Social Work in Mental Health

ISSN: 1533-2985 (Print) 1533-2993 (Online) Journal homepage: www.tandfonline.com/journals/wsmh20

Parents Involved With Child Welfare: Their

Perceptions of Mental Health Services

Marlys Staudt & Kristy Massengale

To cite this article: Marlys Staudt & Kristy Massengale (2015) Parents Involved With Child
Welfare: Their Perceptions of Mental Health Services, Social Work in Mental Health, 13:4,
336-348, DOI: 10.1080/15332985.2014.936544

To link to this article: https://doi.org/10.1080/15332985.2014.936544

Published online: 30 Jun 2015.

Submit your article to this journal

Article views: 517

View related articles

View Crossmark data

Citing articles: 3 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=wsmh20
Social Work in Mental Health, 13:336–348, 2015
Copyright © Taylor & Francis Group, LLC
ISSN: 1533-2985 print/1533-2993 online
DOI: 10.1080/15332985.2014.936544

Parents Involved With Child Welfare: Their

Perceptions of Mental Health Services

MARLYS STAUDT, MSW, PhD and KRISTY MASSENGALE, MSSW

College of Social Work, University of Tennessee, Knoxville, Tennessee, USA

Parents involved with child welfare were interviewed to ascer-

tain their experiences with the outpatient mental health treatment
they and their children had received. Semi-structured interviews
consisting of open ended questions were conducted with 20 par-
ents recruited from three agencies providing home-based services
to children and families referred by child welfare. Interviews
were audio-recorded and transcribed. Transcripts were analyzed
using the traditional qualitative iterative approach of reading
and re-reading transcripts to identify patterns in the data. Four
primary themes emerged from the analysis: relationships with
therapists, perceived treatment benefits, availability and acces-
sibility of services and therapists, and treatment expectations.
Recommendations for practice and for future research are made.

KEYWORDS mental health treatment, treatment barriers, treat-

ment participation, child welfare, high-risk families

INTRODUCTION

Parents of children involved with child welfare frequently present with

an array of service needs, including the need for mental health treatment
(Marcenko, Lyons, & Courtney, 2011). Using data from the National Study of
Child and Adolescent Well-Being (NSCAW), Libby and her colleagues (2007)
estimated that 21.4% of parents had a mental health or alcohol/drug problem
at the time of the protective services investigation. Also using NSCAW data,
Burns et al. (2010) reported that 40% of parents experienced depression at

Address correspondence to Marlys Staudt, MSW, PhD, College of Social Work, University
of Tennessee, 202 Henson Hall, Knoxville, TN 37996, USA. E-mail: mstaudt@utk.edu

336
 Parents Involved With Child Welfare 337

some point during the three-year study period, but only a third of them
received mental health services.
Children engaged with child welfare also have high rates of need for
and use of mental health services. Using data from the Patterns of Care
Study in San Diego County, researchers found that children in the child
welfare system had a significantly higher rate of specialty mental health ser-
vices use than did children not in the child welfare system (Hazen, Hough,
Landsverk, & Wood, 2004). A study of service use among homeless children
found they had a higher rate of mental health service utilization compared
to low-income housed children, and children who experienced episodes of
both foster care and homelessness were more likely to use mental health
services than were children experiencing either homelessness or foster care
(Park, Metraux, Culhane, & Mandell, 2012). Moreover, regardless of a history
of homelessness, a history of foster care placement increased the likelihood
of using mental health services. Farmer and her colleagues (2001) examined
the use of mental health services for three groups of youth: those with a
history of foster care placement; those never in out-of-home placement but
in contact with county-level department of social services; and those living
in poverty with no foster care placements or contact with social services. All
three groups had a high level of using mental health services. However, the
youth in foster care and the youth in contact with social services (but not in
foster care) had a higher rate of using mental health services than did the
youth not in foster care or not in contact with social services, when con-
trolling for severity of mental health problems, insurance, and demographic
variables. In terms of clinical need, the youth in contact with social services
were no different than the youth in foster care.
Despite the higher rates of need for and use of mental health services for
children and parents involved in child welfare, there remains a gap between
the need for and the use of mental health services for both children and
parents (Burns et al., 2004; Libby et al. 2007; Swenson, Brown, & Sheidow,
2003). In fact, Libby et al. (2007) described the unmet need for parents as
“immense” (p. 157). Knowing how parents perceive their encounters with
mental health services could shed light on barriers and obstacles to use
of mental health services for themselves and their children. Villagrana and
Palinkas (2012) used data from the Patterns of Youth Mental Health Care
in Public Service Systems study conducted in San Diego County to examine
caregiver perceptions of barriers to mental health treatment for their children.
Barriers were examined with the Measurement of Parental Endorsement of
Barriers, where parents responded yes or no to each of 54 potential barriers.
Their findings included that barriers for all caregiver groups (birth parents,
relative caregivers, and foster parents) existed in the realm of perceived help-
fulness of services. Foster parents and relative caregivers endorsed barriers
related to the relationship with the mental health professional and the effec-
tiveness of services. Caregivers who did not perceive any barriers or who did
338 M. Staudt and K. Massengale

