A Crisis of Credibility: Professionals’ Concerns about the Psychiatric Care Provided to Clients of the Child Welfare System

McMillen, J. Curtis; Fedoravicius, Nicole; Rowe, Jill E; Zima, Bonnie T.; Ware, Norma C.

doi:10.1007/s10488-006-0096-5

Cited by 37 publications

(37 citation statements)

References 21 publications

(18 reference statements)

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“…Other factors not included in this study may influence assessment, referral practices and service provision for youth. Studies conducted with the St. Louis Children’s Division (Fedoravicius, McMillen, Rowe, Kagotho & Ware, 2008; Foster & Stiffman, 2009; McMillen, Fedoravicius, Rowe, Zima & Ware, 2007) show that mental health services for youth in the child welfare system are frequently court ordered. The pressure to comply with court demands for documentation and time constraints influence workers’ assessment and referral practices (Fedoravicius et al, 2008; Foster & Stiffman, 2009; Smith & Donovan, 2003).…”

Section: Discussionmentioning

confidence: 99%

Child Welfare Workers’ Connectivity to Resources and Youth’s Receipt of Services

Bunger

Stiffman²,

Foster³

et al. 2009

ASW

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Youth involved in the child welfare system are at high risk for mental illness, substance abuse, and other behavioral health issues, which child welfare workers are expected to address through referrals. Child welfare workers (N=27) who participated in Project IMPROVE (Intervention for Multisector Provider Enhancement) reported on services they provided to youth (N=307) in their caseloads. Using survey and administrative data, this paper examines workers’ service actions on behalf of youth. Results were consistent with the Gateway Provider Model and showed that youth received help from a greater variety of service sectors when their workers were able to identify behavioral health problems, and were familiar with and connected to other providers in the community. Improving service delivery to youth in child welfare may be accomplished by training workers in the signs and symptoms of behavioral health problems and familiarizing them with providers in the community.

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Section: Discussionmentioning

confidence: 99%

Child Welfare Workers’ Connectivity to Resources and Youth’s Receipt of Services

Bunger

Stiffman²,

Foster³

et al. 2009

ASW

View full text Add to dashboard Cite

show abstract

“…Discharge or involuntary commitment decisions are often made unilaterally by psychiatrists, for example, as well as decisions to medicate clients. This power imbalance is troublesome, given that many social workers are not impressed or pleased with the level of care that clients receive from prescribers (McMillen et al 2007). Navigating such hierarchies while advocating for clients is often one of the more challenging aspects of working in a host setting.…”

Section: The Context Of Clinical Decision-making: Mezzo Level Factorsmentioning

confidence: 99%

Making Assessment Decisions: Macro, Mezzo, and Micro Perspectives

Lacasse

Gambrill

2015

Critical Thinking in Clinical Assessment and Diagnosis

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This chapter addresses potential barriers to good clinical decision-making, found at all levels of practice. It begins with decision-making at the micro-level-that is, at the level of the individual clinician, who faces a series of decisions with each new case: how to frame problems, what outcomes to pursue, when to stop collecting information, what risks to take, what criteria to use to select practice methods, and how to evaluate progress. The flexible and diverse nature of clinical practice, while allowing for consideration of specific client needs, also leaves room for many kinds of error. These errors can be avoided, or at least minimized, by the use of evidenceinformed assessment practices as outlined in the chapter. At the mezzo-level, requirements of the practice setting (such as mission and funding source) can shape and constrain the way assessment takes place; the media, professional literature, and structure of professional training also exert a powerful influence. Macro-level influences include the widespread medicalization of human behavior; the pharmaceutical companies and managed care institutions comprising the "biomedical industrial complex;" and entities such as the National Institute of Mental Health, the American Psychiatric Association, and the welfare and legal systems. The chapter concludes by urging students to consider the biases that may be inherent in the information on which they base their decisions, as well as how the environment they work in may affect their ability to make sound clinical decisions.

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“…The increased use of psychotropic medication lends the possibility of increased misuse of psychotropic medication for youth in out-ofhome care. Interviews with child welfare and mental health professionals suggest serious concerns regarding psychotropic medications in out-of-home youth, including too high of dosages or too many prescriptions, often with minimal oversight by clinicians (McMillen, Fedoravicius, Row, Zima, & Ware, 2007). Clearly, more work needs to be done to examine the medication patterns and trends for children in residential group home care.…”

Section: Changes In Mental Health Needs Of Youth Over Timementioning

confidence: 99%

The Changing Mental Health Needs of Youth Admitted to Residential Group Home Care

Hurley

Trout

Chmelka

et al. 2009

Journal of Emotional and Behavioral Disorders

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Youth entering residential care possess significant emotional and behavioral needs; yet, it is uncertain whether these needs have remained constant or are changing over time. This study examined mental health variables from the admission files of 1,047 youth entering residential group home care in 1995 and 2004. Sequential logistical regression analyses revealed that the mental health needs of youth admitted in 2004 were greater than those for youth in 1995 with regard to having multiple psychiatric diagnoses, being prescribed two or more psychotropic medications, and using alcohol or drugs. As such, these analyses should be replicated in other group homes as well as in other placement settings within the system of care.

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A Crisis of Credibility: Professionals’ Concerns about the Psychiatric Care Provided to Clients of the Child Welfare System

Cited by 37 publications

References 21 publications

Child Welfare Workers’ Connectivity to Resources and Youth’s Receipt of Services

Child Welfare Workers’ Connectivity to Resources and Youth’s Receipt of Services

Making Assessment Decisions: Macro, Mezzo, and Micro Perspectives

The Changing Mental Health Needs of Youth Admitted to Residential Group Home Care

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