interactions between family members that lead to co-joint therapy being provided to both family members, where these interventions can be delivered in an early intervention program before either family member is diagnosed with a disorder. Carr [1,2] used the term ‘systemic therapy’ to describe evidence-informed interventions that are provided simultaneously by one therapist to two family members. Systemic therapy is distinguished from traditional therapy as a clinician has two clients whose interests need to be considered. Another characteristic of systemic therapy is that early intervention therapy is provided to address risk factors rather than diagnoses. This definition of systemic therapy includes interventions that are derived from different theories, provided that interventions generate evidence of efficacy in improving collaboration between family members.
Carr [1,2] reviewed evidence-informed systemic therapies and cited data that systemic therapy is as effective as individual therapy in the management of many child issues. However, Riedinger et al. [3] commented that interventions used in systemic therapy are often not well defined, making it difficult to replicate studies.
Arguably, families who present with the most complex issues are those who are referred to family-oriented courts, either a family law court when parents separate and take disputes to court or a child protection court when an allegation is made that a child is at risk of harm due to maltreatment by their parents. Legislation governs practices in family-oriented courts. Legislation in some jurisdictions requires that a family be offered an opportunity to participate in focused therapy to remedy parenting practices that have been criticized before steps are taken to remove children from parental care. Before issuing an order, a court might review the evidence base for a proposed intervention.
The review focuses on risk factors for the mental health of children and parent–child therapies that have been identified in research that are relevant for families where there are risks to the development of a child’s mental wellbeing and where therapies are relevant for court-involved families. The review includes research by Baidawi and colleagues [4,5] that is relevant to a cohort of children called crossover children, as the family first presents to a child protection court over allegations a child has been maltreated, and later the child faces a juvenile justice court as the child is alleged to have committed offenses, including violent offenses, while in the care of the state.
Dual-Involvement Children
In Australia, there is concern about the plight of children who have been termed ‘crossover children’ or ‘dual-involvement children’ [4,5]. Dual-involvement children are children who are first removed from the care of their parents and placed in out-of-home care following an order from a child protection court, and the child later commits offenses and faces a juvenile justice court. Government policies encourage the provision of early intervention therapy for children and parents before a child is removed from parental care and placed into out-of-home (OOH) care.
Baidawi and Sheehan [4] reviewed 300 court files of Australian children aged 10–17 years who had been involved in two courts in a four-year period (a child protection court and a juvenile justice court) to understand characteristics of children who were involved with both courts. Their review produced the following findings: children aged 10–14 years who received child protection services were nine times more likely than other children to come under supervision of the child justice system; 43% of children were first notified to child welfare before the age of 2 years as their parent struggled to manage the child’s behavior; children had a mean of 7.7 notifications; 62% of children had their first OOH placement after the age of 10 years, although 70% of the children had a notification before the age of 10 years; most OOH placements occurred due to reasons of parental incapacity, ongoing maltreatment and parental relinquishment of a child; 72% of children exhibited challenging behaviors, 61% of children had a mental disorder, and 70% absconded from care; 60% of children spent time in residential care following breakdowns in foster care; 36% of children had a history of being excluded from school due to behavioral problems; and initial police charges were laid primarily when children were aged 10–12 years and after children had been placed in OOH care.
The Baidawi et al. [4,5] studies found that residential services referred children to police for misbehaving while in residential care, as rostered staff were reluctant to intervene with children who engaged in risk-taking behaviors. The studies found that 20% of crossover children were first charged when they were aged 10–12 years, and children had a median of seven charges against them, with 86% of charges being against a person. Placement in residential care was associated with an escalation rather than a reduction in criminal behavior. The study found that 48% of children were referred for mental health services, primarily for an assessment to be used in evidence, with 25% of children receiving more than one type of service. Parents were reported to find it challenging to engage in therapy services, and 24% of children declined to participate in therapy.
Macvean et al. [6,7] reviewed evidence about parenting programs for vulnerable children and identified 81 published parenting interventions for children aged up to 6 years that appeared relevant for court-involved children who were vulnerable to the risk of being maltreated and developing mental health disorders. They reported that the most effective interventions were delivered partly to the family home. Outcomes that were targeted most frequently involved managing children’s behavior, parent–child relationships, and child development. Interventions that were most effective were delivered by professionals who operated independently of the child protection agency that prosecuted families.
The Macvean et al. reviews [6,7] identified the following common components in effective parenting interventions: (a) assess and promote the mental health of children; (b) use structured planning sessions; (c) involve both parents and children; (d) assess interactions between a parent and child; (e) educate parents about usual child development; (f) focus on child safety and what is maltreatment; (g) educate parents about managing risks and resilience in children; (h) teach relevant safety skills; (i) teach negotiation skills to parents; (j) convey information to parents in the form of discussions rather than lectures; (k) focus on positive methods to manage child behaviors rather than on criticisms of current parental practices; (l) regulate both parents’ and children’s expression of emotions and encourage moderate expression of emotions; (m) promote parental problem solving skills; (n) reduce excessive externalized thinking and blaming by parents, and inappropriate feelings of guilt in children; (o) monitor and promote positive/healthy peer relationships with children outside of the family; and (p) promote family wellbeing. Other models video a parent interacting with their child while they engage in structured tasks, and a therapist provides feedback to the parent.
Wade et al. [8] found that there was low use of evidence-based intervention programs for vulnerable children in Australia. They identified three explanations for the low use of early intervention programs. The first explanation is that many interventions are published in journals that are not easily accessible. A second explanation refers to a shortage of practitioners qualified to provide interventions. A third explanation is that practitioners prefer to provide individualized interventions for vulnerable families, but authors of some parenting programs insist their programs be implemented in a standardized way to meet fidelity requirements that facilitate comparisons in scientific studies.
Therapy for Court-Involved Families
Greenberg et al. [9] wrote about therapy interventions that are relevant to helping children who live in court-involved families. Their article reviews evidence on the efficacy of psychological models used by clinicians to analyze children’s behavior and to design therapeutic interventions for families where there are risk factors suggesting a child may be on a trajectory that involves ongoing aggressive behavior, and where early intervention therapy is warranted.
The current review is based on the premise that delivery of systemic therapies involving parents of children who are vulnerable will be enhanced if interventions used by systemic therapists are clearly defined, with known inter-rater reliability, validity, and error rates. The article reviews psychological models that have generated evidence about families where children are at an increased risk of developing a mental disorder and engaging in aggressive offending.
Researchers who contribute to systemic therapy use distinctive research designs. Figueiredo et al. [10] noted that it is common practice for researchers to study behaviors of two family members at one point in time, called cross-sectional research, where observations are made of variables without any intervention to change variables. Cross-sectional research allows associations between variables to be identified using correlations, but correlations at one point in time provide no insight into causal mechanisms that link variables. On the other hand, longitudinal research measures the same variables repeatedly over prolonged periods of time and identifies differing pathways of development or trajectories. Longitudinal studies provide greater insight into causal links between variables. The paper reviews studies that have used a longitudinal design to examine patterns that occur in dysfunctional parent–child relationships.
The review aims to clarify evidence about themes that are identified in longitudinal studies of families where children are vulnerable and to build an evidence-informed framework that will help policy-makers and clinicians to provide early intervention and systemic therapy for court-involved families where children are vulnerable.
This entry is adapted from the peer-reviewed paper 10.3390/encyclopedia6050112
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