not perceive issues with the provider were significantly more likely to use
mental health services for their children. These findings suggest that parent
perceptions of and attitudes toward services, as well as actual characteristics
of the service system, can either impede or facilitate service use. However,
most studies have focused on how child, parent, and family demographic
and psychosocial factors influence service use and have neglected to include
service system–level variables (Liu, 2011). Using NSCAW data, Liu found that
service system factors, including insurance, referrals, assessment processes,
and supportive communities, played a role in children’s service use, and rec-
ommended that efforts should be made to improve the services system to
increase use of services. To this end, more information from parents about
their experiences with using services is needed.
Qualitative research methodology lends itself to gaining parent’s unique
perspectives and attitudes about services. Qualitative interviews provide an
opportunity for parents to tell their own stories about their experiences with
mental health services, and can provide in-depth information about how par-
ents perceive certain factors to act as barriers or facilitators to services use.
To our knowledge, there are no qualitative studies that ask parents involved
with public child welfare about their experiences with and perceptions of
mental health services. This article reports on a qualitative investigation
of how parents involved with child welfare perceived the mental health
services that they and their children had received. Given the lack of stud-
ies on how parents engaged in the public child welfare system perceive
mental health services, an exploratory approach using semi-structured inter-
views was deemed appropriate for the question we posed: How do parents
involved in child welfare perceive the mental health services they and their
children have received?

METHOD

Semi-structured interviews consisting of open-ended questions were con-

ducted with 20 parents. Parents were recruited through three agencies that
provided home-based services to families referred by the public child wel-
fare agency. All three agencies were in the same region of the state and
had contracts with the Department of Children’s Services to provide ser-
vices to children at risk of out-of-home placement. The home-based services
of each agency included parent education, family counseling, case man-
agement, and referrals to other agencies as needed. The primary goal of
the home-based services was to ensure child safety and permanency by
increasing parental coping and parenting skills. Duration of services was
typically three to six months, and visits usually occur weekly, though the
duration and intensity varied based on individual family needs. Purposive
sampling was used to recruit parents who had experiences within the past
 Parents Involved With Child Welfare 339

year with outpatient mental health services, either for themselves or their
children. The services needed to include counseling/therapy. If the service
consisted only of monitoring medication, the family was not recruited for
the research. The home-based workers introduced the research to parents
upon termination of the home-based services and provided contact infor-
mation of those interested to the research team. A member of the research
team contacted these parents, explained the research in more detail, and
obtained written informed consent. Families who were currently receiving or
had recently received outpatient mental health counseling/therapy services
were eligible for study recruitment. Saturation was reached after interview-
ing twenty parents, and recruitment ended. The research was approved
by the participating agencies and the university’s institutional review
board (IRB).

