Paper
Maltreated children’s mental health: a global approach for designing specific programs at the Centre Jeunesse de Québec – Institut Universitaire (“CJQ-IU”)
- issue: Issue 4 / 2009
- authors: Danielle Nadeau
- keywords:
- views: 3121
- downloaded: 0
- download pdf (64 Kb)
abstract
Context
Prevalence of mental health problems among children receiving services from child welfare agencies is high and deserves attention. In the same way, young people in rehabilitation centers showing high level of psychiatric disorders represent a human and financial challenge for institutions. This paper presents a model developed at Centre Jeunesse de Québec - Institut Universitaire ("CJQ-IU") to address such issues. CJQ-IU is a university-based institution which offers child protection services and operates rehabilitation centres for youngsters with adjustment problems. The institution, as a child welfare agency, does not provide primary social or health care services. Therefore, screening for mental health needs of the young clients and providing access to adequate mental health care is often a problem (in the same way as in fragmented care systems). The proposed model supports innovative child welfare practices to acknowledge the behavioural and mental health needs of vulnerable children that come into care at CJQ-IU under the Quebec Youth Protection Act.
Stage one: key terms
The first step was to acquire a common understanding of key terms such as "Mental Health ("MH")", "MH problem", "disorder", or "illness" and "MH Program". The World Health Organization's definition of MH, combined to the proposed "personal and psychosocial adjustment continuum", illustrates the fact that MH is not a static concept. Furthermore, in a child welfare agency context any "MH program" definition should encompass a broader vision than simple MH service planning for a correctional or rehabilitation unit.
Stage two: needs and key findings
The second step was to develop a better understanding of the young people's care needs and the problems faced by clinical staff in helping them.
A) The service users: A census based on children and youths' records for psychiatric diagnosis and medication intake was conducted in rehabilitation centers and community homes (2006; N = 240). The same survey was carried out a year later with children and youths living with their parents or in foster homes (2007; N= 1644). In addition, a qualitative study examined the way some "multi-problem violent youth" (n=10) perceive their situation and care experience while receiving social services. Global results revealed a very high prevalence of youngsters with a psychiatric diagnosis. Variations related to the children's age, diagnosis characteristics and type of placement (cf: community homes, rehabilitation or correctional centers, foster homes, etc.) were observed. Social service resources seem to focus on "controlling" externalized behaviour (as suggested in literature) rather than address underlying causes. Multi-problem violent youths' discourse exposed histories of abuse, abandonment and complex mental health problems. This placed trauma into perspective. As well, other aspects of interview content highlighted the fact that some group intervention, offered in juvenile units, might aggravate a few clients' psychiatric symptoms. The links between high prevalence of externalized disorders (ex. ADH/D; CD) and sub-trauma after effects should also be explored.
B) The staff: A research study was conducted to collect information pertaining to the clinical staff's perception of their young clients' MH problems. Focus groups (2006) and a staff survey (2007; n = 190) were used to evaluate training needs, clinical support needs and role perception. Results indicate that caseworkers and other clinical staff members' feel short of training and expertise to help children with MH problems access appropriate care. On the other hand, the participants seemed highly motivated to acknowledge the behavioural and health needs of children in a more efficient manner. The same was true for caseworkers and correctional staff members dealing with service users' parents who were themselves affected by serious MH problems.
Stage three: setting priority goals
To face CJQ-IU's empirically-based MH challenges, a conceptual framework setting priority goals for the development and implementation of innovative programs was developed. This framework identifies 3 developmental axes under which child welfare practice needs to be reorganised: Axe 1) Early detection of children in need of care; Axe 2) "Multi-sector" evidence based MH practice; Axe 3) Individualized intervention. The framework combines "top-down" and "bottom-up" approaches in a strategic developmental plan. To be implemented, every new MH program must be related to at least one developmental axe. Consequently, convincing policy and decision makers regarding the content of future programs, money re-allocation in new programs and additional actions when funds are available were made easier for the CJQ-IU.
Stage four: implication for action
The proposed conceptual framework offers the management team a lever to undertake effective actions with many actors (eg. clinical staff, program designers, researchers, students, etc.) in the implementation and evaluation of innovative programs. Three examples of specific emerging projects following endorsement of this approach at CJQ-IU will be mentioned and eventually discussed in the question time session.
Contact details
Danielle Nadeau, Ph.D., LL.B, Psychologue-chercheure, Centre Jeunesse de Québec - Institut universitaire, 2915 Avenue du Bourg Royal, Québec, Canada, G1X 5H8
Email: DanielleNadeau.cj03@ssss.gouv.qc.ca