Parents with Mental Illness in the Child Protection System

1. Parents with Mental Illness in the Child Protection System Susan Smalling

2. Background • Deinstitutionalization leads to more people with mental illness in the community • 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 • Male focused treatment paradigms do not fit for parenting women • At higher risk for losing their children

3. Concerns for mentally ill parents in the child protection system • False assumptions about parenting capacity • 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 communication between the mental health and child protection systems • Available services for parents insufficient

4. Research questions • 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 do child protection workers feel they are able to coordinate with the mental health system to best meet parenting needs?

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

6. Sampled Child Protection Cases • 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)

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

8. Results

9. Prevalence of Parents with Mental Illness

10. 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, 17 receive other mental health services (71%) • 79% of those with diagnosis receive services of some kind • 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) • Only half of those receiving services appear to be getting services specific to their parenting needs

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

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

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

14. Child protection worker survey results

15. Survey results continued

16. Survey results

17. Themes emerging from the qualitative interviews • 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) • Waiting list for psychological evaluations

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