Sample
Sixteen of the participants were mothers and four were grandmothers with
custody of their grandchildren. The mean age of the participants was 39.5
(SD = 11.05). The mean age of the grandmothers was 52, ranging from
44 to 67 (SD = 10.62), whereas the mean age of the mothers was 36.2
(range of 20 to 56, SD = 8.7). In the remainder of this article, parent(s)
refers to all caregivers, including the grandmothers. (As noted later, findings
were similar for mothers and grandmothers, hence our reason for combining
them.) Three of the parents were African American and 17 were European
American. Most of the parents had a high school education (or General
Education Development [GED]) or less, whereas six of the parents had some
college education and one of these had a college degree. All of the parents
received some type of public assistance. The age range of the children in
the families ranged from one to 17, with a mean age of 8.4 (SD = 5.2). The
number of children per family ranged from one to six, with a mean of 2.4
(SD = 1.5).
Eleven of the families had children who had been previously placed out
of the home into foster care. Children received mental health services for
a variety of reasons, including anger management and aggression, attention
deficit hyperactivity disorder (ADHD), bipolar disorder, and anxiety. Anxiety
and depression were the primary reasons parents received treatment.

Data Collection and Analysis

The semi-structured interviews consisted of open-ended questions designed
to elicit parent perceptions of and experiences with the mental health treat-
ment they and their children had received. Interviews were conducted in
the homes of the participants and lasted from 60 to 120 minutes. Parents
received $30 for their participation.
340 M. Staudt and K. Massengale

Parents were first asked a general question about their experiences with
mental health services within the past year. Although the focus was on past
year services use, during the interviews parents would at times discuss earlier
service use episodes. We did not differentiate these in the analysis, as ear-
lier experiences were often used by parents to either substantiate their more
recent experiences or to juxtapose a helpful experience with one considered
not so helpful. More specific probes queried about whether and how the
service was helpful, professional behaviors that were most and least help-
ful, and barriers and facilitators to keeping appointments and remaining in
treatment. Specific questions included: Were there any problems with get-
ting along with your therapist? What made it easy for you to work with your
therapist? Did you ever feel that therapy wasn’t helping, or that you didn’t
need it? What were some changes you saw as a result of therapy? Interviews
were audio recorded and transcribed verbatim. These transcripts were read
by the two authors, as described below, in order to identify common themes
across the interviews.
Analysis was guided by the purpose of the interviews, which was to
explore and more fully understand salient issues related to parent experi-
ences with mental health services and how these experiences influenced
their attitude toward and use of services. Analysis proceeded according to
the procedures described by Strauss and Corbin (1990), including a constant
comparative analysis across transcripts. Each of the authors independently
read and coded the same transcripts and then met to discuss them. Initial
coding consisted of developing categories that described substantive pieces
of text. This was an iterative and recursive process of reading, identifying
themes, re-reading, and comparing themes and content across transcripts
to identify patterns in the data. Analysis included examination of whether
there were differences by whether mental health treatment was for the child
or parent. Similar sentiments were expressed whether treatment was child or
parent focused, therefore findings are not differentiated by whether treatment
was for the child, the parent, or both. In addition, even though only four of
the respondents were grandmothers, we did not discern differences in how
mothers and grandmothers perceived mental health services, thus findings
from these two groups are discussed together and not differentiated. Similar
categories were grouped to yield four primary themes: relationships with
therapists, perceived treatment benefits, treatment availability and accessi-
bility, and treatment expectations. Each of these is described below, and
illustrative quotes are provided to enrich the description of each category.

RESULTS
Relationship With Therapists
The relationship with the therapist could either facilitate or hinder treatment
participation. Parents identified characteristics that contributed to a good
 Parents Involved With Child Welfare 341

relationship, including that therapists listened, encouraged, and really cared

about them. A parent said, “I know it’s her job, but she goes that extra step
to let you know she is there for whatever you need to talk about. She listens
a lot.” Parents valued helpers who were friendly, easy to talk to, and down
to earth.
Perceived professional and social distance was a barrier to forming a
relationship. A parent voiced the following about her therapist: “She’s nice,
but she doesn’t remind me of a normal person. She reminds me of a business
person. She speaks more formal, she dresses more formal, and just that little
bitty difference makes me uncomfortable.” “He’s not friendly” and “he was
not a person that would smile at you much” were reasons parents did not
connect with their therapists.
Parents were put off by therapists who offered advice or recommenda-
tions prior to knowing them. This was exemplified by a parent who stated
about her experiences with a psychiatrist: “Everything he knows about me he
learns in 15 minutes and that’s what he bases my medication on. He doesn’t
have time to know somebody and what’s really wrong with them.” Turnover
among therapists was noted as a barrier to knowing parents and children
and forming relationships with them. Complaints such as the following were
made: “They’re not around long enough to know what really goes on and
what really happens.” “We had three different therapists in less than a year.
About the time my daughter would get in good with one, then she’d leave
and another one would come in.”

Perceived Benefits
The extent to which parents perceived treatment benefits influenced their
evaluation of it, and for some, their continuation with or termination of
services. For many of the parents, benefits included help with basic resources
and medication: “When the lights got cut off, she (the therapist) went digging
through her files to try to get us some assistance. She made phone calls
while we were in the session trying to find somebody to help get them
back on.” Another said, “If I have problems getting my medication she’ll
talk to one of the nurses and she’s helped me get samples of my medicine.”
Getting children on the correct medication and right dosage was appreciated,
especially by parents who had been struggling for some time with their
child’s behavior. However, as discussed later, there were some parents who
thought that medication was recommended too quickly. This is one area
where opinions varied across transcripts.
Improvement in their children’s behavior was noted as a benefit of treat-
ment. Parents appreciated help to develop and implement behavior plans for
their children, because they “needed that extra support.” Likewise, not see-
ing improvement led to disillusionment and even dropping out of treatment.
“They didn’t seem to be helping her and I took her out” said the mother
342 M. Staudt and K. Massengale

of a six-year-old. Some parents also terminated treatment when they were

encouraged by improvement: “It was like you were coming out of all the
problems, it’s like when you start getting better and you start resolving your
problems, it’s like what am I doing here. I’m doing better now. I’m fine.”
Finally, the relief that came from talking and venting was seen as a
treatment benefit: “You feel like a million dollars when you walk out of
there because you can let things out.”

Availability and Accessibility

Three issues related to availability and accessibility emerged: transporta-
tion; waiting time for, and inconvenient, appointments; and availability of
therapists outside of scheduled sessions. Some parents either did not drive
or did not have cars in working order. But even with access to rides or public
transportation, problems were noted. These included not wanting to rely on
others for help and the inconvenience of public transportation. Issues with
transportation were a source of stress: “they wanted me to do this and do
that and I don’t have transportation to do what I need to do, and it’s stressful
on me.”
The amount of time parents waited for an appointment and inconve-
nient appointment times were concerns. When asked what was least helpful,
a parent said being put on a waiting list for six, eight weeks. Practical issues,
such a child-care, influenced preferred appointment times. For example,
mothers with school-aged children preferred morning appointments so they
could be home when children returned from school. For a mother with
depression who had children in school, afternoon appointments were kind
of stressful. Most of the parents were involved with multiple service providers
and expressed how overwhelmed they were with the number of appoint-
ments they needed to remember: “I can’t get my stuff done, it’s always
running for the children and then I have so many doctors’ appointments.”
Therapist availability outside of scheduled sessions was appreciated.
A parent said about her psychiatrist “You know that you can always make
an emergency appointment.” Another said “she is the type of therapist if she
feels something is going on and we feel like we need to get in and see her,
she will work with us to get us in.”

Treatment Expectations
Some parents had little idea what to expect from mental health services: “You
see both versions on TV, you know. Is it they ask questions and help you
figure your problems out, or is it, you tell them and they’re going to figure
it all out for you? Well, it’s the first way.” Different expectations between
parents and therapists primarily occurred in relation to the type of help
provided. Many parents had expectations for help with basic resources. “I
 Parents Involved With Child Welfare 343

didn’t need the counseling and medication as bad as I needed the help
getting everything else and that’s what was stressing me out.” Everything else
included clothing, food, and help with medical needs and car repairs. One
mother shared: “They wanted to put me on medication. But I was depressed
because I was homeless and I got five kids. I don’t take pills so I terminated
that service. They never said nothing about helping me with housing; they
just wanted to see where my mind was at.”
Disagreement and concern about medication emerged in the interviews.
One mother saw the need for her 12 year-old son to see a therapist in addi-
tion to receiving medication: “Basically all we did was go down there and
get the medication.” Another stated: “They just give him the medications and
don’t give no counseling or see what the problem is with him.” One mother
was worried her son would become a zombie as a result of medication.
Parents were also frustrated with the amount and types of questions that
therapists asked. A parent who had received treatment for depression in the
past had this to say about a recent assessment: “He just asked questions he
knew to ask. He asked me to identify three things at the beginning of the
meeting and then at the end asked if I could remember those three things.
He asked what precipitated my depression back then and how I felt my life
had changed and did I ever feel suicidal. I told him, well, no, if I felt suicidal
I certainly wouldn’t be sitting here today.” Another said: “They wanted to talk
about trivial stuff, not the stuff that was bothering me.” When asked what
the therapist wanted to talk about, it was what happened in my past, and
what’s the point of that. These quotes suggest that parents may not under-
stand the purpose of taking a history or why therapists query about past
experiences.

DISCUSSION

Some limitations of the study are important to note. Neither youth nor
therapists were interviewed; thus it is not known whether or how their
perspectives vary from those of the parents. Consistent with the demograph-
ics of the area, most of the sample was non-Hispanic White. The sample
did not include fathers; this was not by design but the primary caregivers in
the families referred to the study happened to be mothers or grandmothers.
The sample was not representative of child welfare parents, as purposeful
sampling was used to recruit families who had current or recent experiences
with mental health services. Sampling strategies in qualitative research do
not aim to produce representative samples. Neither does qualitative research
seek to quantify or count, but to report substantive themes that emerge from
the data. All of the families received outpatient services through community
mental health centers and questions were focused on the counseling/therapy
services the families had received. Future research might attempt to examine
344 M. Staudt and K. Massengale

whether and how experiences vary by specific disciplines or roles (e.g.,

whether the therapist had a degree in social work or psychology; or asking
about therapists compared to psychiatrists). This may require the researcher
to contact the mental health agency as most parents were not aware of or
could not provide the professional discipline of the therapist. Although we
did not find differences between mothers and grandmothers, this may be
due to sample size. Future research might deliberately recruit grandparents
and build in questions about the challenges of raising grandchildren and
how these affect their encounters with mental health as well as child welfare
services. Despite these limitations, the themes that emerged are consistent
with those found from studies with parents in other high-risk groups. The
insights gained from the parents can be useful to mental health practitioners
and also can guide future research.
The importance of the interpersonal context in receiving services was
apparent in the data. Parents could discern professionals who really cared
about them from those for whom working with them was treated as just
their job. Listening and taking the time to really get to know parents and chil-
dren were valued professional behaviors. Villagrana and Palinkas (2012) also
found that caregivers’ positive relationship with the therapist is important to
child receipt of mental health services. Parents of children with develop-
mental disabilities and parents of children in early intervention programs
also consistently indicated the importance of their relationships with staff in
achieving benefits for themselves and their children (Minke & Scott, 1995;
Watson, Kieckhefer, & Olshansky, 2006). Anderson and colleagues (2006)
interviewed low-income mothers with children in mental health treatment
to learn about barriers to seeking help for themselves. Mothers perceived
that the services would focus on changing them, but they perceived their
stress to be caused by external factors that needed to change; meeting basic
needs was more important and relevant than receiving therapy. Mothers also
criticized therapists who did not take the time to know their child. Parent
concern about use of psychotropic medication by their children has also
been reported elsewhere (Kruzich, Friesen, Williams-Murphy, & Longley,
2002; Leslie, Plemmons, Monn, & Palinkas, 2007). Thus, some concerns
about services and treatments cut across different groups of high-risk fami-
lies. These include the relevance of the interpersonal relationship with the
helping professional and the ability of professionals to understand parents’
struggles with obtaining basic resources.
The delivery of mental health services needs to be sensitive to and
relevant to the life situations of high-risk families. In this sample of par-
ents involved with child welfare, this included not only being aware of
their need for basic resources, but also how multiple social service and
health appointments can interfere with mental health treatment. The need
for basic resources and the stresses of daily living may interfere with keep-
ing appointments and other treatment activities, thus lack of participation
should not be interpreted as resistance (Kruzich, Jivanjee, Robinson, &
 Parents Involved With Child Welfare 345

Friesen, 2003). Rather, it is important that therapists assess for and help
parents make arrangements for necessary resources. Some parents may ter-
minate treatment because they have received enough benefits, which may
or may not be consistent with therapist perception of appropriate termina-
tion. Interestingly, what did not arise as a concern or barrier to participation
was fear of the power of the mental health system to report abuse or make
recommendations about child placement. This may be because many fam-
ilies had children who had already experienced an out-of-home placement
and all were already involved with child welfare. Moreover, parents were
“embedded” in the service system, with some having histories of using men-
tal health services extending back to their adolescence and most involved
with multiple social service providers. Although we did not ask parents to
reconstruct their history of using mental health services, it became apparent
during the interviews that some parents had received mental health services
during their adolescence.
Based on the findings from this study and related research, some recom-
mendations for the provision of mental health services to parents similar to
those in the sample can be made. These include: (1) assessing for the need
for basic resources, making appropriate referrals for these, and understand-
ing how these needs can take priority over treatment participation, (2) asking
what parents want from treatment and explaining the treatment process to
them, including the reason for asking questions that may not seem relevant
to their current situation, (3) regularly monitoring how parents perceive the
process (including convenience of appointment times) and benefits of treat-
ment, and (4) asking about and addressing concerns concerning treatment
recommendations, especially the need for medications.
Some interventions address up-front parent concerns and expectations,
and these interventions have resulted in improved attendance and partic-
ipation compared to services as usual (Kazdin & Whitley, 2003; McKay,
Nudelman, McCadam, & Gonzales, 1996; McKay, Stoewe, McCadam, &
Gonzales, 1998; Prinz & Miller, 1991). Grote, Zuckoff, Swartz, Bledsoe, and
Geibel (2007) described an engagement intervention (EI) for women who
are depressed and of lower income. The EI was implemented prior to treat-
ment and addressed practical and logistical as well as psychological and
cultural barriers to treatment engagement and retention. Based on motiva-
tional and ethnographic interviewing, the engagement interview consists of
five parts that can be flexibly incorporated based on client need. The five
parts are: (1) eliciting the story, (2) treatment history and hopes for treatment,
(3) feedback and psychoeducation, (4) addressing barriers to participation,
and (5) eliciting commitment. A small randomized study showed that women
who participated in the EI and brief interpersonal therapy (IPT-B) had a sig-
nificantly higher rate of treatment retention than did women assigned to
IPT-B without the engagement intervention. This same EI was used with
depressed mothers of adolescents receiving treatment at a clinic specializing
in youth who are suicidal (Swartz et al., 2006). In addition to the EI, IPT
346 M. Staudt and K. Massengale

was modified to include a focus on the challenges of being a mother of

a child with psychiatric illness as well as those associated with interacting
with the child’s mental health providers. Of the 11 mothers who attended
the EI, 10 completed the full course of treatment. Moreover, the outcomes
of decreased depression and improvement in functioning and quality of life
were maintained at a six-month follow-up. A focus on building the alliance
and understanding the everyday experiences of lower-income families were
also part of a preventive intervention described by Podorefsky, McDonald-
Dowdell, and Beardslee (2001). These findings are consistent with an earlier
study that compared standard family treatment (SFT) with enhanced family
treatment (EFT) in parent management treatment for the families of 4–9 year-
old boys with conduct problems (Prinz & Miller, 1991). EFT, but not SFT,
included eliciting and discussing parent expectations about treatment, their
reactions about being in treatment, and personal concerns not directly related
to the parent training, for example, work problems and other stresses. Not
only were there significantly fewer drop-outs in EFT (29.2%) than in SFT
(46.7%), but almost 60% of families with high adversity dropped out of SFT,
compared to 29.6% from EFT. Given the consistency of study findings, it may
be advantageous to routinely add components similar to those found in these
EI’s to all mental health services for families, especially families in high-risk
groups. Parents are more apt to stay in treatment, and keep their children
in treatment, if therapists can relate to them informally, ask them about their
other worries, and help them attain needed resources. Ongoing discussion
about what is happening and why could go far to clarify parent concerns
about different treatment aspects, including those related to medication and
why therapists ask the questions they ask.
Research is needed to learn effective methods to sensitize students in the
helping professions to the stresses and burdens of day to day living for many
families, especially those with low incomes and few resources, as well as
how service systems can incorporate more flexible service delivery methods.
For example, interventions other than therapy or counseling, such as refer-
rals to and follow up with community resources, need to be available for
families who need them, as well as shorter waiting times for appointments.
The findings also suggest that assumptions that students and providers may
make should be open to scrutiny. For example, it was at first surprising that
parents in this study were not concerned about being reported for child
abuse/neglect. Upon reflection, this made sense since parents were already
involved with the child welfare system. Students might be asked to think
through what parent initial expectations of treatment might be and how those
might vary from what actually occurs. Students can reflect on their own con-
cerns and apprehensions about seeking or asking for help, whether that be
from professional mental health providers, medical care, or any other source
of formal or informal help. Asking parents to come to classes and share their
experiences with mental health providers could go far to sensitize students
 Parents Involved With Child Welfare 347

to the barriers to appointment keeping and engagement that many families

in their practice will experience. Other research needs include understand-
ing the perceptions of youth and learning more from therapists about how
they reach out to and engage families with multiple needs, including the
resources and supports they need to do so.

FUNDING

The study was funded by a grant from the National Institute of Mental Health,
“Service Participation by Families of Maltreated Children” (5K01MH068473).

REFERENCES

Anderson, C.M., Robins, C.S., Greeno, C.G., Cahalane, H., Copeland, V.C., &
Andrews, R.M. (2006). Why lower income mothers do not engage with the
formal mental health care system: Perceived barriers to care. Qualitative Health
Research, 16, 926–943.
Burns, B.J., Mustillo, S.A., Farmer, E.M.Z., Kolko, D.J., McCrae, J., Libby, A.M., &
Webb, M.B. (2010). Caregiver depression, mental health service use, and child
outcomes. In M.B. Webb, K. Dowd, B.J. Harden, J. Landsverk, & M.F. Testa
(Eds.), Child welfare and child well-being: New perspectives from the National
Survey of Child and Adolescent Well-Being. (pp. 351–379). New York, NY:
Oxford University Press.
Burns, B.J., Phillips, S.D., Wagner, H.R., Barth, R.P., Kolko, D.J., Campbell, Y., &
Landsverk, J. (2004). Mental health need and access to mental health services
by youth involved with child welfare. Journal of the American Academy of Child
and Adolescent Psychiatry, 43, 960–973.
Farmer, E.M.Z., Burns, B.J., Chapman, M.V., Phillips, S.D., Angold, A., & Costello, E.J.
(2001). Use of mental health services by youth in contact with social services.
Social Services Review, 75, 605–624.
Grote, N.K., Zuckoff, A., Swartz, H., Bledsoe, S.E., & Geibel, S. (2007). Engaging
women who are depressed and economically disadvantaged in mental health
treatment. Social Work, 52, 295–308.
Hazen, A.L., Hough, R.L., Landsverk, J.A., & Wood, P.A. (2004). Use of mental health
services by youths in public sectors of care. Mental Health Services Research, 6,
213–226.
Kazdin, A.E. & Whitley, M.K. (2003). Treatment of parental stress to enhance thera-
peutic change among children referred for aggressive and antisocial behavior.
Journal of Consulting and Clinical Psychology, 71, 504–515.
Kruzich, J.M., Friesen, B.J., Williams-Murphy, T., & Longley, M.J. (2002). Voices of
African American families: Perspectives on residential treatment. Social Work,
47, 461–470.
Kruzich, J.M., Jivanjee, P., Robinson, A., & Friesen, B.J. (2003). Family caregivers’
perceptions of barriers to and supports of participation in their children’s out-
of-home treatment. Psychiatric Services, 54, 1513–1518.
348 M. Staudt and K. Massengale

Leslie, L.K., Plemmons, D., Monn, A.R., & Palinkas, L.A. (2007). Investigating
ADHD treatment trajectories: Listening to families’ stories about medication use.
Journal of Developmental and Behavioral Pediatrics, 28, 179–188.
Libby, A.M., Orton, H.D., Barth, R.P., Webb, M.B., Burns, B.J., Wood, P.A., &
Spicer, P. (2007). Mental health and substance abuse services to parents of
children involved with child welfare: A study of racial and ethnic differences
for American Indian parents. Administration and Policy in Mental Health and
Mental Health Services Research, 34, 150–159.
Liu, J-Q. (2011). Mental health services access among children and adolescents
involved with child welfare services. (Doctoral dissertation, School of Social
Welfare, University at Albany, State University of New York, 2011).
Marcenko, M.O., Lyons, S.J., & Courtney, M. (2011). Mothers’ experiences, resources,
and needs: The context for reunification. Children and Youth Services Review,
33, 431–438.
McKay, M.M., Nudelman, R., McCadam, K., & Gonzales, J. (1996). Evaluating a social
work engagement approach to involving inner-city children and their families
in mental health care. Research on Social Work Practice, 6, 462–472.
McKay, M.M., Stoewe, J., McCadam, K., & Gonzales, J. (1998). Increasing access to
child mental health services for urban children and their caregivers. Health and
Social Work, 23, 9–15.
Minke, K.M., & Scott, M.M. (1995). Parent-professional relationships in early interven-
tion: A qualitative investigation. Topics in Early Childhood Special Education,
15, 335–347.
Park, J.M., Metraux, S., Culhane, D.P., & Mandell, D.S. (2012). Homelessness and
children’s use of mental health services: A population-based study. Children
and Youth Services Review, 34, 261–265.
Podorefsky, D.L., McDonald-Dowdell, M., & Beardslee, W.R. (2001). Adaptation
of preventive interventions for a low-income, culturally diverse community.
Journal of the American Academy of Child and Adolescent Psychiatry, 40,
879–886.
Prinz, R.J., & Miller, G.E. (1991). Issues in understanding and treating childhood
conduct problems in disadvantaged populations. Journal of Clinical Child
Psychology, 20, 379–385.
Strauss, A. & Corbin, J. (1990). Basics of qualitative research. Newbury Park, CA:
Sage Publications.
Swartz, H.A., Zuckoff, A., Frank, E., Spielvogle, H.N., Shear, M.K., Fleming, D., &
Scott, J. (2006). An open-label trial of enhanced brief interpersonal psychother-
apy in depressed mothers whose children are receiving psychiatric treatment.
Depression and Anxiety, 23, 398–404.
Swenson, C.C., Brown, E.J., & Sheidow, A.J. (2003). Medical, legal, and mental
health service utilization by physically abused children and their caregivers.
Child Maltreatment, 8, 138–144.
Villagrana, M. & Palinkas, L.A. (2012). Caregivers’ endorsement of barriers to mental
health services for children and youth in child welfare. Journal of Family Social
Work, 15, 111–125.
Watson, K.C., Kieckhefer, G.M., & Olshansky, E. (2006). Striving for therapeutic
relationships: Parent-provider communication in the developmental treatment
setting. Qualitative Health Research, 16, 647–663.